Signs of Autism Your Pediatrician May Miss

Communication Is the Key to an Early Diagnosis

Most pediatricians are trained to check infants and toddlers for physical development. Milestones including height, weight, skeletal structure, and development of physical skills are easy to measure and check, and parents are able to quickly ascertain whether their child can stand, walk, or run. Many pediatricians are also trained to screen for developmental differences that could suggest problems such as autism spectrum disorder—but those signs, if they're subtle, are easy to miss.

Pediatrician with little boy

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Why Pediatricians May Miss Early Signs of Autism

In most cases, the earliest signs of autism are subtle. They may include lack of eye contact, slower acquisition of spoken language, fewer uses of gestures for communication. But the reality is that pediatricians see very young children only briefly, and, after the first year, only once or twice a year. While it's easy enough to see that a child is underweight or unable to jump or run, it's very hard to evaluate the behavior of a child you barely know—especially when that child is in a stressful situation and may be dreading a vaccination or cold stethoscope.

Another confounding factor for pediatricians is the fact that young children develop at very different rates. It's not unusual to see a child who develops spoken language slowly suddenly pick up speed and wind up as absolutely typical six months later. Few pediatricians want to raise red flags for developmental disorders on the basis of a run-of-the-mill difference in developmental speed.

A third reason for pediatricians' difficulty in discovering signs of autism arises from differences in how parents report on their child's behavior. Screening for autism involves asking questions about play skills, social behavior, and communication. But each parent has a different perspective and will answer differently. For example, when the doctor asks "how many words can your child say?" a parent might accurately say "150," but fail to mention that all of those words are memorized from TV scripts. Doctors also know that parents can be over- or under-responsive to their child's behavior. Some "helicopter" parents will see a temper tantrum as a major concern, while more laid back parents may not worry about a significant developmental delay.

Finally, pediatricians know that few children are at their best in a doctor's office. A child who is shy or nervous is likely to talk less, respond more slowly, and generally appear less capable in a doctor's office than at home or in the community. Thus, the doctor must rely to a great extent on his memory of the child in past visits and on parent reports.

How Caregivers Pick Up on Signs That Pediatricians Miss

Parents, preschool teachers, and nannies are usually the best sources of information about a child's development and behavior because they see that child every day in a wide variety of situations. They can compare a child's behavior in one situation to his behavior in another to see if apparent delays are significant across settings. They can also compare the child's development and behavior to other same-age peers. So, for example:

  • They will notice if a child is far behind his peers when it comes to skills such as social communication, abstract thinking, or interactive play.
  • They can tell if speech delays are only present in stressful situations (suggesting shyness) or whether the delays exist in every situation.
  • They will know whether the words a child says are memorized from a favorite movie or TV show.
  • They will know whether the actions or ideas expressed by the child are repeated over and over again, in the same way, without apparent purpose or meaning.

Talk to Your Pediatrician About Early Signs of Autism

Pediatricians' difficulty with identifying autism at an early age is a problem because research shows that the earlier autism is diagnosed, the earlier a child can begin treatment. In general, early treatment through an early intervention program can make a big positive difference in outcomes.

If you see behaviors or delays that look like red flags, don't be afraid to share your concerns with your pediatrician, along with specific detailed information about your child's differences and challenges. If your pediatrician pooh-poohs your concerns, consider finding a qualified autism specialist to conduct an evaluation. At worst, you may find your worries were unnecessary. At best, you may able to help a child get the treatment he needs.

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  • Broder-Fingert S. Improving Screening for Autism Spectrum Disorder: Is It Time for Something New? Pediatrics. May 2018 Commentary

  • Zwaigenbaum, M. Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics. 2015;136(Supplement 1).