A common question new parents ask us at The Quirky Kid Clinic is ‘What do we need to look out for in relation to an Autism Spectrum Disorder (ASD)?’. The following article will discuss what ASD is, the diagnosis of ASD, and what to look out for if you have developmental concerns for your child.
What is ASD?
ASD is a developmental disability characterised by marked differences in social interactions, deficits in verbal and nonverbal communication skills, restricted and repetitive interests/behaviours, and sensory sensitivities. It appears in infancy and the symptoms and severity differ from individual to individual.
The severity of an ASD presentation can range from ‘Level 1 requiring support’, through to ‘Level 3 requiring very substantial support’. When ASD is diagnosed it includes the inclusion or exclusion or an accompanying intellectual disability (American Psychiatric Association, 2013, p. 52).
There is no known cure for ASD, and there is no current consensus amongst medical professionals on the precise cause of ASD. However what is clear is that quality individualised early intervention will support children to increase skill development, communication abilities and develop flexible adaptive behaviours (Dawson et al., 2010).
How is ASD diagnosed?
ASD has shown to be reliably diagnosed in a child as young as 18-24 months old (Charman et al., 2005). However, historically children have been more likely to have received a diagnosis closer to school age than during their toddler years (Mandell et al., 2005; Moore & Goodson, 2003).
Howlin & Moore (1997), who conducted a study of 1200 participants in the UK, reported that whilst the average age parents had any developmental concerns for their child was approximately 18 months old, for the majority of participants studied, the diagnosis did not actually occur until closer to the child turning 6 years old.
In response to ongoing research in the area of ASD diagnosis, in the United States, the American Academy of Pediatrics has now recommended that all children be screened for ASD at approximately 18-24 months old (Johnson & Myers, 2007).
In Australia, Williams et al. (2008) have concluded that currently, we have not matched initiatives occurring in other countries, such as the United States, in relation to early ASD diagnosis and early intervention support initiatives. However, the Autism CRC under the guidance of Professor Andrew Whitehouse and colleagues are currently developing a National ‘Best Practise’ Guideline document for the diagnosis of ASD within Australia. Whilst the document has not yet been finalised the draft submission cites the reliability of an ASD diagnosis for a child of 2 years old by a qualified professional. Although, it is still most common in Australia for children to receive a diagnosis between the ages of 3 and 5 years old (Whitehouse et al., 2017).
A reliable diagnostic process involves identifying the child’s strengths and weaknesses via a comprehensive formal assessment which includes a child observation, such as the Autism Diagnostic Observation Schedule (ADOS-2), a parent interview, such as the Autism Diagnostic Interview-Revised (ADI-R), and cognitive / developmental testing such as an IQ test or a general developmental assessment, completed by an experienced practitioner (Charman, 2010; Whitehouse et al., 2017).
Following diagnosis, access to individualised early intervention with the aim of increasing developmental deficits, and decreasing challenging behaviours can make a huge difference in your ASD child’s developmental pathway.
Early Signs to look out for in infants
Identifying characteristics of ASD in a child younger than two years old can be difficult. Concerns may arise due to the ‘absence’ of behaviours considered to be ‘normal’ development and the ‘presence’ of behaviours considered to be ‘abnormal’ development.
Developmental milestones occur across age ranges so your child may be ahead or behind their peers with respect to milestones such as crawling, walking, and early verbal and nonverbal language development.
Listen to your ‘gut instinct’ as a parent. Consider seeking help from your Child Psychologist or Paediatrician if your 12-month-old infant is not demonstrating the following behaviours, either as an emerging skill that is continuing to progress, or once learnt, does not demonstrate these behaviours consistently across multiple environments (Boyd et al., 2010; Charman, 1998):
- Responding to their name, or to the sound of a familiar voice, by turning their head and referencing the person who spoke or the direction from where the voice came from;
- Referencing a familiar person with eye contact, such as smiling in reciprocation to being smiled at, at times such as feeding, and or when playing ‘peek a boo’ like games;
- Demonstrating joint attention, such as referencing a favourite toy or food, then referencing a familiar person, then looking back towards the item of interest as if to say, “pass it to me”, or “can I have more”;
- Babbling or making noises to get a familiar adults attention;
- Developing an imitation repertoire such as waving and clapping, and or including the imitation of a familiar person’s facial expressions and movements;
- Demonstrating reciprocal interest and enjoyment in play, such as tickles, ‘peek a boo’ like games and cause and effect toys, coordinating eye contact to indicate “more”;
- Tracking objects or familiar people visually around the room and or following a familiar person’s gestures, such as pointing to an object;
- Coordinating gestures in order to communicate, such as pointing at an object to initiate a communication, or waving goodbye;
- Positively responding to cuddling, and or reaching out to be picked up.
Remember that your child may, like all individuals, experience good days and bad days. Your child’s development will occur in spurts and patterns, and it is best to evaluate your child’s development by considering the consistency and frequency of these emerging skills.
If you feel a particular skill is lacking spend the time to practise the behaviour with your child, ensuring that you are providing attention and praise for your child’s attempts at demonstrating the behaviour. If the skill does not start to develop or your child responds negatively to your attempts to model and teach the skill then seek help from your Child Psychologist or Paediatrician.
Commence an individualised early intervention program as soon as possible. Whether your child has a formal diagnosis or not it is advisable to start intervention as soon as you suspect that your child’s development is not progressing at the level expected for their age rather than following a wait and see approach.
Here at The Quirky Kid Psychology Clinic, our experienced team of Psychologists are more than happy to meet with you to discuss any concerns you have in relation to your child’s development and behaviour.
We always start with a parent only consultation to ensure that we get a thorough understanding of your child’s developmental history and a sense of your families identity, history and cultural dynamics. From here we provide an individualised case plan dependent on your child and families needs. Please don’t hesitate to contact our friendly reception on (02) 9362 9297.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Boyd, B. A., Odom, S. L., Humphreys, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32, 75-98.
Charman, T. (1998). Specifying the nature and course of the joint attention impairment in autism in the preschool years: Implications for diagnosis and intervention. Autism, 2, 61-79.
Charman, T. (2010). Developmental approaches to understanding and treating autism. Folia Phoniatrica et Logopaedica, 62, 166-177.
Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J. A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500-513.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., & Varley, J. (2010). Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.
Howlin, P., & Moore, A. (1997). Diagnosis in autism: A survey of over 1200 patients in the UK. Autism, 1, 135-162.
Johnson, C., & Myers, S. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215.
Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480-1486.
Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism, 7, 47-63.
Whitehouse, A.J.O., Evans, K., Eapen, V., Prior, M., & Wray, J. (2017). The diagnostic process for children, adolescents and adults, referred for assessment of autism spectrum disorder in Australia: A national guideline (Draft version for community consultation). Autism CRC Ltd.
Williams, K., MacDermott, S., Ridley, G., Glasson, E. J., & Wray, J. A. (2008). The prevalence of autism in Australia. Can it be established from existing data?. Journal of Paediatrics and Child Health, 44, 504-510.
What’s in a label? Should I get a diagnosis for my child?
‘Labelling a child’ is the term used to describe the process where a psychologist or psychiatrist assesses a child, resulting in a diagnosis or ‘label’. The diagnosis is based on a set of criteria defined in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV).
About 10% of children and young people will have a mental health problem. The most common diagnoses for children include anxiety disorders; attention-deficit and disruptive behavior disorders; autism spectrum disorders; and eating disorders (for example, anorexia nervosa).
If you suspect your child may have a mental health condition, chances are you’ve wondered if it’s beneficial to obtain a professional opinion and perhaps a diagnosis. While professionals were traditionally hesitant to diagnose pre-adolescents with DSM-IV conditions, diagnoses have been on the rise since the 1980s, partly as a result of greater research into child mental health.
What is a diagnosis?
A reputable mental health professional will not give a diagnosis without a thorough evaluation of a person’s symptoms, behaviours, and developmental history. In the case of a child, specialists will usually consult with several other sources (for example, parents, teachers, and family doctors) before confirming a diagnosis.
What are the advantages of a diagnosis?
An accurate diagnosis will give parents and their child a clear and realistic sense of the limitations and challenges the child may face as a result of the disorder. Following a diagnosis, you should also have a good sense of what treatment plans are available, their pros and cons, and how effective they are. This knowledge can provide tremendous peace of mind for families who are struggling.
Other advantages of a diagnosis include:
- An accurate understanding of your child’s strengths and how to best harness them.
- Individual support from Specialists at your child’s school (for example, regular hours with a Learning Support teacher or funding for resources or appropriate training for teachers).
- Subsidized help for the family (for example, home-based intervention such as ABA for children with autism spectrum disorders).
- Effective collaboration between health professionals. For example, a Speech Pathologist, Occupational Therapist and Psychologist can work together to give your child comprehensive treatment.
What are the disadvantages of a diagnosis?
Most professionals agree: forming a diagnosis can be difficult. A child’s behaviour can change depending on their environment, their food intake and the people around them, which can impact the assessment process.
The disadvantages of a diagnosis may include:
- Stigma from other parents or peers.
- Difficulties reversing the diagnosis should behaviour change or improve.
- Children need support when discussing a diagnosis.
- Some families might find a thorough assessment and Diagnostic Report costly.
Finding more support:
Quirky Kid has offices in Sydney and Wollongong,
If you are concerned as to whether or not obtaining a diagnosis for your child is right for your family, you may find it helpful to talk through the decision with a professional yourself. Ask your health care provider about counselling or support services in your community or contact Quirky Kid on +61 2 9362 9297.
Parents may find useful resources at the Quirky Kid Shoppe.
National Institute for Mental Health in England (2008). The Mental Health Act: Essential Information for Parents and Caregivers.
Harakavy-Friedman, Jill M (2009). Dimensional Approaches in Diagnostic Classification: Refining the Research Agenda for DSM-V. American Journal of Psychiatry 166, 118-119
Kimberley O’Brien (2011). Interview on the advantages, disadvantages, benefits and challenges of diagnosing children.
The Cleveland Clinic (2005-2009). “Attention Deficit Hyperactivity Disorder.” http://my.clevelandclinic.org/disorders/Attention_Deficit_Hyperactivity_Disorder/hic_Attention-Deficit-Hyperactivity_Disorder.aspx. Retrieved September 24, 2011.}
We are proud to introduce our newest innovation – The Quirky Kid Tickets! Parents have been asking for and we are proud to introduce our effective behaviour management tool as recommended by Kimberley O’Brien, Child Psychologist.
Tickets are a complete reward system encouraging you and your child to work together to manage behaviour.
You start by setting clear, achievable goals together. Follow this up with lots of direct praise when you see your child achieve the goal. Finally, watch the surprise reward appear before your eyes as they scratch their Tickets to reveal fun and creative activities you can all share in.
‘Tickets’ is the latest resource to come from the creatives minds at the Quirky Kid Clinic. An inventive and cooperative tool for managing your child’s behaviour.
It is simple:
– Set a goal
– Give your child a ticket to acknowledge when the goal is achieved
– When your child collects enough tickets, he/she gets to scratch and win!
– Lastly, enjoy the fun and interactive reward activities together!
The Sunday Telegraph completed an article about our resource. You can read about it on The Telegraph online.
Visit the Quirky Kid Shoppe for more information on the Tickets and other unique Therapeutic and developmental resources for children and families.
We love therapeutic resources and go to great lengths to personally develop and produce our hand-packed kits. We are committed to providing parents and professionals around the world with creative and effective therapeutic tools that are tried, tested and loved in classrooms, clinics and lounge rooms around the globe.
Autism Spectrum Disorders (ASDs) are lifelong developmental disabilities characterised by marked difficulties in social interaction, impaired communication, restricted and repetitive interests/behaviours, and sensory sensitivities.
It is called a spectrum disorder as each child may be affected in a different way. The severity of the disorder can range from mild to severe, and includes Autism, Asperger’s syndrome and Pervasive Developmental Disorder – Not otherwise Specified.
Repetitive behaviours are a core component of the diagnosis of autism, and they form an important part of early identification.
Typical Development of Repetitive Behaviours
- Infants – often demonstrate repetitive behaviours including kicking, waving, banging, twirling, bouncing and rocking. These behaviours however, reduce after 12 months.
- 24 – 36 months – compulsive like behaviours including preference for sameness begin to emerge.
- 4 years – decrease in all repetitive behaviours. By the time a child reaches school age there are usually relatively few repetitive behaviours to be seen.
Repetitive Behaviours in a child diagnosed with an ASD
The amount and frequency of repetitive behaviours seen in a child diagnosed with an ASD is significantly higher than that seen in children without an ASD diagnosis. There are also differences in the types of repetitive behaviour demonstrated in autism and typical development.
Young children with autism are more likely to engage in
- body rocking,
- finger flicking,
- hand flapping,
- unusual posturing.
Recent studies have shown that a combination of therapies that aim to increase receptive language and improve social skills, can reduce the occurrence of repetitive behaviours.
Need more information?
Quirky Kid is registered to provide services under the Helping Children with Austins – FaCHSIA.
Information for this fact sheet was taken from an interview with Child Psychologist Kimberley O’Brien, the Repetitive Behaviours in Autism Spectrum Disorder Workshop attended by Corina Vogler, Provisional Psychologist and the following articles:
Honey, E., McConachie, H., Randle, Val., Shearer, H., & Le Couteur, A. S. (2008). One-year Change in Repetitive Behaviours in Young Children with Communication Disorders Including Autism. Journal Autism and Developmental Disorders, 38, 1439–1450.
Honey, E., Leekham, S., & McConachie, H.. (2007). Repetitive Behaviours and Play in Typically Developing Children and Children with Autism Spectrum Disorder. Journal Autism and Developmental Disorders, 37, 1107–1115.
Social skills is a common concern among parents. Often children can have difficulties in making and keeping friends. They may be left out of games at lunch, not get invited to other children’s houses or may even be teased by some children.
In addition to our Social Skills workshop – The Best of Friends – we have prepared the factsheet below to provide more information to parents about social skill sin children.
An important aspect of maintaining friendships is social skills.
Social skills are specific behaviours such as smiling, making eye contact, asking and responding to questions, and giving and acknowledging compliments during a social exchange. These behaviours result in positive social interactions and have been linked to positive developmental outcomes, including peer acceptance.
How can I tell if my child is having difficulties with social skills?
- Little use of eye contact,
- Uninterested in social interactions,
- Difficulties initiating social interactions,
- Difficulties interpreting verbal and non-verbal social cues,
- Inappropriate emotional response,
- Lack of empathy towards others.
It can be upsetting for parents to realise that their children are having difficulties making friends. Research has shown however, that social skills can be effectively taught to children.
How to encourage your child to develop social skills
- Help your child make friends by organising play dates, having sleepover and joining clubs.
- Offer suggestions on ways to handle situations at school and with friends.
- Children learn a lot by observing how adults interact so it is important to always model appropriate behaviour, such as greeting shop assistants and using Peoples names when possible.
- Help your child to understand different points of view by describing feelings and having conversations about how other people might feel. This can help your child to develop empathy and will help them deal with conflict when it occurs.
- Help develop conversation skills such as asking questions and listening to others
- Discuss behaviours such as teasing and bullying with your child, to help them understand that some comments could upset others.
How can the Quirky Kid Clinic help your child?
The Quirky Kid Clinic is a unique place for children and adolescents aged 2-18 years. We work from the child’s perspective to help them find their own solutions. Additionally, we offer a variety of resources, workshops and individualized consultations to support children experiencing difficulties with social skills.
- The Best of Friends Workshop TM is an innovative social skills and communication program for children aged 3 to 13. This activity-based workshop encourages children to make the most of their friendships by developing good communication skills. Workshops are available throughout t the year both in school and clinic setting.
- How to be a Friend Book – This book published by Quirky Kid helps children to understand how friendships are formed and the best way to handle conflict. It is a must for all children and proactive parents.
- Face it Cards are a set of 35 hand-draw facial expression cards. The cards give greater meaning to discussions involving feelings and behaviors. They can help families resolve conflict and classmates explore social scenarios or ethical dilemmas and also allow children to ‘pointing out’ their emotions, helping then to increase understanding, problem-solving and empathy when dialogue is difficult.
- Tell Me a Story Cards are a useful tool for parents and professionals working with young people. They invite children to recall and retell their own memorable moments of extremity, this facilitates communication, highlights strengths, and boosts self-esteem.
Please contact the Quirky Kid Clinic on 9362 9297 for further information. You can also discuss Social Skills with other parents at the Quirky Kid Hudle – our parenting forums.
Information for this fact sheet was taken from an interview with Child Psychologist Kimberley O’Brien, the Raising Children Network website, and the following articles and was compiled by Corina Vogler, Interm-Psychologist at the Quirky Kid Clinic
Reference: Tse, J., Strulovitch, J., Tagalakis, V., Meng, L., & Fombonne, E. (2007). Social skills training for adolescents with asperger syndrome and high functioning autism. Journal of Autism and Developmental Disorders, 37, 1960-1968.
Rao, P., Beidel, D., & Murray, M. (2008). Social skills training for children with Aspergers’s syndrome or high-functioning autism: a review and recommendations. Journal of Autism and Developmental Disorders, 38, 353-361.