Early Signs: Infancy and Early Childhood

In this chapter, we'll cover in detail how autism can show itself in the first two to three years of life, and the signs that parents and primary care providers should watch for. Our aim isn't to create worry, but to support early referral by raising awareness.

0–12 Months: The First Signs

During this period the signs are usually subtle and noticed in hindsight (in other words, after a diagnosis, families can see these signs more clearly when looking back at video recordings). Findings to watch for: limited eye contact, not turning to look at one's name, a delay in or scarcity of the social smile, less interest than expected in sounds and human faces, and low participation in back-and-forth "peekaboo" games.

12–24 Months: The Signs Become Clearer

This is the period when most families first begin to feel a clear concern. Findings to watch for: not pointing with a finger, or not pointing to show what they want; not establishing joint attention (seeing something, then looking at the parent to share it); scarcity of babbling at 12 months; no single words at 16 months; no meaningful two-word sentences at 24 months; and the loss of any previously gained social or language skill (this always requires urgent evaluation).

24–36 Months: Social and Play Differences Become Clear

During this period, findings such as little interest in peers, limited or delayed symbolic/imaginative play (like feeding a doll or driving cars with a "vroom"), using objects in ways not suited to their function (like spinning wheels and watching them), and clearer repetitive movements are noticed more easily.

• Caution / "Red Flags" to Seek Advice About
• No babbling, pointing, or other gestures at 12 months
• No words at all at 16 months

No spontaneous (non-imitated) two-word sentences at 24 months

The loss of any language or social skill at any age

Any one of these findings is reason enough for a prompt developmental evaluation.

Do Early Signs Mean a Diagnosis?

No. The findings listed in this chapter are not diagnostic; they are only signs that call for a more detailed evaluation. Many children show one or several of these signs and, without receiving a diagnosis of autism, "catch up" to typical development along a different developmental path; in some children, these signs may be a sign of language delay, hearing loss, or another developmental difference. The one thing that is certain is this: when you feel concerned, asking for an evaluation rather than waiting is always the right step.

Tip / Practical Suggestion

Instead of a "wait and see" approach, adopt a "watch and act" approach. If you have a concern about your child's development, don't hesitate to ask your pediatrician for a developmental screening (see Chapter 16); this screening doesn't make a diagnosis, but it clarifies the need for referral.