ESSENTIAL EMOTIONAL AND
SOCIAL MILESTONES IN AUTISM
There is plenty more to be said about parenting techniques applicable to the first six months,
and plenty more is available in the wholistic approach chapter. However for now, I want to
emphasize that babies are fragile beings who are barely coping with their exploratory journey
on earth. Babies are not little adults. They share very little with adults if at all. Babies have very
powerful hearing skills and very poor visual skills. They need every hug they can get and
every moment of attention they can get. They need their parents to remain in plain sight for
the longest possible amount of time of every day especially for the first 2-3 years of life.
Babies need to hear the same voice uttering the same words consistently. They also need their
primary care giver to dress simply in minimal color in order to prevent sensory overload.
According to Eric Erikson, a giant in human development, a newborn has to develop trust in
his or her immediate surroundings as a pre-requisite step for all the stages of later
development. Trust according to Erikson is the baby’s ‘inner certainty’ that the mother is
going to be there when needed. This certainty typically stems from predictability and
consistency of the mother’s actions. It mistrust [danger model] is what emerges from the first
six months, then the baby is at a disadvantage and is likely to experience delay and
disorderliness in later stages of development. Developing trust in the first six months of life is
prerequisite to gaining a sense of control over one’s affairs, as the baby is becoming a toddler.
This is important for the ability to go through toilet training, to feed herself, to bathe herself
and to interact with strangers among other functions. Mistrust in one’s surroundings and
feeling that the world is unpredictable causes the kid to refrain from trying to expand her
world or explore new opportunities. If the mother is inconsistent in her availability and caring
for the baby, then the risk of the baby developing into a mistrusting, withdrawn toddler
How does trust develop in a baby anyway?
The repetitiveness and sameness of actions and behaviors and facial expressions carried by the
mother early on eventually create a repertoire of symbols in the baby’s mind. These symbols
come to represent safety in interaction and have a calming reassuring effect. Whenever these
symbols of familiarity and predictability come up again later in the baby’s life, they serve as an
inherent green light for comfort and sociability.
Please note that trust development may take varying periods of time. The way a mother can
tell that her baby has developed trust in her constant presence is through getting out sight and
observing the baby’s reaction. If the baby reacts with anxiety, frowning, erratic movements
or a crying spell then trust has not matured yet. If the baby does not react at all and continues
doing what she had been doing without a change then this is a sign that trust has been
established. This may take a few weeks or a few months. Once trust has been established
then the mother is free to delegate care giving with greater liberty. Besides other perks of
accomplishing a trusting relationship, is that tension in the baby decreases tremendously and
she will cry or ask for attention less frequently. This is how independence and separation
between self and environment begin to blossom.
According to Erikson, trust early on, motivates the child towards gaining autonomy and
independence as she tries to take charge of their immediate needs. Punishment or
discouragement while a child is attempting to toilet train for example, may lead to shame and
doubt instead of autonomy and independence. Punishment, apprehension, discouragement or
admonishment feeds into developing unnecessary inhibitions in the child. These inhibitions are
a manifestation of ‘fear learning’ and inevitably culminate in avoidance. The child eventually
stops trying and withdraws to her inner world. It is very important to overlook the mistakes
and mess a kid makes as she is trying to take over feeding herself or developing a sense of
fashion or whatever else a creative kid can come up with to show that she is separating
herself from surroundings by being gradually self-sufficient. In fact it is important for the
parents to encourage and reward these early attempts at autonomy no matter how messy they
are. Give some encouraging comfort, validate, celebrate and permit repetition. There is only
one way for a growing sensitive child to learn and reach self-sufficiency and that is to try, fail
and come back and try again until she gets it right. Without trying, failing and repeating a
sensitive child cannot learn by observation only. If as a parent, you feel scared that your kid
may injure herself trying new things, stay just a step behind, and observe without showing any
emotion. Whatever you do, do not let your fear stifle your kid’s growth.
Shame is the feeling of disappointment in one’s self. This is usually the outcome for a
sensitive child who is not allowed the space to try new things and gain independence from
them. For insensitive kids with the same situation, they usually grow defiant and shameless
Doubt is a manifestation of insecurity about the outside world fueled by internal sense of
inability to preserve oneself. Sensitive kids not allowed the space needed to develop their
autonomy end up with a sense of doubt in their personal abilities and worthiness. On the other
hand, insensitive kids faced with the same situation develop a sense of infallibility and
invariably blame outside forces for their mistakes and shortcomings.
The separation between the person and the outside environment is crucial for developing a
sense of identity, individuality and confidence in one’s abilities. Additionally this separation is
important to form secure and lasting relationships later in life. It is also crucial for being able
to stay independent and whole while in friendships or relationships. Anyone who has been in
an uneven relationship where their spouse grows dependent on them understands that an
incomplete sense of self and separation from surroundings may lead to difficulty sustaining
3- Initiative & Experimentation:
When the punishment or disapproval of attempts on autonomy continue, the doubt in oneself
and in personal abilities may develop into inhibitions in the child. Inhibitions develop into guilt
and sense of inadequacy and the inevitable withdrawal. On the other hand encouraging and
rewarding attempts on autonomy allows toddlers to develop initiative. As they gain confidence
in the usefulness of what they can do, they begin exploring other areas and expand their
activities into completely new arenas. This may include looking to play with new toys or
exploring the outdoors or enjoying animals and pets or any of the endless possibilities the
world offers. This is very important for a kid to develop a sense of experimentation through
observation followed by trial and error. This scheme invariably leads to developing an
objective, scientific mind, which can be applied later in most fields of study and prepares kids
for professional excellence. Developing an experimental mentality does not mean that the child
will grow up to become a geeky scientist. It only means that the child develops the scientific
method necessary for exploring novel and obscure areas in life.
As a cautionary note, initiative in children may be devoid of knowledge of consequence. For
example, a child may want to experiment with throwing her 2 month old brother to the floor,
which will create problems for everybody. A child experimenting in ways that harm self or
others needs re-direction. They do not need punishment or prohibition, but rather a parent
who re-directs their energy toward more constructive venues. This is necessary, since
unchecked initiative that proves harmful may also lead to developing guilt and stifling initiative.
One of the perks of initiative is that a child learns about territory and about cooperating with
others in reaching goals and exploring unknown venues. This may be more difficult for
sensitive kids to achieve and they may need gradual introduction into cooperating with other
children. They need to be shown that sharing toys with others produces a better quality of
play and can be more rewarding. Sensitive children are usually gentle and not generically
competitive by nature and may tend to shy away or get upset when competition turns intense.
Sensitive children are typically selectively competitive namely only in the field of utmost
interest to them. Parents are encouraged to try and choose less aggressive and less defiant
kids when trying to get their own sensitive or autistic child to cooperate in a group. We will
expand on this area later in this chapter and in upcoming chapters.
Many parents spend tremendous energy finding the right school for their children or saving up
for a private school that their neighbors are sending their kids to. Many others burden
themselves financially getting their kids lessons in music or martial arts or what have you from
among the obvious ideas that float around in communities in an effort to open their children’s
minds and horizons. Unfortunately, as popular as these things are, they are all non-essential to
a child’s development and to what a child will grow up to be, especially a sensitive child. It is
not the job of the parents to induce their child into a certain field of study or to steer them in a
defined artistic or sports direction or to find them the best school ever. It is the job of the
parents to spend sufficient time with their kids and to provide the loving, encouraging
environment needed for the child to flourish on his or her own. This is essential for the child
to find his or her own natural inclinations toward certain fields of interests through personal
subjective experimentation. Additionally, consuming your kid’s energy in activities not in
harmony with her core inner passions serves as a distraction and diversion away from living
the life she is supposed to live, based on ‘who she is’, and not based on how society or the
neighbors would like her to be. Filling up your child’s days with activities you deem
appropriate, may mask their inner passion and prevent them from finding who they
Ironically finding and financing the “right” activities for children, takes away from the parent’s
energy and patience, something badly needed for a child to thrive. This is another one of those
‘inverted priorities’ I allude to occasionally.
Inhibited children who are punished for “creating a mess” may have great difficulty figuring
out anything for themselves or making choices. If one is not given a real chance to make
choices then one never develops the proficiency to formulate criteria necessary to making
choices. These kids develop into a sense of inferiority and inadequacy, which further prevents
them from being able to grow into who they actually are. The experimentation property, when
allowed to flourish freely, comes in handy for a pre-schooler transitioning into the school
years. There is a certain degree of industriousness needed for a kid going to school including
sitting for several hours in class, learning academic skills and sports and interacting with many
other kids at once and so forth and eventually to explore and uncover their passion for specific
subjects in life.
Industriousness may mean different things in different kids. For some it means proficiency in
reading and comprehension, for others it means proficiency in working and fixing computers
and for others it means dressing a doll uniquely. It matters not what a kid is developing
industriousness at. It only matters that he or she is learning the value of completing work and
taking pride in their creation. The parents’ role is to open up the possibilities and not assign
“gender-appropriate” tasks or enforce their biased sense of what their kid ought to be filling
his or her days with.
Many kids who cannot gain the self-confidence and esteem due to their parents pre-conceived
attitudes may linger many years before they are able to find what they are passionate about in
life. They will, as they grow up, go on a search trying multitudes of things that may or may
not fit their personality until they find their passion. This is a dangerous proposition and many
people get seriously injured and are taken off track before they are even able to get to know
their passion in life. This is how many young sensitive adults are exploited, taken advantage of
and many times end up getting lost to oblivion and isolation. They may not be able to identify
their passion early on, and a sense of incompleteness inside leads them to start a search for the
missing parts. However, there are many predators out there waiting for a young person unsure
of him or herself to exploit them sexually, personally, and professionally. Some wise up and
do things like joining the Peace Corps or similar safe organizations until they find a clear path.
Yet many others are ruined for good by viscous acquaintances or employers…
Please note that none of these stages of development is irreversible if missed or only
incompletely achieved. In fact, most people grow up with a deficiency in one or another area.
However, achieving these behavioral milestones early in life is that much easier than have to re-
do some stages as adults. Redoing childhood milestones in adulthood is very painful and
fraught with all types of dangers and viscous loops in the process.
Author: Rami Serhan, MD
(206) 659-1ASD (273)
Note: this article is an excerpt of the upcoming book, “PSYCHE-SMART AUTISM”.
Copyright 2010 Rami J Serhan, MD