From “Deficit” to “Difference”: Recognising Early Signs of Autism Through a Modern Lens

In 1943, child psychiatrist Leo Kanner published a paper describing 11 children who shared a “powerful desire for aloneness” and an “anxious obsessive desire for the maintenance of sameness” (Kanner, 1943).

For decades, this condition, now known as Autism Spectrum Disorder (ASD), was viewed strictly through a medical lens as a set of deficits to be fixed (Mintz, 2016). However, our understanding has evolved significantly. Today, researchers and advocates view autism not just as a medical checklist, but as a form of neurodivergence — a natural variation in how the human brain is wired (Dwyer et al., 2024).

While every autistic child is unique, research has identified specific patterns in social communication and behaviour that often appear in the first two years of life. Recognising these early signs of autism is not about labelling a child; it is about understanding their needs to provide the right support.

Key points

• Historical shift: The definition of autism has moved from a rare, narrow diagnosis to a broad “spectrum” covering a wide range of abilities (Lord et al., 2018).
• Prevalence: According to the CDC, approximately 1 in 36 children in the U.S. is diagnosed with autism, with boys being diagnosed about 4 times more often than girls (Maenner et al., 2023).

A brief history of the diagnosis

The term “autism” comes from the Greek word autos, meaning “self.”

While Kanner identified “infantile autism” in the US, Austrian pediatrician Hans Asperger simultaneously described a similar group of children in 1944. However, Asperger’s work was not widely translated into English until the 1980s (Frith, 1991)

For a long time, diagnosis was rare. It wasn’t until the 1980s, when the definition was broadened in the Diagnostic and Statistical Manual of Mental Disorders (DSM), that we began to understand autism as a spectrum (Zeldovich, 2018).

In 2013, the DSM-5 combined various diagnoses (like Asperger’s Syndrome and PDD-NOS) into the single umbrella of Autism Spectrum Disorder. This shift acknowledged that while support needs vary, the core differences in processing the world remain consistent.

Modern Theories: The “Double Empathy” Problem

Before looking at specific signs, it is important to understand why social differences occur.

Traditionally, academic theory focused on the “Theory of Mind” hypothesis, which suggested autistic people struggle to understand the mental states of others (Baron-Cohen et al., 1985).

However, a more recent academic theory, the Double Empathy Problem, proposes a different view. Dr. Damian Milton (2012) argues that communication breakdowns occur because autistic and non-autistic people have different experiences of the world. It is not that autistic people lack empathy; it is that the two groups struggle to empathize with each other’s distinct perspectives.

This reframes the “signs” of autism not as failures to socialize, but as differences in socialising.

1. Differences in Social Communication

One of the earliest indicators of autism involves “Joint Attention.”

Joint Attention is the shared focus of two individuals on an object. It is typically seen when a child points at a bird and looks back at their parent to make sure they see it too.

Research shows that deficits in joint attention are among the most reliable early markers of autism, often visible between 12 and 18 months (Mundy et al., 1986).

Other social communication signs include:

• Inconsistent Eye Contact: A 2002 study by biological psychiatrists found that autistic children may have reduced eye fixation or gaze aversion, rather than simply “ignoring” people (Dalton et al., 2008).
• Reduced Response to Name: A study in the Archives of Pediatrics & Adolescent Medicine found that distinct failure to respond to their name by 12 months is a strong predictor of autism (Nadig et al., 2007)
• Literal Interpretation: As children grow, they may struggle with sarcasm or idioms, interpreting language very literally (Walenski & Love, 2018)

2. Repetitive Behaviors and Interests

The second core domain of autism involves “restricted, repetitive patterns of behavior, interests, or activities” (APA, 2013).

“Stimming” (Self-Stimulatory Behavior) This includes hand-flapping, rocking, or spinning. While often stigmatized, academic research suggests these behaviors help autistic people regulate their sensory systems and manage anxiety (Kapp et al., 2019).

Intense Interests Autistic children often develop deep, focused interests in specific topics. Unlike typical hobbies, the intensity or focus of the interest may be unusual (e.g., focusing on the wheels of a toy car rather than the car itself).

Sensory Processing Many autistic children are hyper-sensitive (over-sensitive) or hypo-sensitive (under-sensitive) to sensory input.

• Hyper-sensitive: Covering ears at loud noises, disliking certain clothing textures.
• Hypo-sensitive: Seeking deep pressure, crashing into sofas, or not noticing pain.

3. Developmental Trajectories: Regression

While some signs appear early, other children experience regression.

A study in the Journal of the American Academy of Child & Adolescent Psychiatry indicates that about 32% of autistic children experience a loss of language or social skills they previously had, typically occurring between 15 and 24 months (Ozonoff et al., 2011).

Conclusion

Recognising these signs is the first step toward understanding.

Academic consensus today emphasises that early intervention, such as speech therapy, occupational therapy, and parental support, can significantly improve outcomes. However, the goal of modern intervention is not to “cure” autism, but to provide the tools for autistic children to navigate a world that isn’t always built for them.

For more information about ASD Assessments at Patches, click here.

To make a referral, click here.