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Some infants may show minor differences in social communication that point to ASD before their first birthday, a study finds. Willie B. Thomas/Getty Images
  • Some infants with autism spectrum disorder (ASD), or autism, may exhibit social communication differences as early as 9 months of age, a new study suggests.
  • Compared to their typically developing peers, infants with ASD may show signs such as a lack of appropriate eye contact and inability to respond to attention.
  • However, these signs may not always be as apparent to parents. Hence, getting help from specialists with child development backgrounds could put concerns to rest.
  • The study’s findings also point to a critical window for targeted early intervention that could help children with ASD reach their full developmental potential.

Although speech is many parents’ first concern when spotting signs of autism spectrum disorder (ASD), there may be other forms of communication that could point to autism early on in infancy, a new study has found.

Social communication skills such as eye gaze and facial expressions, for example, develop rapidly in the first year of life for babies — more specifically, between 9 to 12 months.

Developmental gains in these skills before the baby says their first words, generally around 12 to 18 months, may go unnoticed.

“Social communication differences are part of the diagnostic criteria for ASD. Yet, we don’t really know how early in life these differences appear. Beginning at around 9 months of age, typically developing infants use their eye gaze, facial expression, sounds, and gestures to communicate. They also begin to show very early play skills around this age,” said Dr. Jessica Bradshaw, assistant professor of psychology at the University of South Carolina and corresponding author.

Bradshaw said she wanted to determine whether social communication differences were apparent as early as 9 months in infants who had a greater familial likelihood of autism, which is months before they would usually receive a diagnosis.

Published in the journal Child Development, the longitudinal research studied the social development of 124 infants between the years 2012 and 2016.

The researchers then carried out an early social-communication assessment at both 9 and 12 months, measuring the babies’ social, speech, and symbolic skills.

Later, when the babies reached the age of 2, researchers used gold standard diagnostic tools to see if any infants fit the ASD diagnostic criteria.

Infants who were later diagnosed with ASD showed significantly fewer social and early speech skills at 9 months of age, the study found.

And at 12 months, infants with ASD had lower performance scores on almost all measures of preverbal communication.

The infants with ASD showed the following three unique patterns of social-communication development:

  • Their communication with eye gaze, facial expressions, and sounds were “consistently low” between 9 and 12 months.
  • Their symbolic use of objects such as being creative with toys was delayed at 12 months.
  • There was a “growing gap” between typically developing infants and infants with ASD when it came to using gestures and the frequency of communication.

The findings are in line with previous research, which has shown that infants with ASD have specific areas of vulnerability and unique patterns of change that indicate a disorder.

“It was interesting to see that there were distinct patterns of social communication development from 9 to 12 months for infants who later developed ASD. Some skills were consistently low while other skills showed a ‘growing gap’ between 9 to 12 months,” said Bradshaw.

Dr. Mayra Mendez, a psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California, said she was not surprised by the findings that indicated nonverbal social communication skills differed between typically developing infants and infants who are later diagnosed with ASD.

“The characteristics of ASD may be subtle and are qualitative in presentation rather than directly identifiable as atypical. This means that the quality of interactions and social-emotional presentation of an individual diagnosed with ASD differs from the quality of the same characteristics in typically developing children,” she said.

She explained that this quality is measured by the frequency, intensity, duration, degree, and number of behaviors present.

“In the first few years of life, salient signs of autism include lack of appropriate eye contact and inability to initiate or respond to joint attention that qualitatively varies in everyone. Since ASD does not just suddenly present, rather it evolves throughout the first 2 to 3 years of life with symptom presentation becoming more evident and noticeable from 18 months of age forward, it is not surprising to see that even in 9-12-month-old infants, subtle signs of social-emotional differences may be noticed.”
– Dr. Mayra Mendez

Mendez said the prospect of being able to spot symptoms of ASD as early as 9 to 12 months could empower parents, caregivers, and clinicians working with families, as well as increase awareness of social-emotional development, and support child and family interventions to ensure a child’s developmental is not hindered.

She acknowledged that research was limited on early ASD signs and symptoms before 18 months of age but that there was some anecdotal evidence from parents, such as videos.

“In such parent reports, the difference becomes more evident when language skills are expected to develop and when the expectations for social and relational engagement are anticipated at higher levels than those exhibited by the 2- to 3-year-old who presents with signs and symptoms of ASD,” she said.

“I advise parents to consider the intervention as a gift to their infant’s development and to the parent-child relationship. With that in mind, I advise parents to seek specialists with child development backgrounds.”
– Dr. Mayra Mendez

The study suggests that if a parent or caregiver can spot such signs and differences in social communication in babies, they can learn how to use intervention strategies to aid communication and development early on.

With the proper support, parents could enrich the baby’s learning environment and possibly shape their learning trajectories, said Mendez.

“Social communication starts early! [F]or parents, especially those who have a family history of ASD, this means that early concerns are valid. A great resource for parents who have questions about their infant’s development is,” said Bradshaw.

Mendez said the findings were significant for early intervention practice.

“Research supports that the earlier intervention begins, the better it is for positive long-term outcomes of symptom management in ASD,” she said.

“It is never too early to engage in early intervention when it is applied to enhance positive attachment and bonding, social-emotional competence, and developmental progress in a child.”
– Dr. Mayra Mendez

Mendez said the American Academy of Pediatrics (AAP) also supports behavior and communication approaches that provide structure, direction, and organization for the child, in addition to family participation.

She said early intervention practices would likely focus on stimulating social engagement, understanding of symbolic and nonverbal communication, as well as reinforcing attachment and meaningful bonding with caregivers, grandparents, siblings, extended family, and family friends.

“It is important to know that early intervention is not toxic to a child; rather, it is delivered through play engagements that are understandable and support the increase of a baby’s language, social skills, cognitive processing, and emotional regulation,” she added.

Mendez underscored that parents play a critical role in the developmental trajectory of the child.

She said parents could adopt strategies such as modeling, praising engagement, promoting language/communication development with storytelling, reading to babies, singing songs, playing games involving reciprocity such as patty-cake, peek-a-boo, give and take to promote flexible thinking and efficient neurodevelopmental brain activity.