BOSTON — Social difficulty and repetitive behaviors are better early flags of autism than are communication problems, according to one family physician.
Lack of spontaneous sharing is an early indicator of autism, said Dr. David Gregory, an assistant professor of clinical family medicine at the University of Virginia in Lynchburg and director of pediatric education.
Children with an autism spectrum disorder tend not to volunteer information about what they are thinking, doing, or feeling, Dr. Gregory said. “They have a sense of self that separates them from others.”
Autistic children often engage in repetitive, compulsive behaviors that can be difficult to distinguish from obsessive-compulsive disorder. If you see a 2-year-old who is engaging in repetitive behaviors frequently, it could be an early indicator of autism.
Repetitive behaviors are common in the normal toddler, but the autistic child's repetitive behavior will be focused on the parts, rather than the whole. For example, the autistic child will spend hours focused on the wheel of a truck but not seem to notice that the truck can move. Older autistic children tend to focus on more complex subjects, he said.
One tool that physicians can use is the joint attention screen. The test involves shaking keys or making another loud noise. Watch to see if the child looks to the source of the noise, then at their parents to “share” the experience, and back to the object.
It is a good sign if the child looks toward the object making the noise. However, the most important part of the test is for the child to look at the parent for acknowledgment and then focus back on the object together.
Shared attention is an important potential indicator of social impairment that can be observed in the office in a brief amount of time.
Dr. Gregory recommends using a joint attention screen at the 6- or 9-month well visit. If a child fails to demonstrate joint attention, consider an earlier evaluation of the child with a standardized autism screening test, he said.