Early Predictors of Autism Spectrum Disorder

There are many early signs of autism in young children which include challenges with shifting attention, decreased joint attention, and limited imitation skills to name a few. However a recent study by UC Davis which was published in the Journal of Abnormal Psychology, suggests that babies as young as 9 months old who look at objects in an unusual way may be at a higher risk for autism.

In particular, this study found that infants who developed autism “exhibited more frequent unusual visual inspection of objects." This was described as a particular type of repetitive behavior involving prolonged visual inspection, examination of the object from odd angles or from peripheral vision, as well as squinting or blinking repeatedly while examining the object, by 9 months of age compared to those who did not develop autism.

Unusual visual inspection at 9 months predicted 12 month social behavior controlling for 9 month social behavior, but not vice versa, consistent with major theories of autism suggesting that an increased focus on objects early in life has detrimental effects on social behavior. "Close monitoring of unusual visual inspection of objects by 9 months of age may be an important aspect of early detection and may be valuable to integrate into early screening tools.” Miller, M., Sun, S., Iosif, A.-M., Young, G. S., Belding, A., Tubbs, A., & Ozonoff, S. (2021). Repetitive behavior with objects in infants developing autism predicts diagnosis and later social behavior as early as 9 months.  Journal of Abnormal Psychology, 130(6), 665–675.

While visual preferences such as looking at objects through the corners of the eyes, holding objects up close to the eyes, looking at objects with one eye closed, or looking at objects intently for 10 seconds or more have long been associated with autism, this is first study that has identified visual preferences as young as 9 months, and may prove to be valuable in identifying children through early screening measures.

Other early characteristics of autism spectrum disorder (ASD) can include:

• Avoiding or fleeting use of eye contact

• Not responding to name by 9 months

• Limited facial expressions by 9 months

• Limited play in early social games such as peek-a-boo by 12 months

• Few or no gesture use by 12 months

• Limited to no joint attention by 15 months

• Does not point or look at what you point to by 18 months

• Limited pretend in play by 30 months

In addition, young children may exhibit restricted or repetitive behaviors. These behaviors or interests set ASD apart from conditions defined by only problems with social communication and interaction and can include:

• Lining up toys or other objects, and may become upset when the order is changed

• Repeating words or phrases over and over (i.e., echolalia)

• Playing with toys in the same manner

• Focusing on parts of objects (e.g., wheels of a car)

• Getting upset by minor changes in routines or surroundings

• Having obsessive interests

• The need to follow certain routines

• Mannerisms such as flapping hands, rocking body, or spinning self in circles

• Unusual reactions to the way things sound, smell, taste, look, or feel

Additional characteristics may include:

• Delays with expressive and/or receptive language

• Delays with gross motor or fine motor skills

• Delays in cognitive or learning skills

• Hyperactivity, impulsiveness, and/or inattentive behavior

• Epilepsy or seizure disorder

• Unusual eating and sleeping habits

• Gastrointestinal issues (e.g., constipation)

• Unusual mood or emotional reactions

• Anxiety, stress, or excessive worry

• Lack of fear or more fear than expected

It is important to note that children with ASD may not have all or any of the behaviors listed in the examples above.

The signs and symptoms of ASD can be identified by early monitoring and screening. This includes an active on-going process of watching a child grow and encouraging conversations between parents and providers about a child’s skills and abilities. Autism-specific screening should occur via a child’s pediatrician and should occur at 9 months, 18 months, 24- or 30-month visits, as well as whenever a concern is expressed.

The CDC offers free materials Learn the Signs. Act Early, including a Milestone Tracker app, to help parents and therapists work together to monitor children’s development and know when there might be a concern and if more screening is needed.

If you have any concerns about your child's development, be sure to reach out to your child's pediatrician.