Although autism is a disorder of infancy, it is not usually diagnosed until between 3 and 4 years. In a recent consortium study, 664 infants who were sibs of ASD children were followed monthly from 6 mos. to 36 mos., when they were assessed for ASD (Ozonoff et al, 2011). There were no concerns at 6 mos. At 9 mos., 6 of the 26 children who ended up with the diagnosis of autism raised some concerns. At 12 mos., half raised concerns, but one raised concerns about autism. At 18 mos. only half of the children showed signs of autism. At 24 mos., there were more, but only by 36 mos. do all the children look autistic. Early symptoms in a 12-month old: (1) Problems with imitation;(2) Repetitive behavior; (3) Abnormal play patterns; (4) Communication disorders; (5) Problems with social orienting, attention, engagement, and initiation.
Dr. Rogers showed a video to demonstrate the core diagnostic symptoms. In the video the little girl showed no gaze shifting; she was locked into stimuli. She was tracking well, transferring well from one hand to the next, and her fine motor skills seemed normal for age, but she had little finger movements that looked like repetitive movements. She shifted her gaze nicely from one toy to another but not to the person, the researcher. When she was offered a baby doll, she inspected it, moves it in space, but did not mouth it. When the researcher called her name, she did not look at her. Instead, she watched the lights and shadows. The researcher tried to play peek a boo with her and although the child first looked up at her, the child quickly shifted her gaze to the light, and then started to cry. Her parents worked very hard with her and she received intensive therapy. She is now at normal levels in speech and everything else including pretend play and initiation, except for gross motor, at 2 years.
What are the Underlying Neurological Problems in ASD? The social brain networks are different in children with ASD (Dawson et al, 2004, 2005). Impairment in the neural social reward circuitry leads to a lack of salience to social rewards, creating a deficit in social approach and orientation. Because these children are biologically not getting as much reward back from social engagement, they do not discriminate and look for it, and the baby provides fewer attentive moments to parents in that way affecting the caregiving relationship. So the child does not adequately engage in social learning and experiences social deprivation, which alters the future course of neural and psychological development. Parents adapt both by protecting the child and also by not intruding in a way that the infant finds aversive. The are “reading the baby’s cues. Rogers says that autism functions like a “Gardol Shield”, an invisible protective shield that protects the child from distressing intrusion but also continues the social deprivation. In effect, by not intervening early and helping parents change the way they behave with their children, we may be contributing to the creation of brain differences. The data is clear that autistic people are good learners throughout their lifetime when provided with educational experiences, but the early social learning in the infant and toddler period is critical.
