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How early can you detect signs of autism, Asperger's, and PDD?

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In my parenting group, a mom recently confessed to worrying that her newborn daughter was more interested in a ceiling fan than gazing into her loving eyes. I remember the feeling. If you frequent online mom forums, you’ve seen the inevitable concerns over smiling and other newborn social behaviors: “My baby doesn’t make eye contact while we’re nursing – what’s wrong?” or “Why does my baby smile at a moving tree branch, not me or my husband?” With the incidence of autism-spectrum disorders rising, and the well-known symptoms of social difficulties, it’s not surprising that anxiety runs high.

When Symptoms Emerge

But according to a study released last month in the Journal of the American Academy of Child & Adolescent Psychiatry, even though genetics play a role in autism disorders, the signs are not evident as early as previously thought. The group of researchers followed both normal-risk and high-risk babies (based on having a diagnosed sibling) and found that the children who ultimately did have some form of autism were similar to those who didn’t for most of the first year of life. At six months, they made the same eye contact, smiled, and gestured equally. Only by twelve months had the groups diverged; those who were later given an autism diagnosis made significantly less eye contact at one year and had significantly fewer social smiles by 18 months.

Difficult to Label

Autism is known to run in families, indicating that genes are at least partially responsible. For example, younger siblings of children with autism are more likely to struggle with social communication even if they don’t have the diagnosis themselves. It’s a condition with fuzzy boundaries, which is why the trend now is to speak of autism as a continuum, having multiple roots and taking on varying forms. In fact, the new version of the Diagnostic and Statistical Manual of Mental Disorders will wrap autism, Asperger’s, and Pervasive Developmental Disorders into one spectrum diagnosis.

In hopes of better understanding the entire continuum, there has been a recent trend toward looking for signs of developmental delay earlier and earlier. Many researchers thought that symptoms might even be present from birth. But previous studies relied heavily on parents’ retrospective reports, which are not very accurate – our memories aren’t as clear as we think. In the current study, scientists were watching the children’s progress themselves.

It turns out that, despite many worried moms’ fearful diagnoses, most kids appear to develop typically for the better part of year one. After that, symptoms emerge and children who are delayed start to regress, showing slow declines in social behavior, though not the abrupt changes some have expected. That decline continues into the children’s preschool years.

Clearly we still have much to learn about the autism spectrum – the fact that we haven’t even sorted out how to describe and group the disorder is testament to that. It’s a heterogeneous group: some struggle with subtle social cues, others with major cognitive impairment and very little language, and still others with varying degrees in between. Understanding the full picture is a tall order, but piecing together when and how the symptoms unfold will be an important step.

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