Part II: A Closer Look
Appropriate Play Skills
What are appropriate play skills for a child Mark’s age?
Play Skills
- Child uses objects symbolically, for example, uses a crayon to pretend to give baby a bottle
- Child uses toys as complete objects rather than becoming preoccupied with one part of the toy
- Child is excited about the company of others and imitates the behaviors of others
Language Development Concerns
What are the concerning aspects of language development in this case, and what would you optimally like to see in a child’s language skills by 24 months of age?
Delays
Pre-speech
Communication delays consisting of the absence of speech are usually fairly obvious. However, more subtle abnormalities with pre-speech can be early warning signs of ASD. These include:
- Lack of appropriate gaze
- Lack of alternating back-and-forth babbling
- Decreased use of pre-speech gestures (such as waving)
- Lack of expressions such as “uh-oh”
Language Development Concerns
Scripted Speech
As children develop speech, scripted speech can be an early warning sign of ASD.
Scripted speech is when a child repeats a word or phrase he has heard elsewhere, such as from a television program or movie. The child uses the phrase out of context, and it is not used in an attempt to communicate.
For example, when a child is asked, “How are you doing?”, he may state, “Don’t worry, tomorrow we’ll be back for more frolic and fun,” which is a quote from a television show.
Echolalia
Echolalia can be an early warning sign of ASD.
Echolalia, sometimes called parroting, is defined as the repetition of someone else’s speech. When the repetition occurs immediately, it is called “immediate” and when it occurs hours, days or weeks later it is called “delayed.” The child may repeat the speech in the same intonation in which it was heard.
An example of this is that the child may hear his mother say, “Do you want juice?” and then the child promptly says “juice?”
Typically developing children often go through a period of repeating the last word or phrase they have heard during their normative explosion in word learning. One distinction is that the typically developing child will state “juice!” with an emphatic declarative intonation, while the child with ASD will state “juice?” with the same questioning intonation that he or she heard. For typically developing children, the period of word repetition associated with the vocabulary boom may last several months in the second year of life; for children with ASD, this word repetition may continue.
Watch the videos to compare…
Out of Context
As children develop speech, using words out of context can be an early warning sign of ASD.
Using words out of context (using “pop-up” words) is an instance where words are said without any communicative intent and without any stimulus. A child may use one “pop-up” word for several days or weeks and then stop using it.
For example, a child may state “train” several times per day for a period of time, and then, suddenly stop using the word. The child does not direct his speech toward others when saying the “pop-up” word.
Expectations
For a typically developing 2-year-old child, you would like to see the child:
- Use language for communicative purposes
- Use and understand about 50 words
- Speak spontaneously and use the words he knows to convey needs and desires to others
- Direct his speech toward others
- Put words together into short phrases of two to four words in length
- Briefly repeat new words and then quickly begin using them on his own in the appropriate context
Early Warning Signs
There are many early warning signs in Mark’s language, social, and behavioral profile. What are the early warning signs for autism spectrum disorder?
Warning Signs Mark Is Displaying
The early warning signs for ASD include concerns regarding a child’s social skills, communication, and restricted or repetitive patterns of behaviors, interests, activities, and emotional regulation.
Some red flags Mark shows include:
- Lack of response to name
- Deficits in joint attention
- Inappropriate play with a toy
- Lack of pointing
- Intolerance of changes in routine and schedule
Some other warning signs that indicate a child should be evaluated include:
Impairment in Social Interaction
- Inappropriate gaze
- Lack of warm, joyful expressions
- Lack of sharing interests
- Lack of response to contextual cues
- Lack of response to name
- Lack of coordination of nonverbal communication
Impairment in Communication
- Lack of showing
- Lack of pointing
- Unusual prosody
- Lack of communicative consonants
- Using a person’s hand as a tool
Repetitive Behaviors & Restricted Interests
- Repetitive movements with objects
- Repetitive movements or posturing of body
- Lack of playing with a variety of toys
- Unusual sensory exploration
- Excessive interest in particular toys
Emotional Regulation
- Distress over removing objects
- Difficulty calming when distressed
- Abrupt shifts in emotional states
- Unresponsive to interactions
Regression
Developmental or behavioral regression should always be taken seriously. When regression occurs in association with ASD, motor skills are generally preserved.
Developmental or behavioral regression describes a significant loss of previously acquired milestones or skills. Although some debate exists regarding the accuracy of parental reports regarding regression, it is generally believed that regression occurs in minority of children with ASD. The mean age at which parents report autistic regression is 20 months.
The most frequently reported aspect of regression is loss of language, followed by loss of social-emotional connectedness.