How do I know if my baby or young child is autistic?

Every week, I get emails from concerned parents who are worried that their baby or young child may be showing signs of autism. Parents send me a list of things they see and wonder if these are early indicators of autism. Every child is an individual and will not develop in the same way, hitting each milestone at the same time. A number of signs need to be present in order to receive an autism diagnosis. Doctors and pediatricians will not diagnose a baby with autism under the age of 14 months, but if there are concerns about a baby’s development they should be addressed with a doctor.

Autism is a broad spectrum and individuals present very differently. Some babies will hit all of their developmental milestones on time like walking or crawling, but have less obvious differences in the development of body gestures (like pointing), pretend play, and social language.

Understanding Developmental Milestones and How These Present in Autism

Lisa Jo Rudy, autism consultant and writer, lists some important points about developmental milestones in her article on the Very Well Health website. She states that children with autism tend not to reach all of their developmental milestones at the appropriate times. The reality is:

1. Many autistic children reach early developmental milestones on time or early, but then lose ground.
2. Most autistic children reach some of their developmental milestones on time or early, but reach others late or not at all.
3. Some autistic children reach some of their developmental milestones extraordinarily early but reach others extraordinarily late.
4. Children with autism can appear to gain important skills—but in fact, be unable to use those skills in real-world situations.
5. Many children with autism have so-called “splinter” skills, which can be very advanced but which are not useful in daily life.
6. Autistic children, particularly girls who are high-functioning, are sometimes able to hide or overcome some developmental delays.

Early Signs of Autism

The Healthy Children website has a very good list of early signs of autism spectrum disorder (ASD). Below is the list from their website. The number of symptoms and severity of them can vary a great deal. No child will have all the same symptoms as another child.

Social differences in children with autism

-May not keep eye contact or makes little or no eye contact
-Shows no or less response to a parent’s smile or other facial expressions
-May not look at objects or events a parent is looking at or pointing to
-May not point to objects or events to get a parent to look at them
-Less likely to bring objects of personal interest to show to a parent
-May not have appropriate facial expressions
-Has difficulty perceiving what others might be thinking or feeling by looking at their facial expressions
-Less likely to show concern (empathy) for others
-Has difficulty making and keeping friends

Communication differences in children with autism

-Less likely to point at things to indicate needs or share things with others
-Says no single words by 15 months or 2-word phrases by 24 months
-Repeats exactly what others say without understanding the meaning (often called parroting or echoing)
-May not respond to name being called but does respond to other sounds (like a car horn or a cat’s meow)
-May refers to self as “you” and others as “I” and may mix up pronouns
-May show no or less interest in communicating
-Less likely to start or continue a conversation
-Less likely to use toys or other objects to represent people or real life in pretend play
-May have a good rote memory, especially for numbers, letters, songs, TV jingles, or a specific topic
-May lose language or other social milestones, usually between the ages of 15 and 24 months (often called regression)

Behavioral differences (repetitive & obsessive behaviors) in children with autism

-Rocks, spins, sways, twirls fingers, walks on toes for a long time, or flaps hands (called “stereotypic behavior” or stereotypies)
-Likes routines, order, and rituals; has difficulty with change or transition from one activity to another
-May be obsessed with a few or unusual activities, doing them repeatedly during the day
-Plays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck)
-May not cry if in pain or seem to have any fear
-May be very sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
-May have unusual use of vision or gaze—looks at objects from unusual angles

If your child just has one or two of these symptoms and is developing normally, chances are they do not have autism; however, there may still be challenges present such as a speech delay or sensory issues. These can be addressed with the appropriate professional who can help your child.

What to Do If There Are Concerns

If you are concerned about your child’s development, talk to your doctor or pediatrician. There is no medical test for autism – it is diagnosed through interviews, observation, and evaluations. Some examples of these are:

• Speech evaluations – these check your child’s ability to understand and use spoken speech in an age-appropriate and meaningful manner
• Occupational therapy evaluations (tests to check for age-appropriate fine motor skills, visual and spatial awareness, sensory responses, and other neurophysical concerns)
• Hearing tests (to ensure symptoms are not caused by hearing loss)
• Autism-specific questionnaires, such as the ADI-R, for parents to fill out about their child’s developmental milestones, behaviors, sensitivities, challenges, and strengths
• Other tests, such as the Autism Diagnostic Observation Scale (ADOS) and the Checklist for Autism in Toddlers (CHAT), which examine observations of children’s behaviors based on norms

If you are placed on a waiting list for an assessment, there is a lot you can do to support your child’s development while you wait. Have a look at this past blog post for some ideas.

Parents need to trust their instincts and not be afraid to ask questions or seek help. Early intervention improves long term outcomes for children with autism spectrum disorder. There is a great deal of information out there to help parents recognize the early signs of autism. Another great resource for early signs of autism in toddlers is the Autism Navigator website.

Discussing concerns with your doctor can help you feel less overwhelmed and develop a plan for what the next steps are. This is a process that takes time and you will need professional support and guidance.

Note – I am unable to offer a diagnosis via e-mail nor am I qualified to say that there are signs in an infant that warrant seeking an autism diagnosis. If you have questions and concerns regarding your baby’s development, please make an appointment to see you doctor or pediatrician as they can offer the best medical advice. I am a parent of two autistic young adults and I have no medical background. I am unable to offer an opinion about parental concerns around infant development based on a list of symptoms.