One of the most important clinical pearls I learned came not from my professors at New York University School of Medicine, but from my mother. I was the last of 5 children born in my family with two of my severely mentally retarded brothers (twins). While doing my pediatrics rotation at Bellevue Hospital, I became very interested in pediatrics. I was seeing children with very rare diseases and various developmental delays. I remembered that my mother had told me that my brothers had not been officially diagnosed as mentally retarded until they were 5 years old and now that I was in medicine I realized that it took too long to give the diagnosis. They should have been diagnosed at a much younger age so that they could have received therapies at a younger age. Of course, my mother knew that something was wrong with her children. In fact, my mother told me that she knew something was wrong shortly after her birth. I remember her telling me this story many times growing up, but it became more meaningful when I was studying child development in my pediatrics rotation. I was curious as to how she knew something was wrong when the medical community told her that her severely retarded sounds would “disappear” (you can’t make this up!) year after year. I asked her how she knew something was wrong, and her response turned out to be one of the most valuable pieces of information I’ve ever used in my pediatric practice. She told me that at 3 months of age they did not smile or react to her like my older brothers did. This pointed to a problem very early in her life despite the fact that the medical community (of which I am now a part) did not acknowledge her concerns.

This information was helpful in two ways. First, she told me the most important developmental milestone to look for in a baby, and second, she taught me to always listen to what the mother says.

Autism and mental retardation are not the same diagnosis. There are some autistic children who are also mentally retarded, but there are many autistic children who have normal IQs.

There can be many signs of autism in a baby less than 1 year old. I have many families in my practice with autistic children and if you ask them they will tell you that the autistic sibling was very different as a baby than the undiagnosed autistic sibling. Depending on birth order, a father of a second baby may have a problem early on, like my mother did. I can give you an example of the reverse of this scenario. Early in my pediatrics days, I was reviewing an 8-month-old boy whose 3-year-old brother was diagnosed with autism. When I asked the mother about the new baby’s development, she confidently said the baby was “completely normal.” I asked the mother how she was so sure and she told me that all the signs that her autistic son had when she was a baby were not evident in the second child. Sometimes the best learning comes from mothers and being a young pediatrician at the time and a new mother I was not going to let this opportunity to learn something pass me by. She then told me that her autistic son always seemed like “she wasn’t there” when she was a baby. She was also much less verbal with minimal babbling and no reciprocal speech interactions. These are some signs that a father might not be aware of unless he has had previous experiences with raising babies.

I’m going to talk about early signs of autism, but I don’t want parents to panic if they feel one of these signs may exist in their baby. If you ever have any concerns, you should address them with your pediatrician.

One of the first signs of socialization in a baby is smiling. This occurs around 2 months of age in a full-term baby. This is the time when they also start cooing and responding to the outside world. If this milestone is significantly delayed, a red flag has been raised. At this time, babies will recognize a human face and begin to follow it. They will also orient to the sounds of voices, but will not recognize or call on your name at this time. This is a common concern raised by parents. Babies do not begin to recognize their name until the end of the first year.

Not responding to your name at the right age can be a sign of autism. This usually happens at the end of the first year, but if it doesn’t, it could also mean that your child doesn’t hear well. Poor eye contact, a preference for playing alone, a lack of imaginative play, repeating words or phrases without knowing the meaning, and repetitive or ritualistic behaviors are signs of autism in the second year. Resistance to physical contact or not pointing as a means of communicating needs are other signs of a problem.

There are also signs to look for that can help put your mind at ease if you are worried about autism. A smiling, responsive and playful baby with good eye contact is a good sign. However, one of the first signs I look for to rule out autism is if the baby is pointing. This is a sign that the baby wants to communicate with the world and is always a good sign, even if other areas lag behind. Language comprehension is also a very good sign and helps in assessing development. If the toddler understands the commands and can follow them, the lack of expressive language is much less of a concern.

The most important thing for a parent to remember is that if you ever have any concerns about your child’s development, you should discuss them with your pediatrician. If for any reason he feels that he is not getting the right answer, it is important to get a second opinion from a child development specialist.