7 Signs of Autism in Toddlers

Today I want to share 7 signs of autism in toddlers. Watch the video.

Parents… these are the things speech-language pathologists and other professionals look for when we’re screening late talking toddlers for autism. Here we’ll be talking about things that kids with autism do that are different than kids with typically developing language skills and kids with other kinds of language delays.

(From ASHA Practice Portal… Autism Spectrum Disorders)

1. Kids with autism will have differences in eye contact and eye gaze.

The first difference is in how kids with autism use their eyes, particularly how they use their eyes when you are communicating with them.

This looks like kids who have:

•  difficulty paying attention to your face when you talk to them. They look away or seem to avoid eye contact.
• difficulty following your point. They aren’t very interested in what you’re pointing at and talking about, or they may be intensely focused on what they’re doing and miss that you’re pointing in the first place!

The classic way to assess for this is to dramatically point to something across the room as you say, “Look!”

If a child over 12 months of age doesn’t consistently look at what you’ve pointed to, he’s having difficulty developing joint attention.

Kids who have weaker joint attention skills have difficulty learning to talk because they are not interacting and attending well enough to link meaning with your words.

For example, when you and your child are together and you say, “Look! It’s a cat! See? The cat!” we want a child to look and listen as you give him words for what he’s seeing. When you do this, over time, a child learns to first understand that “cat” means the furry animal who says “meow,” and eventually, he begins to say “Cat.” It all begins with him watching you, paying attention to what you’re showing him, and listening to your words as you talk.

Watching you and listening to what you’re talking about is how kids learn what words mean and eventually, to say those words.

We want to see kids maintain eye contact and look at what you’re talking about consistently by 12 months.

If they’re not doing that, it’s a red flag for autism.

2. Kids with autism have difficulty responding to their own names.

By 12 months old, kids with typical development and kids with other kinds of language delays consistently respond to their own names.

When a child doesn’t look at you when you call his or her name, it’s a huge red flag for autism.

In fact, in my nearly 30 year career, it’s the first thing I look for within 30 seconds of meeting a child!

Many times parents will try to compensate or justify by saying things like, “He’s super busy,” or “He’s ignoring me,” or “He’s just stubborn.” While those things may seem true, it’s not the real reason a child isn’t responding.

Not responding to your own name is a classic sign of autism in toddlers.

(For tips for teaching a child to respond to his own name, watch this video!)

3. Kids with autism don’t point to and show you objects of interest.

The third difference is in how kids with autism interact with and communicate with you.

How does this look?

They don’t use very many gestures or body movements to request your attention or show you what they want. They don’t try to show you things that are interesting to them.

When a child hasn’t learned to point by 15 months and isn’t taking things to his parents or other adults to show them and listen to them talk about the object by 12 to 15 months, it’s a red flag for autism.

 4. Kids with autism have difficulty learning to play with toys.

By 15 months most toddlers – even those with language delays – can demonstrate how a familiar object is used. For example, you give them a cup and they try to drink. Or you give them a hair brush and they brush their hair. They see sunglasses, and they put them on their eyes.

A child with autism may explore the object without using it correctly – look at it, hold it up to the light, spin it on the floor, or any other kind of repetitive movement – rather than playing with the toy.

Another big marker is that kids with autism don’t have lots of pretend play.

By 24 months, we want kids to do things like pretend to feed a baby doll and put it to bed.

Or take one object and use it as something else. For example, pretending a block is a telephone or a car.

This marker is easy to see but is often dismissed by parents who say, “My child doesn’t like toys.”

That’s not the case. It would be more accurate to say they can’t play with toys rather they don’t like toys.

Toys are the tools of childhood – so when a child doesn’t know how to play with toys, he misses hundreds of opportunities to learn every day. Play is how little kids learn everything including:

• early cognitive concepts like cause and effect and simple problem solving
• early quantity and math skills
• how to share and make friends
• language as they talk and play with other people.

When we don’t see a child playing with a variety of familiar toys and pretending, it’s a red flag for autism.

5. Children with autism will have difficulty learning to imitate. 

Imitating is how kids learn everything!

They watch you and then do what you do…and they listen and say what you say.

Usually by 12 months, babies copy body movements such as waving bye-bye and can complete hand motions in a song like clapping to “Patty Cake.” He’s watched you do those things, and then he begins to do them too.

After a child has had practice imitating nonverbally with actions, he begins to imitate verbally with sounds and words.

Researchers have found there’s a neurological disruption in kids with autism. They’re wired differently from the beginning and imitating is so hard for them! IT’s yet another reason kids with autism have difficulty learning to talk!

When a child is not copying actions and words by 16 months, it’s a red flag for autism.

6. Toddler and preschoolers with autism have difficulty with nonverbal communication.

Kids with autism don’t always understand or use nonverbal ways to communicate message.

They may have a “flat affect” or limited facial expressions or body language. It may take them a while to laugh during a game with you or to respond with “twinkly” eyes when they’re excited about something you’ve said. You may not see a true social smile. They may smile, but many times it’s not a social smile. It’s very self-directed – so a child smiles  in response to something that’s happened, but not directly at people.

Kids may have difficulty reading your body language or gestures too! They don’t “get” what the stern look on your face means or may by irritated by new baby brothers or sisters who are crying.

Nonverbal communication, particularly gestures, are so important for language development. Gestures are a huge predictor for late language skills and always develop just before words in children with typically developing language and kids with other kinds of language delays.

Actually, using gestures is a strength of many kids with other kinds of language delays. They often make up their own elaborate gestures to compensate for their lack of words.

When a child isn’t learning to understand what gestures mean or to use gestures themselves to communicate specific message to other people, they’re not learning to be symbolic thinkers. If they can’t use symbols nonverbally – meaning a wave means bye – shaking my head like this means no – they won’t be able to use symbols verbally. What do I mean by that? Just like gestures, words are symbols too. When we don’t see gestures, we probably don’t hear words.

Variety matters too! We don’t want to see just one act of nonverbal communication – like leading parents to another room by the hand. we need to see lots of gestures like pointing, waving, giving high 5, clapping, shaking head for yes or no, etc…

When a child isn’t using 16 different gestures by 16 months, it’s a red flag for autism.

7. The last red flag is differences in language development in kids with autism.

Many kids with autism do not learn to talk on time. Generally, first words appear between 12 and 15 months when a child’s language skills are typically developing. By 18 months, typically developing kids have 50 words and are starting to combine words to use phrases. The outer limit for that language milestone is 24 months.

But there are other differences we see in kids with autism beyond vocabulary size.

Differences are also noted in not only what a child can say, but in what he understands. By 18 months we expect children to understand and follow many simple directions during their everyday routines. When a 2 or 3 year old child does not follow directions, there’s more going on than late talking.

Some children with autism may talk but not communicate with others. They may quote lines from a movie or show or book. This is called echolalia and it’s prevalent in many verbal kids with autism. Typically developing kids also learn to quote lines from shows or to sing songs or recite books, but they are performing when they’re doing it. There’s eye contact and interaction with the listener.

Lastly, and this is a big one, in some kids with autism, expressive skills may be at a higher developmental level than receptive skills in autism on a formal speech-language assessment. That means that a child says more than he can understand. This pattern is OPPOSITE of how test results compare to typically developing kids and late talkers who understand more than they can say. When you see these results, it’s a red flag for autism.

That’s the list – all 7 signs of autism in toddlers.

If you’re a therapist, I challenge you to memorize these so you can spot these differences.

For parents… if you’re seeing several of these signs in your own child, I’d encourage you to talk with your child’s pediatrician who will also probably complete a set of questions with you about your child’s development and talk about your next course of action. You may go ahead and opt a full developmental evaluation to rule out autism. At the very least, you’ll want to begin speech therapy to help a child learn to understand and use words. This is actually a very positive step for you and your child because early intervention works!

The biggest regret parents have shared with me over the years is waiting. They knew something was wrong – yet they waited to do anything about it. I don’t want that to happen to you! If you suspect autism in your child, make those calls and get into action now. You don’t want to waste any time.

I can help with that too!

Excellent resources here at teachmetotalk.com for you are…

The Autism Podcast series – a series of one hour videos for parents and professionals discussing the differences we see in children with autism and more importantly, what to do about it. Podcasts beginning at 401… through the newest episode this week.

The Autism Workbook is my newest treatment manual with a comprehensive plan outlined for you to help you determine what your child needs help learning. Parents are telling me it’s getting them back on track with therapy – especially in this age of virtual services. Therapists are telling me it’s helping them with new ideas and information to share with families. Take a look at that today and get the child you love moving in the right direction!

For therapists – this was just a brief review of those characteristics. If you’d like more in-depth information, take my 1.5 hour CE course called Characteristics that Differentiate Autism from Other Language Delays.

Check out our library of over 30 hours of continuing education videos available for early intervention SLPs and other therapists who treat toddlers and preschoolers with communication delays and disorders. Watching is always FREE – information is available for parents, teachers, or anyone else who would like to access quality clinical information specifically for working with toddlers and preschoolers. Therapists can obtain an hour of CE credit for only $5 with a certificate that’s generated and delivered via email. For SLPs, ASHA credit is also available.