Early differences in social and communication skills – when to act

Professor Andrew Whitehouse, The Angela Wright Bennett Professor of Autism Research at Telethon Kids Institute and The University of Western Australia and Director of CliniKids

What are social and communication differences?

Babies are born with remarkable abilities to communicate. Sometimes, the social and communication skills of babies can develop differently to what we typically expect — they may not meet milestones at the expected timepoints, or they may communicate, play, or interact differently to other babies of the same age.

Early differences that we may see at around 12 months of age include:

  • Not consistently using eye contact to get someone’s attention.
  • Rarely pointing to or holding up objects to show you things.
  • Not consistently responding to their name being called.
  • Not consistently using gestures on their own.
  • Not consistently smiling back at you or other familiar people when you smile at them.
  • Rarely copying other people’s actions.
  • Not sounding like they’re having a conversation with you when they babble, or not babbling at all.

Any one of these behaviours on their own is not a clinical indication, but when we see a number of these behaviours in the same child, it is important to have a closer look to see if the child needs support.

Significantly more children are now recognised as having difficulties learning social communication skills. This has led to an increase in the number of children being diagnosed with autism – now estimated to be two percent of the Australian population.

Typically, in the clinical pathway for autism, these early behaviours are monitored until the age of two years, after which children may receive an assessment that leads to a diagnosis of autism. This ‘wait and see’ approach to early developmental differences is based on the premise that child development is highly variable, and that we should be cautious in providing clinical services when they may not be required.

Of course, the drawback of this approach is that, for those children who are developing differently, our therapies are not being applied in the first two years of life, when the brain and mind are developing rapidly.

What is changing?

While genetics play a major role in brain development, it is also highly influenced by early experiences, especially the interactions a child has with their caregivers.

There is strong evidence that increased sensitive and responsive caregiving styles early in life has positive downstream effects on child development and wellbeing. A landmark, multi-site clinical trial led by the Telethon Kids Institute has found the first evidence that pre-emptive therapy (iBASIS) in infancy could significantly reduce clinical autism diagnoses being made in early childhood.

The trial identified more than 100 babies with early signs of potential autism (reduced eye contact, imitation, or response to name) and found that the babies who received the program had improvements in their social communication ability, while parents were better able to adapt their communication style to the needs of their baby.

Inklings program

Inklings is an early childhood program based on the iBASIS program for babies aged six to 18 months, showing early social communication delays, and therefore, at increased likelihood of autism. The program uses video feedback as a means of helping parents to recognise their baby’s communication cues and respond in a way that builds their social communication development.

The Inklings program is funded in Western Australia through the National Disability Insurance Scheme (NDIS) as part of a new partnership between the NDIS, Telethon Kids Institute, Child and Adolescent Health Service and WA Country Health Service to support babies showing early social and communication differences. It is now accepting referrals and the program is funded for eligible WA families.

The findings from the clinical trial provide strong evidence for a new model of providing clinical support to children with developmental differences.

Rather than waiting until a diagnosis to start therapy, we need to identify developmental differences as early as possible. Then we need to provide developmental supports that nurture each child’s strengths.

At its most basic, this is a change of clinical support from “wait and see” to “identify and act”.

What does this mean for GPs?

Be on the lookout for early differences in social and communication skills in babies.

  • Consider early referral for services when multiple differences are seen in the same child. This may include early intervention services, allied health professional or a paediatrician.
  • Consider referral to the Inklings program for babies aged six to 18 months with social communication delays or differences.

What additional support is available?