Expert: James Michael Roan - 8/2/2008

Question
Hi,

I know it may be a bit early for this.....My daughter (only child) is 15 weeks and she barely ever makes a peep. She coos MAYBE 5-10 little noises per day on a good day. Some days none at all. She has had the back and forth "conversations" a few times when she first started cooing at 9 weeks, but has not done that for the past month. Now it is just the here and there occasional coo/gurgle. She has laughed 2 times, both within the last week. I am just worried that she may be delayed because she is not "cooing all the time" (much less babbling) as most babies are doing by 8 weeks from what I have read. She is just quiet all the time. I know she can hear well, and she otherwise interacts wonderfully (excellent eye contact, smiles all the time, very animated, grabs things). Should I take her to a specialist?
Thank you for any insight.

Answer
Hi Gina;

She's really too young to tell. Most markers for possible concern begin at 6 months. Here they are:

-Poor social attention
-failing to seek contact
-excessive exploratory activity with objects-Not making eye contact with parents during interaction
-Not cooing or babbling
-Not smiling when parents smile
-Not participating in vocal turn-taking (baby makes a sound, adult makes a sound, and so forth)
-Not responding to peekaboo game

The following is quote from the following source and is copyrighted:
Crane, Jennifer L., Winsler, Adam. Early Autism Detection: Implications for Pediatric Practice and Public Policy, Journal of Disability Policy Studies 2008 18: 245-253

A typically developing infant begins to vocalize in a social manner as early as 2 months of age (Werner, Dawson, Osterling, & Dinno, 2000). During the second 6 months of life, typically developing infants begin to exhibit a greater amount of social babbling, such as verbal turn taking, and nonverbal behaviors, such as pointing at objects. Infants seek attention from others in social situations through imitative vocalizations, directing the attention of others through nonverbal behavior (pointing), greeting others, and requesting objects. Infants and toddlers later diagnosed with ASD have been shown to lack many of these typical behaviors through both retrospective video analysis and parental report (Baranek, 1999; Watson et al., 2003). The AAP (2001b)
states that parents report noticing differences in their child’s social behavior around 7 months of age, on average. Parental concern about early cognitive or language development often predicts a later diagnosis of an ASD (AAP, 2001b). The problem with retrospective parental report is that memories are affected by the stress of raising a child with ASD and what they remember may be incorrect or exaggerated, so these reports are limited for use in empirical research (Watson et al., 2003). This research highlights a constellation of infant behaviors that are indicative of later ASD diagnosis (Volkmar, 1999; Werner et al., 2000). Table 1 outlines a number of studies using retrospective video analysis and specific behaviors found to be significantly different for infants later diagnosed with ASD. This constellation of behaviors includes impairments in social attention (eye contact, responding when called by name), affective responsiveness (social smiling), and prelinguistic vocalizations. The constellation of behaviors associated with later diagnosis of ASD can be outlined as follows: Infants later diagnosed with ASD often fail to respond to their names, fail to orient toward people, and show less verbal and nonverbal communicative behaviors. The DSM–IV states that children with autistic disorder must have qualitative impairments in social interaction; qualitative impairments in communication; and restricted repetitive and stereotyped patterns of behavior, interests, and activities (American Psychiatric Association, 1994). Although it may be difficult to observe an infant or toddler having restricted interests and stereotyped behavior, the first two of these criteria have been identified through specific behavioral deficits in infants younger than 12 months of age. An infant who ignores parental attention, who does not watch the parent for social cues, and who does not respond to his or her name likely has measurable difficulties in communication and socialization characterized by ASD and outlined in the DSM–IV. The DSM–IV criteria for diagnosis of ASD can be relevant for use in infants and toddlers if clear and concise definitions of infant and toddler behaviors related to DSM–IV criteria are developed for use by practitioners.

Finally, recent research has found that observed behavioral changes in children later diagnosed with ASD are preceded by abnormal cranial growth. First, many ASD infants are born with relatively small heads followed by a sudden, excessive increase in head size between the ages of 2 months and 14 months (Courchesne et al., 2003). Courchesne et al. state that this type of sudden acceleration in rate of head growth can also serve as an early sign of ASD. The compelling evidence discussed here indicating biological markers for ASD suggests that brain morphological variables could be used effectively as part of an overall screening program for ASD.

Although it may be difficult to observe an infant or toddler having restricted interests and stereotyped behavior, the first two of these criteria have been identified through specific behavioral deficits in infants younger than 12 months of age. An infant who ignores parental attention, who does not watch the parent for social cues, and who does not respond to his or her name likely has measurable.

Finally, recent research has found that observed behavioral changes in children later diagnosed with ASD are preceded by abnormal cranial growth. First, many ASD infants are born with relatively small heads followed by a sudden, excessive increase in head size between the ages of 2 months and 14 months (Courchesne et al., 2003). Courchesne et al. state that this type of sudden acceleration in rate of head growth can also serve as an early sign of ASD. The compelling evidence discussed here indicating biological markers for ASD suggests that brain morphological variables could be used effectively as part of an overall screening program for ASD.

You may also email me at: roanpsych@gmail.com and I'll send you a developmental questionnaire.

Kind regards,
James