Red Flags

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. There is often nothing about how people with ASD look that sets them apart from other people, but they may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less.

ASD begins before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with ASD show hints of future problems within the first few months of life. In others, symptoms may not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an ASD noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age.

Autism looks different in every person who has it.  I have hi-lighted below some of the things we noticed early on, and even now, with Chase, but please know that not every child with Autism does these things or shows these symptoms.  And Chase doesn't do or act certain ways that other kids with Autism act either.  There are thousands of different signs and "red flags" that could indicate ASD.  Below are the "red flags" taken from the CDC website and how they relate to Chase.

Possible "Red Flags"

A person with ASD might:

• Not respond to their name by 12 months of age
  We started noticing around 12-15 months that Chase would "tune us out" when we said his name.  We would say his name over and over, louder and louder and he would just "zone out" or not even turn his head to look at us.  We literally had to get down in his face and make him look us in the face, still rarely in the eyes though.  Now, I can call his name from another room and he will come in to the room where I am to eat, or leave, or get dressed...early intervention and therapy are KEY!!!
• Not point at objects to show interest (point at an airplane flying over) by 14 months
  This is still something Chase will rarely do.  He has gotten better at pointing to objects or books when they are presented to him at school or in therapy or is he is asked a question regarding something being presented to him, but if he wants something out of reach he has never pointed to what he wants, or anything in the distance, etc.  I have videos of him around 11-12 months out in our front yard trying to point to a garbage truck going by, but aside from that incident I can't remember him pointing to anything ever.
• Not play "pretend" games (pretend to "feed" a doll) by 18 months
  Pretend play is something Chase still struggles with.  He is fine to play with toys or objects that have a clear function - like blocks, marble mazes, puzzles, play doh, etc., but he has never played "make believe" with anything.
• Avoid eye contact and want to be alone
  We started to notice Chase's lack of eye contact around a year old.  It progressively got worse around that time he would "zone out".  He looked like he was looking "through us" rather than at us.  Now he looks us directly in the eye and seems to really "see us".  He has always preferred to play alone or be off to the side doing his own thing.  He still does this quite a bit.  He likes to lay in his bed and play his iPad and have his "me time", but more and more recently he has shown less interest in being alone on his iPad and prefers to be with the rest of us, playing, and interacting...which is HUGE!!!
• Have trouble understanding other people's feelings or talking about their own feelings
  I am still not sure how much Chase understands regarding emotions.  I feel like he has always been more tuned to in to this than I realize though.  There have been several instances where he has seen me crying and come over to me and hugged or kissed me.  And there are plenty of times he sees us laughing or playing and comes over to join in the fun.  He has always been very loving and cuddly, which I am always grateful for.  He gives the BEST hugs ever! ;)
• Have delayed speech and language skills This was our NUMBER ONE red flag with Chase.  He was starting to say a few words around 12 months, but then they just stopped.  No more imitating sounds, just a lot of "squawking" and babbles.  He still refuses to even try to imitate sounds or language.  This is a huge struggle for him.  Even imitating oral motor exercises like sticking out his tongue or popping his lips or clicking his tongue are hard for him, although improving tremendously as of lately!
• Repeat words or phrases over and over (echolalia)
  This doesn't relate to Chase, as he is non-verbal, but I have friends who children on the spectrum "memorize conversation" and answers to questions.  Or kids who "script" repeating movies or cartoons over and over.
• Give unrelated answers to questions
• Get upset by minor changes
  Chase has never had a lot of meltdowns, but when he did they were bad.  Chase started having meltdowns over MINOR changes in routines or anything really around 15-18 months.  Even as he got older, he would flip out in the backseat if I drove a different route home.  His most recent meltdowns occur when he can't do his "routine" when we get home from school...he likes to go swing before he comes inside and when it's raining or he can't swing for some reason a 10 minute meltdown ensues.  His meltdowns are minor in comparison to some I have seen or heard from other ASD parents, but they are still meltdowns
• Have obsessive interests This wasn't initially a concern with Chase, but as he's gotten older he has become slightly OCD about things around the house.  For example, I got a new rug for his room, so I moved his old one in to Miles's room and he kept trying to drag them back to how they were before! ;)  I also rearranged a few things around the house recently and he moved them back - things like a candle and a ceramic pottery plate.
• Flap their hands, rock their body, or spin in circles
  Chase started flapping his hands around 15-18 months I think.  I can't remember exactly, but initially it wasn't that bad.  It got progressively worse, along with his jumping up and down and running aimlessly in lines back and forth.  He also used to take every toy he touched - whether a stacking cup, puzzle piece, lego, whatever he touched - he would try to spin it.  He would find anything round, like his stacking rings, and sit and spin them for HOURS...it was so frustrating.  The first 2 months after we started speech therapy with TEIS, I swear we spent the entire time trying to make him stop spinning toys.  We have come so far!  Other kids will spin themselves for hours though, or rock back and forth, or jump up and down.
• Have unusual reactions to the way things sound, smell, taste, look, or feel
  Chase began around 18-20 months old to be a VERY picky eater.  He got really sensitive to way food looked, felt, smelled...no matter how we tried to tweek his foods, if we changed brands or the way we cut something even, he wouldn't touch it.

Social Skills

Social issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social "difficulties" like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to ASD:

• Does not respond to name by 12 months of age
• Avoids eye-contact
• Prefers to play alone
• Does not share interests with others
• Only interacts to achieve a desired goal
• Has flat or inappropriate facial expressions
• Does not understand personal space boundaries
  Chase has a lot of sensory seeking behaviors that cause him to crave input, whether it's jumping on a trampoline or bouncy ball, or wanting deep pressure or hugs.  He used to always climb all over us, pressing his head in to ours or rubbing his head on our shoulders or backs.  It has gotten a lot better since we changed his diet and started some alternative treatments, but he still occasionally craves that input and will climb all over us (or anyone down on the ground that he can climb up on) ;)!
• Avoids or resists physical contact
  As I mentioned above, this has never been a concern for Chase, as he craves hugs and squeezes, but some kids hate to be touched or hugged.
• Is not comforted by others during distress
  Chase has always been very easy to calm down.  When he did or does have a meltdown they usually don't last long or we are able to redirect him to something else that makes him happy. 
• Has trouble understanding other people's feelings or talking about own feelings

Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving "bye bye". Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an ASD might have a very hard time learning to interact with other people.

Chase was waving "bye bye" and blowing kisses and clapping around his 1st birthday, but those things gradually faded and went away and he just stopped being able to do them without hand over hand making him do them.  He has started clapping again, but waving "bye bye" still doesn't look like a typical wave from a typical child.

Communication

Each person with ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood.

Examples of communication issues related to ASD:

• Delayed speech and language skills
• Repeats words or phrases over and over (echolalia)
• Reverses pronouns (e.g., says "you" instead of "I")
• Gives unrelated answers to questions
• Does not point or respond to pointing
  As I mentioned above, Chase never pointed to things he wanted or objects when asked questions about them.  He also would not respond if I or a therapist pointed to something across the room.  He could not follow our finger or gaze to whatever we were pointing at to look at it.  We would say "look at the ball" a few feet to his side and he wouldn't even act like he knew what we were saying.  Now, he will look at things I point out to him, but it was amazing to realize how much of a struggle to understand it was for him. 
• Uses few or no gestures (e.g., does not wave goodbye)
• Talks in a flat, robot-like, or sing-song voice
• Does not pretend in play (e.g., does not pretend to "feed" a doll)
• Does not understand jokes, sarcasm, or teasing

People with ASD who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with ASD say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with ASD, "Do you want some juice?" he or she might repeat "Do you want some juice?" instead of answering your question. Although many children without an ASD go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an ASD can speak well but might have a hard time listening to what other people say.

People with ASD might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with ASD might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an ASD might smile while saying something sad.

Unusual Interests and Behaviors

Many people with ASD have unusual interest or behaviors.

Examples of unusual interests and behaviors related to ASD:

• Lines up toys or other objects
• Plays with toys the same way every time
• Likes parts of objects (e.g., wheels)
• Is very organized
  Chase is kind of OCD in this sense.  He likes things in a certain place and in a certain order.  Not to a point where he can't function or has a come-apart if they aren't that way, but he is still kind of particular about how he likes his room or things around the house (like I mentioned above)
• Gets upset by minor changes
• Has obsessive interests
• Has to follow certain routines
• Flaps hands, rocks body, or spins self in circles

Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an ASD might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or "stimming."

People with ASD often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with ASD. They might "lose control" and have a "melt down" or tantrum, especially if in a strange place.

Some people with ASD also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.

Other Symptoms

Some people with ASD have other symptoms. These might include:

• Hyperactivity (very active)
  Chase is VERY active.  He craves sensory input and physical activity.  Sometimes I wish I had just a fraction of his energy!
• Impulsivity (acting without thinking)
• Short attention span
• Aggression
• Causing self injury
  Chase has gone through a few short phases of self injury type behaviors where he would his himself on the head or legs or throw himself down on the floor, but thankfully those didn't last very long and as his "sensory issues" have gotten better, so have these behaviors. 
• Temper tantrums
• Unusual eating and sleeping habits
  Chase has always been a great sleeper, since birth, but most recently, last year, he went through a phase where he would wake up in the middle of the night anywhere from 2am-4am just laughing hysterically at nothing or "talking" to himself and would be awake for several hours.  Sometimes he would wake up at 3-4am FOR THE DAY and never go back to sleep, until he crashed at some point during the day.  Melatonin is our best friend!
• Unusual mood or emotional reactions
  As I mentioned above...Chase has gone through phases where he would just laugh hysterically at nothing, or just start crying (so pitiful) for no apparent reason.  I realize now it was reactions to the food he was eating and they way his body was processing that food, but at the time we had no idea what was going on. 
• Lack of fear or more fear than expected
• Unusual reactions to the way things sound, smell, taste, look, or feel

People with ASD might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an ASD limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.

Gut issues are something I never thought that Chase had a problem with.  He was never constipated or had chronic diarrhea.  But I realize now, after several tests and doctors visits, he does in fact have a "leaky gut" as do a LOT of kids on the spectrum.  But that's a whole other post...

People with ASD might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.

I can honestly say that Chase's laughing and crying fits are due to his gluten and dairy sensitivities.  After we cut gluten and casein from his diet those things went away 100% and only rear their ugly head if he accidentally eats something with gluten or casein. 

Development

Children with ASD develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an ASD might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a "b" makes.

Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life. To learn more about developmental milestones, visit "Learn the Signs. Act Early," a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible "red flags" for autism spectrum disorders.

I am not a doctor, nor an expert on Autism.  I simply know what we have experienced.  I urge anyone with the SLIGHTEST doubt or worry to contact a developmental pediatrician or TEIS (they will do an assessment on your child for free if under the age of 3) and have your child assessed!  You can never do this too early!  Early intervention is soooo important!