Autism spectrum disorder is a developmental disability caused by differences in the brain that impacts about one in 44 children in the U.S., making it a fairly common health condition. Autism can present itself in various ways, with some children experiencing delayed developmental milestones while others have severe disabilities.
With that, it’s understandable to want to have early signs of autism on your radar. But these early signs can be tough to notice. “Symptoms of autism are not always obvious due to the fact that the presentation of symptoms can vary significantly across the spectrum from relatively mild to very severe,” says Steven Pastyrnak, PhD, pediatric psychologist, Corewell Health Helen DeVos Children’s Hospital.
Daniel Ganjian, MD, a pediatrician at Providence Saint John’s Health Center in Santa Monica, Calif., agrees. “Autism is a spectrum, so there is mild, moderate, and severe autism,” he explains. “The severe ones are easier to diagnose, but the mild and moderate cases are harder to spot.”
While your child should be screened for autism during routine visits to the pediatrician, given that you spend the most time with your little one, you may be able to spot something their provider misses. If you have concerns about your child’s development, keep this information for early signs of autism in mind.
What Are Early Signs of Autism in Toddlers and Babies?
According to the NIH, these are more typical early signs that babies and toddlers have autism:
Problems with eye contact
Not responding to his or her name
Problems following another person’s gaze or pointed finger to an object
Poor skills in pretend play and imitation
Problems with nonverbal communication
Children may also have the following laundry list of symptoms of autism, the CDC says:
Avoids or does not keep eye contact
Does not respond to name by 9 months of age
Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age
Does not play simple interactive games like pat-a-cake by 12 months of age
Uses few or no gestures by 12 months of age
Does not share interests with others by 15 months of age
Does not point to show you something interesting by 18 months of age
Does not notice when others are hurt or upset by 24 months of age
Does not notice other children and join them in play by 36 months of age
Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age
Does not sing, dance, or act for you by 60 months of age
Lines up toys or other objects and gets upset when order is changed
Repeats words or phrases over and over
Plays with toys the same way every time
Is focused on parts of objects
Gets upset by minor changes
Has obsessive interests
Must follow certain routines
Flaps hands, rocks body, or spins self in circles
Has unusual reactions to the way things sound, smell, taste, look, or feel
Delayed language skills
Delayed movement skills
Delayed cognitive or learning skills
Hyperactive, impulsive, and/or inattentive behavior
Epilepsy or seizure disorder
Unusual eating and sleeping habits
Gastrointestinal issues like constipation
Unusual mood or emotional reactions
Anxiety, stress, or excessive worry
Lack of fear or more fear than expected
But doctors warn against assuming your child has autism if they have just one of the symptoms listed above. “I always tell parents it’s a cluster of signs, not just one or two,” Ganjian says.
What Are Developmental Red Flags for Autism?
The Centers for Disease Control and Prevention (CDC) has created developmental milestones that break down what skills babies and toddlers are generally expected to have mastered by particular ages. Developmental milestones, the CDC explains, are things most children can do by a certain age.
When it comes to red flags for autism, “delayed speech and limited interest in others are two of the first signs that we look for,” Pastyrnak says. Regression of speech, which is when a child uses a number of words to communicate and then seemingly stops using those words, happens in nearly a quarter of children with autism, Pastyrnak says.
“Atypical sensory processing, repetitive motor behaviors, and repetitive speech can also be early signs,” he says.
If you have concerns about your child’s development, Twachtman-Bassett recommends looking at the CDC’s developmental milestones and seeing how well your child meets the expectations for their age.
When Is Autism Diagnosed?
Many children show symptoms of autism by 12 to 18 months of age or earlier, according to the National Institutes of Health (NIH). “We typically start to see symptoms as early as nine to 12 months, although we may see symptoms earlier,” says Jennifer Twachtman-Bassett, MS, autism clinical specialist at Connecticut Children’s. “A lot of times, the symptoms before nine months aren’t as reliable.” Plus, many of the symptoms of autism are non-verbal “so it’s not as easy as whether a child says their first words on time,” Twachtman-Bassett says.
What Does Early Autism Intervention Look Like?
Again, your child should be screened for autism spectrum disorder by their pediatrician during routine visits, but “sometimes parents do notice things earlier than we do,” Ganjian says.
He recommends bringing up your concerns to your child’s pediatrician. They can evaluate your child to see if they may benefit from more intensive testing that can be done by a behavioral psychologist or other specialist, Ganjian says.
Pastyrnak agrees. “Early identification is ideal as there are typically interventions and school-based services available to help,” he says. These early intervention programs may include family training, speech therapy, hearing impairment services, physical therapy, and nutrition services, according to the NIH. And they typically begin at or before preschool age, as early as 2 or 3 years of age, to ensure that they are as effective as possible.
“With early intervention, some children with autism make so much progress that they are no longer on the autism spectrum when they are older,” the NIH reports.