Signs and symptoms of autism in babies and toddlers
If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.
The earliest signs of autism involve the absence of normal behaviors—not the presence of abnormal ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.
Some autistic infants don’t respond to cuddling, reach out to be picked up, or look at their mothers when being fed.
Early signs of autism in babies and toddlers
- Doesn’t make eye contact (e.g. look at you when being fed)
- Doesn’t smile when smiled at
- Doesn’t respond to his or her name, or to the sound of a familiar voice
- Doesn’t follow objects visually
- Doesn’t point or wave goodbye, or use other gestures to communicate
- Doesn’t follow the gesture when you point things out
- Doesn’t make noises to get your attention
- Doesn’t initiate or respond to cuddling
- Doesn’t imitate your movements and facial expressions
- Doesn’t reach out to be picked up
- Doesn’t play with other people or share interest and enjoyment
- Doesn’t ask for help or make other basic requests
The following delays warrant an immediate evaluation by your child’s pediatrician.
- By 6 months: No big smiles or other warm, joyful expressions
- By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions
- By 12 months: Lack of response to name
- By 12 months: No babbling or “baby talk”
- By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving
- By 16 months: No spoken words
- By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating
Signs and symptoms of autism in older children
As children get older, the red flags for autism become more diverse. There are many warning signs and symptoms, but they typically revolve around impaired social skills, speech and language difficulties, non-verbal communication difficulties, and inflexible behavior.
Signs and symptoms of social difficulties in autism
- Appears disinterested or unaware of other people or what’s going on around them
- Doesn’t know how to connect with others, play, or make friends
- Prefers not to be touched, held, or cuddled
- Doesn’t play “pretend” games, engage in group games, imitate others, or use toys in creative ways
- Has trouble understanding or talking about feelings
- Doesn’t seem to hear when others talk to him or her
- Doesn’t share interests or achievements with others (drawings, toys)
Basic social interaction can be difficult for children with autism spectrum disorders. Many kids on the autism spectrum seem to prefer to live in their own world, aloof and detached from others.
Signs and symptoms of speech and language difficulties in autism
- Speaks in an abnormal tone of voice, or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question)
- Repeats the same words or phrases over and over
- Responds to a question by repeating it, rather than answering it
- Refers to themselves in the third person
- Uses language incorrectly (grammatical errors, wrong words)
- Has difficulty communicating needs or desires
- Doesn’t understand simple directions, statements, or questions
- Takes what is said too literally (misses undertones of humor, irony, and sarcasm)
Children with autism spectrum disorders have difficulty with speech and language. Often, they start talking late.
Signs and symptoms of nonverbal communication difficulties in autism
- Avoids eye contact
- Uses facial expressions that don’t match what he or she is saying
- Doesn’t pick up on other people’s facial expressions, tone of voice, and gestures
- Makes very few gestures (such as pointing). May come across as cold or “robot-like.”
- Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises.
- Abnormal posture, clumsiness, or eccentric ways of moving (e.g. walking exclusively on tiptoe)
Children with autism spectrum disorders have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.
Signs and symptoms of inflexibility in autism
- Follows a rigid routine (e.g. insists on taking a specific route to school)
- Has difficulty adapting to any changes in schedule or environment (e.g. throws a tantrum if the furniture is rearranged or bedtime is at a different time than usual)
- Unusual attachments to toys or strange objects such as keys, light switches, or rubber bands
- Obsessively lines things up or arranges them in a certain order
- Preoccupation with a narrow topic of interest, often involving numbers or symbols (e.g. memorizing and reciting facts about maps, train schedules, or sports statistics)
- Spends long periods of time arranging toys in specific ways, watching moving objects such as a ceiling fan, or focusing on one specific part of an object such as the wheels of a toy car
- Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behavior, or “stimming”). Some researchers and clinicians believe that these behaviors may soothe children with autism more than stimulate them.
Children with autism spectrum disorders are often restricted, inflexible, and even obsessive in their behaviors, activities, and interests.
Common self-stimulatory behaviors: