Fast Five Quiz: Autism Spectrum Disorder

Stephen Soreff, MD


July 05, 2019

Baron-Cohen and colleagues demonstrated that the absence of symbolic play in infants and toddlers is highly predictive of a later diagnosis of ASD. Therefore, screening for the presence of symbolic play is a key component of the routine assessment of well babies. The absence of normal pretend play indicates the need for referral for specialized developmental assessment for autism and other developmental disabilities.

In symbolic play for a child around age 18 months, children may use one object to represent another object and engage in one or two simple actions of pretend play. In symbolic play for a child around age 36 months, children may engage in "make-believe" that involves several sequenced steps, assigned roles, and an overall plan or sometimes pretending by imagining an object without needing the concrete object present. Unusual play may take the form of interest in parts of objects instead of functional uses of the whole object. For example, a child with ASD may enjoy repeatedly spinning a wheel of a toy car instead of moving the entire car on the ground in a functional manner.

In contrast to toddlers with delayed or normal development, toddlers with ASD are much more interested in geometric patterns. Toddlers who prefer dynamic geometric patterns to participating in physical activities, such as dance, merit referral for evaluation for possible ASD. They may spend hours with these dynamic geometric patterns.

An absence of typical responses to pain and physical injury may also be noted. Rather than crying and running to a parent when cut or bruised, the child may display no change in behavior. Sometimes, parents do not realize that a child with autistic disorder is hurt until they observe the lesion. Parents often report that they need to ask the child if something is wrong when the child's mood changes, and may need to examine the child's body to detect injury.

Protodeclarative pointing is use of the index finger to indicate an item of interest to another person. Toddlers typically learn to use protodeclarative pointing to communicate their concern about an object to others. The absence of this behavior is an important predictor of a later diagnosis of autism. The presence of protodeclarative pointing can be assessed by interview of the parent or caregiver. Screening questions include, "Does your child ever use his or her index finger to point, to indicate interest in something?" A negative response to this question suggests the need for a specialized assessment for possible pervasive developmental disorder.

Read more on the presentation of ASD.


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