Early Signs of Autism in Toddlers: When to Seek a Diagnosis

What’s covered in this article:

• How Do I Know If My Child Is Autistic
• Key Social, Communication, and Repetitive Behaviours in Autistic Toddlers
• What Causes Autism In Toddlers?
• When Should I Seek a Diagnosis for Autism?
• Who Can Diagnose Autism in Young Children?
• How Does Early Intervention Help Toddlers with Autism?
• How Can Online Speechie Help?

How Do I Know If My Child Is Autistic?

While you are wondering if your toddler’s development is on track, you might notice behaviours that feel different from what you expect. I know it’s sometimes tempting to just brush it off as a phase but I think it’s so important to trust those parental instincts! While every child develops at their own pace, recognising certain signs of autism can be crucial in getting the right support early on. Early signs of autism can include challenges with communication, social interaction, repetitive behaviours and even delayed motor milestones. As a speech pathologist working with children on the spectrum, I’ve seen how early recognition of these signs can lead to the right support and intervention, making a significant difference in a child’s life.

To help you better recognise the early signs of autism, I’ve grouped them into key areas: social skills, communication skills, behaviors, sensory preferences and physical development. This breakdown makes it easier to understand where your child’s development may differ.

Social Skills:

• Might not respond consistently to their name being called, even in quiet environments.
• Appear happier when left playing alone.
• May not always respond verbally or through facial expressions (e.g. smiling back).
• Does not follow others’ gestures (e.g. pointing to show them something interesting).
• Difficulties understanding the meaning of facial expressions.
• Appears uninterested in interacting with peers.
• Lack of eye contact to get your attention (e.g. not looking at you when they want to be picked up).
• Lack of joint attention to share their interests (e.g. not looking at a bird outside and back at you to show you what they see).
• Often doesn’t imitate simple actions.
• May avoid initiating interactive games, like hide-and-seek.
• May not engage in imaginative play.

Communication Skills:

• Limited use of gestures such as waving goodbye or reaching out when they want to be held.
• By 9 months, they may not imitate any sounds.
• By 12 months, they may not babble, have very little babbling or do not babble in a turn-taking manner.
• By 16 months, may say very few words or only repeat a couple of the same words over and over.
• By 24 months, they may have difficulties with using two-word phrases.
• Appear to prefer grabbing your hand over using words to get your attention (e.g. instead of saying “help”, they may direct your hand towards the object they need help with).
• Might repeat entire sentences they’ve overheard (e.g. repeat a line from a cartoon, without understanding the meaning).
• Might stop using words or gestures they previously used, such as saying “mama” and then suddenly stopping.
• Difficulties with staying on topic or responding with unrelated topics to questions.
• Might have difficulty following simple instructions (e.g. “Put your shoes on” or “Bring me your cup”).

Behaviors:

• Displays intense interest in specific objects (e.g. choosing the same book and getting upset if another one is offered).
• Engages in repetitive actions (e.g. opening and closing doors repeatedly).
• Plays with toys differently to intended purpose (e.g. stacking blocks in a precise line rather than building towers).
• Becomes distressed if routines are disrupted (e.g. needing to wear the same jacket every day or sit in the same chair at the table).
• May engage in repetitive body movements (e.g. spinning in circles or bouncing up and down while sitting).
• May have difficulties with going to sleep and staying asleep.
• May display self-harming actions (e.g. biting their own hand, hitting head).
• May appear aggressive or disruptive.
• May appear passive.

Sensory Preferences:

• May be more sensitive to loud sounds (e.g. being distressed by the vacuum cleaner or crowded environments like shopping malls).
• May be under sensitive to pain.
• May be sensory seeking (e.g. rubbing their cheek against soft fabrics or pressing their body against walls).
• Being a picky or fussy eater due to texture preferences.

Physical Development:

• May have delayed motor milestones (e.g. not walking at 18 months).
• May display tip-toe walking or flapping their hands when excited.
• Prefers consistency in textures and environments (e.g., only eating crunchy foods or insisting on wearing soft fabrics).
• May have difficulty with coordination and appear clumsy (e.g. frequently falling, difficulties with skipping, jumping).
• May have low muscle tone affecting posture and balance.
• Reduced fine motor skills (e.g. difficulties with picking up small items).

Key Social, Communication, and Repetitive Behaviours in Autistic Toddlers

 

While there are many possible signs as listed above, it’s usually a combination of certain behaviours that is most closely linked to autism in toddlers. Below are the group of signs most commonly associated with autism in toddlers, particularly in the areas of social interaction, communication, and repetitive behaviours.

Inconsistent Eye Contact:

They might make eye contact during fun activities or games but may avoid it at other times, like when they’re holding something up or requesting something.

Rarely Shares Toys of Interest:

They may enjoy playing with their favourite toys on their own rather than sharing the experience with you.

Rarely Respond to Their Name:

You might find yourself needing to call their name multiple times. They may rarely respond by looking towards the person that called them.

Does Not Use Pointing to Show You Something:

They may rarely point to direct your attention, like pointing at a bird or an aeroplane, which children often do to share what they’re seeing.

Difficulty Following Other People’s Gestures:

When you point something out, like a dog in the park, they may not follow your gesture or look in the direction you’re pointing unless you help guide them by tapping on them.

Little Interest in Other Children:

They may prefer to play on their own rather than join in during play dates or mum groups.

Loss of Words or Skills:

Some children may seem to lose words they once used or have a noticeable drop in language skills, which can be an important sign to pay attention to.

If your child is mostly using single words or short phrases and shows three or more of the behaviours above, it’s a good idea to seek further assessment. Reaching out to a speech pathologist or paediatrician as soon as possible can help, and it’s fine to go with whichever professional is available first.

What Causes Autism In Toddlers?

This is a question I get in the clinic quite frequently after a client’s been diagnosed! According to research, there is no single known cause. Researchers believe that multiple causes may be involved.

Genetics:

• Autism may be linked to genetic conditions like Rett syndrome or fragile X syndrome.
• Genetic changes may affect how the brain develops or how brain cells communicate, resulting in the various communication and behavioural differences.
• Genes linked to autism are passed down through families.

Environmental Factors:

• Viral infections
• Complications during pregnancy
• Exposure to certain pollutants

ASD is so complex and it can look different for every child. I would like to share this analogy: Think of autism like planting a garden. The seeds (genetic factors) are the foundation, but how the garden grows depends on many things, like the soil, sunlight, and water (environmental factors). Some gardens may have more flowers, others may have more trees, and some may grow in unexpected ways. Just as every garden is unique based on its combination of seeds and environment, each child with autism is unique because of the different factors that shape their development. No two gardens are the same, just like no two children with autism are exactly alike.

When Should I Seek a Diagnosis for Autism?

Research shows that early identification of autism can significantly improve developmental outcomes. If you notice the above signs occurring consistently, it may be time to consider a formal evaluation for a possible autism spectrum disorder (ASD) diagnosis. It is important to note that the above signs don’t necessarily confirm autism, but differences in the development of social skills and behaviors can be indicators of ASD.

According to studies, most children can be reliably diagnosed with autism by the age of 2, though many parents report noticing signs even earlier. Early diagnosis allows for earlier intervention, which research has shown to be highly effective in improving social, cognitive, and communication skills. For example, toddlers who start intervention before the age of 3 tend to show greater improvements in language and social behaviors compared to those who begin later.

If you’ve been noticing behaviors that feel different or concerning, trust your instincts. As parents, you know your child best. Seeking an early diagnosis not only provides clarity, but it can increase participation in schooling, and help your child better understand their needs and identity from a young age.

In Western Australia, an official autism diagnosis can also provide access to important funding and support services, such as the National Disability Insurance Scheme (NDIS). This funding can help cover the cost of therapies and support services tailored to your child’s needs.

Who Can Diagnose Autism in Young Children?

In Western Australia, autism spectrum disorder (ASD) can be diagnosed by a single qualified health professional or a multidisciplinary team, depending on your child’s needs. A diagnosis typically involves a combination of observations, assessments, and developmental history.

The multidisciplinary team usually includes a speech pathologist, a clinical psychologist, and sometimes a pediatrician. The clinical psychologist assesses cognitive, emotional, and behavioral aspects, while the pediatrician looks at overall physical development and medical history. The speech pathologist can conduct assessments that focus on communication and social skills, which are key indicators of autism.

How Does Early Intervention Help Toddlers with Autism?

Early intervention can offer meaningful support for toddlers with autism, helping them build important life skills during a critical period of development. Research shows that when children receive targeted support before the age of 3, it can enhance their ability to communicate, interact socially, and learn new skills. More importantly, early intervention focuses on nurturing your child’s strengths to navigate challenges in a supportive, inclusive way.

Early intervention can also provide a sense of confidence and control for families. It gives parents and caregivers practical strategies to create an environment that embraces and supports their child’s neurodiversity.

These interventions would usually involve a combination of speech therapy, occupational therapy, physiotherapy, and psychologist. Your child’s multidisciplinary team will assist you and your child to create and work towards goals that will increase participation in meaningful activities and overall independence.

How Can Online Speechie Help?

Here at Online Speechie, we can help determine whether your child meets the criteria for autism spectrum disorder, following the guidelines outlined in the Diagnostic & Statistical Manual, 5th Edition (DSM-5). In some cases, a speech pathology assessment may be all that’s needed for a diagnosis, while other times, a multidisciplinary team approach is necessary a more comprehensive assessment.

With comprehensive assessments provided by Online Speechie, we may be able to help your child receive appropriate supports from NDIS or the education department. For more information, read this article on Assessments to Access NDIS and Educational Supports.

If you have questions or would like to book an assessment, visit our Autism Assessments page.

References:

Child and Adolescent Health Service. Autism Spectrum Disorder (ASD) Diagnostic Service. Published 2023. Accessed October 19, 2024. https://www.cahs.health.wa.gov.au

Huguet G, Ey E, Bourgeron T. The genetic landscapes of autism spectrum disorders. Annu Rev Genomics Hum Genet. 2013;14:191-213. doi:10.1146/annurev-genom-091212-153431. https://doi.org/10.1146/annurev-genom-091212-153431

Robins DL, Fein D, Barton ML. Modified Checklist for Autism in Toddlers (M-CHAT). J Autism Dev Disord. 2001;31(2):131-144.

Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol. 2008;37(1):8-38. doi:10.1080/15374410701817808. https://doi.org/10.1080/15374410701817808

Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA. 2014;311(17):1770-1777. doi:10.1001/jama.2014.4144. https://doi.org/10.1001/jama.2014.4144

Zwaigenbaum L, Bryson S, Lord C, et al. Clinical assessment and management of toddlers with suspected autism spectrum disorder: Insights from studies of high-risk infants. Pediatrics. 2009;123(5):1383-1391.