Case Study of the Development of an Infant with Autism from Birth to Two Years of Age

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Abstract

This report describes a case study of the development of an infant with autism who was observed closely by professionals from birth and to whom a comprehensive psychological evaluation was administered at approximately 1 and 2 years of age. During the first 6 months of life, this infant displayed difficulties in oral motor coordination and muscle tone that fluctuated between hypotonia and hypertonia. He startled easily, had poor state regulation, and was hypersensitive to touch. Notably, however, during the first 6 months, this infant vocalized and responded socially to others by smiling and cooing. During the second half of the first year, he continued to demonstrate diffuse sensorimotor difficulties and diminished oral motor control. Hypersensitivity now extended to a wider range of stimuli. He had problems in sleep regulation. Motor stereotypies, including rocking, head banging, and toe walking, were observed. Difficulties in the domain of social interaction began to emerge during the second 6 months, including poor eye contact, failure to engage in imitative games, and lack of imitative vocal responses. By a little over 1 year of age, this infant met diagnostic criteria for autism based on the Autism Diagnostic Interview. There were several domains in which this toddler with autism did not show impairments. In the areas of immediate memory for actions, working memory, response inhibition, and speech perception, this 1-year old with autism displayed no evidence of significant impairment on the tests administered. This case study offers clues regarding the nature of autism at its earliest stages. Understanding early development in autism will be important for developing early screening and diagnostic tools.

Section snippets

Case report

The infant with autism (or I.A.) lived at home with his parents, two older brothers, and one younger brother. At the time this report was written, I.A. was a toddler. I.A.'s father reportedly had motor coordination and attention problems. According to a parental report, the father's sister was diagnosed with obsessive-compulsive disorder and depression. I.A.'s mother reported being shy as a child. I.A.'s oldest brother had been diagnosed with Asperger syndrome based on a multidisciplinary

Autism Diagnostic Interview—Revised

The Autism Diagnostic Interview—Revised (ADI-R; Lord, Rutter, & LeCouteur, 1994) was scored by the first author. I.A.'s total score was 27.5. He clearly met diagnostic criteria for autism based on the Autism Diagnostic Interview—Revised. In the domain of reciprocal social interaction, the following symptoms were present: B1—failure to use direct gaze (42), to engage in social smiling (43), and to use a range of facial expressions (52) to regulate social interaction; B2—failure to show interest

Discussion

In this report, we describe the development of an infant with autism from birth through 2 years of age. At 2 years of age, this child met DMS-IV criteria for autism and, on standardized tests, exhibited below average nonverbal ability along with significantly delayed skills in verbal ability. Thus, this 2-year-old toddler with autism was not globally mentally retarded. Instead, even at this early age, he displayed the uneven cognitive profile of higher visual–spatial than verbal skills that is

Acknowledgements

We wish to acknowledge the contribution of the parents of this child who generously shared their knowledge and experience to the benefit of other parents and professionals in the field of autism. This work was supported by the National Institute of Child Health and Human Development and the National Institute on Deafness and Communication Disorders (grant PO1HD34565). Leslie Carver provided feedback on an earlier version of this paper.

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