Grandparents 'may be first to spot autism in a child'

"Grandmas are usually the first to spot autism in children," the Mail Online reports.

The headline was prompted by a US online survey of parents and family members of children with autism spectrum disorder (ASD).

Researchers wanted to explore the factors linked to early or late diagnosis. They found several factors were linked, one of which was time spent with grandparents, particularly grandmothers.

More than half of parents who said another person recognised the diagnosis said this was a grandparent, and a quarter said it was the maternal grandmother.

The likelihood that grandmothers recognised a problem increased with the amount of contact they had with the child.

The findings are arguably not that surprising. People who have frequent close contact with a child often recognise things others may not – and it just happens that these close family members are often grandparents, particularly grandmothers. 

The researchers offer a number of speculations about why this effect occurs, such as grandparents having more experience in child raising, or possibly having a more objective, less emotionally engaged, viewpoint.

The findings are interesting, but need to be followed up in further studies. This was also a US sample and the findings may not be replicated in other surveys.

If you have concerns about your child's development or interactions with others, it's important to raise this with health professionals so your child can get the support they need.

Read more advice on how to request a diagnosis if you're concerned about ASD.

Where did the story come from?

The study was carried out by researchers from Columbia University, Carnegie Mellon University, and the Ichan School of Medicine at Mount Sinai, all in the US, and was supported by grants from the Organization for Autism Research and the Seaver Foundation.

It was published in the peer-reviewed journal Autism.

The Mail Online story generally reflects the findings of this study accurately, but without discussing the logical reasons why these survey findings may have come about.

What kind of research was this?

This was a cross-sectional survey of parents of children with ASD, which also included follow-up surveys of friends and family mentioned by the parents.

The aim was to explore the effect family structure can have on diagnoses of autism, and investigate the factors that may be involved in early or late diagnosis.

Autism spectrum disorders (ASD) are lifelong developmental conditions characterised by problems with social interaction and communication, often with a preference for rigid set routines and patterns.

Children with autism usually have a lower than normal IQ, though children with Asperger's can often have heightened intellect in particular areas.

As the researchers say, ideally children would be diagnosed before the age of two, but diagnosis is often delayed until around school entry.

Earlier diagnosis means children get the support they need as they begin learning and interacting with others, a "crunch time" in terms of development.

What did the researchers do?

The first survey included 477 parents of children diagnosed with ASD. In most cases (86%), the survey was completed by the mother.

A second survey included 196 friends and family whose contact details were provided by the parent.

Researchers found 80% of the children with ASD were male and average age at diagnosis was 33 months.

The researchers don't provide details of the questions asked in the survey. They say they carried out analyses to look at the effects of different variables on the age of diagnosis.

What did they find?

The factors associated with diagnosis were as follows:

Siblings

The researchers first examined the effect of siblings. Overall, they found only children were diagnosed on average six to eight months earlier than those with siblings.

This was reported to be consistent with the theory that new parents pay more attention to their only child and are especially cautious or risk averse.

Other family members

A quarter of parents reported that others who have close contact with their child thought the child may have a serious condition before they were aware themselves. The two most common people identifying this were maternal grandmothers (27%) and teachers (24%).

However, 59% of parents who said someone else had voiced concerns reported it was a grandparent (maternal or paternal).

The likelihood of the grandparent raising concerns was linked with their frequency of contact. Frequent interactions with grandparents, especially the grandmother, were found to lead to diagnosis about five months earlier.

Friends and family survey

More than half of respondents to this survey were either grandparents or aunts or uncles, and 58% saw the child at least weekly.

Just under half of all respondents (48%) reported that they suspected a condition before they were aware that the parents had any concerns themselves. Of those who did suspect a problem early on, only half told the parents of this, with about a quarter "hinting".  

What did the researchers conclude?

The researchers said that, "While this pilot study requires replication, the results identify potential causes for accelerated or delayed diagnosis, which if better understood, could ultimately improve age of diagnosis and treatment, and hence outcomes." 

Conclusions

These cross-sectional parent and family surveys explore the factors that may be associated with the timing of diagnosis of autism spectrum disorders.

It's important to put these findings into the right context. The surveys found grandparents, particularly maternal grandmothers, were often the first to recognise the signs of ASD.

But this doesn't necessarily mean grandmothers have some sort of "superpower" for recognising developmental conditions.

The fact that in a quarter of cases close family members suspected a problem before the parents themselves may reveal that people slightly removed from a family's day-to-day life may notice things people who spend constant time with a child may not.

But this study doesn't prove cause and effect – that is, though it found grandparents often recognised the diagnosis, or were linked with slightly earlier diagnosis, it didn't explore the process by which each child was diagnosed.

And it hasn't proved that the grandparent was actually instrumental in leading to the confirmed diagnosis.

Other limitations of this study include the fact the methods the researchers used aren't completely clear.

They don't say how they identified their study sample, or give details of the surveys the parents and family members were given.

This also appears to be a US sample, though location is unclear, so the findings may not be representative of people in the UK. 

Overall, the intricacies of people's feelings, and how and why they recognise things, are quite difficult to pull apart. This pilot study doesn't provide the whole answer.

If you have concerns about your child's (or grandchild's) development or interactions with others, it's important to raise this with health professionals so the child can get the support they need as soon as possible.

Read more about the early signs and symptoms of autism.