In 1943, autism was first reco­gnized by Dr. Leo Kanner of John Hopkins Hospital. At the same time, the German scien­tist Dr. Hans Asperger has described a milder form of the autistic state, now known as asperger syndrome. The diagnosis of “autistic spec­trum” includes:

• Symptoms of the autistic spec­trum range from very mild to very severe
• Infan­tile autism, asperger syndrome
• Rett Syndrome
• PDD NOS (perva­sive deve­lo­p­mental disorder, without further specification)

In the recent diagnostic there is a summary term: autism spec­trum disorder (ASD) which includes all former diagnoses of autism

Autism is a condi­tion with a broad spec­trum. A steadily incre­a­sing percen­tage of the popu­la­tion is affected (1 in 59, according to esti­mates by the CDC’s autism and deve­lo­p­mental disa­bi­li­ties moni­to­ring (ADDM) network, Surveil­lance Summa­ries / April 27, 2018 / 67(6); 1–23). Boys are 4 times as likely as girls to be affected.

The exact number of children with autism is not known. A report by the US center for disease control and preven­tion shows that autism and related limi­ta­tions are more common than previously thought. It is unclear whether this is due to the rising rate of autism or an incre­ased ability to diagnose this condition.

Unlike other limi­ta­tions and condi­tions, the symptoms of autism are usually not appa­rent at birth. The autistic signs usually become appa­rent in the first three years of life. There is curr­ently no blood or DNA test to diagnose autism.

Autism is a series of symptoms. After these, the doctor usually don’t look until certain deve­lo­p­mental delays and limi­ta­tions cannot be explained in any other way.

• Has a short atten­tion span
• Shows repe­ti­tive body movements
• Shows a strong need for routines
• Has very violent outbursts
• Has very limited interests
• Perse­vera­tion on the same subject or thoughts

Is aggres­sive towards oneself or others

Towards the end of the first year of life, most todd­lers start by looking at the same items or acti­vi­ties as their care­giver. In order to create a common atten­tion with the care­giver, typi­cally deve­lo­ping children begin to turn their gaze from toys to the person. They follow the poin­ting of others with the gaze and observe the direc­tion in which others are looking. They point to things and acti­vi­ties to share inte­rest or to show other toys.

This beha­vior has a certain quality of commu­ni­ca­ting. For example, the toddler might point to a plane flying over his head, looking at his mother or father as if to say, “Look there!”

In contrast, todd­lers with autism have great diffi­culty sharing atten­tion with others. They rarely turn their gaze to showing others. They don’t often switch their gaze from items to people. And they don’t really seem to be present when the care­giver watches things, people or acti­vi­ties and talks about them. They rarely turn their gaze to show some­thing to others.

Typi­cally deve­lo­ping todd­lers are imita­tors. Even babies can mimic facial move­ments (for example sticking out tongue or opening their mouths). Already at the age of 8 to 10 months, the mother and toddler mimic each other’s sounds and move­ments. Imita­tion also plays a very big role in well-known finger games, such as “pat-a-cake” or “how big?” (“how big is …? This big!” while the child stret­ches her arms up).

Todd­lers with autism mimic other people less often. They demons­trate fewer imita­tions with the body or face (waving, making faces, playing toddler games) and also mimic less with objects.

Typi­cally deve­lo­ping children react socially to others. They smile when they are smiled, they also initiate smiles and laugh when playing with toys or others. When typi­cally deve­lo­ping children watch other children cry, they may start to cry them­selves or look distressed. Slightly older todd­lers then perhaps crawl close to the crying person, cares­sing or trying to offer comfort in other ways. These some­what later beha­viors indi­cate compas­sion and can be observed espe­cially in children in the second year of life.

In contrast, children with autism seem not to perceive the feelings of others. They don’t notice the smiles of others and there­fore they don’t look. They might not smile back in response to each other’s smiles, either. They may ignore the sadness of other people.

Several scien­tists have shown that children with autism are more likely to be distressed than compas­sio­nate when another injures them­selves. For example, if an adult pretends to get their knee injured, young children with autism look less at the adult or show concern in the facial expression.

Someone once said, “playing is the child’s work.” Todd­lers love role play in which they pretend to be a mother, a father, a baby, a fire­fighter or a horse. Although the children play with toys at about 6 months old, it does not come to the pretend play until the end of the first year of life. This way of playing, for example, could start by feeding the mother or a doll. Or the child combs the doll or puts the bear to bed. Around the second birthday, children play imagi­nary games. Dolls then take on human quali­ties such as spea­king or house­hold routines are re-enacted. The children may then imagine that a sponge is some­thing to eat, a buil­ding block a hat or a plastic bowl a swim­ming pool with water.

In contrast, the play of children with autism high­lights many defi­cits. The toddler may not be inte­rested in objects at all, or the inte­rest is more focused on the move­ment of her own hand or on a piece of string. If they are inte­rested in toys, it is often only very specific toys that elicit inte­rest. These are used in a repe­ti­tive way, which doesn’t align with the way most other kids would play with the toy. One may be more inte­rested in flip­ping a toy car and spin­ning the wheels instead of pushing the car back and forth. Summing up, the quali­ties of pretend play are comple­tely absent from children with autism under the age of two.

Special features of hearing are of great impor­t­ance, but diffi­cult to clas­sify. Many children are consi­dered to have hearing diffi­cul­ties in the begin­ning. Very few children are deaf. However, they don’t respond to their name and don’t seem to be swayed by noise-like changes around them. Children with autism even seem to ignore very loud noises that would make most other children shrug. This could have some­thing to do with a gene­ra­lized disin­te­rest in the environment.

Because children with autism are very sensi­tive to certain sounds, this could be related to an unusual percep­tion. For example, children with autism some­times develop a fasci­na­tion for certain sounds such as from a toy or react to the noise caused by remo­ving the pack­a­ging of a choco­late bar at a greater distance. Other sounds, on the other hand, then appear to cause extreme discom­fort, such as police sirens or the barking of a dog.

In infants, play and social inter­ac­tion are so directly linked that it is precisely at this stage of deve­lo­p­ment that the beha­vior of the child is conspi­cuous. Infants with autism often show no inte­rest in the games that require social inter­ac­tion with parents.

The absence of this joint acti­vity seems to be very signi­fi­cant. The study by Frith and Soares shows that state­ments by parents with children with autism show an absence of common inte­rests and acti­vi­ties within the first year of life. The children do not point to things that inte­rest them, do not take an active part of finger games and do not want to carry out acti­vi­ties together.

Early concerns of parents about progress in the infant’s deve­lo­p­ment should be taken into account. When a mother expresses fears about the social and emotional responses, as well as the skills in percep­tion, profes­sio­nals should be on alert regar­ding autism.

Adequate refer­rals to specia­lists for children with and without deve­lo­p­mental disa­bi­li­ties could mean that the diagnosis can be made faster than in the past. While infants can show autistic traits, only a compre­hen­sive diagnostic approach can reveal whether they have autism or have beha­vioral charac­te­ris­tics of other difficulties.

This is best clari­fied in a child deve­lo­p­ment unit. Several experts are needed for this, because good team colla­bo­ra­tion yields better results for an accu­rate diagnosis. The assess­ment includes an over­view of family history, pregnancy, child beha­vior and progress in deve­lo­p­ment. A physical exami­na­tion is necessary to detect hidden medical condi­tions that contri­bute to devia­tions or delays in expected development.

The deve­lo­p­ment inves­ti­ga­tion includes:

• Fine and gross motor skills
• Language (language compre­hen­sion, expres­sive language and sound production)
• Sensory percep­tion
• Social and emotional development
• Play

The quality of deve­lo­p­ment is an important factor in the assess­ment. It’s a big diffe­rence, for example, whether skills are only present, or whether they are also used for social beha­vior. A child with autism may have the ability to repeat words, but not yet an under­stan­ding of their meaning. Or a toddler with autism can point to things, but doesn’t use that ability to draw another person’s atten­tion to it.

Ideally, children should be observed in their ever­yday envi­ron­ment, for example at home or in daycare.

Diagnosis of autism is unli­kely to occur within just one exami­na­tion date, espe­cially if the child is still very small.

Close moni­to­ring of deve­lo­p­ment and regular assess­ments are necessary to get a full over­view. But regard­less of a defi­ni­tive diagnosis of autism or autistic spec­trum, help can be offered to the children and their parents. Infants suspected of a deve­lo­p­mental disorder (autism autistic spec­trum) may receive services tailored to each needs. Parents can be inst­ructed on how to support their child in the respec­tive stages of development.

A child is diagnosed with autism when they show diffe­rent forms of beha­vior in three deficit areas. These three areas are:

1. Social inter­ac­tion
2. Commu­ni­ca­tion
3. Behavior/ inte­rest.

Defi­cits of the autistic spec­trum include:

1. Lack of eye-contact
2. Missing rela­ti­onship buil­ding with peers
3. Diffi­culty putting oneself in the posi­tion of others
4. Lack of pretend play

When proper teaching is not given, many children are controlled by the effects of autism until they can no longer manage even simple human interactions.

The autism spec­trum can usually be reli­ably diagnosed at age three. In the mean­time, the latest rese­arch supports the diagnosis of autism even at the age of six months.