Every parent has wished for a crystal ball to look ahead and see a healthy kid. And any parent who has fears about what their child's life might look like with autism has likely wished doubly hard for that glimpse into the future. The reason is clear: There is much we don’t know about what causes autism, and early signs can be so subtle that they’re easy to overlook. “Many parents may miss signs like a lack of gesturing, imitation, or eye contact,” says Parents advisor Rebecca Landa, Ph.D., director of the Center for Autism and Related Disorders at Kennedy Krieger Institute, in Baltimore. That’s one reason the average age of diagnosis is 4 years old. As a result, most interventions won’t begin until after a child is already having trouble in areas of development, like communication and social skills.
But these days, some of the most cutting-edge autism research focuses on interactions with babies 9 to 12 months old, long before a diagnosis is possible. “A baby’s brain is establishing new pathways and will later get rid of the ones it doesn’t need,” says Damon Korb, M.D., a behavioral and developmental pediatrician and director of the Center for Developing Minds, in Los Gatos, California. “One theory is that kids with autism have jumbled pathways, which makes their processing inefficient. But if you establish these pathways starting as early as 9 months, you might help the brain make better decisions about which ones to prune and which to keep.”
This sounds complicated, but it’s actually all about play. Engaging with your infant in specific ways can enhance their ability to relate to and connect with the people around them. Although the methods might seem lighthearted, their impact can be profound. “Some of the atypical behaviors of autism may not develop or will be less encompassing,” says Dr. Landa. “You can help your child be more socially engaged and encourage language development.” In one small study by Dr. Landa, babies whose parents tried at-home interventions before they turned 1 had significantly milder autism symptoms at age 3. In addition, these methods of play are neurologically beneficial to any baby, not just those who will go on to receive an autism diagnosis, because they still help to increase a baby’s language and social skills and enhance your bond.
PHOTO:LUMINA/STOCKSY
Babies with autism are less likely to initiate play. They might be quieter or seem content by themselves. “Most young children are curious about other people and try to imitate them,” says Lisa Shulman, M.D., a neurodevelopmental pediatrician and interim director of the Rose F. Kennedy Children’s Evaluation and Rehabilitation Center at Montefiore Medical Center, in New York City. “But if a child has autism, they may not be as nosy or inclined to imitate.” That’s why, if you have a passive child, it’s important for you to take the lead.
The bottom line: You can have a critical role in your baby’s development by using a few strategies while you’re having fun together. “We forget how much power our interactions can have,” says Dr. Landa. (And if you’re reading this and worrying it’s too late for your older child to benefit from this kind of play, rest assured that there is still plenty you can do to assist them with a diagnosis of autism—your pediatrician and other specialists can work closely with you.) Use this guide to incorporate as much beneficial play as possible into your baby’s day.
Photo by Shirota Yuri
Imitate.
If your baby is shaking a rattle, you shake one too. If they coo, coo back. “Imitation is one of the main ways babies learn about the social world—we figured out how to behave by watching what others do,” says Geraldine Dawson, Ph.D., director of the Duke University Center for Autism and Brain Development. “Our brains have circuits designed for imitation, but that part of the brain doesn’t function normally in children with autism. When you copy your baby, it helps them see a link between what they’re doing and what you’re doing, which can stimulate those important neural circuits.”
Show excitement.
Let’s say you’re playing with a pop-up toy. Whenever a figure pops up, look your little one in the eyes and show surprise and delight. “The sharing of enjoyment helps your child understand how to make sense of what’s going on in their environment,” says Dr. Shulman. This is also the perfect way to encourage what experts call joint attention skills—when a child directs your attention somewhere. While it develops in most babies around age 1, it isn’t as natural a skill for those with autism. “If your baby is playing with a block, point at it and tell them how excited you are about it,” says Dr. Dawson. “This shows them you’re aware of what they’re playing with and that you can enjoy things together.”
Follow your baby’s lead.
You may have a preconceived notion of what playtime looks like (stacking cups! banging blocks!), but observe what makes your baby happy and engage them with that. “Let them show you what they’re interested in,” says Dr. Dawson. If they’re playing with a drink coaster or a paper-towel roll, don’t try to get them to read a book—get down on the floor and marvel at the coaster with them. “For a baby who might be developing autism, you want to enter their world and make it fun,” says Dr. Dawson. “Letting them direct things helps you make sure they enjoy playtime.”
Sing all the time.
Children who are later diagnosed with autism may not have the same language skills as other kids. Luckily, you can help head that off by changing your tune. “Songs turn routine moments into chances to communicate, and because words are attached to a melody, it’s easier for your baby to engage with them—especially when there are gestures that go along with what you’re singing,” says Dr. Shulman. Changing a diaper? Sing “Head, Shoulders, Knees, and Toes” while touching each body part. Giving them dinner? Sing about veggies.
Take turns.
“One early sign that a child has autism is that they don’t initiate communication, so you want to help your baby grasp that it’s something they can do,” says Dr. Shulman. You may not be having actual conversations, but you can still introduce the concept that first you do something, then they do it, with the back-and-forth repeating again and again. Plenty of classic games involve taking turns, like peekaboo and rolling a ball back and forth. It can be as simple as clapping your hands, then encouraging your child to clap theirs.
Grab the spotlight.
“A child who may have autism struggles to grasp that people are more important than objects,” says Dr. Korb. To help your baby distinguish people from things, make a spectacle of yourself. “If you walk into a room and they’re sitting there, talk to them and be super-interesting,” says Dr. Korb. You can do a funny dance or speak emphatically. Another way to encourage them to look at you is to put yourself front and center while you feed them or read them a book. “Position yourself so your face is directly in your baby’s sight,” says Dr. Dawson. For a baby who is less interested in looking at people, you want them to associate pleasurable activities, like eating, with your face. They’ll realize you’re part of the experience.”
A version of this article originally appeared in Parents magazine's October 2020 issue as “Can We Lessen the Effects of Autism Before They Start?.” Want more from the magazine? Sign up for a monthly print subscription here
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