Make eye contact, such as looking at you when being fed or smiling when being smiled at
Respond to his or her name, or to the sound of a familiar voice
Follow objects visually or follow your gesture when you point things out
Point or wave goodbye, or use other gestures to communicate
Make noises to get your attention
Initiate or respond to cuddling or reach out to be picked up
Imitate your movements and facial expressions
Play with other people or share interest and enjoyment
Notice or care if you hurt yourself or experience discomfort
Developmental red flags
The following delays warrant an immediate evaluation by your child’s pediatrician:
By 6 months: No big smiles or other warm, joyful expressions
By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions
By 12 months: Lack of response to name
By 12 months: No babbling or “baby talk”
By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving
By 16 months: No spoken words
By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating
Signs and symptoms in older children
As children get older, the red flags for autism become more diverse. There are many warning signs and symptoms, but they typically revolve around impaired social skills, speech and language difficulties, non-verbal communication difficulties, and inflexible behavior.
Signs of social difficulties
Appears disinterested or unaware of other people or what’s going on around them
Doesn’t know how to connect with others, play, or make friends
Prefers not to be touched, held, or cuddled
Doesn’t play “pretend” games, engage in group games, imitate others, or use toys in creative ways
Has trouble understanding feelings or talking about them
Doesn’t seem to hear when others talk to him or her
Doesn’t share interests or achievements with others (drawings, toys)
Basic social interaction can be difficult for children with autism spectrum disorder. Many kids on the autism spectrum seem to prefer to live in their own world, aloof and detached from others.
Signs of speech and language difficulties
Speaks in an atypical tone of voice, or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question)
Repeats the same words or phrases over and over, often without communicative intent
Responds to a question by repeating it, rather than answering it
Uses language incorrectly (grammatical errors, wrong words) or refers to him or herself in the third person
Has difficulty communicating needs or desires
Doesn’t understand simple directions, statements, or questions
Takes what is said too literally (misses undertones of humor, irony, and sarcasm)
Children with autism spectrum disorder have difficulty with speech and language. Often, they start talking late.
Signs of nonverbal communication difficulties
Avoids eye contact
Uses facial expressions that don’t match what he or she is saying
Doesn’t pick up on other people’s facial expressions, tone of voice, and gestures
Makes very few gestures (such as pointing). May come across as cold or “robot-like.”
Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises. Can also be unresponsive to people entering/leaving, as well as efforts by others to attract the child’s attention.
Atypical posture, clumsiness, or eccentric ways of moving (e.g., walking exclusively on tiptoe)
Children with autism spectrum disorder have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.
