Childhood autism spectrum disorders (autism) are a common group of neurodevelopmental disorders characterized by impaired social interaction, narrow interests and repetitive stereotypic behaviors, and sensory abnormalities. In recent years, the prevalence of autism has increased significantly in countries around the world, with an estimated global prevalence of about 1%, making it one of the most common causes of disability in children. Improved awareness and diagnosis of autism among physicians, increased public awareness of autism, and revision of autism diagnostic criteria are the main reasons for the increase in the prevalence of autism. Despite the high prevalence of autism and the high rate of disability, autism is one of the most effective disorders in terms of treatment and intervention among all types of disorders that cause disability in children. Most children with autism can improve to varying degrees with scientific interventions, and a significant proportion of them can live, learn and even work independently in adulthood, and a small number of them can make important contributions to society, especially those who are diagnosed and intervened early. Therefore, early diagnosis and early intervention of autism is a priority for autism prevention and treatment in countries all over the world. The newly revised Diagnostic Disorders Manual of Mental Disorders, Fifth Edition (DSM-5) clearly states that as a category of congenital developmental behavior disorder, symptoms of autism must appear in early infancy, which provides a reasonable basis and criteria for doctors to make early diagnosis of autism. Unlike some congenital defects that manifest themselves at birth, in autism, although sensitive parents can detect the early signs and symptoms of autism in infants under one year of age, and a few experienced physicians are able to make a diagnosis within one year of age, most children do not begin to show symptoms of autism until a certain age. symptoms of autism. The diagnosis of autism is usually more reliable and stable after the age of 3 years, which means that the diagnosis of autism at a younger age is sometimes unreliable. This is of course related to whether the physician follows standardized procedures, uses high-quality diagnostic scales and assessment tools, and is also closely related to the personal clinical experience of the diagnosing physician. So do we need to give a definitive diagnosis after the age of three years in order to ensure the reliability of the diagnosis? The answer is clearly no. For autism and other developmental disorders, such as intellectual disability and cerebral palsy, early diagnosis has proven to be extremely important because early diagnosis allows for early intervention, i.e. early treatment. For children with autism, if we can diagnose the child at the age of two or even one year and start treatment early, the child’s chances of improvement are significantly higher than if the intervention is started at an older age, which can have a multiplier effect. Of course, it has also been pointed out that, given the unreliability of early diagnosis and the negative impact of diagnostic labeling, children who do not have obvious symptoms can be undiagnosed; however, undiagnosis does not mean no help, and targeted interventions should still be given. It is not necessary to wait until the child is older and the symptoms become typical before starting interventions. So what are the early signs of autism? Even in a normally developing child of about one year old, we do not have high demands on the child’s social interaction because the main activities of life are taken care of by the parents, and the child is not required to have the ability to interact with other children. ability” to display stereotypical behaviors such as spinning and arranging objects. Therefore, early diagnosis of autism is not easy even for the most experienced doctors. But early diagnosis is not impossible. To detect autism early, child health workers and parents need to be aware that the earliest symptoms are usually not the presence of certain abnormal behaviors, but rather the lack of certain normal behaviors. These include the following: 1) the child does not respond to his or her name or only responds to his or her name when someone walks right up to him or her and makes a face; 2) the child used to say a few words and then does not say them anymore (language regression); and 3) a child as young as 2 years old has regressed social skills. For example, a child who used to clap his hands or play games like “buggy” and peek-a-boo, and wave goodbye, loses these skills; 4. “bottle” or “duck” and then gradually stopped using them and no other new words appeared. 5. Children have learned to use their fingers to express requests for objects, but never use “point” to show objects to others or to get their attention. More than half of parents take their children to the doctor or seek help because of their child’s inability to speak. For children over one and a half years of age, the inability to speak meaningfully (e.g., pointing to “mommy, daddy”) must be considered a possibility for autism. Of course, we know that there are many reasons why a child may not speak or may have a mild speech delay. These include autism, as well as idiopathic language development disorders, mental retardation, cerebral palsy, deafness, etc. Doctors should be careful not to tell parents casually and reassuringly, “Don’t worry, it will get better when you are older”. Doctors can consider the language problem as an entry point for autism and start to learn more about the child’s other conditions, gather more developmental and behavioral information, and make a preliminary judgment or referral accordingly. It is also important to note that in China, it is very difficult for pediatricians to diagnose autism in the general office because of the lack of space and toys for children to play freely in the general office, the limited time available for pediatricians to see the child, the difficulty in observing the lack of the aforementioned skills, and the fact that children are generally afraid of doctors and do not look at them, do not respond to others’ speech, or are unwilling to play. . The appropriate use of common screening tools is an important tool to improve the early diagnosis of autism. For example, the Modified Checklist for Autism in Toddlers (M-CHAT), which can be used to screen children from one and a half to two years old, is the most commonly used screening test in China. Communication and Symbolic Behavior Scales Developmental Profile (CSBSDP) for infants 6 months to 2 years old; the first year inventory (FYI) for infants 9 months to 1 year old; and the Early Screening for Autistic Traits (ESAT) for children aged 15-18 months; most of these scales are available in Chinese and can be used by primary care physicians. However, the problems with these screening tests are exactly the opposite of what we had estimated. Experts originally feared that these tests might be “overdiagnostic” and would include a large number of children who did not have autism. But in fact, these tests miss many cases that should be diagnosed as autism. Researchers at Florida State University have observed that the following characteristics can be used as early warning signs (red flags) of autism in infants and toddlers of all ages. If a child shows any of the following signs, the child should be referred to a professional for further evaluation of autism as soon as possible. Early warning signs of autism in infants and toddlers 1. by 6 months of age, the child is not laughing or making other enthusiastic, cheerful expressions 2. by 9 months of age, the child is not interactively sharing sounds, smiles, or other facial expressions 3. by 12 months of age, the child is not babbling 4. by 12 months of age, the child is not making gestures, such as pointing with fingers, showing things to others, reaching for things, or waving 5. by 16 months of age, the child does not have language No language by 16 months of age 6. No meaningful two-word phrases by 24 months of age (not including imitation or repetition) 7. Degradation of speech, babbling, and social skills at any age How should we view suspicious positive results of early screening? As mentioned above, pediatric developmental behavior specialists with extensive experience can already make a diagnosis of autism in individual typical cases around or even before the age of one year. In practice, however, in most cases doctors are still more cautious. Doctors do find that some children who do not pass the screening test, i.e., screen positive or suspicious, have some early signs of autism around the age of one, such as not being able to respond to a call (not a hearing problem); not being able to gaze (not a visual impairment); lacking attachment to the mother; but these children do not have stereotypic behaviors; language is not present but is within the developmental range; for such children, doctors usually do not make a diagnosis. For such children, the physician usually does not make a diagnosis, but gives intervention instructions; follow-up visits are required every month or two months. If the child’s condition gradually improves, this is the desired outcome; if the child’s problems seem to be becoming more pronounced, the doctor will make a final diagnosis and provide intensive intervention, depending on the situation. So parents may ask why intensive intervention is not given from the beginning. The reason is that educational activities in an enriched environment may be sufficient for a child of a younger age without delaying the child’s condition; in addition, the diagnosis of “autism” can put parents in a state of excessive anxiety at this stage due to the overall poor prognosis or severity of the problem, which is not always appropriate, because in clinical practice It is true that some children have these problems from 6 months to about a year old, and then gradually improve and develop into normal children. The American Academy of Pediatrics stated in 2008 that primary care pediatricians must ask, observe, and document early signs of autism during the infant’s 9-month health care visit, and if they find any of these early signs, they should refer the child to a specialist if they are unsure of the diagnosis and provide parents with easy early intervention methods. In fact, early intervention activities before and after the first year of age, especially before the first year of age, are not very different from normal child rearing, and are not very specialized or advanced techniques or measures, but rather reinforcement of normal education, that is, educational activities in an enriched environment. The key points include the following: 1. As much as possible, the child is not left alone (or busy alone), and the parent is always in a one-on-one, face-to-face interaction with the child. Parents should use rich eyes, realistic and slightly exaggerated expressions and gestures, and beautiful language to provide intensive social interaction with their children. Parents need to be enthusiastic and articulate in their speech. 3. Parents should intervene with the help of the child’s physical needs, daily parenting activities, parent-child games and other processes. Avoid children watching TV or playing computer games as much as possible. Do more traditional infant and toddler games. 4. Emphasize parents’ understanding of infant temperament and implement individualized parenting accordingly to help children form secure attachments. 5. Emphasize relevant parent-child games and social interaction activities according to the laws of children’s social development. Whether the child responds or not, parents should not be influenced by this. If the child responds appropriately, then continue such activities happily; if the child does not respond, do not stop the planned educational activities because of feeling frustrated, but ensure that the child grows up during this period with rich social interactions with parents and family members. Perhaps the child gradually improves and is not autistic anymore, and we and the parents are optimistic; perhaps the child still has autism-related characteristics as he/she ages, then we are not holding the child back, and the theory of early infant neuroplasticity tells us that the previous educational interventions had a remitting effect on the child’s symptoms, and even that an important reversal of the remitting effect occurred.