Pediatricians or family physicians are often the first physicians consulted by families with concerns about their children's developmental delays. Many families continue to report that the family physician often attempts to reassure them and may be dismissive of their concerns. There is now evidence that parental concerns are generally reliable and should be given more credence by physicians. Listed below are tools that can enable physicians to recognize Autism Spectrum Disorders (ASD) and promptly pursue further evaluation.

 

There is also evidence that early intensive behavior therapy implemented during the relatively narrow window of "brain plasticity" can have a positive impact on child development and provide a better outcome.

 

Parental Concerns that are RED FLAGS for Autism: (typical concerns brought to the family physician).

Communication Concerns

Does not respond to his/her name

Cannot tell me what (s)he wants

Language is delayed

Doesn't follow directions

Appears deaf at times

Seems to hear sometimes but not others

Doesn't point or wave bye-bye

Used to say a few words, but now he doesn't

 

Social Concerns

Doesn't smile socially

Seems to prefer to play alone

Gets things for himself

Is very independent

Does things "early"

Has poor eye contact

Is in his own world

Tunes us out

Is not interested in other children

 

Behavioral Concerns

Tantrums

Is hyperactive/uncooperative or oppositional

Doesn't know how to play with toys

Gets stuck on things over and over

Toe walks

Has unusual attachments to toys (e.g., always is holding a certain object)

Lines things up

Is oversensitive to certain textures or sounds

Has odd movement patterns

 

Absolute indications for immediate further evaluation

No babbling by 12 months

No gesturing (pointing, waving bye-bye, etc) by 12 months

No single words by 16 months

No 2-word spontaneous (not just echolalic) phrases by 24 months

ANY Loss of ANY Language or Social Skills at ANY Age

 

Ask Specific Development Probes: "Does (s)he...?" or "Is there...?" (questions that the family physician should ask after the concerns listed above are brought to them by a family).

 

Socialization

...cuddle like other children?

...look at you when you are talking or playing?

...smile in response to a smile from others?

...engage in reciprocal, back-and-forth play?

...play simple imitation games, such as pat-a-cake or peek-a-boo

...show interest in other children?

 

Communication

...point with his finger?

...gesture? nod yes and no?

...direct your attention by holding up objects for you to see?

...anything odd about his/her speech?

...show things to people?

...lead an adult by the hand?

...give inconsistent responses to name? ...to commands?

...use rote, repetitive, or echolalic speech?

...memorize strings of words or scripts?

 

Behavior

...have repetitive, stereotyped, or odd motor behavior?

...have preoccupations or a narrow range of interests?

...attend more to parts of objects (e.g., wheels)?

...have limited or absent pretend play?

...imitate other people's actions?

...play with toys in the same exact way each time?

...strongly attached to a specific unusual object(s)?

 

Source: Filipek PA et al, The screening and diagnosis of autistic spectrum disorders, J Autism Developmental Disorders 1999;29(6):439-484. Copyright 1999 Plenum Publishing Corporation