Early Signs of Autism: 10 Symptoms of Autism in Childhood

Medically Reviewed By Dannell Roberts, PhD, BCBA-D

Autism spectrum disorder (ASD) is a neurodevelopmental condition that may present symptoms in early childhood. Prompt diagnosis and effective management can improve the outcome for an autistic child. Therefore, being aware of early indicators of the condition may help you support the children you care for. Some signs and symptoms of ASD can begin early in a person’s life and development. The National Institutes of Health (NIH) suggest that many children demonstrate symptoms of ASD by 12 months Trusted Source National Institute of Child Health and Human Development Governmental authority Go to source of age.

Spotting symptoms early in a child’s life can help them receive necessary support, even before a formal diagnosis. The NIH notes that early detection and support interventions can improve outcomes for autistic people.

This article explains early signs and symptoms of ASD, and answers frequently asked questions. This article also discusses when characteristics may indicate ASD and how to seek help.

Everybody’s symptoms and development are different

ASD is a condition that can have many different manifestations. As a result, each person’s or child’s symptoms can be slightly different.

Additionally, not all differences in behavior and development in children are due to a neurodevelopmental condition. Children may experience some characteristics of ASD without having the disorder. Conversely, some children with ASD may not experience all stereotypical symptoms.

If you are unsure whether your child has ASD or might benefit from support, contact the child’s pediatrician for personal advice.

1. Little response

A man and young child sit together and laugh.
Lucy Lambriex/Getty Images

Sometimes, early symptoms of ASD can affect nonspeaking communication styles. These include facial expressions and eye contact.

For example, a child may:

  • avoid or not maintain eye contact, or make no eye contact at all
  • not respond to smiles or facial expressions, for example, not smile if someone smiles at them
  • not show facial expressions associated with being happy, sad, angry, or surprised by 9 months Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source
  • not respond to their name by 9 months

An autistic child or infant may still facially show emotions and feelings. However, typically this does not occur in response to someone else’s emotions or feelings.

2. Lack of gesturing

Other differences in behavior that can be symptoms of ASD include:

  • not using many gestures, such as waving, by 12 months Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source
  • not showing or pointing out something of interest to you by 18 months
  • not pointing in response to prompts

3. Differences in social interaction and play

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) notes that persistent deficits in social communication and interaction can indicate Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source ASD.

These characteristics can include:

  • difficulty making or sustaining friendships
  • not joining other children in play by 36 months Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source
  • not being interested in peers
  • not engaging in pretend or role play, such as pretending to be a superhero or doctor, by 48 months
  • not demonstrating play, such as singing or dancing, for caregivers by 60 months

4. Delays or differences in verbal communication

Young children with ASD may experience developmental delays in speech. This can result in early symptoms such as:

  • not babbling by 12 months
  • not using one-word communication by 16 months
  • not using two-word phrases by 24 months

Additionally, they may communicate differently in social situations. For example, older children may not engage as much in back-and-forth conversation. They may not initiate or respond to social interactions.

5. Delays in motor development

Researchers, including those from a 2018 study, have observed that fine motor skills develop more slowly for some autistic children. Fine motor skills refer to the ability to make precise, coordinated movements with the hands and wrists.

Therefore, an autistic child may not develop fine motor skills in line with generalized projections for their age.

6. Lack of empathy

ASD can affect how people interact with and relate to others. It can manifest as differences in empathy or interpersonal identification, including:

  • not noticing when others are hurt or upset by 24 months Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source
  • difficulty interpreting what others think or feel based on their facial expressions
  • being less likely to show empathy or concern toward others

7. Marked reactions

Another symptom of ASD can be marked or unexpected reactions to sensory input or stimulation. This can include emotional or strong reactions to how things taste, smell, look, feel, or sound.

8. Differences in emotional processing

Some autistic people may experience differences in how they experience and perceive emotions.

These symptoms may include:

  • fearlessness or more fear than expected
  • anxiety or excessive worry
  • stress
  • not crying when in pain or afraid

9. Repetitive or focused behaviors and interests

One significant set of symptoms of ASD is repetitive behaviors or interests. These behaviors or interests may be restricted or focused.

For example, an autistic child may:

  • line up toys or objects, and become upset with changes to this order
  • repeat words or phrases many times
  • play with items the same way every time
  • focus on very specific parts or aspects of objects, such as wheels or lights
  • have profound or obsessive interests
  • need to follow certain routines to avoid distress
  • stim, exhibit repetitive or otherwise unexpected behaviors such as:
    • listening to the same noise or song repeatedly
    • flapping the hands
    • biting nails

Learn more about stimming, including its causes and management tips.

10. Loss of previously attained skills

Sometimes, autistic children develop skills and then later experience a regression, or loss of acquired skills. This regression typically occurs between 15–24 months. Some refer to this as “autism with regression” or “regressive autism.”

Researchers from a 2015 study suggest that about one-third Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of children with ASD lose some skills during preschool ages. These skills may be social, speech, nonspeaking communication, or play skills.

Clinicians are not sure why or how this happens. However, early diagnosis and treatment may help to improve outcomes.

Additional symptoms

There are other signs and symptoms of ASD in children, including:

  • atypical eating or sleeping habits
  • hyperactive, inattentive, and impulsive behavior
  • good memory, especially for specific information such as numbers, songs, or a specific topic
  • mixing up pronouns, for example, referring to themselves as “you”
  • being difficult to soothe when crying
  • not enjoying cuddling or physical contact

Early signs of autism in girls

The DSM-5 does not make clinical distinctions for symptoms of ASD based on gender or sex.

However, symptoms of ASD in people assigned female at birth can be different from standard clinical and social expectations.

For example, some females may not experience as much repetitive or restrictive behavior as people assigned male at birth. Additionally, some claim that some females may be better able to hide characteristics of ASD when they are young. They also may assimilate to social expectations.

Some caregivers suggest that gender stereotypes can impact how people interpret symptoms. For example, some may dismiss a girl’s obsessive interest in horses as expected. This interest fits certain gender stereotypes.

If you believe a female child may have a neurodevelopmental condition such as ASD, advocate for their support. Helping them to receive an early diagnosis can improve the quality of their care and outcome.

How to monitor symptoms

It may be helpful to keep track of the child’s behaviors and mannerisms. This can include keeping a diary or using an app. The Centers for Disease Control and Prevention (CDC) offers a Milestone Tracker Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source app to record noted characteristics and developments.

The CDC runs the Learn the Signs. Act Early. Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source program, which outlines standard milestones for childhood development. This program offers free resources to help with developmental monitoring.

When to seek medical advice

All children develop differently and can have different characteristics.

The American Academy of Pediatrics suggests that children undergo developmental screening at 9, 18, and 30 months Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source . Additionally, they also recommend screening for ASD at 18 and 24 months.

The DSM-5 clarifies Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source when certain characteristics may indicate a clinical presentation of ASD. To meet the diagnostic criteria of ASD, a child must have:

  • persistent impairments in at least three areas of social communication and interaction
  • two of four specific types of restricted or repetitive behaviors

A doctor or pediatrician can offer advice regarding diagnosis. They may refer you to a specialist, such as a child psychologist. Doctors use tests and observational methods to diagnose ASD.

However, some children with ASD may not have obvious symptoms of the disorder. In addition, it is not always possible to interpret fixed clinical guidelines precisely. Some clinicians may tell Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source caregivers to wait to see if a child will “grow out of it” or reach certain milestones later.

All of these factors can mean a delay in diagnosis and support. In such cases, it is advisable to seek a second opinion.

If you believe that a child you provide care for could benefit from support, you can advocate for it. You do not need to wait for a formal diagnosis.

Learn more about the diagnosis, management, and treatment of ASD.


Dannell Roberts, Ph.D., BCBA-D, has reviewed the following frequently asked questions.

How do you rule out autism?

There is no one clinical test to confirm or “rule out” ASD. Instead, a doctor or child psychologist will examine the child’s medical and developmental history, and observe their behavior. Doctors can do this by using questionnaires or checklists based on scientific research.

Do toddlers with autism spectrum disorder laugh?

Each autistic infant will have slightly varying symptoms. As a result, some autistic toddlers may laugh, and others may not. However, some symptoms of ASD can include lack of response to interaction with others, which may impact laughing.

When do autistic babies speak?

Speech onset will be different for every child, including those with ASD. However, a 2013 study suggests that autistic children typically say their first words at about 36 months Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source . Children without ASD may produce their first words between the ages of 12–18 months. Additionally, some autistic children may mainly use nonspeaking communication. This means that they mostly do not speak at all.


ASD can appear from early childhood. It can manifest as many different symptoms, including differences in how infants and children interact with others, play, and develop.

Each child’s presentations may be distinct. However, recognizing early signs of ASD can help you to support them and get them the care they need.

Not all children who experience a few characteristics of ASD have the condition.

For a more precise and individual diagnosis, contact the child’s pediatrician. Advocating for support can help a child improve their outcome and quality of life.

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Medical Reviewer: Dannell Roberts, PhD, BCBA-D
Last Review Date: 2022 Sep 14
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