If you’re concerned your toddler may be showing signs of autism, it’s helpful to look for certain behaviors. Below is a guide based on the M-CHAT (Modified Checklist for Autism in Toddlers) and the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for Autism Spectrum Disorder (ASD). Remember, every child is different, and showing some of these traits doesn’t necessarily mean they have autism.
1. Lack of Eye Contact
- What to look for: Your toddler may avoid looking at your face when you’re talking or playing with them. For example, when you’re reading a book together, they might not look at the pictures or your face.
2. Limited Response to Their Name
- What to look for: If you call their name, they may not respond as often as you’d expect. Sometimes, this can seem like they don’t hear you, but their hearing is usually fine.
3. Lack of Pointing or Showing Interest
- What to look for: By 18 months, most toddlers point at things they want or are curious about (like a bird outside). If your toddler doesn’t point to things or bring objects to show you, this could be a sign to watch.
4. Limited Social Interaction
- What to look for: Some toddlers with autism may not smile back when you smile at them or seem uninterested in playing with others. For example, they might prefer to play alone or not take part in games like peek-a-boo.
5. Delayed Speech or Lack of Words
- What to look for: Many toddlers with autism may have delays in speaking. They might not use words to communicate by the age you expect. Instead, they may make sounds or use gestures.
6. Repetitive Movements or Behaviors
- What to look for: Repeated hand-flapping, rocking back and forth, or lining up toys can be common signs. These actions may be soothing for them but might seem unusual to others.
7. Strong Reactions to Sensory Input
- What to look for: Some children with autism are very sensitive to sounds, lights, or textures. They might cover their ears to block out sounds or avoid touching certain fabrics.
8. Rigid Routines and Difficulty with Change
- What to look for: Toddlers with autism may get upset if their routine is changed, like a different route to daycare or a change in daily schedule. They may show distress when things aren’t done in a specific way. Your toddler might become very upset when visiting new places, such as a friend’s house or a grocery store. They may have difficulty transitioning from one environment to another.
9. Unusual Play with Toys
- What to look for: Instead of playing with toys the typical way, they might focus on parts of the toy (like spinning wheels on a car) or line toys up in a particular order rather than playing imaginatively.
10. Limited Gestures or Facial Expressions
- What to look for: They may not use gestures, like waving or clapping, as much as other toddlers their age. Their facial expressions might not match the emotions you’d expect, like not smiling when they’re happy.
11. Difficulty Expressing Emotions
- What to look for: Your toddler might not recognize or respond to other people’s emotions. For instance, if someone is crying, they may not seem to notice or show concern, which is different from what you might expect from most toddlers.
12. Echolalia (Repeating Words or Phrases)
- What to look for: Instead of using their own words, your toddler might often repeat words or phrases they hear, like lines from a TV show, without seeming to understand their meaning.
13. Limited Interest in Playing with Others
- What to look for: While many toddlers love playing with other kids, a child with autism might not show much interest in group play. They may prefer playing alone and not join in with games like “tag” or pretend play with peers.
14. Inconsistent Use of Language
- What to look for: Your toddler might know a few words, but not use them consistently. For example, they may say “mama” one day but then not use it again for weeks.
15. Unusual Tone of Voice
- What to look for: Some children with autism may have a “flat” tone of voice, not showing much emotion when they speak, or they might speak in a sing-song manner. It might sound different from typical toddler speech patterns.
16. Fixation on Specific Interests
- What to look for: While it’s common for toddlers to have favorite toys, children with autism may develop intense and sometimes unusual interests, like being fascinated by fans, lights, or certain objects, and they may talk about these things repeatedly.
17. Difficulty Imitating Actions
- What to look for: Toddlers usually enjoy copying others, like pretending to talk on the phone or mimicking facial expressions. A toddler with autism may not show much interest in imitating what you do.
18. Lack of Pretend Play
- What to look for: By age 2, many children engage in pretend play, like pretending to feed a doll or using a block as a phone. A child with autism might not engage in this type of imaginative play, focusing more on objects themselves rather than pretending.
19. Difficulty with Joint Attention
- What to look for: Joint attention means sharing an experience with someone else by looking at the same object or event. For example, if you point to an airplane in the sky, a typical toddler will look at it with you. A child with autism may not follow your pointing or try to share that experience.
20. Unusual Response to Pain or Discomfort
- What to look for: Some toddlers with autism might have a high pain tolerance and not react to minor injuries, while others may overreact to small discomforts. They might not seek comfort when they fall or get hurt.
21. Unusual Gait or Motor Movements
- What to look for: Some toddlers with autism may walk on their toes, have stiff or awkward movements, or show unusual ways of moving their bodies.
22. Challenges with Self-Regulation
- What to look for: Your toddler may struggle to calm down when upset and might have more frequent or intense meltdowns than other children their age. They may find it difficult to self-soothe or recover from changes in routine.
23. Unusual Eating Habits
- What to look for: Toddlers with autism may be very picky eaters, not just preferring certain foods but being extremely selective about textures, colors, or food presentation. They might refuse foods that are mixed together or have a particular smell.
24. Difficulty with Simple Instructions
- What to look for: Many toddlers can follow simple instructions like “give me the ball” or “come here.” A child with autism might seem to ignore or not understand these requests, even though they may understand other parts of the conversation.
25. Difficulty with Transitions Between Activities
- What to look for: Moving from one activity to another (e.g., from playing to eating) might be particularly challenging. Your child might get upset or resist stopping what they’re doing, even for something they usually enjoy.
Autism traits in children under three years old can vary widely, but there are some common signs to watch for. Early identification is important for early intervention, which can significantly impact a child’s development.
What to Do if You Notice These Signs:
If you notice any of these traits in your child, it’s a good idea to discuss them with a pediatrician. Early evaluation by specialists, such as developmental pediatricians or speech and occupational therapists, can help determine if a child is on the autism spectrum and identify the best interventions.
Each child develops at their own pace, so some variations in development are typical. However, if several of these signs are present or if you have concerns, early action is always beneficial.