While many children with autism spectrum disorders (ASDs) don't show signs until well into toddlerhood, there's good evidence some clues may be observable even before their first birthday. Other symptoms will likely appear by the time they turn 2 years old.
Though these behaviors may not necessarily point to autism, being aware of them can help parents and guardians get early diagnosis and treatment--crucial to a child's overall development and function.
The First Signs
An absence of social back-and-forth is one of the earliest indications of ASD. In their first year, if a baby isn't smiling, making eye contact or attempting to communicate through expressions and sounds, it may signal an issue.
"As early as 9 months--this is the earliest visit where I'll pick up on things, such as not responding to their own name and poor eye contact," says Sierra Coartney, DO, a pediatrician at LewisGale Physicians in Salem, Virginia. "At 12 months, it's more concerning if the child hasn't picked up these skills yet."
By 12 months, children should have begun to communicate using hand gestures, like waving or reaching for things. Babbling--making noises that may imitate grown-up speech patterns--is also typical by this age. A lack of either could suggest a problem. "You shouldn't expect other words yet below 1 year old, but you should expect a social response to sound or interaction," says Dr. Coartney.
At this stage, if you call your child's name and there's no reaction, it could be a cause for concern, as well. Don't be alarmed if they don't respond to an unfamiliar face, though. Coartney says not acknowledging someone new, like a recently hired babysitter, isn't necessarily a sign of developmental delay.
Another possible clue, however: poor joint attention skills. When an 8- or 10-month-old baby discovers something appealing, they'll frequently use gestures to try to catch your eye and share what they've found. They'll look at you to make sure you're paying attention, too, and follow your gazes and gestures. These are social interactions children with ASD don't show much interest in--and their absence is considered a hallmark of the condition.
Clues After the First Year
Between the ages of 12 and 24 months, previous signs of ASD, like a lack of interaction, may become more pronounced, and other new clues might surface. These could include:
- No verbal development--no words at 16 months, and no simple phrases that convey meaning at 24 months
- Strange body or hand movements
- Babbling that sounds like whining or humming
- An unusual fixation with a particular object, like a toy
- Losing a gained ability, like language
"Tantrums that are out of proportion, such as [in response to] a change in sound in a restaurant" are another sign, says Coartney. A child not getting their way is a more typical cause for a meltdown, she adds.
Plans for Treatment
It's important to note: while these early behaviors may point to autism, they could indicate a different health issue. "A speech delay can be a sign of autism or a range of medical conditions, such as a hearing problem," says Dr. Coartney. They may also mean nothing at all--and simply be part of your child's development.
In addition to asking about developmental milestones at all checkups, pediatricians often screen for autism as part of well visits at 18 and 24 months. Many use a test called the M-CHAT, a 23-point questionnaire followed by an interview. "A child is evaluated based on communication, cognition, fine motor skills, gross motor skills and a vocabulary of six or more words," says Coartney. It's also useful for detecting developmental delays in general.
However, you can reach out to your child's doctor at any time if you're concerned about the potential for ASD. They can perform a screening, and if signs point toward a possible problem, recommend a formal evaluation. Autism can be diagnosed reliably by age 2, though most cases aren't identified until age 4, according to the Centers for Disease Control and Prevention--often because adults don't recognize the clues.
An early diagnosis of autism means earlier intervention--the most effective way of improving outcomes for a child. Early intervention therapists help children under the age of 3 address speech delays, fine motor skill development and cognitive issues, says Coartney. Every state provides resources and at least some funding for the services; speak to your doctor or get in touch with your state's Part C coordinator for more information.