Focusing on Early Childhood to Better Understand Autism
The following article was published in the January 2011 issue of OCD's newsletter Developments. To download a PDF of the issue, click here. 

Mark Strauss was struck by a comment made several years ago by Temple Grandin, the Colorado State University professor who has become a leading advocate for those, like herself, who live with an autism spectrum disorder. She said it wasn’t until she was 5 years old that she could tell the difference between dogs and cats—and even then by using a process much different and deliberate than the way typically functioning children make such distinctions.

"She taught herself how to do it by realizing that dogs have particular noses and cats have retractable claws," said Strauss, PhD, professor of psychology and director of the Infant and Toddler Development Center at the University of Pittsburgh. “I had been studying the development of these automatically learned things in babies and it became apparent from Temple Grandin’s comments that she didn’t have these built-in mechanisms. She had to explicitly teach herself things that babies automatically learn.”

Dr. Strauss is among the researchers investigating such developmental differences as part of the Pittsburgh Early Autism Study, a comprehensive effort to identify markers of autism in early childhood and gain a deeper understanding the developmental pathways of autism. Gaining such knowledge has implications for diagnosing autism earlier and intervening sooner to help children with an autism spectrum disorder (ASD).

Autism is a range of complex neurodevelopment disorders with no known cure. The causes of the disorders are not well understood. Although symptoms vary among those with autism, common characteristics include social impairments; communication difficulties; and restricted, repetitive, and stereotyped patterns of behavior.

A Growing Concern

The number of people diagnosed with an ASD has risen sharply, but the precise reason why remains unclear. For example, it is not known the extent to which greater awareness and a broader definition of ASD has contributed to the rise in prevalence in recent years. One year ago, the U.S. Centers for Disease Control and Prevention revised its estimate of the prevalence among American children from 1 in 150 children to 1 in 110 children.

An ASD diagnosis today is typically made when a child is around 36 months old. Autism can be diagnosed earlier in children who exhibit multiple and very apparent deficits in areas such as language, attention, and behavior. The difficulty is making a reliable early diagnosis among infants and young children experiencing a deficit in only one or two domains. It’s not uncommon for some children, for example, to exhibit a language delay early in life that is corrected later.

Research suggests some children benefit from structured interventions, such as intense behavior modification therapies. Such interventions, while not a cure for autism, can be useful in helping children develop more appropriate behaviors and function better in society. Studies also suggest that the earlier interventions begin, the better.

Understanding the subtle early makers of the disorders and the developmental trajectory of autism symptoms are critical to finding a reliable, accurate tool for early diagnosis and being able to begin appropriate, well-targeted interventions as early as possible. At the moment, however, little is known about what is happening early in the development of children who are later diagnosed with an ASD.

“Parents will say they notice something in the first year. But we have no real sense of what the developmental course is,” said Susan Campbell, PhD, a Pitt professor of psychology who is the principal investigator of one of three studies in the project. “A lot of parents will say their child was developing normally until, say, 18 months and then they started to lose skills. Unless we do these prospective studies, we won’t have a good handle on whether there are different subtypes with different developmental patterns, or whether people just weren’t noticing things before.”

Investigating Early Autism

Autism research is a relatively young field with the body of evidence consisting mostly of studies over the past few decades involving older children and adults.

In their effort to learn more about autism during the early months of life, researchers with the Pittsburgh Early Autism Study recruit infants with older siblings who have been diagnosed with an ASD. Studies indicate there is a genetic component to autism and it is estimated that 18 percent to 20 percent of infants with an older sibling with autism will later be diagnosed with an ASD. A sample of infant siblings of typically developing children is also included in the study.

Researchers are looking at a range of possible early markers of autism by studying early cognitive and social development, and also early language and communication development in studies led by Dr. Strauss, Dr. Campbell, and Jana Iverson, PhD, an associate professor of psychology at Pitt who has studied aspects of autism for nearly a decade.

The Pittsburgh Early Autism Study is affiliated with the University of Pittsburgh’s Center for Excellence in Autism Research, which is directed by psychiatry and neurology Professor Nancy Minshew and is one of five such centers funded by the National Institutes of Health. The researchers are also among 22 investigators in the Baby Sibling Research Consortium, which is exploring issues related to early autism in infant populations around the world.

For his part, Dr. Strauss focuses on cognitive ability, attention, memory, and how knowledge is developed. Of particular interest is studying how children perceive faces and facial expressions.

Infants learn a great deal about their world by observing and interacting with it. Within the first year of life, they are learning enough about faces to make fine discriminations among different people, allowing them to recognize, for example, who is familiar and who is not. “Babies learn faces, expressions, that dogs—even though they look different from one another—are a different category than cats,” Dr. Strauss said. “We know babies are learning this by 10 months of age.”

But, as Temple Grandin’s comments reveal, children with autism have difficulty doing what comes automatically to typically functioning infants. Even autistic adults exhibit similar deficits. Researchers are studying this issue by showing them movies and pictures and using a device that track what they are looking at, how long they are looking at it, and how they distribute their attention. In doing so, they hope to identify when the deficits begin and what type of deficits they are. In one study, researchers are finding differences at 6 months of age between the infants whose older siblings have autism and infant siblings of typically developing children.

“The way they are paying attention to pictures is different,” said Dr. Strauss. “They are paying attention to smaller details and they are not seeing holistic things. That is critically important to children’s early learning because the way you know, for example, that two different dogs are dogs— that a German shepherd and a collie are both dogs—is by being able to see their general shape, not focusing only on the color of the nose or ear.”

Dr. Campbell is studying early social development, paying particular attention to the interactions between mother and infant. She studies mothers and children in several situations during different developmental stages to examine social reciprocity, pretend play, empathy, and emotion regulation.

When studying social reciprocity in infancy, Dr. Campbell observes face-to-face interaction between mothers and their 6-month-old children. For example, she observes mothers engage their babies in play and notes such things as the infants’ reactions to exaggerated facial expressions as well as their reactions when their mothers are asked to be non-responsive. Typically developing toddlers spontaneously begin to enjoy pretending, something that is difficult for children with autism. Dr. Campbell is studying the development of pretend play in these children during their second year.

In another scenario, she is observing the reaction of children between the ages of 11 and 16 months when they are shown a toy elephant that walks and makes noises. It’s the kind of toy that typically developing infants would be interested in, but wary of, and would tend to look to their mothers for cues about whether to approach it or not.

“We are looking at the give and take of parent-child interaction and how infants use mom as they explore the world,” Dr. Campbell said. “The assumption is that the high-risk infants who are later on going to have a diagnosis (of autism) are going to make much less use of their mothers as a base for exploring the world, or as a way of getting information about what is okay to touch.”

Rounding out the scope of the Pittsburgh Early Autism Study is Dr. Iverson’s work, which includes investigating of the emergence of communication skills, such as language and gesturing, beginning with babbling.

The early markers of autism most consistently reported in research literature are related to early social communication. Most infants are able to speak a few words by the age of 18 months and nearly all are able to use gestures of some sort to communicate their interests, wants, and needs. The exceptions are infants with an ASD who typically do not communicate at such levels during their first 18 months or do so infrequently.

Dr. Iverson begins observing children when they are 5 months old. A key aspect of her work is that she regularly videotapes the children in their homes. “What is important to us,” said Dr. Strauss, “is that she is getting a diary snapshot, if you will, of every month of development, which allows us to look at a variety of things.”

Although each researcher is investigating separate issues, those issues are often related. One example is gesture and social interaction.

“One of the things people talk about with children with autism is they use certain gestures to get something they want, but they don’t use gestures that children use for sharing,” said Dr. Campbell. “In my lab, we look at how often children show mom a toy. Showing is a social gesture. They are showing mom a toy to share something. Or they point at something interesting as a way to sharing it. Those are gestures that seem to be delayed in children with autism, which fits with Jana Iverson’s work.”

Taken together, their work could reveal a comprehensive profile of early autism that today remains elusive. Such information would help identify more precise early markers of autism and perhaps a reliable method of early diagnosis. “There is a big push now within pediatrics and child psychiatry toward early intervention,” said Dr. Campbell. “But we don’t really know who to intervene with unless we can be sure we are picking up the right cues.”

For More Information

Parents with infants – regardless of whether or not they also have an older child with autism—can get more information about the project including how to participate by calling 866-647-3436 or going to