Early Red Flags and Warning Signs of Autism

Autism Awareness: Interview with Nancy D. Wiseman

MedicineNet interviews Nancy D. Wiseman, author of Could It Be Autism? A Parent's Guide to the First Signs and Next Steps and president and founder of First Signs, an organization dedicated to educating parents and professionals about the early warning signs of autism and other developmental disorders. As a parent of a child with autism, Wiseman believes in the power of early intervention.

Interview by Angela Generoso
Staff Writer, MedicineNet.com

Reviewed by William C. Shiel Jr., MD, FACP, FACR

April 17, 2007

Can you explain the link between genetics and autism?

We know there's a genetic link, but science and research is pointing to other variables, including environmental insults and immune system abnormalities, which may be contributing to the development of autism.

Environmental insults can be attributed to everything from mercury in immunizations to pesticides out on the lawn to chemicals in shampoo and deodorant and all the additives and dyes in processed foods. We're putting horrible things in our body. Then look at the percentage of kids with developmental, learning, and behavioral disorders - one in six, -- quite a dramatic rise compared to years ago. These toxins can attack the body of a genetically vulnerable child.

My daughter had a severe allergy to soy, a condition I noticed when she was 4 weeks old. I think it may have pushed her over the edge and compromised her immune system, making her vulnerable to toxins in the environment. It's not that kids with autism are getting more toxins in their system than other kids, it's just that they can't excrete them through the normal channels. The effects of mercury can mimic signs and symptoms of autism. Same with lead poisoning. We must consider everything we put into our body that could compromise our immune system.

Why are symptoms of autism sometimes evident at an early age, while at other times, the symptoms develop at age 2?

Often parents will miss the earliest signs, like lack of joint attention, gestures, or social reciprocity (the cornerstone of healthy development). Instead, they notice that their child is delayed in language or that they are not responding to their name when called. This is why it is so important that parents and professionals learn the critical, yet often overlooked, milestones for social, emotional, and communication development. Even before you see warning signs, it's imperative that parents chronicle the milestones and share them with their pediatrician.

At 4 months, is your child...

  • Following and reacting to bright colors, movement, and objects?
  • Turning toward sound?
  • Showing an interest in watching people's faces?
  • Smiling back when you smile?

These are a few of the early milestones that are critical to the foundation of healthy development.

The cornerstone of healthy development is social reciprocity - that back and forth, continuous flow of gestures, communication, and play.

When my daughter's first words came in, I counted the number of words because my pediatrician asked me at every well visit how many words she had. I didn't know that the quality of words was more important than the quantity. At two, my daughter had only four words and they were not meaningful words. Some were words that she echoed after hearing me speak them.

What are some significant warning signs of autism?

There have been studies that show impairments in social communication can distinguish infants who are later diagnosed with autism. According to research conducted by Drs. Amy Wetherby and Julian Woods at Florida State University, the common warning signs for autism in the second year of life are

  • Lack of showing
  • Lack of gestures: pointing, reaching, waving, showing
  • Lack of sharing interest or enjoyment with others
  • Repetitive movements with objects
  • Lack of appropriate eye gaze
  • Lack of response to name (something parents report very frequently)
  • Lack of warm, joyful expressions
  • Unusual prosody (rhythm and intonation of language)
  • Repetitive movements or posturing of the body

Early red flags:

If your baby is showing any of these signs, parents should ask their physician for an immediate evaluation:

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
  • No babbling by 12 months
  • No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
  • No words by 16 months
  • Loss of speech
  • No two-word meaningful phrases (without imitating or repeating) by 24 months
  • Any loss of speech or babbling or social skills at any age