One in 68 kids have autism, and the disorder is roughly five times more likely to affect boys than girls. It’s called a “spectrum disorder” because it encompasses a handful of related conditions, all of which may present in different ways, with symptoms ranging from mild to severe, says Juhi Pandey, PhD, a pediatric neuropsychologist, and scientist with the Center for Autism Research at Children’s Hospital of Philadelphia.
What are the symptoms of autism?
Autism’s early warning signs usually emerge sometime before a child turns three. Symptoms can start as early as 12 or 18 months for some children, while other kids with autism may not be diagnosed until the second or third grade, Pandey says. “Symptoms occur over time, and they don’t always happen in a doctor’s office,” she says. “That’s why parents watching for symptoms and providing [the doctor with] that information is important.”
Pandey also says parental symptom-spotting is vital because the sooner a health professional can intervene, the better off the child will be. “You cannot get autism-specific intervention until you get a diagnosis,” she adds.
So what are the symptoms of autism? Here are 12 that parents need to know. Just keep in mind: Diagnosing autism is complicated. “We need to see a number of these symptoms to make a diagnosis, not just one,” Pandey says.
Also, different symptoms emerge at different ages. What may be a red flag for autism at age 3 could be considered typical behavior at age 1 or 2. While you should tell your child’s doctor if you notice any of these symptoms, spotting one of them—or even several of them—is not a guarantee that your child has autism.
1. Poor eye contact
Pandey calls poor eye contact “one of the hallmarks” of autism. Young children tend to lock eyes with loved ones and strangers alike. But a child with autism may avoid eye contact—never looking directly at his parent or doing so inconsistently or fleetingly. “Some kids who are severely impacted may make no eye contact at all,” Pandey adds. At the same time, she says some children may just be shy. A lack of eye contact is not always indicative of autism—a caveat that applies to every symptom on this list.
2. Flapping hands or repetitive gestures
Repetitive motions or gestures—often flapping or spinning hands, flicking fingers, or rocking back and forth—are a red flag, Pandey says. Especially if a child repeats these or similar gestures when he’s worked up or excited, that’s something to note.
3. Repeating phrases or babble
While many young kids babble or repeat themselves, Pandey says young children with autism may repeat the same “jargony” phrase over and over again in the exact same way—almost like they’re singing the verse of a song. “I had one child who would repetitively count the way he heard it on Elmo,” she says. This is known as “scripted language,” she adds. Repeating a phrase or babble with odd rhythms or in sing-song voice are also warning signs, Mayo Clinic experts say.
4. Heightened sensitivity or sensory aversion
Autism can cause a child’s senses to be touchy. A child may enjoy rubbing smooth or soft surfaces, or he may smell everything, Pandey says. But he may not like to be held or cuddled. “Everyday sounds might be really hard for them,” she says of children with autism. She mentions toilet flushes and vacuum cleaners as common irritants. “They might hold their hands up to their ears,” she says. A child with autism may also be very sensitive to bright light, according to the Mayo Clinic.
5. Inspecting toys rather than playing with them
Most young kids will inspect a toy before playing with it. But a child with autism may not move past the inspection phase, Pandey says. So while a child without autism will race a car along the floor, or fly an airplane through the air, a child with autism might continue to spin the car’s tires or examine the bottom of the plane. “Their interest is in the parts of the object rather than the whole,” she says.
6. Playing alone
Again, some kids are just shy. But solitary play can be an indicator of autism. Pandey says a child with autism may not know how to approach other kids or may be more interested in doing her own activities. If another child tries to interact or play with him, a child with autism “may not know how to react,” she adds. She says this kind of behavior isn’t uncommon at young ages, but if it’s still happening later—like at age 7—that’s a stronger warning sign.
7. A lack of interest in pretend play
For kids with autism, pretend skills may be absent or lacking. “[These kids] don’t use objects for pretend play—stuff like picking up a sponge and using it as a pretend phone,” she says. Play-feeding a doll or pretending the couch is a truck or train are other examples. If this kind of pretend play hasn’t started by 18 months, that’s a warning sign, notes the CDC.
8. Obsessive interests
For older children with “high achieving” forms of autism, they may become fixated on a specific topic—something like the weather or a baseball team, Pandey says. “That’s all they’ll talk about and all they’ll do,” she says.
9. Unresponsive to his or her name
By 12 months of age, most children will look up or respond when someone calls them by name. If a child does not, that may be indicative of autism, the CDC says. These kids may also seem not to hear their parents or other people, or they may struggle to understand or follow simple commands or instructions.
10. Stereotyped behavior
A child with autism may get “stuck” on certain habits, interests, or behaviors, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development. For example, he may always want to hold the same toy—refusing to put it down even when he’s trying to play with something else. Or he may spend a lot of time lining up cars or arranging objects in a specific order.
11. Loss of language or social skills
Children with autism may seem unwilling to speak or verbalize even though they used to do so. For example, a baby who used to babble or make nonsense noises might stop as he gets older. Children with autism may also withdraw from social situations even though they used to seem comfortable playing with or around other kids, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
12. Doesn’t point or respond to pointing
Children will typically start pointing out things to their parents by 14 months. If a child doesn’t point out airplanes or dogs or other interesting things, that could be a red flag. The same is true if a child doesn’t look at things her parent is pointing out. Failure to wave or to respond to waving is another warning sign, notes the CDC.
What should I do if my child is showing symptoms of autism?
Call your pediatrician or your state’s Early Intervention program to schedule an appointment for a formal autism screening. From there, you may be referred to a specialist for a full diagnostic evaluation. Before your child’s screening, you may find it helpful to fill out the M-CHAT, which stands for Modified Checklist for Autism in Toddlers and is an American Academy of Pediatrics-approved screening tool for autism. Print out your results and bring them with you to discuss with your child’s doctor.
