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As a parent you should find out what behavior can be expected of your child at different ages. Dr. Greenspan gives the following timetable:

•   0-2 months: responds to sights and sounds; can calm self down

•   3-7 months: shows signs of pleasure and joy

•   4-9 months: communicates wishes by showing various feelings with gestures, facial expressions, and sounds

•   10-18 months: expresses complex feelings and demands with gestures, words

•   24-36 months: uses language and pretend-play to work out fears and emotional needs (e.g., may hug a doll when Mom is away)

•   30-48 months: employs logical thinking and demonstrates knowledge of the difference between reality and fantasy

Parents should seek help if a child does not show these coping skills roughly on this time schedule. Parents also should seek help if the child is constantly irritable, inattentive, withdrawn, won’t eat, can’t sleep, bites or hits other children, or doesn’t talk by 18 months.

With help, parents can overcome some of these problems by learning to understand the baby’s behavior and to respond to it by adjusting their own behavior accordingly. The first step, says Dr. Greenspan, is to establish a connection. You do this by playing on the floor with the baby. You learn to read the child’s signals. With a passive infant – one who doesn’t do or say much – you exaggerate: “Oh, what is this? Do you want to see that?” Then you follow up by engaging the baby’s interest by pointing out details. With an active child, you try slowing and focusing techniques. If he or she stops at a toy, for example, engage the baby in talk about the object.

“One child we had in treatment,” Dr. Greenspan relates, “would stop at a toy for only 2 seconds. We extended the stop to 6 seconds, eventually to 30 seconds.”

He cites the following as problems likely to begin in infancy:

•   Autism – The child doesn’t communicate with any other human being.

•   Depression – The child is sad, weepy, cannot sleep, cannot eat.

•   Attention disorder – The child seems unable to focus on anything – toys or humans – for more than a few seconds.

Dr. Phillip Strain, an associate professor of psychiatry at the University of Pittsburgh, has a new way to deal with autistic children. In LEAP (Learning Experiences, An Alternative Program for Preschoolers and Parents), at the Mifflin School in Pittsburgh, he places normal children with the autistic children to serve as role models for behavior and communication.

“We get many to go on to kindergarten,” Dr. Strain says. “And if we get the autistic child by 2.5 years, we usually can prevent the self-injury so common in these children.” (Some of their self-destructive acts are head banging, eye gouging, hair pulling, and hand biting.)

Autism remains a mystery. Doctors theorize that some autistic children have a chromosome deficiency that may have caused the illness, while others may have got it from a virus. Under the best programs, some autistic children develop to their maximum potential.

Patty Caito placed her two normal children in Dr. Phillip Strain’s autism program when they reached age 3. The experience of helping other children, says Mrs. Caito, enriched her children, too.

“There was an autistic child named David who never said a word,” she relates. “He just screamed. After a few months, he was saying words. My kids would come home and say, ‘Dave said this and Dave said that.’ They loved seeing his progress.”

Infant psychiatry itself is still in its infancy, but Dr. Stanley Greenspan asserts, “If we can provide them with the right emotional environment early enough, most of these troubled babies can be won.”

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GENERAL HEALTH