early autism

Understanding Early Signs of Autism

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As a parent, I believe monitoring your child’s developmental milestones is a crucial aspect of raising a child. By observing these milestones, caregivers can identify delays — in areas such as motor skills, language, and social interactions — allowing timely intervention and support. 

Studies indicate that receiving an autism diagnosis and obtaining intervention services early can lead to significant improvements in symptoms and skills. (Robins et al., 2009) Children under the age of two frequently do not receive an autism diagnosis from their pediatrician, as clinicians may prefer to allow additional time for the child’s development. 

This give-it-time approach acknowledges that children can progress at varying rates, and a diagnosis may be more accurately determined as the child continues to grow and develop. (Miller, 2024) In addition, some children who initially show typical development by reaching all milestones may exhibit regression around the age of two. Many children have been misdiagnosed or remain undiagnosed because the signs of autism are not well recognized. 

There are many signs and symptoms that may indicate your child has a developmental delay. However, It is important to remember that not all children with ASD will exhibit every symptom listed in this article.

early signs of autism

Signs and symptoms that may indicate a delay in development

2-6 months 

  • Slow to smile or laugh 
  • Resists cuddling or holding 
  • Avoids eye contact 
  • Shows little interest in others
  • Doesn’t orient toward people speaking near them
  • Difficult to calm when upset

8-12 months 

  • Limited expressive communication, with little to no babbling 
  • Does not show a range of facial expressions 
  • Doesn’t consistently react to sounds
  • Doesn’t respond to their name or orient towards people speaking to them
  • Minimal interest in simple interactive games such as peek-a-boo and pat-a-cake
  • Doesn’t orient toward objects when another person points it out
  • Prefers not to be touched or cuddled
  • Limited or no communicative gestures such as pointing, waving, or reaching toward caregivers to indicate they want to be picked up or held

12-16 months 

  • Limited response to bids for their attention, such as calling to them “come here” with arms out
  • Does not follow simple instructions
  • Little to no imitation of others during both play and daily activities
  • Does not engage in pretend play
  • More interested in objects than people
  • Repeats unusual movements with objects, such as spinning or lining up items
  • Gets excessively upset over changes to routine and activities
  • Unusual reactions to sounds and textures

16-24 months 

  • Limited expressive communication may use single-word phrases such as “mama” and “dada”
  • If communication is present, does not communicate to share or show interest with others and instead labels items in their environment
  • Limiting speech to repeating words or phrases
  • Unable to follow instructions related to their daily routine (e.g. get your shoes)
  • Becomes upset frequently and unable to soothe, longer and more intense tantrums
  • Carrying specific objects for long periods of time
  • Forming specific routines with toys and being unable to play in different manners
  • Playing with parts of toys instead of the whole toy set

Signs of autism that can occur at any age: 

  • Loss of skills 
  • Fails to respond to name 
  • Lack of eye contact 
  • Delayed speech and language development 
  • Repetitive behaviors (finger movements, arm flapping) 
  • Repetitive sounds or words 
  • Sensory issues (loud sounds, food textures) 
  • Rigidity in their daily routines 
  • Lack of social interactions 
  • Lack of empathy toward others 
  • Sensory sensitivities (such as textures, lights, colors, sounds and smells) 
  • Limited or restrictive interests 

If you’re worried about your child’s development: 

  • Complete the M-CHAT-R screening: The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) is an easy online questionnaire that can help assess whether your child might need a professional evaluation for autism. It only takes a few minutes to fill out and you are able to complete this form on your own. Follow this link for free access to the M-CHAT-R Screening (Robins et al., 2009). If the results suggest a high likelihood of autism, consult your child’s doctor. 

Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R™) | Autism Speaks

  • Bring your concerns to your pediatrician: If you have any concerns regarding your child’s developmental progress, please do not hesitate to discuss them with your pediatrician. Should you have any doubts or require further clarification, consider seeking a second opinion. 

 

References

Babycenter.com Signs of autism in babies and toddlers | BabyCenter

Robins , D., Fein, D., & Barton , M. (2009). Modified checklist for autism in toddlers, revised (M-chat-RTM). Autism Speaks. https://www.autismspeaks.org/screen-your-child 

U.S. Department of Health and Human Services. (2021, April 19). Early intervention for autism. Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/earlyintervention#f1 

Miller, C. (2024, February 19). Why autism diagnoses are often delayed. Child Mind Institute. https://childmind.org/article/why-autism-diagnoses-are-often-delayed

 

Desare Fleming specializes in early childhood intervention. She began working in ABA at the advice of a friend. The more she learned about the signs of autism, the more she realized a relative showed signs at an early age but never received a diagnosis or any form of intervention. With over nine years of experiences as an RBT, she plans to pursue becoming a BCBA to help more children and families accomplish their goals. Desare has a master’s degree in Special Education with a concentration in Applied Behavior Analysis from Arizona State University. 

Early childhood intervention

Help, My Child Has an Autism Spectrum Disorder (ASD) Diagnosis! What Do I Do Now?

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If your child has recently been diagnosed with Autism Spectrum Disorder (ASD), you may be finding yourself faced with mixed emotions – possibly “feelings of shock, disbelief, confusion, anger, sadness, worry, denial, guilt, relief” (Smith-Young et al., 2020). It is okay for you to be experiencing these feelings, and remember that you are not alone – on average, 1 in every 36 children has been diagnosed with ASD (Maenner et al., 2023). Now that your child has a diagnosis, you may be wondering: “What resources are available for my child?” “Where do I go from here?” “What’s the next step?” In this blog post, we’ll explore navigating early intervention services available for children with autism.

Early childhood intervention

Step 1: Identify the Services Available

What are Early Intervention Programs?

Early Intervention Programs are available to infants and young children demonstrating developmental delays and disabilities. These services help children learn new skills that will help them be successful in life. These services can include applied behavior analysis (ABA) therapy, speech therapy, occupational therapy, physical therapy, and more. 

What is Applied Behavior Analysis (ABA)?

“Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior” (Autism Speaks). When your child receives ABA, you will have a Board-Certified Behavior Analyst (BCBA) who evaluates your child and then creates an individualized behavior plan uniquely tailored to your child and your concerns for your child. Registered Behavior Technicians (RBTs)/Behavior Technicians (BTs) implement your child’s behavior plan on a day-to-day basis under close supervision of a BCBA. 

What is Speech Therapy (ST)?

Speech Therapy is a therapy that helps an individual improve their communication and language skills. According to the Cleveland Clinic, a Speech-Language Pathologist (SLP) will complete an evaluation of your child and create exercises and treatment goals to help address your communication needs and understanding of language.

What is Occupational Therapy (OT)?

According to Timothy Finlan (2020), an occupational therapist “helps kids who have a physical, sensory, or cognitive disability” learn how to perform daily living tasks (i.e., getting dressed, writing, taking a bath/shower, etc.) through various activities, supports, aids, and equipment. Occupational therapy can also “help kids with sensory processing disorders find ways to interact with their environment in more comfortable and appropriate ways” (Finlan, 2020). 

What is Physical Therapy (PT)?

You probably have heard about physical therapy for adults, but you may be wondering, how does physical therapy help my child with ASD? Some children with ASD may have additional mobility difficulties, such as low muscle tone, poor balance, and incoordination. A pediatric physical therapist can create programs for your child to help them move through their environment easier. Some areas that a physical therapist may help your child work on are “Gross Motor Skills, Balance/Coordination Skills, Strengthening, and Functional Mobility/Motor Planning” (Children’s Hospital of Philadelphia Research Institute, 2020). 

 

Step 2: Find Services that Best Fit Your Child’s Needs

Ask your child’s pediatrician for recommendations.

Talk with your child’s doctor about your concerns, and they will provide recommendations for local services and providers who will best fit your child’s needs.

Check with your insurance provider.

Your insurance company may have a list of providers in your area who are in-network with them. Your child may need a qualifying diagnosis for insurance to cover specific services. Speak to your provider for more information.

Utilize recommendations from friends and family.

Some of your friends and family may have a provider that they trust and can help you get in contact with.

Check out these websites for additional resources.

 

Step 3: Contact the Provider

Once you find a provider for your child, it is important that you contact them regarding their intake process, as each company has a different one. 

Some general things you can expect a provider to require from you are:

  • A doctor’s referral
  • Insurance Approval
  • An initial meeting with you—This can be an opportunity for you to tour the facility, ask questions regarding services, and ensure that their services are a good fit for your child by asking what type of support you need.

Keep in mind that many providers may have a waitlist for services. But, once you take that first step to start the intake process, you will have a better idea of how your child will benefit from services and an idea of a timeline for receiving services. Do not be discouraged if one provider does not work out for your child and family – no two providers are the same, and it may take some time to find the perfect fit for your family.

 

References

Applied Behavior Analysis (ABA). Autism Speaks. (n.d.). https://www.autismspeaks.org/applied-behavior-analysis

C. medical. (n.d.). How do I know if I need speech therapy? Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22366-speech-therapy 

Finlan, T. (Ed.). (2020, January). Going to an occupational therapist (for kids) | nemours kidshealth. KidsHealth. https://kidshealth.org/en/kids/occupational-therapist.html#:~:text=A%20kid’s%20occupation%20is%20to,with%20toys%20or%20other%20kids. 

Maenner, M., et. al., (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2020. Center for Disease Control and Prevention. 72(2). 

Smith-Young, J., Chafe, R., & Audas, R. (2020). “Managing the wait”: Parents’ experiences in accessing diagnostic and treatment services for children and adolescents diagnosed with autism spectrum disorder. Health Services Insights, 13, doi.10.117863292090214.

The role of the pediatric physical therapist for children on the autism spectrum | Children’s Hospital of Philadelphia Research Institute. (2020). https://www.research.chop.edu/car-autism-roadmap/the-role-of-the-pediatric-physical-therapist-for-childen-on-the-autism-spectrum 

 

Mei Mei Gibbons, Registered Behavior Technician (RBT), has been dedicated to working with children since her childhood and has been a professional in the Applied Behavior Analysis (ABA) field since 2016. She became interested in ABA after witnessing the significant positive impact of scientifically proven ABA techniques on her clients and their families. Mei Mei has a deep compassion for children who exhibit challenging behaviors due to communication difficulties.

Mei Mei has worked in various settings, including schools, clinics, and homes, allowing her to develop a versatile approach to ABA. Her experience includes working alongside Board Certified Behavior Analysts (BCBAs) to help develop individualized behavior intervention plans for her clients and assist in training new technicians in the field.

One of Mei Mei’s most memorable experiences was helping a child with low verbal behaviors develop basic communication skills, ultimately enabling them to express their needs and reduce frustration-related behaviors. This success story continues to inspire her work and commitment to ABA.

Currently, Mei Mei is pursuing a Master of Education in the Foundations of Applied Behavior Analysis at the University of Cincinnati and expects to graduate in December 2024. She believes in a client-centered approach, emphasizing the importance of tailoring interventions to each individual’s unique needs and strengths. Her philosophy is grounded in empathy, patience, and a relentless pursuit of positive outcomes for her clients.

She aims to leverage her education and experience to help individuals become more independent and enrich their life experiences.

NCR: Noncontingent Reinforcement

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Noncontingent Reinforcement Part 1: Overview
by Gabriel Gafner at ABA Connect

Noncontingent Reinforcement (NCR) is the presentation of a reinforcer, independent of the presence of a specific behavior. The learner receives reinforcement on a set schedule instead of for a positive response.

The classic example is of a student sitting in the front of the classroom, next to the teacher. The student is receiving consistent reinforcement in the form of attention without “earning” it. This would reduce the instances of challenging behavior that are normally exhibited to earn attention.

A second example is if I decide to buy myself a McFlurry (MnM, obviously) because I wanted to treat myself and I did so independently of having done anything to earn it, this would be NCR. Conversely, if I told myself that I would buy myself a new video game after cleaning the house this would not be NCR because I earned the video game contingent on cleaning the house.

Another way to think about it is that reinforcement is normally dependent on the presence of a behavior. NCR is therefore not dependent (not contingent) on any behavior.

In a clinical setting NCR is delivered on a set schedule that is setup to deliver reinforcement frequently enough that the learner is no longer motivated to engage in the problem behavior that is getting them that reinforcer.

In our next blog post we will look at more applications of NCR and some important considerations to keep in mind.

T-Shirt for A Cause

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This month we have created a fundraiser to contribute to a local Austin nonprofit group VELA. VELA helps families who have children with special needs by connecting them to community as well as providing educational support.

We are selling ABA t-shirts, at cost here: https://www.bonfire.com/fund-raiser-for-vela/https://www.bonfire.com/fund-raiser-for-vela/

For every t-shirt purchased, ABA Connect is donating $10 to VELA, up to $500. These t-shirts will only be available for 15 days, so if you would like one, please order soon! #aba # #specialneeds #families #donate #autismawareness #autismawarenessmonth

People in ABA

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Robert Koegel and Laura Schreibman developed PRT (Pivotal Response Training).  It targets self-initiation of the subject’s preferred activities in a natural setting..

Fred S. Keller developed PSI (Personalized System of Instruction), a self-paced teaching method.

Ogden Lindsley developed precision teaching which uses a semi-logarithmic chart also known as a Standard Celeration Chart.  The chart has a slope of 34 degrees.

Stimulus Control: Salience, Masking and Overshadowing

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Stimulus Salience refers to how obvious or prominent a stimulus is in a person’s environment.  If a person has visual deficits, then visual stimulus will not have as much salience as auditory stimulus, for example.  In order to notice stimulus, and for that stimulus to have salience, a learner must possess pre-attending skills necessary for the setting.  The pre-attending skills for kindergarten, for example, include looking at the instructional materials, listening to instructions and to the teacher and sitting quietly while instruction is happening.

Masking is when the salience of a stimulus is decreased.  A competing stimulus blocks the evocative power of the stimulus, decreasing its effectiveness.  For example, a teenager may follow directions when alone with a parent, have a more difficult time when peers are present.  This example is competition of different contingencies of reinforcement which makes it more difficult for the subject to mind the discriminant stimulus.

Overshadowing is when the first stimulus has no more stimulus control.  An example is a teenager who can study in a classroom, but not in front of the a group of cheerleaders.

In order to reduce the effect of overshadowing and masking, we must apply antecedent interventions such as:  arranging the environment to reduce “noise” from unwanted stimulus, making the instructional stimuli intense and consistently reinforcing behavior in the presence of desired stimulus.

Reinforcer Assessment

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The quality / power of reinforcement can be determined with a reinforcer assessment.  A variety of direct, data-based methods are used to present one or more stimuli contingent on a target response and then measuring the future effects on the rate of responding.

  • Concurrent schedule of reinforcer assessment: pits two stimuli against each other to see which will produce the larger increase in responding when presented as a consequence for responding.  The more effective reinforcer is the one that has more responses.
  • Multiple schedule reinforcer assessment: reinforcers are delivered for the same behavior, on the same schedule but at different times; an SD is present to signal which schedule is in effect.  The more effective reinforcer is the one associated with the session with the highest rate of behavior.
  • Progressive schedule: response requirements for reinforcement are increased systematically independent of responding.  The practitioner gradually requires more responses to receive reinforcement until a breaking point is reached and responding declines. A progressive ratio increases the behavior that must be emitted before receiving reinforcement.  The reinforcers that produce the most behavior are considered the most reinforcing.

Behavior

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Behavior is movement of an organism through space and time.  It must past the “dead man’s test” which is to say, “if a dead man can do it, it isn’t behavior.”  Behavior can only be done by a living organism and does not include movements due to physical pressures exerted upon that organism.  For example, someone getting blown over by the wind does not constitute behavior.  Someone rolling around and getting up because of the wind exerting force on their body does constitute behavior.

3 fundamental properties by which behavior can be measured (Johnston and Pennypacker 1993a)

  1. temporal locus – when in time that behavior occurs
  2. temporal extent – how long that behavior lasts
  3. repeatability – how many times that behavior happens over time (aka, rate of behavior)

 

Token Economy

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Response Cost: Is a negative punishment that involves taking back tokens that have been earned.  It can be thought of as a fine for unwanted behavior which, hopefully, creates a decrease in the future possibility of this behavior occurring.

A token can serve as a Generalized Conditioned Reinforcer (GCR).  That is, it has been paired with many conditioned and unconditioned reinforcers.  GCRs are reinforcers that can be exchanged for other reinforcers and are less likely to be influenced by satiation and deprivation.  Money, for example, is a type of GCR and has little sensitivity to satiation.

Baseline Logic

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Baseline logic looks at 3 dimensions of single-case design.  These are : prediction, verification and replication.

Prediction: What do you think will happen in the future
Verification: Showing that the dependent variables (DVs) would not change without intervention (independent variables: IVs).
Replication: Taking away the intervention, reintroducing it, and obtaining similar outcomes