Autism spectrum disorder rates continue to rise. The most recent data from the CDC, the most comprehensive surveillance of diagnostic rates in the U.S. to date, reveals that 1 in 36 eight-year-olds were diagnosed with autism spectrum disorder in 2020, up from 1 in 44 just two years prior.
Whether the increase is due to more children being born with autism or experts and parents getting better at recognizing the signs of autism in toddlers, the undeniable truth is that millions of children are being diagnosed with autism. And though awareness has improved, the average age of diagnosis has not.
In the United States, the average age of an autism diagnosis is five, but many experts believe it should be earlier and that the early signs of autism can be identified in infants. Identifying the early signs of autism in babies, especially in 9-12-month-olds, can be “invaluable,” said Abigail Delehanty, assistant professor and Program Director for the Language Disorders and Autism Clinic at Duquesne University, in speaking about a 2021 study published in Child Development.
“The primary signs of autism are in areas around social communication and interaction and behavior, interests, or activities that have restricted or repetitive patterns,” Dr. Sharief Taraman, CEO of Cognoa, a pediatric behavioral health company, tells SheKnows. “[W]e really should be aiming to get children with developmental delays help before they are 3 years old to maximize opportunity for their greatest potential and abilities.”
Wendela Whitcomb Marsh spent a decade as a school psychologist evaluating infants and toddlers age 18 months to 3 years to determine eligibility for autism programs. “Although often, children are not tested for autism until they reach preschool- or school-age, there are signs that parents can be aware of in children who are only 1 or 2 years old,” she tells SheKnows. According to Marsh, these are some early signs of autism in toddlers and babies that parents should look out for.
Lack of interest in faces and/or lack of response to sounds and name
Typically, babies are more interested in looking at people’s faces than they are in looking at other objects, but babies who are exhibiting signs of autism may avoid looking at you when you are smiling, talking, or playing peek-a-boo. Not only might they avoid looking at you, but babies exhibiting early signs of autism may not smile or respond to social cues from others and they may not turn at the sound of their parent’s voice or respond to their name, Dr. Michael Romas, Coordinator of Training and Professional Development for Developmental Disabilities Institute tells SheKnows.
Likewise, a child might occasionally prefer looking at an interesting object when you are trying to get their attention, but if your baby normally ignores you when you try to interact playfully with them that may be an early sign of autism.
Inability to share attention
Joint attention is one of the beginning stages of forming social communication skills. Most children, even babies, will share attention with another person. This can include responding to joint attention by looking at what you’re interested in or initiating joint attention by showing you something they are interested in. For example, if you turn to look at something across the room and point at it, saying, “Look at that!”, does your child follow your gaze or finger to look at what you are trying to show them? If so, they are responding to joint attention. On the other hand, children exhibiting signs of autism may appear to ignore the parent’s bid for joint attention or may go to the object but may not include the parent in the activity.
One way you can look for joint attention is by blowing bubbles as a surprise while they are playing without letting them see what you are about to do. When the bubbles float into their view, how do they respond? Are they delighted with the bubbles and ignore the other people in the room? Or do they glance at you or another person, even briefly, as if to share their enjoyment of the surprise bubbles? Going straight for the bubbles without referencing another person or seeking to bring another person into the experience, at least momentarily, could be one of the early signs of autism in toddlers.
Lack of direct communication
How does your child let you know what they want or need? Do they point at the toy on the top shelf and look back and forth between you and the toy? This is typical nonverbal communication, which most babies use before they can talk. A child exhibiting early signs of autism might struggle with nonverbal gestures, including pointing, showing, or reaching for things, Dr. Puji Jonnalagadda, Developmental Behavior Pediatrician at Pediatrix, tells SheKnows.
The result may be a child who just screams without looking at anyone or gesturing to indicate what is wrong. Then, parents have to play a guessing game: holding up a toy, a bottle, crackers, etc. until the child stops screaming, which is the only indicator that the parent guessed right and figured out what their child wanted. Children exhibiting signs of autism are frequently unable to get their ideas or needs across to other people, either verbally or nonverbally.
Using a parent’s hand to communicate
Sometimes a child will take their parent’s hand and pull them toward the kitchen to let them know they are hungry, often while glancing back at the parent. They may pat a parent’s arm or try to turn their parent’s face toward them if they want attention, such as when the parent is using their cell phone. This is not unusual. However, pay attention if your child tries to use your hand as a tool without looking at you. For instance, if they can’t open something, do they pick up your hand and place it on the object without looking at your face? This is seen more often in children exhibiting signs of autism than in typically developing children. It is as if they understand that this hand is able to open this thing, so they go directly to the source, the hand, to get the job done.
Avoiding social interaction
When you go to a park, playground or other place where you see other children your child’s age, how does your child respond to seeing other kids? Typically, babies, toddlers and preschool children show a lot of interest in other children. They may want to run over and play with them. They may be shy and watch them from behind their parents or between their fingers. In either case, they definitely notice them or show interest.
On the other hand, children exhibiting early signs of autism seem oblivious to other children. They may run over to them, but it is to play near them on the same playground equipment without actually interacting. Delays in reciprocal play and engagement and a pattern of not following along with other children in social routines and activities can be signs of autism in toddlers, notes Dr. Romas.
Many children who are later diagnosed with autism may show appropriate interest in other children at a young age, but as they grow older, this seems to plateau, and they are left behind socially. They continue to interact with others the way preschoolers might and may prefer playing with younger children or adults or much older children, while being unable to respond appropriately to children their own age.
Lack of language, eye contact, and/or smiling
Parents can also pay close attention to their child’s language skills to pick up on early signs of autism, licensed psychologist Dr. Crystal I. Lee tells SheKnows. If your child doesn’t babble by 12 months, says no clear words by 16 months or says no meaningful, spontaneous two-word phrases by 24 months (not including repeating or imitating phrases), you should consider an assessment.
However, Lee adds that just because your child exhibits these signs, it doesn’t necessarily mean they have autism. “These are just behaviors that should prompt you to get testing,” she says.
By the same token, early signs of autism in babies “can look like decreased or absence of joyful expressions such as smiling,” and inability or difficulty maintaining eye contact, notes Jonnalagadda. In fact, new tools that assess eye tracking in infancy have found that infants exhibiting signs of autism prefer to track nonsocial stimuli as opposed to social stimuli, says Romas.
Noticeable regression in developmental skills
All children meet their developmental milestones at different rates, but research shows that approximately one-third of children showing signs of autism may regress, aka lose some of the skills they’d previously mastered. Usually, the regression is in speech, but it can impact nonverbal communication or social skills.
Jonnalagadda urges parents to pay attention if their child seems to have suddenly lost skills they previously had, such as no longer saying words they used to say.
Displaying repetitive movements
Repetitive movements are a typical part of an infant’s development in helping them understand how their bodies work. Infants and toddlers typically kick their legs, clap their hands, and rock back and forth. But these same behaviors, especially if they persist and continue, can also be among the early signs of autism in babies, according to Jonnalagadda, who notes that repetitive behaviors such as flapping their hands, rocking their body, or making the same sounds repeatedly may be an early sign of autism.
What to do if your child shows signs of autism
If your child ticks a number of these boxes, Marsh recommends contacting your local county office of education to find out what assessment and early intervention services may be provided for children your child’s age. Your child may be eligible for early intervention as a child at risk for autism before they have a proper diagnosis, and you should take advantage of whatever opportunities are available. Be aware that your child’s doctor may not be able to recognize the signs of autism in infants at the well-baby checkup unless the autism is extremely obvious, as many doctors don’t have specific training in autism assessment.
Whatever the outcome, try not to view a diagnosis of autism in negative terms. “Your child is the same adorable, charming, curious, funny, precious little treasure the day after you hear a diagnosis as they were the day before,” says Marsh. “You know who your child is, and that has not changed. The purpose of a diagnosis is not to put a ceiling or close a door on what your child may accomplish. Don’t let anyone tell you otherwise or warn you against letting your child be ‘labeled.'”
Noticing and identifying signs of autism and then receiving a diagnosis of autism might be daunting, but it’s the first step toward getting your child the support they need to live a fulfilling life on their terms — and the support you need to help them live that life. If your child does exhibit early signs of autism, a diagnosis is the crucial first step to meeting their needs.
Before you go, grab these cold and flu essentials for your kiddos:
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