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Is Atypical Cry an Early Biomarker for Autism?

At about the same age all typically developing children, no matter what culture they are born into, manifest similar patterns of speech and language acquisition. In autism, however, there is no clear and rigid pattern during the first year, whereas in later years there appears a pattern typical for autistic children’s development (Saint-Georges et al. 2010).

Crying as a ‘language’

Vocalization and babbling can be considered the earliest expression of language development (Chericoni et al. 2016). Even crying is sometimes considered as a language (Lester, Zeskind 1978) that represents an adaptive communication system facilitating an infant’s choices of survival. Lester and Zeskind note that crying is more than just reflex and is better understood as a motor response to distress followed by sound. The cry seems to carry information that affects the infant-caregiver relationship because adults react differently to the cries of high-risk and low-risk babies. The cry of high-risk babies not only differs acoustically but also is perceived differently – as a signal of the need for special attention (Lester, Zeskind 1978). Though crying cannot be formally defined as a language, it serves as a tool typically developing babies use to communicate with their mothers. Already at this stage mother and child ‘speak the same language’.

Research shows that as early as the first months of age babies who are later diagnosed with autism produce a different pattern of cry than those with other types of developmental disabilities and typically developing infants. Esposito and colleagues (2017) suggest that atypical early vocal calls (i.e., cry) may represent an early biomarker for autism (or at least for a subgroup of children with ASD), and thus can help with early detection. “Moreover, cry is likely more than an early biomarker of ASD; it is also an early causative factor in the development of the disorder”.

Sheinkopf’s team (2012) examined the acoustic properties of cries of two groups of 6-month-old babies: those at risk for autism and typically developing infants. The at-risk infants (later diagnosed with autism) produced pain-related cries with higher pitch, the widest frequency range (with great variability) than low-risk babies. The authors conclude that differences in cries may be seen as an early manifestation of an atypical affective state, which is likely to play a role in the impairments in social communication.

Kikusui and Hiroi (2017) hypothesise that atypical crying is likely to induce a ‘self-generated environmental factor’ in caregivers that, in turn, influences the prognosis of the disorder. Because atypical crying in autism is difficult to understand, it may have a negative impact on the quality of care by the caregiver.

Mothers – interpreting emotional signals of their babies

Research shows that mothers of typically developing babies could interpret the cries and vocalisations communicating different needs. In contrast, mothers of autistic children sometimes found it difficult to understand ‘the message’, as the cries of their babies are often idiosyncratic (Ricks, Wing 1975). It means that already at this early stage of communicative development ‘the foreign language’ of an autistic baby is not understood by the mother and results in the failure of ‘intentional communication’, which typically begins at about nine months. Parents often report that they had great difficulty decoding emotional signals of their babies (with autism), especially during the first year. As they cannot understand the meaning of the cry, it’s hard for them to figure out the causes of crying episodes (Esposito, Venuti 2010; Bornstein et al. 2016).

Why doesn’t conventional soothing work with autistic babies?

Such a lack of understanding regarding the triggers of their infant’s distress can initiate a vicious cycle – the mother doesn’t know what’s upset her baby, so she cannot meet her child’s needs. Esposito and Venuti (2010) report that while mothers of typically developing babies or infants with developmental delays were more likely to use tactile of vestibular stimulation to calm down their children, mothers of infants with autism used more verbal soothing. Esposito and colleagues (2017) provide a possible explanation of this: ‘when parents cannot understand the meaning of a crying episode, they use more verbal interactions.’

I’d add some clarification: from their experience (when mothers had tried to use ‘conventional methods of soothing’ that made it even worse) the only thing they could do was talking/singing, etc. Why doesn’t conventional soothing work? The reasons may be different for different infants: for some (with tactile hypersensitivity), being engulfed in embrace is too overwhelming, suffocating and even painful; for others (with vestibular hypersensitivity) rocking is not the best soothing technique; some can have other sensory problems, for instance, fragmented perception – when children react to one ‘piece’ of the person/ place instead of the whole situation:

I experienced this in the first few months of my son’s life when I would be feeding him. I used to wear the same red dressing gown when I went to feed him and it was always the same ritual that allowed me to bond with my baby quietly and in peace. That was – until one day, when I changed my outfit to a different one. That day I wore a blue one.

What followed was one of the worst meltdowns I had ever seen with him. He was screaming and protesting so loudly, that I was beginning to worry not only about the neighbours in other flats of our block but even those on the other side of the street. I was lucky that one of my neighbours, instead of calling the police, decided to check for herself what was going on. She knocked at the door and asked me if everything was alright. She sure knew it wasn’t, but now she could see I wasn’t torturing my baby.

The kind lady offered to help – taking Alyosha from me and immediately… he stopped crying. We both were deafened by sudden silence. I got back my ability to think, looked at the puzzled neighbour and literally saw the answer to the riddle: she was wearing a red dress!

My son did not see me as a whole, he associated me with the red colour: that day he was unable to recognise me because I was not wearing the same-coloured gown that he had grown used to. The “bit” of me which he usually focused on completely changed, making me an imposter in his eyes. His meltdown made sense: his mother (whom he recognised by the red colour) was replaced with an imposter, no wonder he was scared to death and the only thing in his disposal was his voice to show it.


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