**5. Results and discussion**

#### **5.1 Results**

Remember that the main objective of this research is to first identify the average age of detection of the first signs of ASD by parents and then identify the nature of these signs. In other words, we seek to identify what is the area most identified by parents. Statistical analysis was performed using SPSS software. The results are presented in the following tables:

#### *5.1.1 Average age of recognition of the first signs by the parents*

**Table 3** shows that the average age of identification of the first signs of autism by parents is around 19 months.

#### *5.1.2 Nature and percentage of signs reported by parents*

**Figure 1** shows that the highest number of parents report signs that relate to verbal communication with a percentage of 30.50%; 28.81% of them first identify signs related to non-verbal communication; 12.71% identify social and emotional abnormalities; 11.86% of parents identify sensory particularities; 11.2% are alarmed by behavioral particularities; and finally, 5.06% of them identify motor specificities.

#### *5.1.3 Identification of warning signs of ASD and economic level of parents*

An analysis of variance was carried out in order to know if a difference exists between the different economic levels of the parents in the age of the identification of the first signs.


**Table 3.**

*Average age of detection of the first abnormalities by the parents.*

*Identification of Autism Spectrum Disorder: The First Signs Identified by Algerian Parents DOI: http://dx.doi.org/10.5772/intechopen.108000*

**Figure 1.** *Percentage of different warning signs reported by parents.*

#### *5.1.4 Economic level of fathers*

**Table 4** shows that the p-value (0.48) is greater than 0.05. These results indicate that there is no significant difference between the economic levels of the fathers in the age of detection of the first signs of ASD. However, the descriptive analysis shows that fathers with a high socioeconomic level detect precursor signs earlier than parents with medium and low socioeconomic levels (mean, standard deviation 21 (8.78)).

#### *5.1.5 Economic level of mothers*

**Table 5** indicates that the p-value (0.31) is greater than 0.05. This result reveals that there is no statistically significant difference between the economic levels of the mothers and the age of detection of the first signs of ASD by the parents. On the other hand, the descriptive analysis highlights that mothers with a low economic level detect the warning signs earlier than mothers with a higher and average level (mean, standard deviation (10.27)).

#### **5.2 Discussion**

There is a consensus on the question of the need to spot and identify early the developmental particularities that could evolve into a neurodevelopmental disorder.


**Table 4.**

*Economic level of fathers and age of detection of first signs.*


#### **Table 5.**

*Economic level of mothers and age of detection of first signs.*

Pry [6] points out that this question of identifying signs is based on both theoretical and practical reasons. The theoretical reasons consist of saying that TND (neurodevelopmental disorders) in particular Autism Spectrum Disorder is of early and neurodevelopmental origin, the first behaviors tend to change in meaning but also in function with the advancement in age. The practical reasons relate primarily to aspects of early interventions that aim to change the developmental trajectory of these behavioral formulations.

Therefore, this study focused on the question of the identification of early signs by parents. This is therefore a "retrospective" study based on data from interviews with parents, the main objective of which was to estimate the average age at which parents identify the warning signs of ASD, but also to identify the signs most reported by parents (concerns relating to motor, verbal, emotional, social development, etc.).

The results of our study show that the first signs of ASD are on average identified by parents around 19 months. In other words, it is only from the age of one and a half that parents begin to observe particular behavioral formulations. Thus, the calculation of the percentage of signs indicates that the most reported signs concern the field of communication, first "verbal" (30.51%), then "non-verbal" (28.81%).

The results obtained are in agreement with certain studies, notably that of Rogers [14] according to which the majority of parents (41%) identify the first signs during the second year. Most of the research on this subject emphasizes that parental concerns appear around the second year Guinchat et al. [8].

Concerning the origin of the first concerns, it is mainly about the delay in the development of the language [7, 13, 15].

These results can be partly explained by the involvement of certain factors, in particular the cultural and social factor. Indeed, parents may not be sensitive to the typical development of intentional communicative acts addressed to the environment and its deviations such as gazing, sharing attention, or pointing. These acts of course precede the appearance of the first words. Therefore, the concerns are quite late because the parents mainly wait for the age when the expressive language (first words) is supposed to appear to be alarmed. The knowledge of the parents on the early psychological development of the child and more particularly, the sociocommunicative development, is probably not sufficient to be able to detect its anomalies, delays, or deviations.

We also note that only 5.08% of the signs relate to motor behavior, except that several studies confirm that the first manifestations relating to developmental disorders concern motor development with atypical ocular motor skills, asymmetrical postures, or even particularities of the spontaneous movements [16]. These relatively late concerns can also be explained by the number and position of the child among the siblings. Indeed, during the interviews within the framework of consultations with the parents, we noted that having only one child or when it was the first child in the siblings, the parents had difficulty in evoking information related to the early

#### *Identification of Autism Spectrum Disorder: The First Signs Identified by Algerian Parents DOI: http://dx.doi.org/10.5772/intechopen.108000*

development of the child because of the lack of a possibility of comparison with children of the same age. This situation can lead parents to miss a set of early signs, including signs relating to motor or sensory development.

A third element that can be used for interpretation consists of taking into consideration the "regressive" process usually cited in research on the baby to become of ASD. Indeed, the data of the literature underline the presence in certain cases of a regression or even a loss of communicative and language skills between 16 and 20 months. This phenomenon may explain the relatively late identification of the first signs.

We have also sought to study the factors that may possibly influence the age of identification of the first signs, in particular the socioeconomic factor of the parents, first of the fathers and then of the mothers.

The statistical analysis reveals an absence of significant link between the socioeconomic levels of the parents and the age of the identification of the first signs. In other words, the social and economic level of the parents has no influence on the precocity or not of the identification of the first signs of ASD. Parents with a higher level are not necessarily able to detect the first anomalies early.

One way to interpret this result is to say that the profession of parents with a higher level leads them not to spend a lot of time with their children, and therefore, they have less opportunity to carefully observe the appearance of the first signs.

This observation was assessed during the interviews with the parents and confirmed by the descriptive analysis concerning the economic level of the mothers. Indeed, the results of our study tell us that mothers with a low economic level (generally inactive mothers) tend to spot the first signs well before mothers with a higher to average level.

#### **6. Conclusion**

Autism is an early-onset neurodevelopmental disorder, the first behavioral expressions of which are the subject of several studies. A broad consensus exists on the need to identify the first behavioral deviations as early as possible. The interest of this approach consists of answering the following problem: can early interventions (educational, developmental, behavioral, or others) possibly modify the evolutionary course of the child, but also what is the most that makes it possible to modify the child's development as quickly as possible (before school age).

This work shows that Algerian parents detect the signs of autism during the second year of life (19 months) and that the signs reported relate mainly to nonverbal communication (pointing, gaze, gestures) language skills (delay appearance of language). Thus, the socioeconomic level of the parents is not linked to the age of detection of the first signs.

Parents should therefore be encouraged to carefully observe the child's developmental sequences in order to be able to identify developmental deviations earlier, which may relate to a set of areas (other than the area of non-verbal communication and verbal) such as motor development but also emotional or sensory.

#### **Acknowledgements**

We would like to thank all the people who contributed to the realization of this work.

First of all, we would like to express our gratitude to the parents of children with autism for their patience and availability to answer our questions.

We would also like to thank Doctor Lotfi Bendiouis for giving us the opportunity to carry out this work in the field by welcoming us to his psychiatry and psychotherapy practice.
