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Recognizing the warning signs of autism

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Parents often know in their guts that something’s not right. But they may not be able to express their concerns. And it can take months or years for doctors to make a definite diagnosis of an autism spectrum disorder (ASD), such as autistic disorder or Asperger syndrome.

To help identify at-risk children, all toddlers should now be screened for ASD under guidelines set by the American Academy of Pediatrics (AAP). These developmental screenings can help parents and doctors pinpoint early warning signs of autism so that treatment can start sooner. Although there’s no cure for autism, early intervention can help a child reach his or her full potential.

Earlier screenings for autism
The AAP guidelines call for screening much earlier than before. They now suggest screening all children for signs of autism at 18 and 24 months of age, whether or not a parent has any concerns. Doctors can use autism screening tools that assess language, social interaction and other aspects of development at well-child visits.

Risk factors and signs of autism
Major risk factors for autism include a sibling who has been diagnosed with autism or concern from the child’s parent, another caregiver or the child’s doctor. If any of these risk factors are present, then the child’s doctor will proceed with further screening and close follow-up. Two or more risk factors will prompt a referral for a more complete evaluation.

Early signs of autism, even in the first several months, can signal a problem. Looking for these symptoms in your child can lead to earlier diagnosis and treatment. Tell your child’s doctor if you notice that your baby:

  • Smiles late or very little. Babies start to smile as a way to engage others in the first few months of life.
  • Seldom makes eye contact with people. From about 2 to 4 months old, babies make eye contact with mom, dad and other familiar people. Toddlers should also look at adults when making requests and asking for help, even if they are not yet using words.
  • Doesn’t turn when you say his or her name. This normally occurs around age 8 to 10 months.
  • Doesn’t turn or look when you point or say, “Look at this.” This usually happens around age 10 to 12 months.
  • Doesn’t point at objects or people at about 12 to 14 months old.
  • Doesn’t babble back and forth. This usually begins at about 6 months of age. Between 8 and 10 months, babbling becomes more complex with more syllables (“ba-da-ma”). Babies also start to mimic the pitch and tone of their native language.

Doctors consider the following red flags that warrant immediate evaluation:

  • Not babbling or pointing by 12 months of age
  • Not using single words by 16 months of age
  • Not using two-word spontaneous phrases by 24 months of age
  • Loss of language or social skills at any age

Sometimes a hearing problem can cause language delays. The doctor may rule this out by checking your child’s ears for fluid or referring him for a hearing test.

Share with your child’s doctor any other concerns you have about his or her language development and social skills, especially if he or she has lost language or social skills. About one in four children with autism and other conditions related to autism begin to say words, but then stop speaking. This may happen between 15 and 24 months of age. They may also lose other communication skills, including pointing, waving and eye contact. This is called regression, and parents should always tell their doctor about it.

Treatment can start even before a formal diagnosis of autism. Early intervention, including speech and language therapy and behavioral interventions, appears to have long-term benefits for kids with autism and can help them reach their full potential.


  • Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: Saunders; 2004.
  • First Signs. Screening guidelines. Accessed: 07/28/2010
  • Centers for Disease Control and Prevention. Screening and diagnosis, autism spectrum disorders. Accessed: 07/28/2010
  • Plauch Johnson C, Myers SM, the Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

View the original Recognizing the warning signs of autism article on myOptumHealth.com


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