Autism Symptoms & Early Signs: What to Look for in Babies, Toddlers & Children

Understanding autism

One Baby's Story

One Baby's Story of Autism Melanie is a healthy one-year-old, but her parents are worried because she’s not doing many things that her older brother did at her age, like playing peek-a-boo and mimicking expressions and gestures. Melanie’s mom and dad try to engage her with toys, songs, and games, but nothing they do gets her interest, let alone a laugh or a smile. In fact, she rarely makes eye contact. And although her hearing has been checked and is normal, she doesn’t babble, make other baby noises, or respond when her parents call her name. Melanie needs to be checked out by a child development specialist right away.

Autism is not a single disorder, but a spectrum of closely related disorders with a shared core of symptoms. Autism spectrum disorders appear in infancy and early childhood, causing delays in many basic areas of development such as learning to talk, play, and interact with others.

The signs and symptoms of autism vary widely, as do its effects. Some autistic children have only mild impairments, while others have more obstacles to overcome. However, every child on the autism spectrum has problems, at least to some degree, in the following three areas:

Communicating verbally and non-verbally

Relating to others and the world around them

Thinking and behaving flexibly

There are different opinions among doctors, parents, and experts about what causes autism and how best to treat it, and much that we still don’t know. But on one fact, everyone agrees: early and intensive intervention works. For children at risk, it can make all the difference.

Early detection of autism is up to parents

Is your child meeting milestones?

Click here for milestone checklists from the CDC’s Learn the Signs, Act Early campaign. Includes checklists for children from the ages of 3 months to 5 years.

As a parent, you’re in the best position to spot the earliest warning signs of autism. You know your child better than anyone and observe behaviors and quirks that a pediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your child’s pediatrician can be a valuable partner, but don’t discount the importance of your own observations and experience. The key is to educate yourself so you know what’s normal and what’s not.

Monitor your child’s development. Autism involves a multitude of developmental delays, so keeping a close eye on when—or if—your child is hitting all the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays don’t automatically point to autism, they do indicate a heightened risk.
Take action if you’re concerned. Every child develops at a different pace—so you don’t need to panic if your child is a little late to talk or walk. When it comes to healthy development, there’s a wide range of “normal.” But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child’s doctor immediately. Don’t wait.
Don’t accept a wait-and-see approach. Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply “grow out” of their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.
Trust your instincts. Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it’s telling you something is wrong and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.

Regression of any kind is a serious autism warning sign

Some children with autism spectrum disorders start to develop communication skills and then regress, usually between 12 and 24 months. For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or a child may stop playing social games he or she used to enjoy such as peek-a-boo, patty cake, or waving “bye-bye.” Any loss of speech, babbling, gestures or social skills should be taken very seriously, as regression is a major red flag for autism.

Signs and symptoms of autism in babies and toddlers

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. If detected by 18 months of age or even earlier, intensive treatment may even be able 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 be very quiet 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 make noises to get your attention.
Doesn’t 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.

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

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 little world, aloof and detached from others.

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).

Signs and symptoms of speech and language difficulties in autism

Children with autism spectrum disorders have difficulty with speech and language. Often, they start talking late.

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).

Signs and symptoms of nonverbal communication difficulties in autism

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.

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.
Abnormal posture, clumsiness, or eccentric ways of moving (e.g. walking exclusively on tiptoe).

Signs and symptoms of inflexibility in autism

Children with autism spectrum disorders are often restricted, inflexible, and even obsessive in their behaviors, activities, and interests.

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 hours arranging toys in specific ways, watching moving objects such as a ceiling fan, or focusing on one specific part of an object.
Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behavior, or “stimming”).

Common self-stimulatory behaviors:

Hand flapping
Rocking back and forth
Spinning in a circle
Finger flicking
Head banging
Staring at lights
Moving fingers in front of the eyes
Snapping fingers

Tapping ears
Scratching
Lining up toys
Spinning objects
Wheel spinning
Watching moving objects
Flicking light switches on and off
Repeating words or noises

Causes of autism

The causes of autism are not well understood, but most experts agree that both genetic and environmental factors are involved. One popular theory is that certain individuals are born with a genetic predisposition for autism that is then triggered by something in the environment, either while the baby is still in the womb or sometime after birth. However, there is no scientific consensus about how these components interact to trigger the disorder.

The lack of answers can be frustrating and upsetting. It’s only natural to want to know why your child is struggling. But rather than worrying too much about unknown causes, try focusing instead on the effective treatments available. What’s most important is making sure you give your child the best chance at a full and happy life.

Genetic causes of autism

Research indicates that genes—particularly inherited genetic glitches and spontaneous DNA mutations—play a primary role in the development of autism. But no single gene is to blame. Scientists believe that at least 5 to 20 major genes are involved in autism, with many others also contributing to the risk. Studies also show that older parents are at a significantly higher risk of having autistic children.

Environmental causes of autism

Environmental causes of autism Since genes don’t completely explain autism risk or the rising number of new cases, scientists are searching for environmental explanations to fill in the blanks. The idea is that toxins, chemicals, or other harmful external elements may trigger autism, either by “turning on” or exacerbating a genetic vulnerability or independently disturbing brain development.

Possible environmental culprits include air pollution, food additives, mercury in fish, flame-retardants, pesticides, insecticides, various prescription drugs, and chemicals used to make plastics and other synthetic materials.

Autism and vaccines

Autism and vaccines While you can’t control the genes your child inherits or shield him or her from every environmental danger, there is one very important thing you can do to protect the health of your child: make sure he or she is vaccinated on schedule.

Despite a lot of controversy on the topic, scientific research does not support the theory that vaccines or their ingredients cause autism. Five major epidemiologic studies conducted in the U.S., the U.K., Sweden, and Denmark found that children who received vaccines did not have higher rates of autism. Additionally, a major safety review by the Institute of Medicine failed to find any evidence supporting the connection. Other organizations that have concluded that vaccines are not associated with autism include the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), the American Academy of Pediatrics, and the World Health Organization.

Myths and facts about childhood vaccinations

Myth: Vaccines aren't necessary.

Fact: Vaccines protect your child from many serious and potentially deadly diseases, including measles, meningitis, polio, tetanus, diphtheria, and whooping cough. These diseases are uncommon today because vaccines are doing their job. But the bacteria and viruses that cause these diseases still exist and can be passed on to children who aren’t immunized.

Myth: Vaccines cause autism.

Fact: Despite extensive research and safety studies, scientists and doctors have not found a link between childhood vaccinations and autism or other developmental problems. Children who are not vaccinated do not have lower rates of autism spectrum disorders.

Myth: Vaccines are given too early.

Fact: Early vaccination protects your child from serious diseases that are most likely to occur—and most dangerous—in babies. Waiting to immunize your baby puts him or her at risk. The recommended vaccination schedule is designed to work best with children’s immune systems at specific ages. A different schedule may not offer the same protection.

Myth: Too many vaccines are given at once.

Fact: You may have heard theories that the recommended vaccine schedule overloads young children’s immune systems and may even cause autism. But research shows that spacing out vaccinations doesn’t improve children’s health or lower their risk of autism, and as noted above, actually puts them at risk for potentially fatal diseases.

What to do if you’re worried

If your child is developmentally delayed, or if you’ve observed other red flags for autism, schedule an appointment with your pediatrician right away. In fact, it’s a good idea to have your child screened by a doctor even if he or she is hitting the developmental milestones on schedule. The American Academy of Pediatrics recommends that all children receive routine developmental screenings, as well as specific screenings for autism at 9, 18, and 30 months of age.

Schedule an autism screening. A number of specialized screening tools have been developed to identify children at risk for autism. Most of these screening tools are quick and straightforward, consisting of yes-or-no questions or a checklist of symptoms. Your pediatrician should also get your feedback regarding your child’s behavior.
See a developmental specialist. If your pediatrician detects possible signs of autism during the screening, your child should be referred to a specialist for a comprehensive diagnostic evaluation. Screening tools can’t be used to make a diagnosis, which is why further assessment is needed. A specialist can conduct a number of tests to determine whether or not your child has autism.
Don’t wait for a diagnosis to start treating the symptoms. The diagnostic process for autism is tricky, and can sometimes take awhile. But you don’t have to wait for an official diagnosis before you get help for your child. You can take advantage of early treatment as soon as you suspect your child has developmental delays. Ask your doctor to refer you to early intervention services. Early intervention is a federally funded program for infants and toddlers with disabilities.

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Autism Symptoms and Early Signs

What to Look for in Babies, Toddlers, and Children

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