Did you know that lack of pointing with your index finger by the age of 18 months is a
red flag for possible autism?
In this video blog I'm going to show you how you can keep an eye on this early communication
skill in babies and toddlers and how to work on teaching toddlers with or without a diagnosis
of autism this important skill of pointing.
Hi, I'm Dr. Mary Barbera, autism mom, board-certified behavior analyst, online course creator, and
best-selling author of The Verbal Behavior Approach.
Each week I provide you with some of my ideas about turning autism around so if you haven't
subscribe to my YouTube channel you could do that now.
When my son Lucas was diagnosed with autism one day before his third birthday I started
learning the warning signs of autism that everyone seemed to miss.
I was really upset that not only didn't I know about the importance of pointing, but
Lucas' pediatrician and his speech and language pathologist didn't know that lack of pointing
was a red flag for autism.
Instead of pointing Lucas used a lot of what they call hand leading, which I didn't know
what this was.
So what he would do is if he'd want something he would take my hand and he would pull it
and put it on the item he wanted.
This is call hand leading.
Hand leading and lack of pointing with the index finger are core deficit often associated
with early autism.
The assessment of pointing is used in many autism screenings and is considered a big
red flag.
There are two types of pointing which I found out after Lucas' diagnosis of course.
There's a type of pointing called imperative pointing which means pointing at an item to
make a request, such as pointing at a cookie on a shelf when you want a cookie.
And then there's a second type of pointing that's even more important and this is declarative
pointing, which is pointing at an object or an action to get someone's attention.
So this could be pointing at an airplane in the sky, and even if the child's not talking
if they're pointing and looking to an adult to also show them the airplane in the sky
... This is a very good skill to have at 15 to 18 months old.
And most children with autism don't have that type of pointing that early on.
So both types of pointing, the imperative and declarative pointing, are almost always
delayed or absent in children with autism when they are young.
Pointing to request or gain attention and other gestures such as showing an item to
a caregiver, reaching to be picked up with both arms, waving, and shaking head no, should
all emerge between the ages of 9 and 15 months of age for typically developing children.
So failure to point and use these other typical gestures by 18 months is a deficit in joint
attention and could mean possible autism.
Now, I want to say this is not a definite sign.
You could point and you could still have autism.
You could point and you could have some skills regress.
Like Lucas used to wave beautifully but then he regressed and stopped waving.
So you could have a infant that points maybe at 12 or 15 months old, or waves or shows
you items, and then this becomes rarer and rarer.
But you could point and still have autism.
You could not point and not get diagnosed with autism.
So it's just one of the signs that practitioners who can diagnose autism will look for.
And I wanted just to tell you how important this skill is.
And I also have good news about pointing.
It's a behavior that can be taught just like any other behavior.
You don't have to wait for a diagnosis, since even children at high risk that aren't pointing
yet can learn how to point.
So over the years I've developed a system to teach pointing and it's pretty easy.
So I'll show you the first step that is to teach a child to point with their index fingers
to actually touch items with their index fingers.
Here's a real short clip of a former client, Jack, and on this video we're working on teaching
him to point to items and pictures in a book, and also to pictures.
Good.
Touch the cow.
Yay!
Thank you.
Pardon me.
What time is it?
It's time for lunch.
What time is it?
It's time for lunch.
Touch Adam.
Adam.
Good, touch momma.
Momma.
Touch Adam.
Adam.
Momma.
What would you like?
Movie.
So once pointing to touch items in a book or on flashcards is mastered or on toys, we
want to teach pointing with an index finger to things like the cookie on the shelf or
the airplane in the sky.
And this will involve a little bit more of a process.
But totally doable.
So to summarize, there are two types of pointing.
One is called imperative pointing, and this is where young children point to things to
request items.
And then there's the declarative pointing which is when toddlers point to get attention,
such as pointing to an airplane in the sky.
Lack of pointing with the index finger on a regular basis by 15 to 18 months can be
an early sign of autism.
But there are ways to teach the skill of pointing and this is often a big turning point to start
seeing progress.
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And for more information on my approach for turning autism around, attend a free workshop
at marybarbera.com/workshops.
And I'll see you right here next week.