Is Lack of Pointing a Sign of Autism?

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.

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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. So if he’d want something he would take my hand and he would pull it and put it on the item that he wanted. This is called hand leading.

Hand leading and lack of pointing with the index finger are core deficits 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. 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. Then there’s a second type of pointing that’s even more important and it is declarative pointing, which is pointing at an object or an action to get someone’s attention.

An example of this is a child pointing at an airplane in the sky.  Even if the child’s not talking but if they’re pointing and looking to an adult to also show them the airplane in the sky, which is a very good skill to have at 15 to 18 months old. Most children with autism don’t have this type of pointing that early on.

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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 their head no, should all emerge between 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 lack of pointing 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, who used to wave beautifully but then he regressed and stopped waving. So you could have an infant that points at 12 or 15 months old, or waves or shows you items, and then this becomes rarer and rarer.  You could also not point and not get diagnosed with autism. It’s just one of the signs that practitioners who can diagnose autism will look for. I wanted to tell you just how important this skill is. 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.

Over the years, I’ve developed a system to teach pointing and it’s pretty easy. So I’ll show you the first step to teach a child to point with their index fingers is to actually touch items with their index fingers. Here’s a short clip of a former client, Jack, and on this video we’re working on teaching him to point to items in a book, and also to pictures.

Once pointing to touch items in a book, on toys, or on flashcards is mastered, we want to teach pointing with an index finger to things like the cookie on the shelf or the airplane in the sky. This will involve a little bit more of a process but can be done. So to summarize, there are two types of pointing. One is called imperative pointing, where young children point to things to request items. And there’s 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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