Autism spectrum disorder (ASD) is a group of neurodevelopmental conditions with behavioral, social, and communication symptoms that may be seen as early as the first year of life.

Autism spectrum disorder (ASD) affects the way a person perceives and interacts with both other people and their surroundings.

Signs and symptoms of ASD often present during the first few years of life. They can include things like problems interacting or communicating with others, as well as repetitive behaviors or routines.

But what are some more specific signs and symptoms of ASD? And how is the condition diagnosed? Continue reading as we explore these topics and more.

Learn more about autism spectrum disorder (ASD).

What are the early signs of autism?

Early identification and diagnosis of ASD is very important. When support strategies are started early, it can make a big difference in a child’s quality of life and ability to function.

Children often show early signs of ASD between the ages of 6 and 12 months. However, many children don’t receive a diagnosis until after the age of 3. This is because sometimes the early signs of ASD can be difficult to spot.

What signs can you look for?

Early signs of autism

Some of the early signs of ASD in children include things like:

problems making or maintaining eye contact

not responding when their name is called

trouble utilizing nonverbal forms of communication, such as pointing or waving

difficulties with verbal communication, such as cooing or babbling in very young children and use of single words or two-word phrases in older children

trouble with play, including disinterest in other children or difficulty imitating another person

If you notice any of these behaviors, consult with your child’s doctor as soon as possible. Early intervention and support for children with autism is very important. It can enhance a child’s development and may significantly improve social skills.

What are the categories of symptoms of autism in children?

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, divides symptoms into two categories:

problems with social interactions and communication
behaviors that are repetitive or restricted

We’ll explore both of these categories in more detail below. Let’s start with social interaction and communication. Since these are two rather broad topics, they may be separated into subcategories.

Some examples of problems with social skills include:

avoiding or having difficulty maintaining eye contact
not responding when their name is called
appearing to not hear you when you talk to them
preferring to play alone instead of with others
appearing not to share interests with others
avoiding physical contact, such as being held or cuddled
having a flat facial expression
having difficulty expressing their own feelings or understanding the feelings of others

Communication

Some examples of trouble with communication include:

delays or regression in speech and language development
reversing pronouns, such as saying “you” when they mean “I”
not using gestures like pointing or waving
difficulty understanding nonverbal cues, like gestures or facial expressions
talking in a flat or sing-song voice
experiencing trouble starting or maintaining a conversation
not following directions
repeating certain words or phrases over and over again (echolalia)
experiencing trouble playing pretend
not understanding things like jokes, sarcasm, or figures of speech

Restricted, unusual, or repetitive behaviors

Some behaviors to look for include things like:

repetitive movements, such as rocking back and forth and hand flapping
developing routines or rituals and becoming agitated if they’re disrupted
becoming intensely fixated with an object or activity, like watching a ceiling fan spin
having very specific or obsessive interests
being extremely organized, such as lining up toys in a specific order
having intense interest in the details of a thing, such as the wheels on a toy car, rather than the whole object
odd movement patterns, like walking on their toes or exaggerated body language
being sensitive to sensory stimulation, such as lights, sounds, or sensations
having very specific aversions or preferences for foods, which can include specific food types, textures, or temperature

Other potential symptoms

There are also some additional signs and symptoms children with ASD may exhibit along with the above lists. These can include:

intense temper tantrums
large amounts of energy or being very active
acting impulsively
irritability or aggression
engaging in behaviors that can cause self-harm, such as head-banging
problems with sleep
being more fearful or less fearful than would be expected

When should you take your child to see a doctor?

Here are some indications that you need to make an appointment with your child’s pediatrician.

See your doctor

Some signs or symptoms that you may want to discuss with your child’s doctor, depending on their age, include:

rarely or never making eye contact with you

not responding when you engage with them

not imitating your sounds or facial expressions

not using gestures such as pointing and waving

not developing, or losing, their language or communication milestones (can include things as early as babbling to later developments like speaking single words or short phrases)

not engaging in imaginary play or pretend games

While every child develops differently, some signs of ASD can appear early. If you have questions or concerns about your child’s development, speak with your child’s pediatrician as soon as possible.

How is autism diagnosed in children?

Before we summarize the diagnostic process for ASD, let’s first go over the diagnostic criteria. The DSM-5 defines two categories of symptoms:

deficits in social interaction and communication
restricted or repetitive behavior patterns

Symptoms are further broken into subcategories: three for social interaction and communication and four for behavioral patterns.

A child must meet symptoms in all three social and communication subcategories and also in two of the four behavioral pattern subcategories to receive an ASD diagnosis.

Other criteria for symptoms include the following:

Symptoms must be present from an early period of development.
Symptoms must lead to a significant disruption in an individual’s ability to function, such as socially or in their job.
Symptoms can’t be explained by another developmental or intellectual condition.

Autism screening

Developmental screenings can help identify ASD early. During a developmental screening, your child’s doctor will evaluate things like your child’s behavior, movements, and speech to see if they meet typical milestones.

While pediatricians check your child’s development at every well-child visit, it’s recommended that more focused screening for any developmental conditions be done during the following well-child visits:

9 months
18 months
24 or 30 months

Specific screening for ASD is recommended at well-child visits at 18 and 24 months. If screenings indicate that your child may have ASD, you’ll likely be referred to a specialist who works with children with ASD for further evaluation.

Tools for screening and diagnostics

While screening tools aren’t a definitive diagnosis, they’re useful for identifying children at risk for ASD so they can be referred to a specialist for further evaluation.

Some screening tools that are specific for ASD are:

Modified Checklist for Autism in Toddlers (MCHAT). This is a parent-completed questionnaire that’s used for identifying children at risk for ASD.
Screening Tool for Autism in Toddlers and Young Children (STAT). This tool comprises 12 activities that can evaluate things like communication and play.

In addition to the diagnostic criteria provided in the DSM-5, other diagnostic tools practitioners may use to help diagnose ASD are:

Autism Diagnosis Interview-Revised (ADI-R): ADI-R can be used for individuals 18 months and older. It assesses communication, social skills, and repetitive behavior.
Autism Diagnostic Observation Schedule, Second Edition (ADOS-2): ADOS-2 uses 30-minute modules to assess communication, social skills, and play.
Childhood Autism Rating Scale (CARS): CARS can be used for children over 2 years old. The scale draws on five different systems for diagnosing ASD.
Gilliam Autism Rating Scale (GARS-2): GARS-2 is a tool that helps parents, doctors, and teachers identify ASD in children between the ages of 3 and 22.

What are some support strategies for autistic children?

Although there’s currently no cure for ASD, there are a variety of treatment options. The overall goal of support strategies is to decrease ASD symptoms while increasing your child’s quality of life and ability to function.

Several different types of professionals may be involved in support options, including doctors, psychiatrists, and speech-language pathologists. A support strategy will focus on addressing your child’s specific needs.

Support strategies for autism

Possible options include:

Psychological therapy: This can include a myriad of different therapy types, including things like various types of behavioral therapy, educational therapy, and social skills training.

Medications: Some medications can help address ASD symptoms, such as aggression or hyperactivity.

Speech and language therapy: This type of speech therapy can help a child improve their speech and verbal communication skills.

Occupational therapy: A therapist will help your child gain everyday living skills.

Treating other health conditions: Children with ASD may also have other health conditions, such as epilepsy. Your doctor will work to manage these conditions as well.

Alternative therapy: Many parents consider alternative therapy to complement other support options. In some cases, risks may outweigh the benefits. Discuss alternative therapies with your child’s pediatrician.

What is the outlook for autistic children?

The outlook for children with ASD can vary greatly by individual. Some children may go on to live relatively independent lives. Others may require continued assistance throughout their lives.

Early detection of ASD is very important. The earlier ASD is diagnosed, the sooner support can begin. This can be vital in making sure a child gets the support they need to improve their symptoms and quality of life.

If your child has symptoms of ASD, make an appointment with their pediatrician. They’ll help combine your experiences, their observations, and available screening tools to determine if your child needs additional evaluation by a specialist.

Takeaway

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects an individual’s behavior, communication, and social skills. There are groups of symptoms that are characteristic of ASD. Some of these symptoms may be seen as early as 6 to 12 months.

Developmental screens can identify early signs and symptoms, and there are screening tools to help diagnose ASD. If you have concerns about your child’s development or behavior, speak with your pediatrician.

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Autism spectrum disorder. (2022). https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder/index.shtml
Autism spectrum disorder (ASD). (2024). https://www.cdc.gov/autism/index.html
Developmental monitoring and screening. (2024). https://www.cdc.gov/ncbddd/actearly/screening.html
Fuentes J, et al. (2020). ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC8140956/
Hyman SL, et al. (2020). Identification, evaluation, and management of children with autism spectrum disorder. https://publications.aap.org/pediatrics/article/145/1/e20193447/36917/Identification-Evaluation-and-Management-of
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