At certain stages of life, children are expected to hit certain developmental milestones, such as recognising familiar faces at 6 months and waving at 12 months of age (CDC's Developmental Milestones 2022). As every child is different and learns at their own pace, the developmental milestones provide a comparative guide to offer cues for parents in monitoring the typical development of their child with other children at the same age. Hence, the absence of certain behaviours at age-specific milestones can be an early sign of developmental delays. The developmental milestones are categorised into 5 main domains: gross motor, fine motor, language, cognitive, social-emotional and behavioural (Misirliyan & Huynh, 2020).
Developmental concerns are defined as atypical developmental patterns that differs from others at the same age, or developmental stage. For example, children with autism may not engage in social activities like peek-a-boo with another social partner at the first year of age. At the second year of age, children with autism may not be aware of negative emotions like sadness of a social partner. Instead, some children with autism may develop such skills at a later age, while others may develop other mechanisms to do so. An atypical development pattern is not conclusive of an autism diagnosis, thus it is important to spot other signs characteristic of autism and consult a physician for further examinations.
Along with milestone observations, there are also two key characteristics of children with autism. Firstly, they often struggle with social-communicative development, which may hence lead to implications in the development of other crucial skills such as motor and cognitive skills (Landa, 2007). At a younger age, the child may not respond to their own names and avoid social interactions (NHS, n.d.). While at older ages, the child may struggle empathising with others, expressing their emotions and making social partners. Secondly, restrictive and repetitive actions are also key characteristics of children with autism (Signs and symptoms of autism spectrum disorders 2022). For example, the child may insist on following a certain routine and constantly repeat motions.
Gender differences in developmental concerns
Boys and girls also display significantly different signs. Female children with autism are more likely to have developmentally-appropriate language skills. Furthermore, similar with neurotypical female children, having a more reticent play behaviour or being avoidant in social settings—which can also be stereotypically viewed as quiet play and bashfulness -- may not be a distinct cue of a developmental delay (Ratto et al., 2017). These gender differences are likely to mask signs of autism. Hence, girls are more likely to fall outside the radar of the current diagnostic measures, only diagnosed at later years. Therefore, it is important for caregivers to monitor the developing milestones of children from birth, documenting crucial milestones or the lack of, for future reporting and diagnosis by physicians.
Overlaps in different diagnoses
Some children with autism may also face delays in other areas such as motor skills, language capabilities and learning disorders (Provost et al., 2006; Signs and symptoms of autism spectrum disorders 2022). A study by Khachadourian et al. (2023) found 74% of individuals with autism had comorbid conditions which are often undetected. Such conditions may include learning disabilities such as dyslexia and dyspraxia. As these conditions also affect the learning abilities of children with autism, it is also crucial for caregivers to identify these symptoms that differs from autism at a young age. Through early interventions and support, it could potentially improve their learning capabilities and quality of life.
References:
Black, R. (2016). Woman seated with hands clasped . Pexel. Retrieved May 14, 2023, from https://pixabay.com/photos/prayer-bible-christian-folded-hands-1308663/.
Centers for Disease Control and Prevention. (2022, March 28). Signs and symptoms of autism spectrum disorders. Centers for Disease Control and Prevention
Centers for Disease Control and Prevention. (2022b, December 29). CDC’s Developmental Milestones. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/index.html#:~:text=Skills%20such%20as%20taking%20a,speak%2C%20act%2C%20and%20move.
Khachadourian, V., Mahjani, B., Sandin, S. et al. Comorbidities in autism spectrum disorder and their etiologies. Transl Psychiatry 13, 71 (2023). https://doi.org/10.1038/s41398-023-02374-w
Landa, R. (2007). Early Communication Development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13(1), 16–25. https://doi.org/10.1002/mrdd.20134
Misirliyan, S. S., & Huynh, A. P. (2020). Development Milestones.
NHS. (n.d.). Signs of autism in children. NHS choices. https://www.nhs.uk/conditions/autism/signs/children/
Provost, B., Lopez, B. R., & Heimerl, S. (2006). A comparison of motor delays in young children: Autism spectrum disorder, developmental delay, and developmental concerns. Journal of Autism and Developmental Disorders, 37(2), 321–328. https://doi.org/10.1007/s10803-006-0170-6
Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G. (2017). What about the girls? sex-based differences in autistic traits and adaptive skills. Journal of Autism and Developmental Disorders, 48(5), 1698–1711. https://doi.org/10.1007/s10803-017-3413-9