Early Signs of Autism

Host: If you saw a kid, about 18 months old, wasn't speaking, you are a little concerned he might be autistic; you certainly would have to make the diagnosis. What would you look at from your point of view, let's say maybe I am a little concerned about the kid, because some kid is not speaking, doesn't mean he is autistic. What would be the signs you would look for? Frank R. Cicero: Yeah, it's not actually the language that's the indicator at that point; I mean obviously as the child is older, then it becomes the language, but at the young level, I would probably look right to the socialization. Now, obviously they are also not necessary playing at that point, but I would look to the emotional interplay between adult in the environment and this child to see for any pointing skills. How does this child make his wants and needs known? The eye contact; is he looking at faces, is he looking more at objects than at faces, that would be a problem? Is he showing interest in the environment; interest in not the physical environment, but -- Host: You talk about expressive language; he is expressing itself, he is reaching out to the environment. Frank R. Cicero: I would look at the nonverbal, expressive language, would probably be very important to me. The pointing, the ability to share, the emotional reciprocity; sharing if the child finds something funny, that he also glances at an adult to see if the adult finds something else funny. The reading of emotions between people. If the parent looks scared, does the child also read that emotion and look scared? Also I would look at the behaviors. Any incidence of the repetitive, stereotypic movements such as hand clapping, running in a circle, a small circle, body tensing, and also just the fact that they are doing it alone, and that they are doing it exclusively -- that they are doing it to the exclusion of other more appropriate play. Host: So in other words, doesn't mean a kid is autistic, but it's a little bit of a red flag. Frank R. Cicero: I would start to have concerns when I see that lack of social development or when I am seeing that lack of appropriate behavior, and in place of that, inappropriate stereotypic behavior; that's when I would start to say, we might want to take a look at something. Host: If the kid is a little bit older, what things would you start looking at and say, maybe this kid might have autism? Frank R. Cicero: When the kids are older, now you are going to look directly at the language, you are going to look to see -- Host: What age would that be, you would say? Frank R. Cicero: Every child is going to develop at their own typical pace, so it's always hard to say, but if at two-and-a-half, I would say the child has very little to no language, I think that will be a little -- I would start to get concerned. Host: Of course we have done all tests. Frank R. Cicero: All of those tests have been done, right. I would start to get a little bit concerned, because even in other developmental disabilities, in some of the developmental disabilities, language does develop. So if there is a zero development of language, that would be a problem, but even so I would look even more towards peer play at that point; whether or not this three year old, four year old is playing with other students, is showing any signs of interest in other students, in other children, that would start to then indicate to me that there is a problem. Host: In a young child, the more you stimulate a kid, the better the kid might be doing in many areas. Obviously if you don't work with your kid, they are not going to develop. So in this institution, Eden II, you have a big emphasis on a thing called ABA, is that correct? Frank R. Cicero: Yes, Applied Behavior Analysis. Host: Now, from your experience, if you did this to allow these kids, what percentage do you think will make you think that the kid maybe could end up being autistic, and maybe get into the mainstream? Frank R. Cicero: That I don't know, that I don't know. Host: 10, 20, 30. Frank R. Cicero: Percent? Host: Yeah Frank R. Cicero: I would say the numbers are lower than that, but there is -- Host: That is a lot better. Frank R. Cicero: Yes, there is always progress. We look at internal progress to the student; not necessarily mainstream, because even when you talk mainstream, what is mainstream? There is a whole variation of what mainstream can be; there is mainstream for one class, mainstream for two class, mainstream for a leisure activity, such as karate or swimming versus full school. Now if you are talking actual losing of the diagnosis, there is evidence to show that Applied Behavior Analysis can work towards that, but the percentages are low. I always tell parents that that's not where -- they should make their actions as if that is their goal, however that should not be their goal. Host: So in other words, it won't hurt the kid, you might help the kid with things like ABA, but there is no guarantee that any of this is going to work? Frank R. Cicero: The more intense the better, and currently Applied Behavior Analysis is the only technique or psychological, educational theory, whatever you want to call it, it is the only technique that has actually been shown to work to improve skills in children with autism, research based. Host: Yeah, it's as good as probably the person doing it too, isn't it? Frank R. Cicero: You do need the training. So you need training in Applied Behavior Analysis to do it. However, you really can train the parent. I always tell parents that they need to use their resources.