According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) of the American Psychiatric Association updated for 2013, autism spectrum disorder (ASD) is a neurodevelopmental disorder, characterized by: A. Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following: 1. Deficits in social-emotional reciprocity. Failure to initiate or respond to social interaction. 2. Deficits in non-verbal communicative used for social interaction, including lack of eye contact and lack of facial expressions. 3. Deficits in developing, maintaining and understanding relationships. Deficits in sharing imaginative play and absence in interest in peers. B. Restricted repetitive patterns of behavior, interest, or activities by at least two of the following: 1. stereotyped or repetitive motor movements, use of objects or speech. 2. insistence one sameness, inflexible adherence of routines or ritualized patterns of verbal or nonverbal behaviors. 3. Highly restricts, fixated interests that are abnormal in intensity or focus. 4. Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment. Severity is based on social communication impairments and restricted repetitive patterns or behavior.

Deciphering the etiology of autism is a complex scientific task. For several decades there have been many research findings pointing to genetic factors. At this stage it is not yet possible to isolate the genetic, environmental and neurodevelopmental influences. The central reference in autism research is in the field of epigenetics, which combines the innate biological data (predisposition) and the environmental aspects that are reflected in the infant's life.

A statistical review in the 1980s indicated four children out of five thousand were diagnosed with autism. In the early 1990s, along with the expansion of the criteria in the diagnostic manual of the American Psychiatric Association, the diagnostic of autism also expanded to PDD (when Asperger's syndrome was included as part of the diagnosis) and the prevalence increased to three children out of a thousand were diagnosed with autism. In 2013, the extent of the autism phenomenon reached extremely high numbers: one in eighty-eight children (1:88) in the USA and one in one hundred children (1:100) in Israel were diagnosed with autism. A decade later, in 2023, statistical publications report one in forty-eight children (1:48) in the USA and one in sixty-eight (1:68) in Israel.

Parents who feel that something is atypical in the development of their interaction with their infant should see a developmental pediatrician. It should be remembered that if the early tests do not show clear results and if symptoms persist, it is advisable to check the infant again after a short period of time. As mentioned, early detection may be critical to the baby's development and the parents must claim their right to this type of assessment.

In recent years, there has been a significant decrease in the age of diagnosis. In Israel, and especially in the center of the country, children are usually diagnosed between the ages of one and one and a half years. In the periphery, diagnoses are given at a slightly later age: at one and a half to two years. This age may be late. Studies conducted at The Mifne Center point to the age of two and under as being more effective for the treatment and modification of an existing condition due to brain flexibility that characterizes infancy. Therefore, it is important to try to receive an evaluation for infants up to one and a half years old at the latest.

In infancy, the brain has great plasticity. In the first 18 months of life, there is an accelerated growth of the neurons in the brain, these neurons connect, creating entangled representation of cells that control the sensory-emotional-cognitive regulation of the infant. An infant who avoids contact with the environment is in many cases an infant who experiences a high sensory overload that makes it difficult for him/her to deal with his/her surroundings. Specialized treatment for an infant experiencing difficulty of this type can help him/her change his/her ability to regulate sensory processing, help in the process of emotional development and thus change the entire course of development.

The diagnostic common tool accepted today is ADOS, and it is suitable for the diagnosis of children from the age of two and a half. -From the age of two, the ADOS-T version for toddlers is usually used - At the age of a year and a half – the CHATT -Up to the age of 15 months, we use the ESPASSI© assessment tool, which was developed at The Mifne Center to detect the existence of a developmental disorder and suspected autism in infants. Where? Diagnoses are done at child development centers of health funds and in the hospitals. Every hospital in Israel has a child development institute, but for the most part it takes a long time for an appointment. Therefore, one should also consider the possibility of a diagnosis done privately by an expert with experience in the field of infancy, in order not to lose precious time. The diagnosis will usually be made by: - Developmental pediatrician -Pediatric neurologist - Child psychiatrist

Mothers usually have good intuitions about their babies and it is important to listen to them. In many cases, parents and professionals tend to wait for a definite diagnosis but miss a critical window of opportunity. Therefore, it is important to find symptoms that are related to autism and raise the possibility of suspecting autism, which is certainly accepted today, and not necessarily a diagnosis of autism. In the end, the baby's difficulties should be treated, not the diagnosis.

Infants are born with the ability to bond and build relationships. This ability can be distinguished already at the age of three months. When a baby does not make eye contact, does not respond, and does not show interest in the environment, the possibility of neuro-physiological difficulties must first be examined (sight/hearing test). When these are found to be typical, an examination of the development of relationship with the infant should be considered. See the 8 early signs of autism

One of the main problems in autism is a lack of integration between the systems responsible for sensory sensation, cognition, emotion and perception. In the past there was a perception that autism denoted a sensory deficit. Today we know that there is actually a sensory overload that creates an imbalance and causes confusion and anxiety. In infancy it is still possible to influence sensory regulation through controlled stimulation, according to the needs of the infant. The lack of regulation is also linked to eating problems in children with challenges in interaction development.

Many toddlers diagnosed on the autism spectrum suffer from eating disorders - disruptions in eating habits develop as a result of sensory, and emotional dysregulation. Toddlers who refuse to switch to solid food, are sometimes afraid of certain textures, colors, the feeling that is created in the mouth, the disappearance of food after swallowing and the act of chewing that changes the state of aggregation of the food can be diagnosed with eating problems in early childhood. In later stages, the problem can also manifest itself in the fear of moving their bowels and using the bathroom. In a study done at The Mifne Center on the relationship between eating habits and behavioral functioning, it was found that improvement in eating habits lead to improvement in a variety of other developmental areas of life. As the child is exposed to a wider variety of foods and begins to become more flexible in tasting and expanding his/her interest in food, you can observe the broadening of the child's interest in the environment, in the expansion of the modes of play, and in the enjoyment in interpersonal relationships.

Eating disorders among children on the autism spectrum are universal. An infant who does not eat, causes parents to worry. Therefore, anxiety may increase and food often becomes a central and frustrating issue. Foremost, it is important to find out if there is a medical problem related to the difficulty in eating. A toddler can be affected by anxiety he feels from the environment. As the infant grows, the difficulty increases, so it is advised to make the meal fun and interesting for the toddler and to be patient and not give up on giving the infant new tastes, textures, and experiences. Important Information: Children eat when they are hungry. If it seems that the child will not cooperate with eating his/her meal, it is sometimes better to give up on one or two meals and not rush to give a bottle as a substitute. A toddler with a sensory sensitivity problem or anxiety will usually not agree to try something new if he is not hungry enough. It is recommended to enlist the help of a professional in the field of eating disorders if necessary.