Parents often like to compare their children with kids of similar ages. Most of the time, it is the achievement in developmental milestones that parents are concerned. While doing the comparison, have you ever wondered why your child seems to be slightly different from other kids? Why is he always playing alone? Why is he not calling papa or mama yet when other kids have already spoken a few words? If this concerns ever arise this could be a sign (prodrome) of autism! Image Credit: zena-in.cz\/ Autism or Autistic Spectrum Disease (ASD) is a spectrum of pervasive developmental disorder which affects a child's communication, behaviour and social skills. It is commonly detected by the age of 2-3 years old but can be seen as early as 12 months old or as late as school-aged or adult. Based on a recent report from Centres for disease Control and Prevention (CDC), every 1 in 59 children aged 8 years old is diagnosed to have autism in USA and it can affect children of all races and socioeconomic groups. In Malaysia, the number of children diagnosed to have autism is on a rise due to increased awareness among parents and provision of early screening assessment. For illustration purposes only. (Image Credit: American Psychological Association) Every child with autism is different from another. They have varied level of intelligence. Some are gifted while some will need special care. They tend to have other medical problems such as Attention Deficit Hyperactivity Disorder (ADHD), intellectual disability, sleep problems, Epilepsy (seizure), feeding problems, motor problems and psychiatric problems. IS MY CHILD AT RISK OF HAVING AUTISM? Autism carries both genetic and environmental influences. Parental ages at conception and family history play important roles in the contributing factors. Your child has a higher risk of getting autism if: \tYour child was born at a paternal age of more than 50 years old or maternal age of more than 40 years old. This double up the risk of having an autistic child. \tYour first-born child was delivered at paternal age of more than 40 years old and maternal age of more than 35 years old. This triple up the risk of having an autistic child. \tYour baby was born prematurely especially for less than 33 weeks. This increases the risk of autism to five higher. \tYour baby had neonatal encephalopathy, a condition of neurological abnormality diagnosed at or after birth. \tYou have a family history of autism. Although we can\u2019t change the genetic influence, but supplements like folic acid and vitamins B6\/12 taken four weeks before pregnancy and eight weeks after pregnancy help greatly to reduce the risk especially in those with family history. In contrary to the myth, immunization does not cause autism. WHEN DO I SUSPECT MY CHILD TO HAVE AUTISM? There are a few tell-tale signs at different ages that parents must take note, by the age of: \t6 months old: Your child shows no smile or joyful, engaging expressions and does not make eye contact with you. \t12 months old: There is no babbling or cooing from your child, fails to show any gestures like finger-pointing\/waving and does not respond to his own name. \t18 months old: Your child does not speak any meaningful single words. \t24 months old: Your child fails to combine two words, not including imitating or repeating. Generally, if you noticed your child has lost any previously acquired speech or social skills at any age it is definitely a red flag that warrants further medical assessment. Besides, children with autism also exhibit both behavioural and communication\/interaction issues. Behavioural issues Autistic child dislikes changes. He appears to be upset when routines are changed. For example, he becomes moody when his toys are kept in a different way. Parents may notice his child shows certain repetitive movements like hand flapping or spinning for no apparent reason. He tends to repeat words or phrases, what we called echolalia. Apart from these, a child with autism shows very limited or no interest at all to his surrounding except certain specific objects like the wheel of a toy car. He may spend hours playing by just spinning the wheel of a toy car. However, this child has unusual and intense reactions to stimuli such as sounds, smells, tastes, textures, lights and colours. He may get irritated to loud noise but lack of painful response. Communication\/ interaction issues Autistic child often shows delayed speech development. He has difficulty in understanding other people's feeling as well as having difficulty to express own feeling. You often see him playing alone than with other kids. Avoiding eye contact is almost a consistent trait with autism. It should raise your suspicion if your child demonstrated this. Furthermore, there is neither imitation of your movement nor two-way interaction. A simple instance, when you point to an object, your child will respond by looking at the same object. In an autistic child, he will never show the expected response. WHAT TO DO IF MY CHILD HAS ANY OF THESE? Don't be afraid if your child demonstrated any of these signs. You should be brave and voice out your concerns to your community nurse during the clinic follow up (Klinik Kesihatan) or any doctors. A simple screening assessment called M-chat can be used to identify the risk of autism in your child. It composed of a series of YES or NO questions regarding your child's behaviours. Based on this, the doctor will do some scoring and inform you if your child is at risk of having autism. In Malaysia, M-chat is easily available in every baby's MOH immunization booklet (blue or pink book) and is routinely done during the 18- months follow up and subsequently repeated at 2 years old to pick up any high risk children. The American Association of Paediatrics (AAP) also recommends a routine M-chat screening at 18 and 24 months. If your child shows risk of autism following the screening, a formal assessment which includes more detailed developmental and neurological assessment by a paediatrician will be required to establish the diagnosis of autism. A family physician or a psychiatrist will be able to make the diagnosis as well. WHAT CAN I DO TO HELP MY CHILD? You are never alone in fighting this battle. Remember, early diagnosis and early intervention are the key points to successful treatment. It's always good to have an idea on the expected developmental milestone on your child so that you will be able to detect the differences at an earlier stage. The key milestones are: \t3 months old: recognize familiar faces, able to focus and follow moving objects, respond to sound. \t6 months old: smile at you, enjoy face-to-face play, babble lots of sounds. \t12 months old: respond to own name, understand 'no', simple gesture eg. point to object, may use a single word. \t2 years old: imitate behaviours eg. sweeping floor, enjoy the company of other children, combine two-word phrases, name few body parts. \t3 years old: able to express affection and emotion openly, use simple sentences to communicate, enjoy pretend-play eg. playing a role as a cashier. \t4 years old: can tell a simple story, sing a song, understand differences eg. big vs small. \t5 years old: can differentiate fantasy from reality, tell longer stories, enjoy singing\/dancing\/acting. Don't be shy and afraid to voice out if you had any concerns on your child's development or behaviour. The earlier you diagnose this, the better is the outcome of your child. Screen time Apart from this, you should limit your child\u2019s screen time to any electronic appliances like hand phone, tablets, computer and television. Studies have shown that prolonged screen time can indeed delay speech and language development. As a guide, no screen time in toddlers below 18 months, maximum of 30 mins of screen time per day in children aged 18-24 months and up to an hour of screen time per day in children aged 2-5 years old. You should choose high quality apps or programs which are age-appropriate to your child and never let your child watch or deal with the gadgets alone. While watching, try to comment and model words to encourage positive learning experience and two-way communication between you and your child. Playtime For illustration purposes only. (Image Credit: cdc.gov) Playtime is crucial as all children learn through playing. Playtime encourages joint attention, an important milestone that develops during infancy for later communication skill. Hence, spare at least 30 minutes of undivided playtime a day with your child. This helps to improve his language skill. For playtime, do fun activities like playing toys, story-telling, outdoor play and water time. Expose your child to different activities instead of screen time and keep your child engaged with toys and activities during waiting time for example, while waiting in a busy restaurant. Communication When communicating with your child, interact at a face-to-face level as this encourages two-way communication. If your child hasn't spoken yet, try to use simple languages to communicate with him. You may start with a single word then gradually to two-word phrases when he starts to pick up. Also, during play, take turns with your child and imitate your child's act. All these help to foster greater learning. In conclusion, you know your child best. Never be afraid to seek for assessment if your child is different. The earlier you detect the better outcome your child be. You may learn more about autism from these reliable resources: \twww.autismmalaysia.com \twww.nasom.org.my All in all, your child is the most precious gift in your life. Stay tuned with Motherhood.com.my for more parenting tips and advice.