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Understanding autism
Understanding autism

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1.2 12 to 24 months

It is often in the second year of life (12–24 months), when language, communication and play are beginning to take off in TD children, that important differences start to emerge, and are picked up by parents. They may notice difficulties with speech and language development, apparent indifference to others, dislike of change, or eating and sleeping issues. They may also notice that the child plays unusually, for instance repeatedly tipping bricks out of their container and then putting them back, rather than building with them. These possible signs may be particularly evident in children later diagnosed as ‘lower-functioning’. The more subtle symptoms of ‘high-functioning’ autism may go unnoticed for much longer, especially if, rather than showing developmental delays, a child seems particularly precocious. For instance, some parents report that their child showed strikingly early skills in reading or naming things.

Between 12 to 24 months, children subsequently diagnosed with autism may show little response to what is said to them (known as difficulty with receptive language), and may not use their few words in a meaningful way (known as difficulty with expressive language). Often this will lead to a hearing check before autism is considered. Children may also exhibit echolalia – simply repeating what has been said to them instead of responding in a typical way. For instance if asked ‘Do you want a drink?’, a child may just repeat that rather than saying ‘Yes please’. This may indicate a lack of reciprocity, the two-way use of language. Another example of poor reciprocity is difficulty taking turns in conversation, such that the person may seem to be in a monologue rather than a dialogue. Even if a child shows no delay or difficulty in developing grammar, vocabulary and other language features, this difficulty in turn-taking may be indicative.

Also in this second year, children subsequently diagnosed with autism may show little eye contact (looking directly at another person), or joint attention, whether looking towards something that another person is looking at, or engaging another person to look where they are looking. One way that TD children do this is by protodeclarative pointing, that is, pointing simply to indicate or share with others their interest in something. Another noticeable difference in an autistic toddler is absence of pretend play, such as ‘driving a vehicle’ consisting of a large cardboard box (Barbaro and Dissanayake, 2013).