Presence

Is your child:

• Not seeing or hearing you, only attending to the toy or object?
• Struggling to connect socially?
• Staring at objects for hours at a time, rather than engaging with people?
• Enjoying watching the ceiling fan or the spinning wheel of a toy car?
• Lining things up meticulously by color?
• Preferring to play alone than with others?
• Running to see a cool toy without a glance to you to see if you like it too?

You may notice your child paying more attention to toys than people. What’s the matter? Your child may be having difficulty with social presence. He or she may be more apt to focus on objects and not on people, particularly eyes and faces.

Some parents start to question their toddler’s hearing or vision. When playing with an interesting toy, a child may seem like he or she can’t hear you at all. Does your child share enjoyment with you when something cool happens?

For example, your child may see a pretty balloon, point and then look at your eyes and smile or say, “Look, mommy!” Does your child establish joint attention?

Establishing joint attention means he or she looks at an object, references it by pointing to it, naming it, or making a sound, and then looks at you and looks back at the object. Being close to people, sharing enjoyment with eyes, gestures, and words, and establishing joint attention are all indicators of early social development.

Clinically, early social engagement has a motor component and an attention component. Considering whether your toddler wants to be close to other people and enjoys social presence is one variable. Another variable to consider is whether your child is more interested in the objects or in the people.

Children who constantly reference, watch and enjoy other people, both adults and children, are progressing socially [5; 6]. Children who want to be near others tend to watch them, model their behavior, and wish to communicate with them.

Children with Autism Spectrum Disorders often lack social reciprocity. Joint Attention and Shared Enjoyment are evaluated through tasks on the ADOS-2 and through questions in interviews and on rating scales. One way to consider these concepts is to think, “Is my child more interested in the social interaction with others or in just the toy itself?”

Children with Autism tend to be more interested in the toys, and parents must work very hard to gain the attention of their child. In these cases, children are often engaged in physical play, spinning, bouncing games, peek-a-boo, and wrestling. Children might make eye contact during physical play but not during quiet play with toys.

Movement and physical activity may be organizing to the brain and thus more engaging to your child. Other children may find such physical play overwhelming, and they are very sensitive to sensory elements. Autism is characterized by social communication deficits and restricted and repetitive behaviors. What we know is that the brain is wired differently, often with areas of strength. The connections made of white matter in the brain are too dense or too sparse, impacting the way information is processed and stored in the brain [1].

Often, children with Autism enjoy repetitive motion that is related to objects. Some children roll toy cars back and forth, watching the wheels. Others line toys in a pattern and become frustrated if one is out of position. It may feel during these times that it does not matter to your child whether or not you are in the room.  Again, a question to ask yourself is whether your child is more interested in you or the toy.

The good news here is that social skills can be taught. When your child is young, and his or her brain can grow and change with the right experiences and therapy. Studies show that children who have good language, good cognitive skills and good adaptive skills are the most resilient [1].

It will be important to assess these areas and to begin treatment quickly. Modeling and scaffolding social interactions can be done by an Applied Behavior Analysis (ABA) therapist. ABA is often covered by insurance if your child is diagnosed with an Autism Spectrum Disorder. In addition, seek Speech and Language Therapy if your child has language weaknesses and Occupational Therapy if fine motor skills are weak or your child has a number of sensory sensitivities.

Resources available online from the University of California at Santa Barbara, where the Koegels developed Pivotal Response Therapy (PRT), are a good place to start as far as accessing tools as a parent to help your child gain and improve skills [2,3]. A website for the Association for Science in Autism Treatment offers information on various treatments for Autism symptoms and on the effectiveness and research behind these treatments [7].

There are excellent social skills guidebooks such as those by Jed Baker [9, 10] that teach children the importance of polite greetings, responding to those who greet us, eye contact, and active listening. Carol Gray’s social stories book is an excellent resource for teaching basic social norms and provides a CD so that the stories can be customized for the child [12].

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Social Communication (Socializing): children with poor social presence tend to struggle significantly with social skills
• Auditory Processing: children with difficulty understanding the sounds within words may struggle socially as well
• Joint Attention (Focusing): children with poor social presence may also have difficulties paying attention to other children socially and following directions
• Expressive language: some children with poor social presence have difficulty expressing their thoughts and ideas
• Receptive language: children who have difficulty comprehending language may also have poor social presence because they are not understanding conversations or social interactions
• Restricted Patterns of Behavior (Repetitive Behavior, Perseverating, Rigidity, Rigid Behavior): some children with poor social presence of restricted or repetitive behavior

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Hearing or Vision Problem – always check with your medical doctor if you think you child may not be hearing or seeing you. Once you determine that these functions are intact it may be plausible to consider other diagnoses.
• Autism Spectrum Disorder: deficits in social communication and restricted interests or behaviors. In young children social, interaction is defined by social presence, making eye contact, watching others, sharing enjoyment, and using joint attention.
• Language Disorder: deficits in language can make it hard for a child to connect. He or she may be frustrated and unable to voice wants or needs. Sometimes children with ASD have language impairments so this is an important area to have assessed.
• Intellectual Disability: individuals with low IQ scores often are slow to develop and may be delayed in reaching social milestones. If this is the case, there will be global delays not just in the area of social interaction.

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child, or to consult ‘live’ with a psychologist
• Psychologist or Neuropsychologist: to consider an evaluation for diagnostic clarification. If you are told you will have to wait one to two years, ask for referrals to other providers who specialize in Autism. Early intervention services are crucial
• Developmental Pediatrician: to guide diagnosis and treatment. This pediatrician specializes in children with developmental delays and can help guide behavioral and medical treatment
• Geneticist/Metabolic Specialist/Neurologist: to provide a thorough evaluation. Depending on the needs of your child, a genetic panel, sleep study, or metabolic intervention might be recommended by the psychologist or developmental pediatrician
• ABA Therapist: to teach functional behaviors. Applied Behavior Analysis uses principles of reinforcement to increase desired behaviors like communication and language and to decrease undesired behaviors like hitting/tantrums
• Speech and Language Pathologist: to teach the language skills needed to communicate effectively. An SLP is an important member of your treatment team if your child has language delays. Treatment works best if all team members can communicate with one another to make sure your child is getting comprehensive services

These professionals may recommend or administer the following tests for this symptom:

• DAS-II Preschool: this test of early cognitive abilities can provide an idea of how a child is developing in language and verbal comprehension, nonverbal reasoning, and spatial processing. Cognitive abilities are not stable until around age seven, but this measure can give an idea of what domains would benefit from intervention and what is developing typically. This measure starts at age 2 ½.
• CELF-Preschool: this test of core language can provide assessment of Vocabulary, Language Comprehension, and Expressive and Receptive Language. This measure can be given to a 3, 4 or 5 year old.
• Mullen: this test of expressive and receptive language, fine and gross motor skills, and visual reception provides an early estimate of cognitive functioning. This measure can be given to an infant and provides age equivalent scores in the 5 domains mentioned.
• ADOS-2 Toddler Module: this test is used for the assessment of social communication and restricted, repetitive behavior. It can be used to rule in or out the presence of an Autism Spectrum Disorder. Getting this diagnosis early opens doors for funding via insurance or Medicaid waivers. Early Intervention has been shown to be most effective, and ABA therapy should commence, using a Pivotal Response approach, immediately

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

• Springer
• Amazon

[2] Koegel Autism Center, University of California at Santa Barbara

• UCSB Koegel Autism Center

[2] Koegel Autism Center, University of California at Santa Barbara.

education.ucsb.edu/autism 

[3] UCSB PEERS Clinic. https://www.semel.ucla.edu/peers

[4] Ozonoff, Sally, Dawson, Geraldine & McPartland, James C. (2014). A parent’s guide to high functioning autism spectrum disorder: How to meet the challenges and help your child thrive.

Amazon: https://www.amazon.com/Parents-High-Functioning-Autism-Spectrum-Disorder/dp/1462517471/

[5] Berns, Roberta M. (2010). Child, family, school, community: Socialization and support.

Amazon: https://www.amazon.com/Child-Family-School-Community-Socialization/dp/1305088972/

[6] Trawick-Smith, Jeffrey (2013). Early childhood development: A multicultural perspective.

Amazon: https://www.amazon.com/Early-Childhood-Development-Multicultural-Perspective/dp/0132868598/ref=dp_ob_title_bk

[7] Association for Science in Autism Treatment, to learn more about effective and research based interventions for Autism www.Asatonline.org

[8] Barton, Erin. Educating Young Children with Autism Spectrum Disorders.

http://www.nasponline.org/books-and-products/products/books/titles/educating-young-children-with-autism

[9] Baker, Jed. (2001). The social skills picture book: Teaching play, emotion, and communication to children with autism.

Amazon: https://www.amazon.com/Picture-Teaching-emotion-communication-children/dp/1885477910/

[10] Baker, Jed. (2006) Social skills picture book for high school and beyond.

Amazon: https://www.amazon.com/Social-Skills-Picture-School-Beyond/dp/1932565353/

[11] Baker, Jed. (Retrieved 2017). Social skills books and resources for ASD.

http://socialskillstrainingproject.com/books.html

[12] Gray, Carol & Attwood, Tony (2010). The New Social Story Book, Revised and Expanded 10th Anniversary Edition: Over 150 Social Stories that Teach Everyday Social Skills to Children with Autism or Asperger’s Syndrome, and their Peers.

Amazon: https://www.amazon.com/Social-Story-Revised-Expanded-Anniversary/dp/1935274058/

Image Credit:
Description: Cute little girl playing with black domino outside the house
Image ID:# 62331245
By: HalfPoint
Signs-of-autism
Previously Licensed on: September 24, 2016
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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