Autism in babies…

[PillowTrout]

My DC is diagnosed autistic and ADHD. Since then, I’ve become very interested in researching neurodiversity and have made friends with many parents of SEN children.

One thing I find interesting is symptoms in infancy. Most health professionals agree that you cannot reliably recognise or diagnose ASD or ADHD until around age 2. I have always maintained that I didn’t notice any symptoms until my DC started primary school, however, since talking to many parents I have found that most of our children exhibited one of the following extremes as babies:

• Extreme passivity as infants. Being too ‘good’. Happy to be left alone for long periods, not crying much, often sleeping through the night from an early age. Appearing very content, but with hindsight, a symptom of not being particularly bothered about interaction. Not particularly bothered about being left with new people, just generally appears very laid back.

OR

• Extremely unsettled as infants. Crying excessively, very clingy, not sleeping well or at all, sensory issues clear since birth. Often not feeding well. Just being generally very hard work. Often described as being very difficult to pacify.

I haven’t met many SEN parents that report average development or behaviours in infancy. It always seems to be extremes of behaviour, although at the time, it wouldn’t be recognised as too abnormal - just a particularly difficult or easy baby. It’s only with hindsight that these are noticed.

Another observation is milestones reached late, or too early. The too early group I find especially interesting as I feel this is under reported. Those in the early group put this down to their DC just being ahead, or strong, or intelligent. It’s certainly true for my DC - they were crawling by 5 months, walking by 11 months, and talking fluently by 18 months. I always assumed that because they didn’t meet milestones late, they were fine and couldn’t possibly be autistic… but this extreme of being so early on certain milestones I see in hindsight could also indicate ‘abnormal’ development.

Interested how many people identify with anything I have observed.

My ex’s family would say he’s NT as well, he’s almost certainly autistic but it wasn’t recognised as such when he was a child. At best, anyone with more than passing knowledge would have seen Asperger’s traits but unfortunately even today people try and brush away what is wrongly called ‘high functioning’ autism as ‘not like real autism’. Hyperlexia (ability to read well as a toddler/preschooler) is a huge flag for autism.

It’s not impossible to diagnose autism before 2.5. It’s certainly not easy to get an official diagnosis due to the process but a high needs child presenting with more typical ASD traits certainly can be well into the diagnosis pathway before 2. My youngest was referred to a paediatrician with autism in mind at 19 months, the waiting list alone is so long that it’s taken 14 additional months to get that first appointment.

This thread has had me thinking. Recently I’ve been concerned my 7 month old is displaying signs that my older 2 children didn’t. I know at this age he is a baby being a baby but autism runs in my family.
Eldest dd hit milestones early although was slow with speech and potty training. She is NT. middle child took longer to hit milestones but was within ‘normal’ range. Very shy and clingy up until mid primary school age. Shown signs of autism (imo) although no professional has ever agreed.
7 month old rarely cries, I can count on one hand how many times and usually only in extreme tiredness or hunger if he refuses a bottle. Rarely naps although sleeps very well overnight since 2 months old. Can say several words clearly but cannot sit up without falling to one side. He does roll around back to front and gets into crawling position. He is clingy but doesn’t mind being put down if I’m nearby. If I leave the room he makes noises that are clear he is unhappy but doesn’t cry. Prefers me holding him over anyone else. He won’t play alone for long, he prefers interaction. But what caught my attention most was the stimming. He kicks his legs and opens and closes his hands repeatedly, usually only when he’s excited. I’ve spoken to relatives who have SEN children and they don’t believe these are symptoms, but I am concerned I must admit. I see how much they struggle parenting their children and I don’t believe in myself that I could cope.
Your theory makes sense. I feel like my baby is in between the 2 extremes so should I stop panicking and revisit at a more diagnosable age? Did anyone else’s child have these symptoms and were NT?

As PP have noted, the issue is many of the traits are also 'norma;' or grown out of.

I always knew DD was different, but accept the fact that it also could have gone the other way entirely.

My ds was basically the second child you describe. I have a good knowledge of asd and signs. I suspected he was autistic from around 9 months old. I involved salt and hv from around 20 month he saw the paediatrician at 26 months was on the pathway for 14 months. Diagnosed at 3.5 years

I have two children with Autism, 29 year old son and a 17 year old daughter. My son was a very passive, contented baby and I could leave him for long periods while my daughter was very clingy, unhappy and distressed, extremely fussy with her food.

@SpeedyDrama With the knowledge we have today, I'd have probably been very worried about DS. He was so hyperactive too. As an adult, married and a parent, with a good job, he shows no ND signs at all. His wife agrees. His DC are NT too.

My two DDs, both NT, have ND children and both of their DC are quite severe and certainly there were red flags from a few months old, looking back, but then two of my three children could also have been described as having them too and they are definitely NT.

The difference between them is that the ND children had speech difficulties, pica, extreme tantrums, sensory issues, strimming, wouldn't answer to their names or make eye contact.

It's really not clear cut in the early years. The spectrum is so vast that many traits can be attributed to autism, without being so.

A friend that is a psychiatrist says the research is pointing towards indicators being observed from babies only a few months old. But these indicators don't equate to diagnosis, but these babies may benefit from early intervention. Interesting concept really.

I think ‘temperament’ is also important and how it interacts with ASD? Studies on attachment theory show that where a child falls on temperament charts (eg ‘slow to warm’/easy/difficult etc) are distinct factors when looking at impact of failed attachment. Also, ASD is an umbrella term used for an individual that displays a ‘cluster’ of behaviours or developmental issues. The two extremes of baby-type in the OP probably map onto two distinct groups of children within two clusters of overlapping issues? Eg the fractious/hard to settle ones may be more likely to develop into the ‘Aspergers’ cluster. (Or not, am talking out of my a*se LOL.)

However, I think studies are difficult to do unless ‘NT’ samples are empirically shown to be so - ie you can’t go on parental- or self-report of NT because ASD/ND’s are often not diagnosed until mid-late adulthood, and often missed because its highly heritable (ie parents are also ND so the behaviours seem normal) or there are multiple familial issues that are used to explain away behaviours/failure to thrive/emotional disregulation.

Ie, a psychologist could not take any of the comments by parents of ‘non ASD’ children about extreme behaviours mentioned above as empirically meaningful unless the have all been assessed and clinically excluded from an ND diagnosis?

@TupperJen Did your friend mention any of the indicators?

I know it would be very difficult to diagnose in infancy, but it’s the early intervention that would be beneficial. Even just being on the health visitors or GPs radar to review progress and behaviours. Many children who are ‘high functioning’ or ‘Asperger’s’ (I know those terms aren’t used), are missed because they don’t have stereotypical signs and can be very intelligent, which masks the deficits until they are older. My DC wasn’t diagnosed until 7.

One of my DSs has autism and it was v apparent as a baby. Didn't like to be held even as a very young baby. Didn't smile, just stared with big round eyes. Behavioural cues were there right from the beginning but obviously you can't diagnose until later.

I think this could be really helpful. I know some parents won’t want to hear that there’s an issue with their infant, but in hindsight from my own perspective, had there been an awareness that, for example, failure to latch/colic-crying/crawling to early when co-occurring, are indicators, then I could have had a fast track into additional support? Eg. measures such as additional SLT, and supported behaviour therapy for parents to do with their DCs from as early as possible could help any parent with an ND child.

@BusyMummy001 I completely agree. My DC’s extreme passivity to everything, combined with meeting motor milestones earlier than expected, then speech developing so rapidly to where they were speaking in sentences with complex vocabulary at 18 months… taken together, I believe these were indicative of their autism. We could have had support or early interventions, rather than having to pay privately for diagnosis and therapies during primary school.

Disclaimer: I've not read the thread

My DS was a very, very unsettled baby. Nothing would soothe him and he just cried and cried. Even with my extensive SEN knowledge now I don't know if I would be able to make things better for him if I went back in time. Also feeding was a nightmare - he would constantly want to be on the boob, but was never satisfied. Then when we switched to bottles he would guzzle one in seconds then throw it all up.
He used to use his bouncer chair to propel himself up and down like he was about to eject himself from it - same with his highchair. Only settled once we bought a very expensive swing!
My sanity at the time was saved by very kind mumsnetters giving me some great advice and things to try.

I am sorry but across my family and friends we would null your hypothesis.

From a family where ND is there so was on my radar. Both my children meet your happy baby, slept exceptionally well, met milestones early. Neither ND.

Family and friends had what could be classed as very high needs and milestones delay, no ND.

Five boys ND, three friends (2 boys 1 girl) across extended family, so eight with ND diagnose, all were middle of the road baby and milestones. 🤷‍♀️

Ideally early detection would be possible to assist parents but I be sceptical of the suggestion given my experience.

Interesting!
DS diagnosed ASD aged 8 (although I'd suspected beforehand).
He was a very passive baby -- I was admitted late on in the pregnancy twice because of lack of movement in the womb.
He slept through the night virtually straight away. Slept too much tbh ... but as I had a 2 year old DD I was rather grateful.
Poor feeder. I constantly got mastitis because he would fall asleep at the breast after about 2 minutes.
But he absolutely refused to take the bottle. How we struggled :(
He was very often sick after feeding too.
He never crawled.
Didn't cry much.
A very late walker - he was over 2 years old before he got up and toddled.
Vocabulary was slow to develop, wouldn't look when you pointed out something, wouldn't hold a pencil at the health visitor 'milestone tests'.
Also failed his hearing tests but we knew he could hear. He just couldn't be bothered to listen LOL
But from age 3 he couldn't stop chatting about everything, and was fantastic at drawing.
He's a brilliant young man now :)

I have two kids with adhd. Both very good babies, definitely not passive, however. Sleeping was dreadful for both of them as soon as they were in a bed and didn't have to stay confined to a cot!

They both became harder work when they hit around 4 years old. Constantly on the move, talking, not sleeping, jumping everywhere. Maybe they just stood out doing it at 4/5 whereas loads of kids were doing this at 3!

Neither of them particularly stood out as difficult babies/toddlers.

Both pretty average meeting milestones too.

OMG I’d forgotten the hearing thing - mine had repeated hearing tests (because of the S&L delay) and they failed them continuously, and even then the audiologist felt they were likely just not complying/playing with us).

I disagree based on my panel of 2 : twins, now 9, one with high functioning autism.
As babies and toddlers they were both ‘average’ babies, not the extremes you are describing. Seeing as I had two of the same age it is fairly easy to compare!
Re milestones, the one with ASD (boy) reached them 1-3 months later than the other one (girl) but this is not unusual for girls to reach these earlier so again, not convinced it was the ASD at play.
ASD traits started being visible at 4yo, and even then it wasn’t flagged as ASD yet.

I have an autistic son (now 19), he was diagnosed aged 2 1/2 years old. He was very obviously autistic and had a quick (6 months) diagnosis. I knew from him being days old there was something different about him, he was so different compared to his older brother. I'd get wrong off the HV about comparing them and she'd sweep my concerns under the carpet. Saw a different HV for his 2 year check and has referred to paediatrics.

Some of the things that jumped out in his first 2 years that I can remember, as it was a while ago and quite a stressful time:

Never cried when hungry, had to guess.
Terrible sleeper, but rarely cried when he was awake to let you know.
Would projectile vomit after practically every feed.
When we moved to solids he refused any liquids from then on, I had to spoon feed milk into him. Even now he doesn't drink much, and only a specific three hour slot at night.
Screamed when unclothed, even worse in the bath (this lasted until he was 5 yrs old). Hated anything on his feet.
Screamed in supermarkets, more so in the fridge sections.
Milestones weren't great, didn't sit up until 10 months, did a weird backwards bum shuffle at 13 months, walked at 15 months but not confidently until 18 months. Walked on tiptoes.
Refused to have a thing in his hands, including toys and food, until almost 2, and then it had to be one in each hand otherwise he'd scream.
Never babbled, never talked until he was 7, only one word sentences though.
Didnt cry when he fell, even if he grazed himself, and didn't seek comfort.
Didnt really smile.
Lots of hand flapping.
Rolled toys in front of his eyes, would lie on the floor doing it forever. Only liked toys that spun.

I knew something was wrong from son's very earliest days too. HV noted "mother is concerned there is something wrong" at his six week check. I think if you have older children you notice differences however small.
Ds1 was a high needs baby yet I was never concerned there was anything wrong even though he cried a lot. Ds3 though screamed constantly and couldn't be soothed and in fact picking him up made it worse.
My concerns at six weeks were that he didn't snuggle in against me he was pretty rigid and stiff when I picked him up and he always looked for a light rather than at my face when I fed him.

My DD was extremely unsettled as a baby. She cried constantly for her first year, constantly clingy and needing to be on me. She was also a very early talker, sentences by 18 months ("Is Daddy upstairs? When is Daddy coming down stairs? Can I have breakfast, please?" etc) but she has no ADHD/ASD. She's a very well rounded 10 year old, very well behaved, top sets in class, loads of friends, no problem interacting with other kids, loads of extracurricular interests etc. I'm not sure how you can quantify someone's description of their baby's behaviour as being in the middle of hard work and passive. Many people don't want to label their kids as hard work, or assume all kids are like that.
What you need to do is analyses data from a longitudinal study, where children have been diagnosed with autism at some point in their childhood, and look for factors that correlate highly with this outcome, such as childhood behaviour, maternal stress/ mental health, drinking in pregnancy, family history of autism (if asked in the study) and even throw in whether or not vaccinated (because why not?) etc.

One of mine was obsessed with wheels as a baby. (Pre one)

Didn't wave or point as a baby. Didn't gesture to be picked up.

One had obvious sensory issues from early on.

Sensory issues alone dont always mean autism though.

DS also looked past me when I fed him, sort of to the side of my face rather than at it.

Some of us with a visual impairment do this too. I can't physically look straight ahead