One child in 50 in Canada has an autism spectrum disorder, according to the Public Health Agency of Canada. It's one of the most common neurodevelopmental disorders, yet delays in diagnosis remain a cause for concern in many regions of Quebec. These delays are not insignificant. A diagnosis made at 2 or 3 years of age opens access to early intervention services during the period when the brain is most plastic. Once this window of development has passed, it never returns.
Every month gained in the process counts. That's why recognizing the warning signs, and knowing where to go quickly, makes a real difference in a child's trajectory.
What is autism spectrum disorder?
ASD is a neurodevelopmental disorder characterized by persistent differences in two major areas. The first concerns social communication and interaction. The second involves restricted and repetitive behaviors, interests or activities. The word «spectrum» reflects the great variability of profiles: some people are little affected in their day-to-day functioning, while others require considerable support in all spheres of life.
It's worth remembering that ASD is not an illness. It's a different way of perceiving and interacting with the world, with its own strengths and challenges, which vary from person to person.
Clinically, the diagnosis is based on DSM-5 criteria. Difficulties observed relate to socio-emotional reciprocity, non-verbal communication and relationship development. We also assess the presence of repetitive movements, insistence on similarity, very intense and focused interests, as well as sensory peculiarities, known as hyper- or hyposensitivity. These elements must be present from early childhood, although they may not become apparent until later, depending on the context.
Early signs to watch for in children
Certain behaviours, or the lack of them, can be alarming from the very first months of life. They don't automatically mean ASD, but they do warrant rapid assessment without delay.
Before 12 months, the absence of babbling, pointing or other social gestures deserves attention. A baby who responds poorly to his or her first name, or who makes little eye contact with familiar people, may benefit from a medical eye.
Between 12 and 18 months, a delay or absence of first words, little spontaneous imitation such as pointing to show something or saying «goodbye», and little symbolic play are signals to be taken seriously.
Between 18 and 24 months, the absence of unimitated two-word phrases, a regression in language or social skills, little shared imaginary play, and marked repetitive behaviors such as lining up objects, going in circles or maintaining rigid rituals are all elements that merit evaluation.
These signals do not have the same value in isolation as when they accumulate. A healthcare professional can help you interpret them in context.
The diagnostic process in Quebec: long, but essential
The diagnosis of ASD is made by a multidisciplinary team, generally comprising a physician or pediatrician, a psychologist and other specialists depending on the child's profile, after an in-depth evaluation. In Quebec, delays in the public system can reach 18 to 36 months in some regions, delaying access to intervention services when they would have the greatest impact.
Evaluations carried out by specialized private teams can reduce these delays. The family doctor or pediatrician plays a key role in this process: he or she initiates the request for evaluation and refers the child to the most appropriate resources, depending on the child's situation and the actual delays in the region.
Early intervention includes developmental services such as speech therapy, occupational therapy, behavioral support and specialized educational services. These services are most effective when they begin before the age of 5, during the period of greatest brain plasticity.
Robust studies show that intensive, individualized early intervention significantly improves the language, cognitive and social functioning of children with autism. This is precisely why every month gained in the diagnostic process has concrete, not just symbolic, value.
When should you consult a healthcare professional?
If you're concerned about any of the behaviours described in this article, talk to your family doctor or a paediatrician without waiting for your child's next routine check-up. A clinic doctor can assess your concerns, administer validated screening tools such as the M-CHAT-R/F for children aged 16 to 30 months, and initiate a referral to a specialized ASD team at your local CISSS or CIUSSS, or to a professional in private practice if public delays are too long.
Waiting is never good for the child. A quick consultation, even if it doesn't lead to a diagnosis of ASD, is always useful to guide follow-up.
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