Individuals on the autism spectrum generally experience challenges in three crucial areas of development; social interaction, communication, and behavior. Each individual will develop at their own rate. One individual on the spectrum may have a delays where others do not. It can be difficult to tell when a child will learn new skills, as everyone does so on their own time. Many of the signs below are not necessarily worrisome on their own, but when they present themselves in conjunction to one another and across the areas of social interaction, communication, and behavior, this may indicate an autism spectrum disorder.
All children should receive special screening during their regular well-check visits with their doctor. Additional screenings for developmental delays and autism should be done as needed if a child is at high risk.
Developmental delay and disability screenings should occur at:
- 9 months
- 18 months
- 24 or 30 months
Children should be screened specifically for autism spectrum disorder at:
- 18 months
- 24 months
Some symptoms that can show up in a screening for autism are found in observing developmental milestones. Some indicators can be:
- 6 months: no big smiles
- 9 months: does not reciprocate sounds, smiles or other facial expressions
- 12 months: does not respond to their name, does not coo or babble, does not demonstrate back-and-forth gestures such as pointing or waving
- 14 months: does not point to objects to show interest
- 16 months: no speech
- 18 months: does not play “pretend” games
- 24 months: no use of meaningful two-word phrases (without repeating or imitating)
- Any loss of speech, babbling, or social skills at any age
A helpful tool may be the Modified Checklist for Autism in Toddlers (M-CHAT). This is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). The M-CHAT-R/F is an autism screening tool designed to identify children 16 to 30 months of age who should receive a more thorough assessment for possible early signs of autism spectrum disorder (ASD) or developmental delay.
Visit this website for the Modified Checklist for Autism in Toddlers (M-CHAT).
Some of the most common symptoms of autism spectrum disorders revolve around social skills. An individual may display the following symptoms:
- Has poor eye contact
- Does not look at objects when another person points at them
- Prefers little physical contact, to not be held or cuddled, or might cuddle only when they choose to
- Prefers to play independently – retreats into their “own world”
- May only choose to interact to achieve a goal such a receiving a snack
- Appears to be unaware when people talk to them but responds to other sounds
- May desire friends or relationships, but can experience challenges relating to others
- May not demonstrate an interest in others at all
- Experiences challenges understanding or expressing an understanding of other people’s feelings. May also have a difficult time expressing or talking about their own feelings
- Experiences challenges in interpreting social “rules”, social cues, and relationships
Every individual on the spectrum has their own communication skills and style. Some individuals show no perceptible symptoms while others may not verbalize at all. An individual may display the following symptoms related to language:
- Has a delay or absence of spoken language
- Experiences a loss of previously acquired language abilities
- Repeats or echos words or phrases said to them, or repeat words or phrases in place of typical language (echolalia)
- May respond to the question, “Do you want a sandwich?” with “Do you want a sandwich?” rather than responding with a yes or no answer.
- Speaks with abnormal rhythm or tone, such as in a monotone or sing-song way
- May be very interested in people, but does not know how to talk, play, or relate to them
- Has trouble expressing their needs using typical words or motions
- May not understand jokes, teasing, or the use of sarcasm
- Experiences challenges interpreting non-verbal communication such as gestures (pointing, waving), body language, or facial expressions
- Repetitively asks many questions or reiterates what is said to ensure understanding
- Perseverates on one topic of a conversation without breaks
An individual’s behavior relays a wealth of information about an individual’s development. Autism is a diagnosis of behaviors. Some individuals will experience all of these symptoms and some only a few, but behavior is key to autism diagnosis and intervention. An individual may display the following symptoms related to behavior:
- Self-stimulatory behavior (stimming) such as repetitive actions like rocking, spinning or hand flapping
- Does not play “pretend” games (pretend to “feed” a doll)
- Lines up toys or other objects
- Plays with toys the same way every time
- Has self-injurious behaviors and/or seems insensitive to pain
- Has attachments to objects or a preoccupation with a topic of interest
- May be fascinated by parts of an object, such as the spinning wheels of a toy car
- Develops specific routines or rituals
- Moves constantly
- Adapting to a routine change can be difficult or upsetting, possibly causing ”meltdowns”
- Has atypical reactions to the way things smell, taste, look, feel, or sound
- Seemingly has no real fear of dangers
- May be unusually sensitive to light, sound, and touch and yet oblivious to pain
- May become upset by minor changes in their routine or environment
- Anxiety and depression also affect some people with an ASD. All of these symptoms can make other social problems even harder to manage
- Atypical eating or sleeping habits or routines
- Physically aggressive actions or attitude
- Chronic constipation or diarrhea
The Kennedy Kreiger Institute has produced a video showing some of the early signs of autism. The video shows both neuro-typical and neuro-diverse children to explain the developmental milestones.
This Webinar, I’m Worried About My Baby’s Development, What Can I Do, is presented by PTI Nebraska.
If You Are Concerned
If you notice these signs in your child, it is important to act early and contact a doctor or nurse to share your concerns, especially if you notice a dramatic loss of skills at any age. If you or your doctor is still concerned, ask the doctor for a referral to a specialist who can take a closer look at your child and the symptoms they may exhibit. A specialist may be a Child Psychologist, a Child Neurologist, or Developmental Pediatricians.
When you are seeking a doctor’s opinion, also call the school district in which you reside. You do not need a referral for this process. The public school system can provide a free evaluation to find out if your child qualifies for intervention services.
To learn more about developmental milestones, visit Learn the Signs. Act Early, a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible signs of autism spectrum disorders.