Autism: The signs from 2 to 24 months that parents need to watch out for

The American Temple Grandin, currently 67 years old, is a professor of animal sciences at Colorado State University, in the United States, and author of several books on autism🇧🇷 The Indian Tito Mukhopadhyay, now 26 years old, is the author of three books of poetry, one of them written when he was still a child. Temple and Tito are two great portraits of what Autistic Spectrum Disorder (ASD)), a neurodevelopmental disorder that compromises a person’s ability to relate to the world around them. Temple is a highly functional autistic, of well above average intelligence, and has never had any major difficulties expressing herself. Tito’s symptoms, on the other hand, are much more severe. He practically does not speak, he was even called “retarded” and needs permanent care. They are totally different. This is TEA. No two people with the disorder are alike.

ASDs are characterized by a constellation of symptoms, but there is a common denominator to them: the difficulty of social interaction and communication and the presence of repetitive behaviors and the need to maintain a routine. From the first weeks of life, babies instinctively look for those who are talking to them and pay enormous attention to their mother’s and father’s eyes. After all, it is through this basic and primitive social interaction that they will establish bonds with those who will take care of them and guarantee their survival. Children with autism are unable to socialize and, without this ability, end up isolating themselves to live no longer in a world where people are the keynote, but in a world where things, objects, are the protagonists. “ASD affects what we call the social brain, that is, for some reason, the brain structures involved in processing information related to communication and social interaction do not work well”, explains Helena Brentani, assistant professor at the Department of Psychiatry at USP. That is, the child has difficulty understanding the world as it is, as it is dominated precisely by relationships between people. For Jair Mari, coordinator of the graduate program at the Department of Psychiatry at Unifesp and director of the NGO Autismo e Realidade, this lack of attention to social stimuli may explain some of the behaviors that occur in ASDs, such as the interest centered on a certain object or theme.

This is perhaps one of the biggest problems when talking about the disorder. As the diagnosis is made based on a list of symptoms and signs and how much they compromise the carrier’s life (read the box “Attention to These Signs”), and since they are often subtle, a large number of children spend their lives fighting with the difficulties they present and will never find themselves with the disorder.

Because it is entirely based on observation and on parents’ reports, the diagnosis is not always correct on the first attempt, as hitting the hammer based only on clinical analysis requires specialized and well-trained professionals, something that is lacking in Brazil. As a result, many parents are forced to go on a journey until they reach the verdict. “Nina never developed like other children. Since she was a little girl, she wouldn’t look you in the eye, wouldn’t answer by name, wouldn’t follow movements, until one day I was called at school with the news that she wasn’t doing any activities. I had no idea what autism was. I went to different doctors, from whom I even heard that she needed a brain operation. It took two months of pilgrimage to arrive at the diagnosis”, says Andrea Ribeiro, mother of Nina, 6 years old.

Early intervention

Although much progress has been made, the causes of ASD are still a great mystery to medicine. It is not known, for example, why autism is three to four times more frequent in boys than in girls and why approximately one in every 88 children will develop the condition. What is known is that autism is a complex disorder – some carriers also have epilepsy, others have a high IQ, while others may have a low IQ – with different genes involved in each case. “Until two years ago, it was assumed that genetic factors would be responsible for 90% of the causes of the disease. Recent studies have shown that they can only explain 50% of the likelihood that a child will develop the disorder. In any case, family history is very important,” says Guilherme Polanczyk, professor of child and adolescent psychiatry at USP. That is, identical twins are more likely to develop the disorder, while the risk of parents whose child has ASD having another child with the same problem is ten times greater than that of parents without children with ASD. Environmental factors also play a role. “It is likely that more than one factor is involved in the increased risk for ASD, including low birth weight, prematurity and advanced age of the father – due to mutations that may occur in spermatozoa”, explains Dr. Jair Mari. The good news is that several studies have attested that the sooner the diagnosis is made and the treatment begins earlier, the greater chance the child has of being able to communicate and relate to the world around him. “There is what is called a window of opportunity for intervention, a moment when acting greatly increases the chances of success, due to the stage of brain development itself”, says Professor Helena.

According to Jair Mari, the objective of current studies is to try to assess, as early as possible, how far these children are from normal development, to map how this will affect their social adaptation and, thus, seek ways to rebuild them. One of the most promising methods for diagnosis in the first months of life is a device called eye-tracking. “Since children with ASD are unable to maintain eye contact, eye-tracking, which tracks eye movement when, for example, they watch a drawing or a movie, could be, in the future, a powerful tool for early diagnosis” , declares Professor Guilherme Polanczyk.

Change starts at home

Currently, there are four or five types of intervention that are showing good results. “These are models whose evidence helps to support, including applied behavioral analysis (ABA), developmental models, hybrid intervention, which mixes characteristics of the first two, and TEACCH, applied by the University of North Carolina , in the United States,” says Fred Wolkmar, from the Center for Child Studies at Yale University and editor-in-chief of the Journal of Autism and Developmental Disorders.

The most used form of treatment in Brazil is the ABA. “The idea behind ABA is to transform behaviors that are stereotyped in autistic people into behaviors that are functional, that is, that allow the child to ‘function’ in the world around them”, explains Antonio Celso Goyos, from the Laboratory of Human Learning Interactive Multimedia and Computerized Teaching (Lahmiei) of the Psychology Department of the Federal University of São Carlos. According to Goyos, it is essential that the child does, for two to three years after diagnosis, 30 to 40 hours a week for the results to be evident.

Bringing the child to a world based on verbal language and social relationships is not an easy task and depends, and a lot, on the parents. “It is often the adults themselves who, out of fear, place barriers to the child’s development”, analyzes pedagogue Andréia de Fátima Silva, who collaborates with the Autistic Spectrum Disorders Program at the Institute of Psychiatry at the Hospital das Clínicas at USP (Protea).

So part of the treatment starts at home. With proper guidance and training, parents can (and should) work to establish a rapport with the child, even if the child is not fully interacting with them.

The fact that a child has ASD does not necessarily mean that he or she cannot develop talents. “We cannot know what the future of our children will be like. We all have strengths and weaknesses. Children with ASD just need to work on their weaknesses more”, declares Helena Brentani. As Temple Gradin once said, ASD sufferers have a different perspective on the world. They think and face the world differently, anyway. But the world needs all kinds of minds.

Inclusion in school is still a challenge

The inclusion of an autistic child in the regular education network is essential for them to develop their creative skills and abilities and it is in the law – but their integration into the school is not yet a reality. Gradually, however, this scenario is changing. “Our great challenge is to transform the school into a space where differences are respected. And this applies to children with any condition or disease”, declares Andréia Silva. According to the pedagogue, although schools are still resistant, educators today are much better equipped to deal with the issue. “The problem, more than anything, is the lack of knowledge about the subject. An example is thinking that the caregiver of a child with ASD – many of them can only attend school accompanied by them – is someone who will disrupt the class, when he can be a facilitator of their learning.” Andrea Ribeiro, mother of Nina, 6 years old, tells that she always had an active participation in the school and that this was decisive for teachers, parents and students to accept her daughter and her limitations. “It was a learning experience for me and for the school, which had never received any autistic children before. I had to start from scratch. As Nina attended this school since she was very young, the other children were always very helpful, as they had known her since she was a little girl. Gradually, at parent meetings, I gained the support of other parents, who began to realize that Nina’s companion was not a disturbing element in the dynamics of the class. My daughter is now able to accompany her classmates even on trips – of course, a whole preparation is made so that she doesn’t find something that is not part of her routine to be strange”, she reports. According to the pedagogue, there is a growing movement among ASD specialists to generate knowledge in schools and train educators to work with children with the disorder. “What we want is for the school, as well as society, to have a fairer look at differences.”

Pay attention to these signs

Generally, a child with ASD is diagnosed when they are between 3 and 5 years old, a period in which social impairment ends up becoming more evident. But parents can be on the lookout for some signs long before that. “Everything indicates that the abnormalities begin between 6 and 12 months. At the beginning of life for children with ASD, social interaction may not be totally reduced, but it starts to drop after 6 months”, says doctor Jair. Child development specialist. Be careful not to enter…