Symptoms Of Autism

DISCLAIMER – The Autism Resource Foundation provides general information to the autism community. The information comes from a variety of sources, and the Autism Resource Foundation does not independently verify any of it, nor does it necessarily reflect the views and/or opinions of the Autism Resource Foundation. Nothing on this website should be construed as medical advice. Always consult your doctor regarding the needs of your family.

 

About.com: Autism

All Autistic People Do Not Look Alike

There's a saying in the autism field: "if you've met one person with autism, you've met one person with autism." In other words: every person on the autism spectrum is unique, and one person's set of symptoms is just that ... one person's set of symptoms! This is, in part, becaue autism is a spectrum disorder: you can be a little autistic or very autistic.

But there's more to it. There are also a wide array of problems which are relatively common among autistic people - such as seizure disorders, gastrointestinal issues, mental retardation and mental illness. At this point, no one knows why these conditions are so common among people with autism spectrum disorders. It is possible that these additional conditions are indicators of different kinds of autism, each caused by a slightly different set of circumstances.

While the conditions listed above are more common among autistic people than among the general population, they are by no means universal among people on the autism spectrum.

In fact, there are many autistic people with no apparent mental or physical illness at all.

Social and Communication Symptoms

Most of the time, autism is suspected in a child or adult because of deficits or stereotyped differences in social and communication skills. Some examples of these differences include:

  • Delayed or unusual speech patterns (many autistic children, for example, memorize video scripts and repeat them word for word with the precise intonation as the TV characters)
  • High pitched or flat intonation
  • Lack of slang or "kidspeak"
  • Difficulty understanding tone of voice and body language as a way of expressing sarcasm, humor, irony, etc.
  • Lack of eye contact
  • Inability to take another's perspective (to imagine oneself in someone else's shoes

While many autistic people have terrific language skills, there are many who have no language at all. In between are people whose verbal skills are idiosyncratic: they may be perfectly able to talk, but have a very difficult time with conversation, small talk, and slang.

Sensory and Motor Symptoms

A majority of autistic people are either hyper or hypo sensitive to light, sound, crowds and other external stimulation. Some have both hyper and hypo sensitivities. This often results in autistic people covering their ears, avoiding or reacting negatively to brightly lit areas, or - on the other hand - crashing hard into sofas and craving strong bear hugs.

While it's unusual to find an autistic person who is obviously physically disabled as a result of the disorder, most autistic people do have some level of fine and gross motor difficulty. This often manifests itself in poor handwriting, difficulty with athletic coordination, etc. As a result, when autistic people get involved with sports, it's usually in individual, endurance sports such as running and swimming.

Personality Differences

While autistic people do differ from one another radically, it is fairly typical for people on the spectrum to:

  • Engage in repetitive behaviors and ritualized activities, ranging from lining up items to following a rigid routine,
  • Have one or a few passionate interests,
  • Have difficulty in making and keeping multiple friends,
  • Prefer activities that require relatively little verbal interaction.

It also seems to be the case - for as-yet-undetermined reasons - that certain interests are of particular interest to many people on the autism spectrum. For example, an enormous number of young children with ASD's are fascinated by trains (and the Thomas the Tank Engine toy), while a great many older children and adults on the spectrum are very interested in computers, science, technology, and animals.

 

Autism Spectrum Disorder (ASD) Video Glossary - Autism Speaks / Cure Autism Now (CAN)

Autism Spectrum Disorder (ASD) Video Glossary (click on above link to access website)

Introduction
Welcome to the ASD Video Glossary, an innovative web-based tool designed to help parents and professionals learn more about the early red flags and diagnostic features of autism spectrum disorders (ASD).

This glossary contains over a hundred video clips and is available to you free of charge. Whether you are a parent, family member, friend, physician, clinician, childcare provider, or educator, it can help you see the subtle differences between typical and delayed development in young children and spot the early red flags for ASD. All of the children featured in the ASD Video Glossary as having red flags for ASD are, in fact, diagnosed with ASD.

Please keep in mind that there are many presenting features associated with autism spectrum disorders (ASD) that are depicted in the video clips you are about to see. However, most children do not show all of the features all of the time. Instead, many children have some of the features some of the time. Awareness of these common presenting features may help to heighten your index of suspicion. Individually, they may not indicate a problem; however, in combination, they may indicate a need to conduct a screening or a diagnostic evaluation. Not all signs and features need be present for ASD to be diagnosed. Please note: the ASD Video Glossary is not a diagnostic tool.

 

Autism Web.com
Does my child have autism or PDD?

According to the National Institute of Child Health and Human Development's Autism Facts, "a doctor should definitely and immediately evaluate a child for autism if he or she:

  • Does not babble or coo by 12 months of age
  • Does not gesture (point, wave, grasp, etc.) by 12 months of age
  • Does not say single words by 16 months of age
  • Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age
  • Has any loss of any language or social skill at any age.

Are there other possible symptoms of autism and PDD?

There are a number of things that parents, teachers, and others who care for children can look for to determine if a child needs to be evaluated for autism.  The following “red flags” could be signs that a doctor should evaluate a child for autism or a related communication disorder.

  • The child does not respond to his/her name.
  • The child cannot explain what he/she wants.
  • Language skills or speech are delayed.
  • The child doesn’t follow directions.
  • At times, the child seems to be deaf.
  • The child seems to hear sometimes, but not others.
  • The child doesn’t point or wave bye-bye.
  • The child used to say a few words or babble, but now he/she doesn’t.
  • The child throws intense or violent tantrums.
  • The child has odd movement patterns.
  • The child is hyperactive, uncooperative, or oppositional.
  • The child doesn’t know how to play with toys.
  • The child doesn’t smile when smiled at.
  • The child has poor eye contact.
  • The child gets “stuck” on things over and over and can’t move on to other things.
  • The child seems to prefer to play alone.
  • The child gets things for him/herself only.
  • The child is very independent for his/her age.
  • The child does things “early” compared to other children.
  • The child seems to be in his/her “own world.”
  • The child seems to tune people out.
  • The child is not interested in other children.
  • The child walks on his/her toes.
  • The child shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants).
  • Child spends a lot of time lining things up or putting things in a certain order.

When should a doctor evaluate a child for autism?

Doctors should do a “developmental screening” at every well-baby and well-child visit, through the preschool years. In this screening, the doctor asks questions related to normal development that allow him or her to measure a specific child’s development. These questions are often more specific versions of the "red flags" listed above, such as Does the child cuddle like other children? Or, Does the child direct your attention by holding up objects for you to see? The doctor will also ask if the child has any features that were listed earlier as definite signs for evaluation for autism.

If the doctor finds that a child either has definite signs of autism, or has a high number of red flags, he or she will send the child to a specialist in child development or another type of health care professional, so the child can be tested for autism. The specialist will rule out other disorders and use tests specific to autism. Then he or she will decide whether a formal diagnosis of autism, autism spectrum disorder, or another disorder is appropriate.

When do children usually show signs of autism?

In most cases, the symptoms of autism are measurable by certain screening tools at 18 months of age. However, parents and experts in autism treatment can usually detect symptoms before this time. In general, a formal diagnosis of autism can be made when a child is two, but is usually made when a child is between two and three, when he or she has a noticeable delay in developing language skills.

Recent studies show that at least 20 percent of children with autism experienced a “regression,” as reported by their parents.  This means that the children had a mostly normal development, but then had a loss of social or communication skills. To date, however, there is little information about this type of regression, such as the age it seems to start, how severe it is, and what, if anything, triggers it. NICHD researchers are looking into a variety of possible causes for both early onset and regressive autism.

What if the doctor doesn't refer my child to early intervention?

AutismWeb Commentary: Sometimes a pediatrician will disagree with you about whether there is a developmental problem or he may have a "wait and see" philosophy about delays. If you believe there's a problem, you may refer your child yourself to your local early intervention office for evaluation. You can find this office by calling your local health department or school system. Or, you can check this list of state early intervention offices: click on your state at the bottom of the page to locate Early Intervention in your community. The developmental evaluation is free. It is better to start treatment earlier rather than later to give your child the best chance. Whether or not your child eventually will be diagnosed with autism or PDD, the Early Intervention Office can start helping him or her with his/her speech or other delays now.

 

Even Better Now
Signs and Symptoms of Autism
Since autism is a disorder and not a disease, it is not entirely accurate to refer to "symptoms" of autism. Instead, there is a range of signs and behavior patterns that indicate autism. Signs of autism may appear during infancy, and the disorder is usually diagnosed by the time the child is 3 years old. Sometimes the child's behavior appears normal until 18 months to 2 years, and then regresses rapidly. This is referred to as "regressive autism". Symptoms of autism occur in various combinations and range from mild to severe.

Signs of Autism in Infants

  • Abnormal reactions to sensory stimuli
  • Resists cuddling
  • Lack of response to others
  • Indifferent to surroundings
  • Sleep disorders
  • Lack of interest in toys
  • Appears content to be alone
  • Does not point out objects of interest
  • Inconsolable crying

 

Signs of Autism in Young Children

  • Apparent hearing problems
  • Uses gestures instead of words
  • Does not respond to name
  • No eye contact
  • Unaware of toys
  • Repetitive use of words or phrases (echolalia)
  • Does not smile
  • Loss of communication and verbal skills at any age
  • Age 16 months with no word use
  • Age 2 years with no two word sentences

Signs of Autism in Children

  • Is not interested in other people and prefers to be alone
  • Resists changes in routine
  • Repeats actions (turning in circles, flapping their arms, rocking, head banging)
  • Tendency to withdraw from social interactions
  • Heightened activity, or very little activity
  • Toe-walking
  • Uneven motor skills
  • Innappropriate attachment to objects
  • Frequent behavioral outbursts, tantrums
  • Seizures
  • Learning difficulties
  • Reduced or increased sensitivity to pain
  • Resistance to touch
  • Abnormally sensitive to sounds, smells, bright lights, or other sensory stimulation
  • No interactive play with other children
  • Lacks empathy
  • Has difficulty interpreting what others are thinking or feeling

 

Diagnostic Criteria for Autism (DSM IV-TR) - In order to make a formal diagnosis of Autism, the following symptoms must be present:

Impairment in social interaction

Lack of eye contact, facial expressions and social gestures

Failure to develop peer relationships

Does not seek out social interaction

Lack of social or emotional reciprocity

  • Impairment in communication skills
    • Language delay or absence
    • Inability to initiate and sustain conversation
    • Stereotyped or 'strange' use of language
    • Lack of make believe or social play
  • Restricted, stereotyped and repetitive behavior, interests and activities
    • Abnormally intense preoccupation with certain activities or areas of interest
    • Inflexible insistence on certain nonfunctional rituals or routines
    • Stereotyped and repetitive movements (ie. hand flapping, preoccupation with parts of objects)

To make the diagnosis at least 6 of the above must be noted, as well as developmental delays in at least ONE of the following areas:

  • Delayed or abnormal social interaction
  • Delay or abnormal use of language in social interaction
  • Delay or absence in symbolic or imaginative play

Please note that many healthy children will display some of these symptoms, this does not make them autistic! The symptoms above can range from mild to severe.

IMPORTANT NOTE: There is no known single cause for autism, and there is also no known single cure. While there are many different theories about the best course of treatment for autism, most professionals agree that the earlier the intervention begins, the better the child can be helped.

We recommend targeted nutritional supplements in conjunction with a detoxification protocolas a simple, non-invasive way to further your child's potential.

 

First Signs

Red Flags

The following red flags may indicate a child is at risk for atypical development, and is in need of an immediate evaluation.

In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that indicate that a child should be evaluated. For a parent, these are the “red flags” that your child should be screened to ensure that he/she is on the right developmental path.

Social/Communication Red Flags:
If your baby shows any of these signs, please ask your pediatrician or family practitioner for an immediate evaluation:

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
  • No babbling by 12 months
  • No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
  • No words by 16 months
  • No two-word meaningful phrases (without imitating or repeating) by 24 months
  • Any loss of speech or babbling or social skills at any age

“Most mommies and daddies tell me “I thought there was a problem at 14 or 15 months...and they told me let’s wait and see because sometimes some kids grow out of it.’ Well, that’s not a good answer. We’ve got to make the distinction between less important problems, where we can wait and see from core problems, which involve a lack of reciprocity and a lack of getting to know your world. For these core problems, we have to act on it yesterday. We can’t wait nine months, we can’t wait two months.” (Stanley I. Greenspan, M.D., Child Psychiatrist)

Sharing Concerns

For most parents, family members, friends, and physicians, sharing concerns about a child’s development can be a challenging and daunting task. Here, we hope to provide the words and encouragement to help get the conversation started. With caring support, and open communication, parents can begin to take action.

When a developmental problem with a child is suspected, you may ask, “What should I say?” Parents may try to describe their observations and concerns to their child's physician. A physician may have the unenviable task of sharing difficult news with a family. Others who know the child and family, whether they are childcare professionals, concerned relatives, or friends, may become tongue tied.

As hard as sharing concerns may be, they may make all the difference in the world to a child. The hardest part is getting started.

Here, we provide tips about the best ways to share concerns about a child:
Sharing Concerns: Parent to Physician
Parents often have a difficult time sharing concerns about their child. The following outlines four crucial steps to follow with your child’s physician, and highlights the importance of a patient but persistent approach.

  • Be prepared
  • Express your concerns clearly
  • Ask questions
  • Follow up

Each well visit provides an opportunity for your child to receive a routine developmental screening; however, if you don’t ask, it may not be offered. Whether or not you have specific concerns about your child’s development, it is best to come to the doctor’s office prepared. Physicians rely on parents to provide information about their child. As a parent, you are your child’s best advocate and a “resident expert” about your child’s health and development. During a well visit, a physician usually sees a child for less than 15 minutes, even less if there has been an emergency that day. It is a challenge, for both the parent and the physician, to cover the wide range of issues related to a child’s health within a limited time.

If you have concerns about your child’s development, take the following four crucial steps: be prepared, express your concerns clearly, ask questions, and follow up.

1. Be prepared. Before you go to your next well visit, print out the checklist of developmental milestones and note whether your child has met each of the expected milestones. If you have questions or concerns, write down a few concrete examples that might assist your physician:

  • “My child doesn’t respond to my voice.”
  • “He spends so much time lining up his toys, he has no interest in other children.”
  • “She hasn’t learned a new word in months.”
  • “He doesn’t look at me—he never makes eye contact.”

Whether or not you have concerns, ask your doctor for a routine screening.

2. Express your concerns clearly. While this issue can be an emotional one, try to focus on your concrete concerns, such as developmental milestones. If your physician doesn’t want to perform a screening, or isn’t responsive to your concerns, be persistent. Ask why. And remember, “don’t worry” or “let’s wait and see” are not adequate responses. Schedule a follow up appointment, if necessary, or ask for a referral to a developmental pediatrician. Your child’s healthy development is your most important concern.

3. Ask questions. If there are terms you don’t understand, ask your physician to explain. After the screening, ask what the results show, and what they mean. Inquire about referrals to specialists. Ask what the next step will be.

4. Follow up. For most parents, routine screenings indicate that a child is following a typical development pattern. Screenings at well visits in the future will help to confirm that. For other parents, who learn from the screening that their child may be at risk of a developmental delay, follow up is crucial. Children at risk of atypical development are routinely referred to Early Intervention for a closer look by a developmental specialist. You also may want a referral to a developmental pediatrician, a psychologist, a neurologist, a psychiatrist, or a specialist for further evaluation.

Through all four steps, some parents may stumble or falter. Grief and disbelief can prove to be great hurdles. Parents may fear the worst and not move forward. Other parents may feel uncomfortable questioning their physicians. Proceed with confidence, as parents know their child best. Only by pursuing your questions and concerns, forming a sharing relationship with your child’s physician and then by following up with him/her, can you ensure the best possible outcome for your child. Be patient with yourself and persistent for your child. Get the help your child needs.

“Pediatricians are the only professionals with knowledge of development who are in routine contact with the families of young children. Parents turn to their pediatrician for information about development, for assessment of whether their children are doing all right or not. If pediatricians don’t know or aren’t sure or don’t have the appropriate tools, the children with delays or disorders are missed.” (Frances Page Glascoe, Ph.D., Professor of Pediatrics)

Sharing Concerns: Physician to Parent
Physicians may also find it challenging to identify children at risk for developmental delays and disorders and difficult to express their concerns about a child's development with parents or caregivers. No doubt about it, these are critical life-changing discussions that require time, sensitivity, honesty, planning, and follow-through on your part. Here are some suggestions as to how you can handle this process successfully with your patients.

Listen to parents

In recent years, parents of young children have become increasingly aware of the need to monitor traditional developmental milestones at each well visit prior to age three, due in large part to the popularity of the What to Expectseries, the Touchpointsbooks, and other baby books currently available. Parents expect to have a dialogue with their child’s physician about development, though even these highly regarded books do not cover social, emotional, and communication milestones well enough.  Nor do they address behavioral problems.

A recent national survey of parents with young children indicated that they want more information and support on childrearing and developmental concerns, yet pediatric clinicians often fail to discuss non-medical concerns with them (Taaffe Young, Davis, Schoen & Parker, 1998). Moreover, detection rates in primary care show that 70% of developmental disorders (Palfrey, Singer, Walker & Butler, 1994) and 80% of mental health problems are not caught (Lavigne et al, 1994). These discussions could yield developmental concerns early, since parent report has been shown to be highly accurate and indicative of a true concern (Glascoe, 999). 

Because parents are with their children around the clock, they are well positioned to be valid reporters about their child’s development. This, combined with routine observations and comparisons of other children is very powerful. This cuts across all populations:  income, education, social level, culture, etc. A physician can make great use of these observations at a well child visit where the average time for a professional to observe a child is only 15 minutes on average. Thus, a collaborative parent/physician relationship is critical to the continued healthy development of a young child.

When you have concerns about a child, remember, this is a family you anticipate having a professional relationship with for the next 18 years. It's important to develop the ability to say, 'Okay, this is a problem you're experiencing, I'm going to take it seriously. I may not agree with you that it's developmental; I may think this is more of an emotional or family problem, but you're telling me it's a problem, and I'm going to do something about it."(the late Robert H. Wharton, M.D., Developmental and Behavioral Pediatrician)

Understand that early identification and intervention are essential

Early intervention’s positive outcome has been well-documented in the literature and goes far beyond IQ. In the short term, it improves the quality of life and functioning for the child and for the family. In the long term, early intervention’s impact extends into such key developmental areas as prevention of secondary emotional/behavioral issues, reduction in teen pregnancy, increase in high school graduates, increase in employment, and reduction in the crime rate. (Glascoe, 2002).

Pediatric clinicians are in a unique and central position to identify developmental concerns early and refer children at risk on for further evaluation and treatment. Parents depend on pediatric clinicians for advice, guidance, and support. They need healthcare professionals who can speak the language of development with them and work with them to keep their child on a healthy developmental path.   

"I would advocate a preliminary developmental screening for all children. And if a parent comes in and has concern about a child, there should be an immediate discussion about it. If the pediatrician doesn't have time, it would be well for him to either have a person to whom he refers the family or for one of his staff to be able to sit down with the family for 15 minutes and make them feel heard. The risks of not doing that are enormous in that the first few years of life are the period of the greatest neuroplasticity and the greatest rate of change in brain development. This is a critical period. If we miss this critical period, we could miss the boat on helping a child to develop to his or her fullest potential(Rebecca Landa, Ph.D., Professor of Psychiatry)

Consider the prevalence of developmental delays and disabilities

Prevalence studies indicate that autism spectrum disorders are dramatically on the rise with the CDC citing 1 in every 150 children on the autism spectrum and developmental disorders representing 17% of young children (CDC: Yeargin-Allsopp, Rice, 2007).

Thus, every pediatric professional can expect to see at least one patient in his/her practice (if not more) that lives with these concerns. This makes it essential for medical practitioners and clinicians to understand the key social, emotional, and communication milestones and to have a firm grasp of red flags.  

"The findings now from very large prevalence studies show that 16 to 18% of children have developmental problems. That's one in every five patients or so, especially if you include the more serious mental health problems. One out of every five patients that you run into will be experiencing a developmental problem...it's a huge concern. It's probably the biggest single issue that you encounter in pediatrics and, yet, it is just a fraction of pediatric training."(Frances Page Glascoe, Ph.D., Professor of Pediatrics)

Heighten your “index of suspicion”

Simply by making developmental surveillance a regular part of every office visit, you can sharpen your observations, elicit better information from parents, and heighten your index of suspicion. (American Academy of Pediatrics, 2001).

Suspicions are eliminated or confirmed through the screening process first by using a broad-based developmental tool and then, if concerns persist, by narrowing the focus through a level-two tool (e.g., autism or Asperger screen). Pediatric physicians’ observations enhance and strengthen the accuracy of screening tool measures. Physicians can use the developmental surveillance and screening processes to increase the chance of detection during very early development and provide a clear compass for referral and treatment if a concern is flagged. By listening closely to parent report during the surveillance process, physicians may be prompted to start the developmental screening process at any time a concern arises as a result. 

"Physicians need to have an index of suspicion. And they need to listen to parents. Even when I was a resident back in the dark ages...there was this whole idea about being an overanxious mother. I don't think I've ever seen a mother that I thought was overanxious. You're usually anxious for a reason and if there is a reason, you need to know what that reason is. So if they've got a busy schedule, it would be appropriate when Mrs. Jones comes in to say, 'Mrs. Jones, I really don't have time today, but let's make an appointment, I'll stay late on Thursday, why don't you drop by and let me hear more about that problem.' The parent needs to be validated, and you, the physician, need to hear the story in more detail. Without that, I don't think you have a clue, frankly."(Margaret L. Bauman, M.D., Pediatric Neurologist)

Make each well-visit an opportunity for screening and surveillance

In response to the increasing number of young children affected by these disorders, leading medical organizations (American Academy of Neurology, 2000; American Academy of Pediatrics, 2001) have issued policy statements that provide specific guidelines toward the routine screening and surveillance of developmental delays and disorders, including autism. By making routine screening a regular part of pediatric practice, physicians can channel parent concerns efficiently, reduce over or under referrals, and accurately validate reported concerns and observations.

"Ask the parent how little Johnny or Susie lets them know what they want and listen carefully for the explanation. If at 12 or 14 months little Johnny or Susie simply cries or wants the parent to guess what he or she wants, but can't use purposeful signaling, such as taking them by the hand or pointing to indicate wants or desires, that's a warning sign. Also, observe yourself. Try to observe a few minutes of free play. You don't have to make a diagnosis, you just want to be alert."(Stanley I. Greenspan, M.D., Child Psychiatrist)

Create a screening training and implementation plan

To make screening and referral a routine part of pediatric practice, it will require planning, training, and implementation. First, if you have someone on staff who is already a champion for children with special needs, get that professional involved in creating an atmosphere of enthusiasm and excitement as an advocate of positive change. Train all staff members, including front office staff. Not getting all suitable staff on board can make or break a program. Host a meeting with local service providers and office staff to build relationships and establish collaborations. Plan and implement a smooth office process for storing, disseminating, tabulating, and replenishing screening questionnaires and referral notes. Arrange to have trained staff available who can interview or interpret questionnaires for those parents who cannot fill out the forms without support. Stock exam rooms and the front office with patient education materials related to these disorders for easy access.  Keep contact information on hand for quick referrals to local service providers and diagnostic services.  

Lastly, look at how other model pediatric programs are meeting this challenge.  One excellent example is the Health Steps program, an approach that designates a trained staff member to be a developmental “Healthy Steps” specialist who regularly addresses issues around child development and behavior. To be sure, innovation can lead to a successful implementation of a screening and referral program.  But plain old-fashioned planning and execution can be all that is necessary to get started.

Deliver difficult news to parents with sensitivity and understanding

We have provided links to many excellent journal articles that discuss how to deliver difficult news to parents in our Reference section below. In addition to these sources, we have provided our own advice for how to approach the difficult conversation of delivering bad news. It is important to remember that positive outcomes of these discussions between a physician and parent will set the tone for how the parent views their child in the future, how satisfied they are with the physician/patient relationship and how positively they view their roles as parents in the years to come.

  1. Set the stage for a successful conversation.

Often, these difficult conversations take place in the physician’s office immediately following a screening. However, if your schedule does not allow adequate time to hold this conversation, schedule a follow-up visit as quickly as you can. Choosing the right time and place for a conversation to share your concerns is very important. And allowing sufficient time with no interruptions is critical. Understand that emotions may be unpredictable. Be ready to listen and offer help through the referral process.

  1. Start with parent observations, questions, or concerns.

It’s important to assess where a parent stands in relation to understanding his/her child’s development before sharing your own professional concerns. The parent may already sense a problem and just not have the words to articulate it. Gently probe and ask questions that will allow a parent to share their own observations, questions, or concerns first. Then share your own observations and screening results in a very neutral manner.  By doing so, you will open an exchange and may even validate a parent’s hidden concerns and fears.

  1. Put yourself in the parent's shoes. Be supportive.

Some of the most memorable conversations that parents of children with special needs report are those that take place at the critical moment a first concern is expressed. An empathetic approach goes much further in establishing trust and understanding than a clinical or professionally-detached one. Your tone and manner should be open and available. Whatever the outcome, in the long run, the parent will remember and appreciate your discussion if it is framed in a caring way.

  1. Focus on the need to "rule out" anything serious. 

By referring for further evaluation, it opens up the opportunity to “rule out” as well as “rule in” the concern. If concerns are ruled out, parents can rest easy. If concerns are confirmed, then seeking help through evaluation and referral will help to get the child back on a healthy developmental path. No harm can be done by checking out concerns. Things can only get better. 

  1. Refer parents and caregivers to other resources.  Some parents need to come to this understanding on their own.

It is also a good idea to give the parent something descriptive to read about the disorder in the quiet of their homes. Seeing disabilities described in writing, whether through literature or on the Web, allows a parent to make the match with his/her own child’s behaviors and needs.  It provides an objective description of common features and allows the parent to come into recognizing developmental concerns at their own pace. Often, when a parent is in denial, reading something that describes their own child’s behaviors closely can be the catalyst for progress.

  1. Emphasize the importance of early identification and intervention. 

One way to look at developmental concerns is that if a child had signs of a serious and persistent physical illness, like asthma, you would want to get it checked out as soon as possible to rule it out. If there really were a problem, it would only make it worse by not doing so. Developmental delays are no different. By not receiving timely interventions for concerns around language, behavior, and social connectedness, the problems will not go away, but will worsen over time. And what’s most hopeful is that early intervention works, improving life in the long and short term for both the child and the family. So life will get better once interventions are underway. 

  1. Be confident that sharing your concerns is always the right thing to do. The hardest part is finding the right words to get started.

Try role-playing what you will say first. Express what you have observed that gives you concern in a caring and supportive way. By doing so, it may lower your own anxiety and give you the confidence to have a heart-to-heart with a positive outcome. Do not be afraid about hurting the relationship with the family. If you present your concerns in a positive and caring way, you will build trust. The bottom line is that the earlier a developmental concern is identified and treated, the better the outcome.