For pediatricians: Red flags for autism

Pediatricians or family medicine physicians are often the first physicians consulted by families with concerns about their children's development. Many families continue to report that the family physician often attempts to reassure them and may be dismissive of their concerns. There is now evidence that parental concerns are generally reliable and should be given more credence by physicians. The two tables below (Table III and Table IV from Filipek PA et al, see reference below), are tools that can enable physicians to recognize autism and promptly pursue further evaluation.

This is not a trivial matter. There is now evidence that early intensive behavior therapy implemented during the relatively narrow window of "brain plasticity" can have a positive impact on development and provide a better outcome.

Table III lists typical concerns brought to the family physician.

Table IV lists the kinds of questions that the family physician should ask after the concerns listed in Table III are brought to them by a family.

Table III. Parental Concerns that are RED FLAGS for Autism

Communication Concerns

Does not respond to his/her name
Cannot tell me what (s)he wants
Language is delayed
Doesn't follow directions
Appears deaf at times
Seems to hear sometimes but not others
Doesn't point or wave bye-bye
Used to say a few words, but now he doesn't

Social Concerns

Doesn't smile socially
Seems to prefer to play alone
Gets things for himself
Is very independent
Does things "early"
Has poor eye contact
Is in his own world
Tunes us out
Is not interested in other children

Behavioral Concerns

Tantrums
Is hyperactive/uncooperative or oppositional
Doesn't know how to play with toys
Gets stuck on things over and over
Toe walks
Has unusual attachments to toys (e.g., always is holding a certain object)
Lines things up
Is oversensitive to certain textures or sounds
Has odd movement patterns

Absolute indications for immediate further evaluation

No babbling by 12 months
No gesturing (pointing, waving bye-bye, etc) by 12 months
No single words by 16 months
No 2-word spontaneous (not just echolalic) phrases by 24 months
ANY Loss of ANY Language or Social Skills at ANY Age

Table IV. Ask Specific Development Probes: "Does (s)he..." or

"Is there..."

Socialization

...cuddle like other children?
...look at you when you are talking or playing?
...smile in response to a smile from others?
...engage in reciprocal, back-and-forth play?
...play simple imitation games, such as pat-a-cake or peek-a-boo
...show interest in other children?

Communication

...point with his finger?
...gesture? nod yes and no?
...direct your attention by holding up objects for you to see?
...anything odd about his/her speech?
...show things to people?
...lead an adult by the hand?
...give inconsistent responses to name? ...to commands?
...use rote, repetitive, or echolalic speech?
...memorize strings of words or scripts?

Behavior

...have repetitive, stereotyped, or odd motor behavior?
...have preoccupations or a narrow range of interests?
...attend more to parts of objects (e.g., wheels)?
...have limited or absent pretend play?
...imitate other people's actions?
...play with toys in the same exact way each time?
...strongly attached to a specific unusual object(s)?

From Filipek PA et al, The screening and diagnosis of autistic spectrum disorders,
J Autism Developmental Disorders 1999;29(6):439-484.

Copyright 1999 Plenum Publishing Corporation

Return to list of commentaries and other autism links

This page last updated on May 20, 2000