DEVELOPMENTAL MILESTONES…WHAT ARE THEY?

Developmental stages and levels determine how humans learn, change and mature from baby to adulthood. These progressions through physical, emotional, social, intellectual, moral, ethical and spiritual changes are wired in the brain before birth. When Autism spectrum disorder is present the brain has neural abnormalities which prevent the achievement of many of these mature developmental milestones. This is the result of a genetic condition.

The most obvious and easiest to observe of these milestones being achieved are the stages a baby moves through in their first twelve months when learning to walk and socialise.

Baby Development: One to Three Months

Baby may start to:

• Smile. Early on, it will be just to herself.

• Within three months, smiling in response to your smiles

• Trying to get you to smile back at her.

• Raise head and chest when on tummy.

• Track objects with her eyes and gradually decrease eye crossing.

• Open and shut her hands

• Bring hands to her mouth.

• Grip objects in her hands.

• Take swipes at or reach for dangling objects

Baby Development: Four to Six Months

• Mastering the use of their hands.

• Discovering their voices.

• Roll over from front to back or back to front.

• Babble, making sounds that can sound like real language.

• Laugh.

• Reach out for and grab objects

• Manipulate toys and other objects with hands.

• Sit up with support and have great head control.

Baby Development: Seven to Nine Months

• Rolling over, figuring out how to move forward or backward.

• Start to crawl. This can include scooting (propelling around on his bottom) or “army crawling” (dragging himself on his tummy by arms and legs), as well as standard crawling on hands and knees. Some babies never crawl, moving directly from scooting to walking.

• Sit without support.

• Respond to familiar words like his name.

• Respond to “No” by briefly stopping and looking at you,

• May start babbling "Mama" and "Dada."

• Clap and play games such as patty-cake and peekaboo.

• Pull up to a standing position.

Baby Development: 10 to 12 Months

• Begin feeding herself. Babies at this developmental stage master the “pincer grasp“-- meaning they can hold small objects such as O-shaped cereal between their thumb and forefinger.

• Cruise, or move around the room on her feet while holding onto the furniture.

• Say one or two words, and "Mama" and "Dada" become specific name for parents. The average is about three spoken words by the first birthday

• Point at objects to get your attention

•  “Pretend play” by copying you or using objects correctly, such as pretending to talk on the phone. 

• Take her first steps

• Standing

• Tottering around unaided

• Running

• Skipping and jumping

The developmental stages a person passes through and the milestones they achieve in their life, will determine to some extent what their abilities and strengths will be. The lack of achievement of particular stages, levels and milestones will also determine their weaknesses. Bloom’s Taxonomy shows that the higher levels of achievement in learning, require broad development across all areas of emotional, intellectual, physical and social growth.
Level 1 learning consists almost solely of information skills. The higher the level the more variety, of not only information collecting and remembering, but decision making, analysis, imagination, intuition, judgement, insight, organisation, empathy and forethought are required. These emotional and intuitive responses, as opposed to solely intellectual responses, are one area where people with ASD, by definition, have extreme difficulties.

BLOOM'S TAXONOMY

Level 1 – Knowledge:

Exhibits memory of previously learnt materials by recalling facts, terms, basic concepts, and answers, recall of information, discovery, observation, listing, locating, naming.

Level 2 – Comprehension:

Demonstrates understanding of facts and ideas by organising, comparing, translating, interpreting, giving descriptions, summarising, discussing, and stating main ideas.

Level 3 – Application:

Solve problems in new situations by applying previously acquired knowledge, facts, techniques, rules in a different way (generalisation), manipulating, and designing experimenting.

Level 4 – Analysis:

Examine and break information into parts by identifying motives or causes. Make inferences and find evidence to support generalisations. Identifying and analysing patterns, organising ideas, recognising trends, imagine realistic alternatives.

Level 5 – Synthesis:

Compile information together in a different way by combining elements in a new pattern or proposing alternative solutions, using old concepts to create new ideas, design and invention, composing, imagining, inferring, modifying, predicting, combining.

Level 6 – Evaluation:

Present and defend opinions by making judgements about information, validity of ideas, or quality of work based on a set of criteria, assessing theories, evaluation, comparison of ideas, evaluating outcomes, solving, judging, recommending, rating, determining consequences.

What Is Autism Spectrum Disorder (high functioning Autism)?
How does it differ from normal development?

Signs & Symptoms
Symptoms of Autism spectrum disorder (ASD) vary from one person to the next, but in general, they fall into three areas:

• Social impairment

• Communication difficulties

• Repetitive and stereotyped behaviors.

People with ASD do not follow typical patterns when developing social and communication skills: compared with neurotypical people of the same age.

In some cases, babies with ASD may seem different very early in their development. Even before their first birthday, some babies become overly focused on certain objects, rarely make eye contact, and fail to engage in typical back-and-forth play and babbling with their parents.

Other people may develop normally until the second or even third year of life, but then start to lose interest in others and become silent, withdrawn, or indifferent to social signals. Loss or reversal of normal development is called regression and occurs in some people with ASD.

Social impairment

• People with ASD make little eye contact

• Tend to look and listen less to other people than their environment or fail to respond to other people

• Do not readily seek to share their enjoyment of activities by pointing or showing things to others

• Respond unusually or not at all when others show anger, distress, or affection.

• Do not respond to emotional cues in human social interactions because they may not pay attention to the social cues that others typically notice.

• People with ASD may focus on the mouth of the person speaking to them instead of on the eyes, which is where people with typical development tend to focus.

• People with ASD appear to be drawn to repetitive movements linked to a sight or sound

• People with ASD may misread or not notice subtle social cues—a smile, a wink, or a grimace—that could help them to understand social relationships and interactions.

• May believe they are being bullied due to this inability to read and interpret subtle social cues

• Statements or questions such as, "Can you wait a minute?" always mean the same thing to the person with ASD, whether the speaker is joking, asking a real question, or issuing a firm request.

• Inability to interpret another person's tone of voice as well as gestures, facial expressions, and other nonverbal communications, means a person with ASD may not appropriately respond due to their own misinterpretation and they can become aggressive and violent.

• ASD’s lack of understanding of social interactions, strict adherence to their own rigid rules and need for control causes typical family members and co-workers to feel bullied and frightened by constant aggressive outbursts from the person with ASD.

• People with ASD also may have trouble understanding another person's point of view.

• By school age, most people understand that other people have different information, feelings and goals than they have. People with ASD lack this understanding, leaving them unable to predict or understand other people's actions.

• It can be hard for others to understand the body language of people with ASD. Their facial expressions, movements, and gestures are often vague or do not match what they are saying. Their tone of voice may not reflect their actual feelings either. Many people with ASD speak with an unusual tone of voice and may sound sing-song or flat and robot-like.

• The reality of life for ASD is constructed by their inner thoughts and assumptions in an effort to control their world. When the truth of this reality is questioned or tested by the outside world the person with ASD will lie to cover-up, justify or refrain from taking responsibility for their actions.

Communication issues

According to the American Academy of Paediatrics, Developmental Milestones, by their first birthday: typical toddlers can say one or two words, turn when they hear their name, and point when they want a toy; when offered something they do not want, toddlers make it clear with words, gestures, or facial expressions that the answer is "no."

For people with ASD, reaching such milestones may not be so straightforward. For example, people and adults with Autism may:

• Fail or be slow to respond to their name or other verbal attempts to gain their attention

• Fail or be slow to develop gestures, such as pointing and showing things to others

• Coo and babble in the first year of life, but then stop doing so

• Develop language at a delayed pace

• Learn to communicate using pictures or their own sign language

• Speak only in single words or repeat certain phrases over and over, seeming unable to combine words into meaningful sentences

• Repeat words or phrases that they hear, a condition called echolalia

• Use words that seem odd, out of place, or have a special meaning known only to those familiar with the person's way of communicating.

• Have difficulties with the back and forth of conversations. Because they find it difficult to understand and react to social cues, people with high functioning Autism often talk at length about a favorite subject, but they won't allow anyone else a chance to respond or notice when others react indifferently.

• People with ASD have not developed meaningful gestures or language so, may simply scream or grab or otherwise act out as they don’t know better ways to express their needs. 

• As people with ASD grow up, they may become aware of their difficulty in understanding others and in being understood. This awareness may cause them to become anxious or depressed.

Repetitive and stereotyped behaviors

• People with ASD often have repetitive motions or unusual behaviors. These behaviors may be extreme and very noticeable, or they can be mild and discreet. For example, some people may repeatedly flap their arms or walk in specific patterns, while others may subtly move their fingers by their eyes in what looks to be a gesture. These repetitive actions are sometimes called "stereotypy", "stereotyped behaviors" or “stimming”.

• People with ASD tend to have overly focused interests. They may become fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up objects in a certain way, rather than using them. They may also become very upset if someone accidentally moves one of the objects.

• Repetitive behavior can also take the form of a persistent, intense preoccupation. For example, they might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses.

• People with ASD do best with routine in their daily activities and surroundings, but their inflexibility is extreme and causes serious difficulties for them and other people. They may insist on eating the same exact meals every day or taking the same exact route to school or work.

• A slight change in a specific routine can be extremely upsetting for them.

• People with ASD can have aggressive, emotional outbursts, especially when feeling angry or frustrated or when placed in a new or stimulating environment.

• Often they are not diagnosed, or diagnosed late in their life, because their difficulties in social situations haven't stopped them from succeeding academically.

• Their lack of good social skills and understanding of social interaction, eventually inhibit their ability to function in many of society’s or family settings, where their academic skills won’t compensate for their social challenges.

 

Areas of High Interest and High Ability

• Hyper-focus or excessive perseverance on a specific topic is typical of people diagnosed with Autism spectrum disorder.

• People may exhibit exceptional ability in language or maths and have very narrow talents in only this one single subject.

• May have extraordinary knowledge about a specific topic, such as dinosaurs or vintage movies.

• This hyperfocus or perseverance may actually be the result of Obsessive Compulsive Disorder (OCD) which is not uncommon in people with Autism spectrum disorder. Physicians often can use appropriate medication to help manage the obsessive behavior.

 

Social Deficits

• Lack of joint attention: the ability to join with other humans in attending to what they find important.

• Deficit in theory of mind: the innate ability most human organisms have to project their own emotional and intellectual processes onto other human beings. Early in development, typically developing people respond to their mother’s faces and early on, learn to respond to their parents' moods. People on the Autism spectrum do not.

• Lack emotional literacy, and need explicit instruction in how to recognize and manage different emotional states.

• Tantrums are frequent in people with Autism spectrum disorder, because they do not know how to express their frustration or how to negotiate with family or peers.

• Executive Function Deficits: Executive function is the cognitive ability to visualize and plan ahead. It includes the short term ability to understand the steps needed to complete a task. Long term it involves the ability to anticipate the many steps that may be required to graduate from high school, to complete a degree, even to follow through on a science fair project.

• Either they are not able to prioritize and master each of the steps necessary to get to a final goal, hence they will procrastinate and be prompt dependent to mask their difficulties; or they can very skilfully plan ahead...but only regarding their 'obsessions' or personal manifesto.(high school shooters and other criminal master minds)

 

Gross and Fine Motor Skills

• People with Autism spectrum disorder may have poor balance and poor gross motor skills. This can become exaggerated as they grow older because they may prefer watching television or using the computer instead of participating in athletic activities.

• People with ASD may also have poor fine motor skills and may dislike using pencils and scissors.

• They may be very hard to motivate to write.

• They may alternatively have exceptional motor skills in a narrow area and expend huge amounts of time pursuing their special interest in sport, music or art.

• Driving vehicles may be a difficulty for some people with ASD due to their lack of ability to attend to many different conflicting cues at once or their flawed spatial relations knowledge.

Academic Deficits

• People with high functioning autism often have areas of great strength and areas of great academic weakness. This is demonstrated by high peaks and troughs on intelligence test graph results. Some people have many academic deficits across the board, from language to maths, and are often diagnosed late because of their obvious intelligence and academic performance in other areas.

• People with ASD are challenged by deficits in social skills and executive function and often struggle to perform in academic settings.

English/Language Arts: 

• People with strong information language skills may struggle to develop the skills of interpretive narrative, metaphor, irony and analysis that they need to do well in English and Language Arts.

• They may have strong vocabularies, especially when they have strong interests that they have read about. Some people with Autism spectrum disorders gain strong vocabularies because they "script," or repeat entire movies they have heard.

• People with ASD exhibiting strong language skills often exhibit good oral reading and listening skills, but are not always good interpreters of meaning, lacking the ability to find the hidden intention of the author by “reading between the lines”. This applies to their interpretation of spoken language also.

• When people with ASD are expected to answer "higher level thinking" questions, such as asking them to synthesize or analyze what they have read (as in Bloom's Taxonomy) they may be able to answer questions at the lowest level, which requires them to remember, but not questions that ask them to analyze ("What made that a good idea?") or synthesis ("If you were Hugo, where would you look?")

• Because of executive function and short term memory challenges, people with Autism spectrum disorder often face challenges with writing. They may have difficulty remembering how to spell, they may forget writing conventions such as punctuation and capitalization, and they may face fine motor challenges that make them reluctant to write.

• Alternatively some people with ASD can be excellent writers and produce great works as novelist, playwright, film writer, opera producer and so on resulting from their obsession, narrow skill set, behaviour or special interest.

Maths: 

• People with strong language or reading skills may have poor maths skills, or vice versa. Some people are "savants" when it comes to maths, memorizing maths facts quickly and seeing relationships between numbers and solving problems. Other people may have poor short and long term memory and may struggle with learning maths facts.

OBSERVING STAGES OF ASD

When we observe and examine the social and friendship skills of people with Autism spectrum disorder, we first ask whether there is a delay in the conceptual stage of friendship. The person may have an overall intellectual ability within the normal range, but their conception of friendship resembles a much younger child. Indeed the natural choice of companion or friend may be someone from within their level of friendship maturity and be considerably younger than their chronological age or much older.

Qualitative differences at each stage from the perspective of the person with Autism spectrum disorder in comparison with their typical peers

Stage 1

• The person with Autism spectrum disorder can be genuinely pleased to be left alone enjoying solitude; or their preference can be to interact with adults only. A child’s motivation may not be to engage in social play, but to learn. Adults (and books) provide information about the world. Their peers may have little knowledge on the topic that they find interesting.

• There can be a difference in perception and priorities. The person with Autism spectrum disorder can walk into a room and focus on objects in the room rather than potential friends. The contact can be constructive, but not interactive.

• The person’s friends and family are perceived as objects only, to avoid any pain of a possible negative interaction.

• To the person with Autism spectrum disorder, social interaction can be quite unpleasant. They have difficulty coping with the noise, interruptions, new ideas of their peers and apparent chaos. They may be more tolerant and interactive in a room with just one companion.

• People with Autism spectrum disorder have a clear end product in mind when engaging with objects, but may fail to effectively communicate this to the other person, or tolerate or incorporate their suggestions, which would produce an unanticipated outcome.

• The person with Autism spectrum disorder wants predictability while their peers want spontaneity and variety. The person becomes very agitated and possibly aggressive when thwarted by having to change their ideas or activity to accommodate the intentions or preferences of the other person.

• Another person joining in stops the person with ASD controlling their own environment. The person with ASD has a clear determination to control the activity. The concepts of sharing, waiting and turn taking are not apparent in their interactions with peers or family members but it may be apparent in their interactions with other adults.

• Their activity can be considered as self-centred rather than selfish, with social interaction avoided to maintain control.

• They tend not to see themselves as part of a group or family but as an individual who prefers to relate to outside people. Family members may be considered as bewildering, ignorant or a nuisance. The bewilderment is due to difficulties reading the intense social cues from intimate connections.

• They may not read the social expressions and body language to indicate feelings that would be intuitively recognised by other typical people. Neurotypical people instantly recognise overt and subtle signs of anger, fear, delight and disgust, yet these signals may not be perceived or considered as factors to modify the interaction by the person with Autism spectrum disorder.

• People with Autism spectrum disorder clearly have difficulty knowing how to socialise with their peers. Their frustration can lead to aggression but it can also lead to anxiety.

• One of the characteristics of Autism spectrum disorder is to have a literal interpretation only of the comment or request of other people.

• When other people approach the person with Autism spectrum disorder, they see someone who does not look any different in terms of size and facial characteristics. They may be engaged in complex constructive activity but when approached, the person with ASD may not offer the expected welcome or inclusion in the activity.

• The person with Autism spectrum disorder is perceived as bossy: sounding and behaving more like a teacher than a friend. Other people’s attempts to become a friend or companion “fall on deaf ears” and as a result the other person may be inclined to move on and develop a friendship or relationship with someone more responsive and less insular or dictatorial.

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  Stage 2
  

• In stage 1 the person with Autism spectrum disorder may have limited motivation to interact with other people and develop friendships and relationships.

• In stage 2 they can actively want to join in but lack specific abilities. They want to interact harmoniously but are not sure what to do. Sometimes they become acutely aware of a lack of friendship and become quite distressed if their naïve attempts at social interaction are unsuccessful.

• They can develop compensatory mechanisms that range from denial and arrogance to low self-esteem and withdrawal.

• Their initial myopic optimism for friendship can also turn to paranoia, especially if they fail to make the distinction between accidental and intentional acts.

• The research on Autism spectrum disorder has established a difficulty with Theory of Mind tasks; that is conceptualising the thoughts, feelings, knowledge and beliefs of others. Other people may recognise from the context and knowledge of the character of another person whether the comment or action had benevolent or malicious intention. For example other people know when someone is teasing with friendly or unfriendly intentions. This knowledge may not be available to the person with Autism spectrum disorder. Also, the lack of tonal quality of voice, appropriate responses and blunt speech (lacking discretion) of someone with Autism spectrum disorder makes it very difficult for a typical person to interpret their intentions.

• People with ASD can have limited ability for character judgements. Other people will know which people are not good role models and should be avoided. The person with Autism spectrum disorder can be somewhat naïve in character judgements and prone to be attracted to and imitate people who may not demonstrate good friendship or moral skills.

• There can be a tendency to be possessive in friendships with an intensity that can eventually be intolerable to their chosen friend. They may not understand that the friend is a free agent who sometimes wants to interact with other people and may refuse their approaches. When these situations occur the person with Autism spectrum disorder may refuse any further contact or become violent with the person whom they perceive as having broken their rigid social rule that a friend or partner will always interact with you.

• They may be intolerant of their friend or family member’s errors and quick to criticise but conversely, hate being criticised themselves. Other people learn to “think it; not say it” so as not to hurt their friends or family member’s feelings. At this stage, the concept of a “white lie” is a feature of friendship, but people with Autism spectrum disorder seek honesty and truth as more important than someone’s feelings. They can be unaware of why their honest comment made their friend upset.

• People at this stage are having more complex interactive occasions and so those with Autism spectrum disorder can become exceptionally emotional if they lose or feel “beaten”. Their concept of being fair is somewhat egocentric. They may always want to win or be first, not necessarily for dominance but to know the outcome. The person with ASD hates surprises or the unknown. They will always focus solely on the goal of finding the outcome quickly.

• When one considers the friendship profile of the person with Autism spectrum disorder at this stage, they are unusual in comparison to their peers in having fewer friends and often not seeking contact with friends. Contact may be organised by others rather than arranged spontaneously by them.

• They may fail to recognise that other people are not displaying signs of friendship and are quite resistant to the suggestion that their “associates” are not genuine friends in their attitude and actions.

• The person with Autism spectrum disorder can be unusual in other ways. In stage 2, neurotypical people talk to each other while they are together. The choice of conversational topic can be quite unusual for the person with Autism spectrum disorder who may want to perform or talk almost exclusively on some aspect of their special interest.

• There is a lack of reciprocity in the choice of activity or topic of conversation.

• They can also appear to be ill mannered or ungracious and somewhat autocratic. It is at this stage that empathy becomes recognised as an aspect of friendship and the typical person can expect words or gestures of compassion, compliments and offers of help.

• People with Autism spectrum disorder may not recognise the cues or know how to respond. Their friend or family member may perceive them as uncaring as a result.

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  Stage 3

• The person with ASD may take on the role of antagonist at home. They may appear to be a Dr Jekyll and Mr Hyde in behaving calmly and sociably with their peers in the outside world but extremely autocratic and intolerant when interacting with their family.

• There can also be a vehement denial that they have any difficulties. When the subject of companionship is bought up at home the person is adamant that they have similar relationships to their peers. It is not known if this is a reflection of their lack of an accurate perception of the nature of their peer’s relationships or an attempt to convince themselves, more than others that they are successful. This denial or arrogance can be impenetrable.

• The person with Autism spectrum disorder may be socially withdrawn and clinically depressed as a reaction to their inconsistent insight into their difficulties with relationships.

•  Socialising with their peers can be exhausting.

• During stage 3, people are learning to constructively manage conflict, but people with Autism spectrum disorder have considerable difficulty with the subtle arts of persuasion, negotiation, knowing when to back down, trying another way, admitting making a mistake and making personal sacrifices for the sake of friendship. These interpersonal management skills require a comprehensive understanding of another person’s thoughts and feelings. This can be elusive for the person with Autism spectrum disorder.

• Peers expect an allegiance to the group, family or marriage. For the person with Autism spectrum disorder, their allegiance is to their rules.

• As regards to the choice of a friend or marriage partner, there is an expectation of choosing someone of a similar age, and values; social conventions not readily recognised by the person with Autism spectrum disorder.

• A boy with ASD may have several friends, including girls who are kind and sociable. Their friends may be considerably younger or older, or from a different cultural background. Their choice of friend may cause them to be ridiculed, as their peer group may not value their chosen friend.

• The person with Autism spectrum disorder is “poor” in terms of the currency of friendship or intimate relationship. In return, the person with Autism spectrum disorder perceives peers as having limited currency for his or her culture, namely knowledge.

Stage 4

• For typical teenagers this stage begins in high school and continues throughout adult years. The difficulties encountered by someone with Autism spectrum disorder include the practical issues of finding someone with the same interests, experiences and thought processes. They can express strong feelings of loneliness and yearning to have a genuine friend.

• Another characteristic can be a lack of personal hygiene and an eccentric personal appearance, which obviously has an effect on other people’s perception of them. There can be real difficulty in knowing what to say and the translation and communication of the social language.

• The person with ASD will have considerable difficulty with the concept of self and introspection. A difficulty conceptualising the thoughts and feelings of others (Theory of Mind skills) can include a difficulty verbalising their own thoughts and feelings.

• The person with Autism spectrum disorder can become acutely aware of their problems and errors in social interaction.

• They may seek excessive reassurance that their intention was understood and dwell on potential social errors.  

• The person with ASD can be gullible and vulnerable with regard to the misinterpretation of signals and intentions. A friendly remark or gesture may be perceived as meaning more than was intended. A friendly smile or touch during conversation could be conceived as indicating the person would like to progress to a more intimate relationship. Others would know that such actions or gestures were simply signs of an effusive personality.

• The person with Autism spectrum disorder can misinterpret the actions of others and develop an emotional attachment that progresses to a special interest in that person which may be misperceived by the others as an infatuation or stalking.

• There can also be desperation to be included in a group, but this can be a group whose values and lifestyle can lead the person to be in conflict with the law. They can act the part, and wear the costume of a marginalised group. Members of that group realise that they are not the genuine article and encourage them to break their strict adherence to their moral and legal code, knowing they are not “street wise” and more likely to be caught by the authorities.

• In an intimate, family relationship there is misinterpretation or ignorance of the other person’s feelings and body language, by the person with ASD.

• If people with Autism spectrum disorder are unsuccessful in finding a friend, they may develop a friendship with animals that accept them for who they are, whose feelings are more easily understood and unlikely to take offence. Their substitute friends and “family” can be a menagerie of animals.

• The person with Autism spectrum disorder can appear to be quite eccentric, immature, passive or aggressive requiring considerable patience and understanding from others.

• Life for family members of someone with ASD is testing and difficult. Their behaviour and lack of innate skills causes problems for family, not just the person themselves. Domestic violence, bullying and emotional abuse is a feature of many more of these families, than the general population.

References:

BabyCentre Medical Advisory Board
http://www.babycentre.co.uk/a6507/developmental-milestones-walking#ixzz2uHzuh9wx

Gina Shaw Reviewed by Renee A. Alli, MD How Your Newborn Grows: Infant Development Baby’s First Year: How Infants Develop

Jenison Autism Journal, 2002 Volume 14 Number 3. The Profile of Friendship Skills in Asperger’s syndrome

Jerry Webster Asperger’s - the Highest Functioning End of the Autism Spectrum Social and Executive Function Weaknesses Impede Academic and Social Success

Attwood, Tony, The Complete Guide to Asperger’s