Often little things are what attract attention: the child does not smile, nor react to a smile, and prefers playing alone rather than with other children.
Many parents are unsettled by possible early signs of an autistic disorder. Some put them out of their mind.
Not every delay in development is a sign of autism, however. Various tests are required for a diagnosis, and not all autistic children are affected with equal severity.
"We noticed something was wrong with one of our sons when he was sitting in a sandbox with a neighbourhood boy," said Renate Zeuner, chairwoman of the regional autism association in the German city of Goettingen.
"It made no difference to him whatsoever whether another person sat there with him or not."
Zeuner recalled that her son's kindergarten teacher once wanted to punish him by not letting him play with other children. But the boy was pleased.
His lack of interest in other children was particularly conspicuous in early childhood but diminished somewhat with time, she said.
Principal symptoms of autism
The principal symptoms of an autistic disorder are impaired abilities to communicate verbally and non-verbally as well as to interact socially, noted Martin Sobanski, director of the Munich-based Heckscher Clinic's Department of Developmental Disorders.
"Healthy infants babble to themselves, for example, while autistic infants often show no signs of verbal expression," he said. Autistic infants also seldom point with a finger or stretch their arms toward their parents. They seem to have no need to express themselves or communicate.
A specific speech development disorder can be a sign of autism, too, said Christine Freitag, director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy at the Goethe University Frankfurt am Main. But it need not be, she added, especially in children with less severe speech problems.
"It's more evident if the child has no interest in playing with other children," Freitag remarked.
She said autistic children generally had less interest in playmates than in particular toys, "with which they can busy themselves extensively." Often they live "in their own world," she said.
No reaction to smiles
Not reacting to smiles is a further sign of autism, noted Freitag, who explained that autistic children were often unable to recognise other people's feelings.
"That's why it's also typical when, for instance, a child with an autistic disorder doesn't comfort another child that has hurt itself at play." She said autistic children often looked the other way and took no interest in the situation.
To determine the possible presence of an autistic disorder, concerned parents should closely observe their child and also speak with the child's kindergarten or school teachers.
Diagnosis best after 3
A reliable diagnosis can be made around age 3, Sobanski said, and essentially is based on a parental interview and direct observation of the child.
The interview aims at getting detailed insight into the child's development to that point. Observation of a play and activity session that lasts up to a hour follows a standardized diagnostic schedule.
Physical, mental and neurological evaluations are included as well "because a simple diagnosis of autism doesn't do a child any good," Sobanski said. "It's also important to check intelligence, language development and motor skills."
While an interview and observation do not provide a diagnosis as reliable as one based on laboratory results as in other disorders, Sobanski said, diagnostic methods have improved and cases of children in the grey zone at the edge of the autistic spectrum can now be diagnosed earlier.
"Frequently we have to say in our clinic, 'Today we can't make a certain diagnosis. We've got to observe the child longer,'" Sobanski said, noting that autistic children were often irritated when observed by an unfamiliar person since they reacted very sensitively to changes in their surroundings.
Premature diagnosis may be false
A premature diagnosis of autism before age 2 can easily turn out to be false, Freitag pointed out. Many parents initially resist a diagnosis of autism. "That's fully understandable," Sobanski said. "After all, it's a diagnosis for life."
But if the diagnosis is relatively certain, parents should soon get in touch with others who have an autistic child.
"Sharing experiences helps in getting over grief and often brings very practical advice on dealing with the developmental disorder," remarked Sobanski, who said it was important that the family learn how to live with the diagnosis.
(Sapa, Philipp Laage, October 2010)