Parentsxperception of the First Symptoms of Autism Spectrum Disorder: A Retrospective Study

Background: The first symptoms of Autistic Spectrum Disorder (ASD) must appear before the child’s third anniversary. Early abnormalities in social development are the best predictors of the ASD diagnosis. However, speech delay rather than  social difficulties, seems to mobilize parents for seeking assistance. This fact ensures the importance of both  research and dissemination of pre-linguistic markers of ASD.   

Objectives: To investigate the type of first symptom that concerned caregivers of children with ASD and the child's age at the time.   

Methods: A database of 150 preschool children diagnosed with ASD, who were treated at the Cincinnati Children’s Medical Center in Ohio, between 2008 and 2009 was used. All children sampled were caucasian, with ASD diagnosis according to Autism Diagnostic Interview-Revised (ADI-R) and with complete date on investigated measures. The introductory part of ADI-R was used as instrument. The data were analyzed using descriptive statistics. Quantitative content analysis of parental reports was conducted to verify the nature of the first symptoms in the three areas impaired by ASD. 

Results: Thirty two children  met the inclusion criteria for participating in the study. The total average age when the parents noticed the first symptoms in development was 17.31 months. Almost half of the parents identified abnormalities in language development (44.73%, n=17) followed by social behavior (23.69%, n=9) and repetitive and stereotyped behavior (13.15%, n=5). When examining both the developmental area and the correspondent mean age, the results showed that social impairments were the first to be observed by the caregivers (mean age: 10.77 months), followed by stereotyped behaviors (mean age: 17.6 months) and the symptoms in language development (mean age: 17.94 months). Regarding the language development, speech delay was the most frequent symptom reported by parents (63%, n=12). Concerning the social area, problems in social interaction were identified by most parents (57%, n=8), including anxiety and/or avoidance of contact with other people,  followed by problems in look/smile quality (29%, n=4). Finally, there was early concern about the repetitive quality of children´s play, such as object rotation and rigid classification  (37%, n=2).  

Conclusions: The results corroborate findings of other studies, highlighting the importance of social deficits in the ASD early identification. Only a few parents noticed impairments in the social area when the child was as young as nine months old, a period that represents a substantial advance in the sociocomunicative development due to the emergence of joint attention (JA). It is pointed out that gestures such as pointing, showing/giving tend to be subte in very young children and may be missed by most parents.