Early Signs of Autism in Children: What to Look For

Autism Spectrum Disorder (ASD) is a developmental condition that affects communication, social interactions and interpersonal relationships. Identifying early signs, such as delayed speech, limited eye contact or repetitive behaviors, is crucial for accessing effective interventions that support a child’s growth.

In this blog, we speak to Betsy Cherian Ittickathra, D.O., a board-certified pediatrician with INTEGRIS Health Medical Group Edmond Renaissance, to highlight symptoms to watch for and explore how ASD can be easily confused with other disorders.

“Autism spectrum disorder looks different for everyone,” Ittickathra says. “Some children may require extensive support while others may have delays that are less noticeable. Standard screening for autism begins at a baby’s 18 month well child check. If you have concerns outside of this, please schedule an appointment with your child’s pediatrician to discuss it further so that we can start helping your child get the support that they need. Autism is a difficult diagnosis on families, but we are here as a health care team to help you however we can.”

What is autism?

What to know: Autism is a developmental condition that affects how people communicate, interact with others and process interpersonal relationships. It’s called a spectrum because it encompasses a wide range of characteristics and abilities, from mild to severe.

People with autism may experience challenges in many areas, ranging from how they communicate to how they focus on activities. 

• According to the Centers for Disease Control and Prevention (CDC), about 1 in 36 children in the United States is diagnosed with autism.
• This rate has increased over the past few decades due to greater awareness and improved diagnostic criteria.

Boys are approximately four times more likely to be diagnosed with autism than girls. 

• However, autism in girls is often underdiagnosed because their symptoms may present differently or be less obvious.

Key areas to observe for autism

Key points: Autism spectrum disorder can present in various ways, but certain signs are commonly observed by the age of 18 months – some developmental delays may be noticeable as young as six months. For some children, symptoms may appear gradually, while others may develop as expected and then lose skills around age one or two (known as regression).

Social interaction challenges are a common visual indicator.

• Babies may avoid looking at faces or making eye contact during interactions.
• By around 12 months, children typically turn toward their name, so a lack of this response can be an early sign.
• A child may seem indifferent to playing with others or engaging in activities like peek-a-boo or interactive games.
• They may struggle to smile back at others or imitate gestures like waving or clapping.

Communication delays or unusual communication patterns are hallmark signs of autism.

• Babies generally start making cooing or babbling sounds by this age, so a lack of verbal sounds can be a red flag.
• No single words by 16 months and no two-word phrases by 24 months.
• Sometimes referred to as echolalia, children with autism may repeat words or phrases they've heard instead of using language meaningfully.
• Limited use of gestures, such as pointing to show interest, can be significant. 

Repetitive behaviors and routines may show up during play time.

• Stimming – repetitive hand-flapping, spinning or rocking – serves as a way for the child to self-soothe or regulate sensory input.
• They may develop fixed routines, from the order in which meals are served to the path they take during a walk.
• Instead of playing with toys as intended, a child might line up cars or spin wheels repeatedly.

Sensory sensitivities can occur, typically divided into hypersensitivity (overresponsiveness) and hyposensitivity (underresponsiveness).

• Overreaction to sounds may show up as covering ears or becoming distressed by everyday noises such as vacuum cleaners or loud music.
• Unusual responses to textures can result in children avoiding certain fabrics, foods or materials.
• Some children may also not seem to notice injuries or respond as expected to discomfort.

What to look for at specific milestones

Here’s a brief checklist of behaviors and milestones to monitor.

• 6 Months: Limited eye contact, no big smiles or joyful expressions.
• 9 Months: No back-and-forth sounds, smiles or other expressions.
• 12 Months: No response to their name, no babbling, no pointing or waving.
• 16 Months: No spoken words.
• 24 Months: No meaningful two-word phrases.

Read more: Use this blog as a guide to determine if your child is speaking enough for their age and when you should become concerned about a possible delay. 

Confusion with other disorders

Why it’s complicated: Diagnosing autism can be complex, as many of its symptoms overlap with other medical or developmental conditions. Traits such as communication challenges, sensory sensitivities and repetitive behaviors can also appear in disorders like attention deficit hyperactivity disorder (ADHD), sensory processing disorder or speech and language delays.

Autism and ADHD share behavioral characteristics, making it difficult to distinguish one from the other in young children. 

• Children with ADHD may struggle to stay attentive, but so can children with autism, especially if they are uninterested in the topic or overwhelmed by their environment.
• While fidgeting, restlessness or impulsive behavior is classic ADHD, children with autism might show similar behaviors, often in response to sensory overload or rigid routines being disrupted.
• Both conditions can impact how children interact with peers, but the reasons differ – ADHD challenges may stem from impulsivity and attention deficits, while autism involves difficulties understanding social cues and context.

Sensory processing disorder (SPD) causes children to have heightened or diminished responses to sensory input, much like children with autism. 

• Both conditions may cause distress in overstimulating environments, such as noise, textures or lights.
• Repetitive behaviors or stimming – rocking, flapping hands or spinning objects – are often seen in sensory processing issues but are also hallmarks of autism as a self-regulation tool.

Delays in speech development are common in children with autism, but these can also occur as standalone issues or in conditions like apraxia of speech.

• A child with autism or a speech delay might not say their first words by 16 months or use two-word phrases by age two.
• Both conditions can involve challenges with expressive language, though autism often accompanies difficulties in nonverbal communication like gestures and facial expressions.
• What sets autism apart is that children may also struggle to use language socially or communicate for shared enjoyment, such as pointing to an airplane in the sky to show interest.

Anxiety disorders or emotional behaviors, such as avoiding new situations or struggling in group settings, might also resemble autism.

• Children with social anxiety may avoid eye contact or interactions, similar to those with autism.
• While both conditions might include a preference for predictability, children with autism usually have these behaviors as part of the broader need for structure rather than fear of judgment.

Hearing loss or auditory processing disorder (APD) may also be confused for autism.

• A child who doesn’t respond might be suspected of hearing loss, but this is also a common early sign of autism.
• Both conditions can present challenges with processing spoken language, although for different reasons.

Next steps: Health care professionals use a comprehensive approach to distinguish autism from other conditions, including screenings such as the M-CHAT (Modified Checklist for Autism in Toddlers) and multidisciplinary evaluations with pediatrics, speech therapy, psychology and occupational therapy. Contact your child’s pediatrician today if you have concerns regarding autism spectrum disorder.

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