How to Spot the Signs of Autism Spectrum Disorder (ASD) and Take Action

The first five years of a child's life are a period of remarkable growth and development. Babies learn how to communicate their needs using physical gestures and spoken language. Toddlers discover how to play "pretend" using their newly-forming imagination. And preschoolers acquire the fine motor skills to begin using tools like scissors.

For the 1 in 54 children born with autism spectrum disorder (ASD), this is also the time when signs of their condition become more apparent in the form of developmental delays or distinct behaviors.

Research shows that early intervention services like behavior therapy and speech therapy can dramatically improve long-term outcomes for children with ASD. But for new parents, recognizing the signs and knowing when to seek help from medical professionals isn't always easy.

In this article, we will:

1. Help you identify the early signs of autism,
2. Equip you with tools to monitor your child's development at home,
3. Show you how to take early action if you have questions or concerns.

Identify the early signs of autism

People with autism spectrum disorder experience a wide range of social, communication, and behavioral challenges. For example, a child with autism might have difficulties initiating conversations or sharing toys with their peers.

However, as stated in the diagnosis, autism covers a broad spectrum, which means that it manifests differently in every person. For example, one person may be completely nonverbal, while another uses single words or short sentences to communicate their needs. This fact can make identifying and diagnosing autism a challenge for parents and professionals. 

According to this guidance from the American Academy of Pediatrics, there are a few early indicators of autism. Below is their summary of these key developmental differences and how to recognize them by becoming aware of their effect on your child’s social and emotional skills, communication, and behavior.

Social and emotional delays in children with autism

Social and emotional skills measure your child's ability to interact with others and exercise self-control. 

Children with autism often have difficulties:

• Making and maintaining eye contact
• Responding to a parent's facial expressions
• Looking where a parent looks or points
• Pointing to objects or events to show a parent
• Bringing items of personal interest to show a parent
• Displaying appropriate facial expressions
• Showing concern for or engaging with others
• Making friends or are uninterested in making friends

Communication delays in children with autism

Communication skills include your child's proficiency in understanding and using language to express needs and emotions. 

Children with autism may:

• Not point to objects to demonstrate needs or share things with others
• Have trouble both expressing emotions and perceiving expressions from others
• Not speak single words by 16 months of age
• Repeat what others say without understanding what the words mean
• Not respond to their name
• Confuse pronouns, like referring to you as "I"
• Avoid communicating with others
• Be unable to maintain a conversation
• Not engage in pretend play 
• Lose language or milestones between the ages of 15 and 24 months

Repetitive behaviors and restrictive interests in children with autism

Restrictive and repetitive behaviors or interests are among the defining symptoms of autism. 

Here are some examples (Note: most children will do any one of these once and a while; it is the repetitiveness of the behavior that marks it as abnormal):

• Rocking, spinning, swaying, twirling fingers, walking on toes, or flapping hands
• Struggling with switching from one activity to another
• Obsessing over a few limited and unusual activities
• Playing with parts of a toy instead of the entire toy
• Seeming unable to feel pain
• Extreme sensitivity or no sensitivity to smells, sounds, lights, and textures
• Experiences extreme distress at sounds or textures that don’t typically bother others 
• Staring at or looking at objects from unique or unusual angles
• Having highly selective eating patterns and preferences

Reassuring behaviors and developmental milestones

Here are behaviors that should give you confidence that your child’s development is on track, as noted by Dr. Wendy Sue Swanson in her book, Mama Doc Medicine:

• Acknowledging when their name is called between 9 and 12 months old
• Smiling by 2 months old
• Laughing around 4 to 5 months old
• Making eye contact
• Playing and finding enjoyment in games like peek-a-boo around 4 to 5 months old
• Trying to use spoken language to communicate by 18 months old
• Copying or imitating you 
• Shaking their head side-to-side to say “no”
• Waving goodbye by 15 months old
• Pointing to something interesting or bringing an object to show parents by 18 months old

Monitor your child's development at home

Pediatricians use a set of known developmental milestones to measure your child's skills in different development areas during well-child visits. Between appointments, there are clinically-validated tools available for you to do the same. 

Being aware of and tracking your child's developmental milestones at home will ensure that your child progresses as expected. You will also be able to identify delays early and seek the necessary supports. 

Use free tools to track developmental milestones

There are dozens of free or low-cost developmental milestone tracking tools available to you, including:

• The CDC's mobile app
• The CDC's milestone checklist
• The Wonder Weeks app

Screen for autism using the M-CHAT survey

If your child is between 16 and 30 months old, another tool at your disposal is the Modified Checklist for Autism in Toddlers (M-CHAT). The M-CHAT is a ten-minute screening survey designed to help you learn whether your child could benefit from further developmental evaluations. This survey is generally given at your child’s 18- and 24-month well-child visits, so make sure not to miss those important screenings!

The M-CHAT asks simple questions like, "Does your child try to copy what you do?" and "Does your child like movement activities?" Based on the score you calculate at the end of the assessment, the M-CHAT website recommends appropriate next steps, which could include contacting your pediatrician.

The M-CHAT is available for free in multiple languages at M-CHAT.org.

Note that screenings and evaluations are not synonymous

It’s important to be aware of the distinction between screenings and evaluations, which have two very different utilities in the identification and diagnosis of ASD:

• Screening tests are the first step to identify children who might benefit from further evaluations. Depending on the type of screening, they can usually be completed by parents and pediatricians. Screenings are created to be overly sensitive to “cast a very broad net” and pick up minor abnormalities. Thus their results should never be confused with a diagnosis.
• Evaluations are comprehensive tests conducted by a team of specialists who are trained to make formal diagnoses. For example, a developmental-behavioral pediatrician might use a combination of cognitive testing, play-based assessments, and family interviews to determine whether a child has autism. 

All of that to say, do not be alarmed if the results of your child’s M-CHAT screening indicate a “high risk for autism.” Follow the screening’s recommended next steps and book an appointment with your pediatrician for further evaluation.

Take action if you have questions or concerns about autism

If your child shows signs that might indicate a disorder on the autism spectrum, receiving a formal diagnosis will unlock a suite of support services that can ultimately improve long-term outcomes. For this reason, it's critical to act early. 

Here are a few steps that you can take if you have additional questions or concerns about autism.

Contact your child's pediatrician

First, make an appointment with your child's pediatrician. Let the office know that you have concerns about your child's development and would like a visit for a screening and assessment.

Before the doctor's appointment, write down a list of your concerns and print any relevant materials, like a completed checklist of developmental milestones or the M-CHAT screening results. Coming prepared with information will help the doctor move along more quickly with an appropriate plan of action.

Request a second opinion, if necessary

If you've already met with your pediatrician and still have concerns, contact another doctor in your network for a second opinion. 

To find providers in your area who are accepting new patients, try consulting with families who have previously sought medical advice for their child’s development — they tend to have the best leads! Otherwise, websites like Zocdoc and Healthgrades have searchable databases of pediatricians you can utilize.

Remember, you know your child better than anyone else does! Don't hesitate to advocate on their behalf if you're unsatisfied with the advice you receive.

Ask for a referral to a specialist 

In addition to your pediatrician, certain specialists can help you find answers about your child's development, including:

• Developmental-behavioral pediatricians, also known as developmental pediatricians, are experts in autism spectrum disorder, learning and intellectual disabilities, ADHD, and other developmental disorders.
• Pediatric neurologists specialize in issues related to the brain, spine, and nervous system. 
• Child psychologists or psychiatrists specialize in a range of emotional/behavioral and developmental conditions, from learning disabilities to severe mental illness.

If you think it may be useful to speak with one of these specialists for further evaluation, ask your doctor for a referral. And if, after an assessment by your child’s pediatrician, you are referred to one of these specialists, make sure you follow through for a full evaluation.

See if your child qualifies for early intervention services

While you're waiting to meet with your doctor, contact early intervention (EI) services to request a free evaluation. Although you do not need a medical diagnosis to receive these services, a referral by a doctor, parent, family member, or childcare provider will likely be required.

• If your child is under three years old, EI services are available through your state.
• If your child is three years of age or older, they can access EI services via the public school system. They do not need to be a student at the school to receive services. 

Early intervention services are available to families at no cost. They are customized to the child's needs and may include physical, occupational, behavioral, and speech therapies, and special education. 

Receiving an autism diagnosis can be a long process

Before seeking developmental evaluations, families should understand that the process of receiving an autism diagnosis can be arduous and time-consuming. In fact, it's come to be known as the “diagnostic odyssey” among some who have experienced it.

While the signs of autism can sometimes be detected in a child at 18 months old, studies have shown that most children are not formally diagnosed until after 3 years of age. There are several factors that contribute to this delay, including:

• Other conditions like hearing loss, speech disorder, and intellectual disability need to be ruled out first.
• There is a national shortage of professionals, such as developmental-behavioral pediatricians, child psychiatrists, and pediatric neurologists, who are qualified to screen for autism and comfortable making diagnoses. This means waitlists can be many months long, with some families waiting up to a year for a comprehensive evaluation.
• The rising costs of care exclude many families from accessing developmental-behavioral and neurodevelopmental specialists.

To that end, it’s critical for your child to enroll in early intervention services as early as possible to begin receiving support services while you're navigating the evaluation and diagnostic process.

A note from Wayfinder

While the prospect of their child having a developmental delay is worrisome for many parents, there are more reasons than ever to be optimistic. Awareness about disorders like ASD continues to increase, along with medical experts' understanding of how to better identify and treat them. For parents, access to guidance, resources, and peer support communities is also improving. Remember to stay positive, seek out the best information, and continually advocate for your child's health.