22 Autism Early Signs From a Speech Therapist (Backed with Data)

Here are 22 early signs of autism and it's a long list. Yes. But it's taken directly out of DSM 5, which is the source material, what psychologists use, what doctors use to make diagnosis for autism. So this is going to be accurate. It's going to give you a sense of where your child at. If you're having some concerns right now, and I'll dive straight into it. We're using something, an instrument that has a high predictability for children, for toddlers who are around like below the age of two. So this thing, this manual I'm going to read off of is called Systematic Observation of Red Flags of asd. It's a whole mouthful, but let's switch to that right now. Yep. So here is the manual of. I'll give the link of this in the description below as well. So I'm just going to skip on the instructions and I'll go directly to the red flags and like, it's better than me sharing. I'll share some of my professional insights about what I see for like autistic children. But I'll go through these first. So number one is limited. Sharing warm, joyful expressions with directed gaze. This is not something that parents will be able to observe by themselves. You need someone professional to look at it. In some countries, even like for me, speech therapists, we cannot make a diagnosis like that. Okay. It's scored from zero to one. Obviously not obvious. The higher the score, the worse it is. Basically, if a child will share an expression looking at you, smiling, large smiles directed at a person with eye gaze, if they don't do that, then that is a red flag. Second is reduced facial expressions. So here it says variety of or multiple changes of facial expressions of effect. For example, a child opening and closing the mouth while pretending to eat is not counted. So like, it needs to be something that is of an emotional thing that. So for instance, happy, content, surprise, excited looks. Right. Also negative ones like protest, where weariness, fear and anger are also good. So again, like, to pass this red flag, you need to at least have four changes from neutral expression. Okay. At least two positive and at least three at least in three different activities. Okay. And then number three is limited sharing interests. Okay. The example here is direct a person's attention to objects, actions or events of interest, also referred to as initiating joint attention. So that's a huge word out there. What it means is that if a child can follow the signals of eye gaze, for instance, I'm looking at something, they look with me, I gesture towards something, I Point or like I show them something with my hand or my sound. If I go and then they look together or the toy makes a sound. Right. Then sharing an interest is defined as using a communicative signal to show bring attention, point out something of interest to share with others. So meaning if they, if there was a alarm ringing, your child would bring the alarm to you and say turn it off or whatever or like a toy that is funny, they might like laugh and point it at you. So to pass this again is to use signals for to share four different interests with others. Okay. The interest considered different if is unique and independent. For example like a toy, car, a balloon and where a similar object should be considered one interest. Like two types of cars book sharing. Each book should be coded as one interest. So these are instructions for directly to professionals. So you're getting from the source material. Right. So if you're looking at your child for red flags, a professional will look for this whether or not there is a diagnosis made and what the implications are of diagnosis, which I will share after I go through these. This list is a different matter. Okay, so the number four is lack of response to name when called, very common, a red flag. So a child's name must be presented with no other active significant contextual cues. For instance, if a child's name is Steve, I don't want to go Steve like or I ring a bell and I go Steve. Or I show them a phone and I say Steve right? To consider the opportunity to respond to the name. So the child needs to be responding to their name and their name only. That's what this text is saying. Okay, to pass this again looks towards the person in response to name most of the time at least three times. Okay, so they have a bunch of activities that talk about at the top where they use as collecting data. And you can just go down and click on this document to look at this yourself. I'm just here to tell you the red flags. So number five is poor eye gaze to face. So eye gaze must be directed to a person's face for lingering and connected moment. The eye gaze is alternating and shifting gaze from a person between person and object. So if I was looking at Mommy, daddy and the object, Mommy, daddy and object, I won't be able to switch the eye gaze like that. So do not create a gaze directed at another body part. So if I'm moving my hand and I'm making like sudden moves, you shouldn't be counting those because then it's not really according to the face. So number Six, limited use of showing and pointing. This is a huge one that a lot of parents say, oh my child is not really pointing that much or showing me stuff. The key point is not the use of the, of the pointing. Although this is where as a speech therapist I would think, okay, there's a showing gesture and the pointing gesture and they define it as well. For example, holding an object out towards another person to reference another's attention. Okay, fair. And then the point is to index finger to reference others attention to an object, picture or an event. The show does not need to be coordinated with gaze. So like the eyes don't need to follow the point as long as they're showing it to another person. That's what they're saying. Okay. But the point must have eye gaze. So when they're pointing to something, they must look at the thing at the person immediately before, during, after the point, which is very specific. All right, so here is like the number six is like using both pointing and showing at least once and uses either five or more times. Okay, so you must have a point in order. The child must use pointing, which is like sometimes children don't have the fine motor skills to make an index finger. And I feel like this is a little bit too stringent. Are we really just looking for ASD or are we caring about motoric skills too? Which is a question mark in my hand, in my head. Right. So number seven, taking person's hand or body as a tool without eye gates. And this is a lot of the hand pulling, the hand leading, whatever you like to call it. So it's basically using you as a tool and not caring you for as a person. We've got loads of videos about how to deal with this and you can check out our videos, just search handful. In fact, we have loads of, we have a full course on that. So if you go to agents of Speech.com course, there's a course called micro course go through that. It's specifically for handful. So yeah, so no use of hand or body as tool is how you pass this red flag. Number eight, limited use of consonants and verb and vocal communication. Again, this is just the red flag. Right? That's a red flag and it's a predictor of whether your child will have autism or not. But the limited use of constants and vocal communication isn't just limited to autistic people. Right. Children with speech delay and speech disorders will have this problem too. Right. So I just want to change my tab and show you just to let you know this is not 100%. If your child hits all the 22 observational rating scale of early signs of autism. Very long name, but I wanted to show you. Okay, here. So it says good sensitivity of 0.77 and specificity of 0.76. So it's a predicting likelihood. Right. Sensitivity means is it going to have a good hit rate? Meaning is it like positive positives, like it's hitting the target specific. I can't even see the word dude. Specificity on the other hand, is going to be about whether it's. It's hitting on the negative. Right. Is it giving a false positive or a false negative? Right. These are the opposite of false positive and false negatives. Okay, so it's pretty good. It's like nearly right. Eight out of ten. And this is when a child is two years old. So you do this when your child is around 16 to 24 months. And then after 24 months you can actually do the assessment. And this is just a screener for which. Right. So anyways, let's go back. Why I'm alluding to this right now is because a lot of like this one is very clear that it's not only for children on the spectrum. Like a lot of children who are language, speech, communication delay, whatever the diagnosis is will have this problem too. Okay. Number nine, limited coordination of nonverbal communication. So the coordination means to use like communicative things, signals simultaneously. So if I'm talking to you, I'm looking at you, I'm using facial expressions. Like I have gestures and sound. You need to use the bundle of everything in order to express your thoughts clearly. So this is fair, I think so for three behaviors to be simultaneous, meaning they're using it all together. So when they say mommy like that, are they looking at you? Are they using like a frustrated face expression, reaching out to you and calling mommy whenever another child or your elder bullies your younger child and go mommy like that. Right. The sounds do not need to include a consonant, but exclude speech sounds like laugh, cries and raspberries. So the, what this means is the sound needs to be a speech sound. It cannot be like an expression. It could be like ah, like that. But it cannot be just laugh, cries and raspberries. Okay. Anyways, so number 10 is less interest in people than objects. Interest in people is evident by demonstration following gaze to pit. Okay, so what it means by if there's a spinning top on a table and the, and the person who gave that toy to the kid, they're more interested in the spinning top than the Person who gave it, then we do have a hiccup there, right? So there's a less interest in people evident by looking at and touching using objects without showing interest in people. I think this is quite a good accurate red flag. I would think that I would use clinically as well to think about goals to teach 11 limited sharing, reciprocal social play. So child does not show reciprocal shared play activity with another person. Meaning share play is evident by directing functional actions used towards other people in play. Very hard words here, man. So what it means is just for example, they're. They're able to use tools, toys with someone, okay? So let's say they're. They're feeding someone with a spoon, they're using the napkin to wipe your mouth, right? That kind of stuff. So shared hearing, attention using, using play actions, feeding stuff, animal looking at other people. So just pretend play, man. Like just if they're able to pretend before all this, right? Before even DSM 5, we have a symbolic play test that we usually use and it's very old. It's like 1980 something that when it was made and has all these here, reciprocal turn taking objects, rolling a ball back and forth, anticipating, anticipating the turn, sharing enjoyment. So I think turn taking is a term that is always used a lot in the industry, but no one really defines it. So turn taking, there are three steps to it. First of all, you have to take the turn and then you have to give the turn and you have to wait for the turn, right? So the last waiting is the anticipation of the turn, right? As I'm waiting for it, therefore I'm not going to grab it, right? So I have to do. I have to kick the ball, I have to let you have the ball, and then I'll have to wait for the ball to come back. So there you go. So do not code actions that are physical play. So like social stuff like tickle game or I'm gonna get you and you run after them, you're just a giant robot toy to them. If you do like tickle and I'm gonna get you or whatever. And this is not really a limited sharing because it's not reciprocal. They cannot tickle you back. They cannot get you back. And so it needs to be reciprocal, okay? It needs to be back and forth, all right? Why we care about reciprocal or back and forth is because having a conversation is reciprocal, right? I talk, I give the turn to you to respond. I wait for you to stop talking, I talk. So it's basically turn taking when we communicate, all right? And then we go on to repetitive movements and restrict restricted interests. Okay, 12 is repetitive movements with objects. So this is the ones that the moms are really scared of. Right. Flicking, hand flapping, learn turning stuff, lining up stuff. But the problem is a lot of children who are bad with play skills, they will have repetitive movements because they don't know other ways to use a toy. So this actually isn't really what we call like a repetitive or idiosyncratic that. That's the word way of playing a toy. Sometimes even language or speech delayed children will have a problem with this because they just don't know how else to play with it. Right. So here it's very. I think it's a little bit too, you know, too strict. Two or more clear instances of repetitive movement with objects. Very easy to get ticks, man. Like here. Very easy to have a red flag here, even if your child is not on the spectrum. Okay, so 13 repetitive movements or posturing of body. Hands and fingers. So flat. Hands. Oh, sorry. This is the hand flapping. This is with objects. Okay. So again, I think this is. Some children with sensory problems also have this. And it doesn't only pertain. Only includes children who are on the spectrum, I believe. So rubbing body parts back and forth, These could be a sensory issue. Okay. Also hand flapping could be a sensory issue that has nothing to do with ASD as well. So also here I think it's a little bit too strict. All right. But it is what it is because we do need to have a guideline. And this is the guideline. Okay. 14 unusual intonation and repetitive words, sounds. I think a lot of times it's going to be insufficient vocalizations to judge, which is we don't have enough data to do it if we're talking about this. Usually children are already very vocal and it's hard. So what are unusual intonations? So one of them is odd intonation, monotonous, like just robot tone. Right. Inappropriate stress. So stress is frustration instance stress is English related. We don't have it in Chinese and Indonesian and Japanese and whatever. We have tonal things. Tonal issue issues in Asian languages. But stress is English specific. For instance, if I say someone's name, let me think, I want to say Florence. Right. Where's the stress is when you go up Florence. Right. But then inappropriate stress in this, in this instance would be Florence. Like that. So the stress goes up at the back. So flat or mechanical sounding. Yeah. So usually maybe even no stress like Florence. Like that. Unusual pitch. Too hard, too whole, too low. Sorry. Irregular rhythm, stiff or jerky, so it suddenly increases. So one of the. I'll give you an example. First ever client, when he said piano, he could only go pino like that. So he kind of hit the wrong stress, the unusual pitch, irregular rhythm. Also unusual voice quality because it's very loud. And he also got all the. All got the consonants wrong, actually. The vowel because of P. Yeah, P. Knee. No, instead of A, he did the I. Right. So anyways, he kind of hit everything here. So three or more uses of repetitive. Okay, so again, very strict man. Like only three or more and you're already like giving it three. But this is quite. I think this is quite a big one. Because this means that they don't really care if you understand it or not, in my opinion. Okay. Just my opinion. And this is quite, Quite an autistic feature, I would believe. Because if I do care about how you think, how you speak and how you would understand, I wouldn't make odd intonations, I wouldn't make unusual voice quality. And I wouldn't play with the rhythm a little bit too much. It's only because I lack. If I were to play with all these. If I said pinino, like I didn't care about what you wanted me to say or if you understood what I said. I just wanted to say pinino instead of piano because it sounded nicer to me. That's it. Right. So number 15 is ritualistic pattern of behavior. So this is like. Ritualistic patterns are like. Like OCD ish, that kind of thing. I'm only saying OCD as a way to make you understand. Doesn't mean they're related at all. Okay, I'm just going to make it clear here. So there's evidence of a clear ritual. So one of them, I think one of my clients before, when they saw a piece of puzzle not put on properly, they will run into that room and put it properly. And that's a ritualistic thing. And one of them, another one that was already in high school, and we were playing this Magic the Gathering card game. And he was really into it. So I also knew how to play. So we were using it as a social game kind of situation. So one of his rituals is that he must put his deck sideways instead of vertical. So when I went ahead and turned it around, he would get pissed. So that's a clear ritual there. Okay, So I think this is quite. This is quite an autistic feature as well, I would believe. And then 16 is marked distress over change. Okay. This is to do with children who cannot transition from an activity to an activity. Right. And why this is. I do think this is quite, quite important. But then the problem is a lot of children who are not on the spectrum will also have a distress over change. And it's very easy for parents to say, oh my God, they can't. They can take change. Yeah. But then also my grandpa can take change. He doesn't like it when I. When we go from one place to another without his. His consent. So I don't know, man. It really depends on the professional eye to make sure that this marked distress overchange is properly marked down and. And to have professional eyes with this. I think it's very easy for anyone like a teacher or a parent to say, oh my God, he's autistic because he can't take changes. But I think there are like the stress must be strong intensity and prolonged at least 30 seconds. Is strong. Is prolonged. My God, I would say needs to be at least two minutes, man. But anyways, so the next one is excessive interest in a particular objects or actions. Yeah. So some children have these kind of problems. They love spoons. One of them, they love tapping something like just things that tap. It could be paper, it could be whatever. One of my clients before, she loves hand sanitizers. Then that was pre Covid. And then like just particular things that what we call idiosyncratic things. Like ways to use these kind of stuff. Children might like a strip of cloth here and then they like to. They like the friction or whatever actions. Intensely interested in making things spin or wobble. Okay. That's to do with the first point of this section. Dump and fill books. And I've had some children like to fill up something, empty it and do it over and over again. Right. So the diagnostic criteria is this difficulty to shift attention away from it. Resistance to a new action, unwillingness to release the object, fussiness over removal of the object, returning to the same interest all over two or more times during the. The sample. Meaning like the. The activity that they use for this particular screening. Okay. So if the. Wait. If the. Has not shifted from an episode sticking more than 60 seconds. My God, that's so short. But anyways it can be coded as excessive interest. Okay, understood. So I think they're trying to be a lot more. Be more safe in these red flags. So they want to include as many of these things to write down so that the point system and they would just be careful about any false negatives. So number 18 is clutches particular objects. So the Child holds on to an object from previous point set and will not release the object easily. So this is related to not being able to go from one. Sorry, overchange. Yeah. When objects removed. So they. It's the same thing. But some children like to hold on to something and it's related to everything. If they cannot let go of it, then this is something that we. This, at least this. These red flags look into. And it doesn't really like sometimes that the underlying problem we. It's really hard to describe and understand. But these are just symptoms. Okay. Just let. Just to let you know. Okay, number 19. We're nearly the end of it, so let's get through this. Sticky attention to objects. If a child does not shift gaze away from an available object within 10 seconds, like that is a sticky attention. An object is available if it's within the child's reach or in child's control. Generally, sticky attention to a specific object is coded when object first presented or encountered. Okay. These words, literally after you read it, it doesn't really make sense. But what it means is that if the child looks away from the object within 10 seconds, then it should be fine. That's what, that's what I meant. All right. So anyways, let's keep on going. Number 20. Fixated interest on parts of object. The child displays a narrow focus on preoccupied parts of an object. Visual attention to a part of the object for extended period of time. Repeated or prolonged manipulation. Objects. Okay, so these are specifically like wheels of a car, cabinet drawers open and closing, something over and over again. Playing with a piece of tissue and only caring for the tip of the tissue. These are things that we see a lot. And these are symptoms. Yet again, this may include toys, clothing, or body parts. It could be even their own body parts, like. Or your body part. One of my clients really likes blackheads. So whenever he sees my blackhead, he just wants to squeeze it and he just stops at nothing. He comes at me and he just squeezes my blackhead. And sometimes I'll let him as a Reward. Anyways, the 21st point is adverse response to specific sound textures or sensory stimuli. This is not just for children who are on the spectrum. This can be children who have a sensory issue. So usually speaking, auditory is going to be more pronounced when children put their hands over the ears. So this is. It could be a learned response as well as a behavior issue. We call that tactile defense, meaning I want to defend from the stimuli the sensory thing, whether or not it's going to cause me any Harm. Because children want to be preemptive. This might be because they had a bad experience from before. And like, this is what. How it works. So there's a defensiveness towards these things. It could be a learned thing as well. It could be that your child is not on the spectrum and has sensory issues as well. Okay. And. But sensory happens a lot inside of a child with autism. Okay. Do you understand what I'm saying? So a person with asd, like a high chance they will have a different sensory profile, but that doesn't mean a child who has sensory problems is on the spectrum. Okay. I hope this makes sense. The last one. Oh, we're there. Okay. Unusual sensory exploration or excessive interest in sensory aspects of environment. So this is hypersensitivity up here. 21. So adverse response. This is what we call hypo, meaning they are seeking for sensory. So a child on the spectrum or a person who has a different sensory profile, they might like. Like some points are hyposensitive, meaning it's not enough sensory, so they want more of it. And some are too sensitive. For instance, for me, my palms are hypersensitive, right? If it's too dry, it's too hot or too cold, my hands are the first to go. It's gonna need to wear some gloves or put on some cream. Right? But whereas my foot is hyposensitive, I require a lot of sensory input there or else I don't feel good. Okay. So that's just me, even for me. And I'm not. I'm probably not on the spectrum. Just telling you these sensory things are good ways to look for, but it also requires you to think about how you're going to treat your child during therapy. Okay. So that's all. And this is like how these are scored and these are the. The activities that they use. Sampling opportunity. For example, if you were to go through this behavioral worksheet thingy, you're not going to be the examiner, my friend. You're going to have to find a therapist or a clinical psychologist to do this. Okay. And now I'm going to talk about what I look for. And this is also, like, shared on this website called Inform slp. I use it quite a lot. I quite like it. And I'll put the link to it below as well. So the first thing is regression. I feel like there are loads of diagnoses out there. Children who have the autism diagnosis, they tend to regress a lot more than the others. Okay. That's what I think. Regression just means they knew something and then they lost it. Okay, so that's how it works. We should be using publish. There's not to do with what I want to say. Sensory concerns is an important sign. Yes, I do think so. So when you see there are sensory things going on, you should screen for an ask for occupational therapists to look into it. So why I say this is because in some parts of the world where occupational therapy isn't very widely adopted just yet, you need to understand a child's sensory profile and not just say they have a sensory need or because they're, they have sensory concerns. That's why they're on a spectrum. That's not how it works. You need to look into what the profile is, how is it like and have it examined. And so that, and this can happen with neurotypical children too. That's what I'm trying to say. So therefore, if you see sensory issues, you should go ahead and check it first. Okay. So that it will be easier for you to know whether it is or is not autism later on as in when they're like two or three. Okay. And this is also very important. If you have one autistic family member, then you like only 33%. What it means is 67% of the time, if your family has history of autism, your child has 2/3 of a chance. That's what the stat is trying to say. Right. Family history is huge, not only for autism, also for speech and language delay and other diagnoses out there. Okay. That's what I look for. And the clinical implications. This is where I'm going to switch up to my head now. The clinical implications for all this. It means not much if you get your child diagnosed with autism. What it means is that you will get resources to, to get therapy done. Okay. You will get more people helping you. That's what it means. How does it change the therapy? It doesn't really. Especially if your child is non verbal functionally just yet now, meaning if they're not using words functionally to speak to you, 9 times out of 10 the therapy is going to look the same whether or not your child is on the spectrum. So with that said, if you want to try these things at home and you want to teach your child more, you, you can go to www.agentsofspeech.com course we have free courses from getting children to speak the first words all the way to telling stories and playing board games with you. Okay, that's all for today's video. If you liked it, you can check out these ones here. All right, thanks.