Autism is a developmental disorder, and that means that children on the spectrum don't follow the typical developmental progression that their peers do. Learning how to spot these differences is important for diagnosis. It's also interesting to learn how children with autism progress through the various stages of development. This can help you understand what to expect from your child and how to support him as he learns and grows.
Language and Communication Development and Autism
According to the American Speech-Language-Hearing Association (ASHA), many children with autism spectrum disorders (ASD) exhibit some type of language delay or challenge involving communication. In some cases, this may mean that a child talks on time (or even early) but that she does not use language to communicate her needs or share information. In other cases, a child may be completely non-verbal. Occasionally, a typically-developing toddler may begin to lose language skills he previously had. Depending on the severity of the delay, this may be one of the first signs of autism that parents and pediatricians recognize.
Language Delay vs. Typical Development
The University of Michigan notes that typical language development follows a fairly standard pattern. Here's some of what you can expect from a typically-developing child:
- By three months - Crying with purpose or using different cries for different needs
- By six months - Babbling repeated consonant sounds ("ba-ba-ba")
- By one year - Imitating the inflection of speech, recognizing own name, and saying at least one word
- By 18 months - Using at least 15 words
- By two years - Communicating needs like "more," waving and gesturing, making animal sounds, understanding "no," and using two words together
- By three years - Using 450 words, speaking in short sentences, identifying body parts and colors, and using some plural words
- By four years - Speaking in sentences of four or more words, telling a story
- By five years - Asking questions, speaking in sentences of at least four or five words, using at least 1500 different words, using past tense
Missing these milestones may signify a language delay, but it's essential that parents have a speech pathologist conduct a formal assessment to know for sure. There are many causes for a language delay, and autism is only one of them.
Language Development in Children With ASD
In contrast, a child with autism may develop in a different way. Because of this, the ages used for typical peers don't apply to these kids. Instead, they may exhibit the following characteristics and stages:
- Developing out of order - Because autism is a disorder, language development can actually happen out of chronological order. For instance, an 18-month-old child may use more than 15 words but struggle with imitating the inflection of regular speech. A five-year-old may speak in long sentences but never ask questions or communicate her needs to others. A speech pathologist can help create a program for a child that targets the specific areas of challenge.
- Echolalia - Many children with autism go through a stage in their language development where they repeat phrases they have heard from others or on television. This is called "echolalia," and it is not as common in neurotypical children. According to Communication in Autism by Joanne Arciuli and Jon Brock, echolalia may help children with ASD learn how words go together in typical speech. In many cases, when they have learned this skill, they stop the repetitive language. In other cases, they may continue to use it as a form of verbal self-stimulation.
- Delayed development - Although some children on the spectrum have a mild delay, many are farther behind their peers. Some are severely delayed and are still completely non-verbal by the age of four years. The medical community once saw this as a sign that a child would never talk; however, a 2013 study published in the journal Pediatrics found that many of these severely-delayed children went on to speak fluently after the age of four. In most cases, intensive speech therapy can help children make huge progress in their language development, and many go on to catch up to their peers.
Social and Emotional Development and Autism
Social challenges are one of the core diagnostic criteria for autism, and in some cases, they begin very early in development. In other situations, a child may have typical social development for a time and then begin to regress.
Social Developmental Delay vs. Typical Development
According to PBS, the standard progression of social development involves several age-related milestones. A typically-developing child will most likely develop according to the following pattern:
- By three months - Smiling, showing enjoyment of interaction, responding to comfort from caregivers
- By six months - Laughing, playing simple games like peek-a-boo, responding to name
- By one year - Showing distress at loss of a toy and anxiety at separation from parent or caregiver, expressing different emotions, responding to gestures
- By two years - Imitating adult behaviors, displaying frustration, pride, affection, and other emotions
- By three years - Understanding gender, playing pretend, watching and interacting with other children
- By four years - Joining in play, taking turns, using more elaborate pretend play routines
- By five years - Adding more detail to pretend play, having friendships
A child who misses these milestones may or may not have autism. If you notice that a child is behind on some of these skills, talk to a pediatrician about a referral to a child psychologist for a formal assessment.
Social and Emotional Development in Children With ASD
When it comes to social development, children with autism don't necessarily progress in a linear way. They may miss milestones entirely or simply reach them at a later time. In other cases, they may be on track with some of their milestones and extremely behind in others. Many kids on the spectrum go through the following developmental stages:
- Gradually improving Theory of Mind - Theory of Mind refers to the ability to understand that others have a different perspective on the world and to comprehend how this perspective may affect others' behavior. This can be a huge challenge for kids on the spectrum, but according to Indiana University Bloomington, they can develop some aspects of Theory of Mind with appropriate therapy and intervention. They may begin by learning about what others see from a different physical perspective and gradually expand to learning about others' feelings and predicted behaviors in various situations.
- Learning about reciprocity - Reciprocity, or the basic back-and-forth that happens during a social interaction, is a challenging area for many kids with ASD, according to Autism Speaks. Turn-taking in all forms can be challenging, but with therapy, kids can begin to polish this skill. Often, this starts with taking turns with toys and games. Later, the child may be able to expand to taking turns in conversations and social situations.
- Establishing sensory self-regulation - According to the Interdisciplinary Council on Development and Learning, one of the most basic stages of development that can challenge kids on the spectrum is self-regulation. Establishing self-regulation allows them to become interested in the world and people around them. Many kids on the spectrum struggle with sensory processing disorders, meaning they have too much or too little sensory information coming in. Working with an occupational therapist and learning about a child's sensory needs can help a lot. Gradually, the child will find new ways to satisfy those sensory needs and still pay attention to people around her.
Physical Development and Autism
Many children on the autism spectrum display typical physical development, but others can show delays in this area. Those with delays may catch up to peers with help, or they may continue to lag behind peers throughout development. As with many aspects of ASD, there is no set trajectory.
Physical Delay vs. Typical Development
The Centers for Disease Control and Prevention (CDC) reports that typically developing children will achieve the following developmental milestones:
- By four months - Holding head up, pushing with legs when supported in a standing position, pushing up to elbows when lying on belly
- By six months - Rolling over both ways, beginning to sit with help
- By one year - Sitting independently, pulling to stand, cruising on furniture
- By 18 months - Walking independently, drinking and eating using utensils
- By two years - Learning to run, walking up and down stairs with help, kicking a ball, copying lines and circles when drawing
- By three years - Running, riding a tricycle, climbing up and down stairs
- By four years - Standing on one foot for two seconds, eating with a fork, catching a ball
- By five years - Standing on one foot for 10 seconds, using toilet, hopping
If a child is not meeting physical milestones for his age, talk to his pediatrician. Even if the the physical delay isn't related to autism, early intervention with a physical therapist or an adaptive physical education teacher can be very helpful.
Physical Development in Children With ASD
Since kids on the spectrum may or may not have a physical developmental delay, it's entirely possible that a child can follow the typical progression of skills and miss no physical milestones. However, according to a 2013 study published in Research in Autism Spectrum Disorders, early motor delays can have a negative effect on other aspects of behavior and development in children with autism. If a child does have a motor delay, you may see some of the following stages of development:
- Proximal-to-distal development - According to Motor Control: Theories, Experiments, and Applications by Frederic Danion, PhD and Mark Latash, PhD, a child must first be able to control the larger muscles and movements before moving on to finer motions. This is called proximal-to-distal development, and it applies to the developmental progress of children with autism. If a child struggles with core weakness and tasks like sitting up or standing, she will also struggle with fine motor tasks like drawing a circle. A physical therapist or occupational therapist can work with the child to strengthen the larger muscle groups needed for these finer tasks.
- Restricted physical activity - Repeating behaviors and following routines is something that is reassuring to many kids with ASD, and according to a 2014 study in the journal Autism, it can affect their physical development. The study found that although kids with ASD got the same amount of physical activity as neurotypical children, they performed fewer types of activities. You can expand a child's skills by working on establishing a greater variety of physical activities she will try.
- Extended head lag - When a baby is lying on his back and you pull his arms to help him sit, you may notice that his head lags behind the rest of his body. This is perfectly normal in young infants, but according to the Kennedy Krieger Institute, 90 percent of children with autism displayed this head lag after six months of age. As they age, children with and without autism usually grow out of this stage, but testing the head lag at six months can be a helpful predictor to determine which kids are at risk for autism.
Things to Remember About Autism and Development
Seeing a child miss milestones can be worrisome, but it's important to remember that kids with autism develop at their unique rate. Keep the following tips in mind as you work with your child:
- Because autism is a developmental disorder, children on the spectrum frequently develop in a way that is outside the typical order of things. Expect the child to reach milestones at different times and maybe not in the progression you see on most checklists.
- Just as you can't compare an ASD child's development to a neurotypical peer, you also can't compare her to another child on the spectrum. No two children with autism are the same. Unfortunately, you can't look at the development of a friend's child and see what your child will be doing next.
- Expect uneven progress. Sometimes, a child will seem to catch up on several milestones at once. Other times, he will appear to stall in a developmental stage. Remember that he may be making progress you can't see at this moment.
- At the same time, if your instincts tell you that a child has not been progressing for a while, talk to his or her pediatrician and school IEP team. You may need to come up with new IEP goals or begin working with a different type of therapist.
- Remember that in many cases, a delay is just a delay. The child will usually reach that milestone at her own pace. For instance, she may play turn-taking games three years later than her peers, but she will play them eventually.
A child with autism goes through many of the typical stages of development, but he may not go through them at the typical times or in the established order. Working with professionals who care about the child and understand his unique development can help him make wonderful progress.