How to find out if your child is autistic

Signs of autism in children

Autism in young children

Signs of autism in young children include:

not responding to their name
avoiding eye contact
not smiling when you smile at them
getting very upset if they do not like a certain taste, smell or sound
repetitive movements, such as flapping their hands, flicking their fingers or rocking their body
not talking as much as other children
not doing as much pretend play
repeating the same phrases

Autism in older children

Signs of autism in older children include:

not seeming to understand what others are thinking or feeling
unusual speech, such as repeating phrases and talking ‘at’ others
liking a strict daily routine and getting very upset if it changes
having a very keen interest in certain subjects or activities
getting very upset if you ask them to do something
finding it hard to make friends or preferring to be on their own
taking things very literally – for example, they may not understand phrases like "break a leg"
finding it hard to say how they feel

Autism in girls and boys

Autism can sometimes be different in girls and boys.

Autistic girls may:

hide some signs of autism by copying how other children behave and play
withdraw in situations they find difficult
appear to cope better with social situations
show fewer signs of repetitive behaviours

This means autism can be harder to spot in girls.

The National Autistic Society has more information about autistic women and girls.

Non-urgent advice: Get advice if:

you think your child might be autistic

You could speak to:

a GP
a health visitor (for children under 5)
any other health professional your child sees, such as another doctor or therapist
special educational needs (SENCO) staff at your child's school

Getting diagnosed can help your child get any extra support they might need.

Find out how to get diagnosed

Page last reviewed: 11 November 2022
Next review due: 11 November 2025

Screening and Diagnosis of Autism Spectrum Disorder

Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s developmental history and behavior to make a diagnosis.

ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable ^[¹^]. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults. This delay means that people with ASD might not get the early help they need.

Diagnosing children with ASD as early as possible is important to make sure children receive the services and supports they need to reach their full potential ^[²^]. There are several steps in this process.

Developmental Monitoring

Developmental monitoring is an active, ongoing process of watching a child grow and encouraging conversations between parents and providers about a child’s skills and abilities. Developmental monitoring involves observing how your child grows and whether your child meets the typical developmental milestones, or skills that most children reach by a certain age, in playing, learning, speaking, behaving, and moving.

Parents, grandparents, early childhood education providers, and other caregivers can participate in developmental monitoring. CDC’s Learn the Signs. Act Early. program has developed free materials, including CDC’s Milestone Tracker app, to help parents and providers work together to monitor your child’s development and know when there might be a concern and if more screening is needed. You can use a brief checklist of milestones to see how your child is developing. If you notice that your child is not meeting milestones, talk with your doctor or nurse about your concerns and ask about developmental screening. Learn more about CDC Milestone Tracker app, milestone checklists, and other parent materials.

When you take your child to a well visit, your doctor or nurse will also do developmental monitoring. The doctor or nurse might ask you questions about your child’s development or will talk and play with your child to see if they are developing and meeting milestones.

Your doctor or nurse may also ask about your child’s family history. Be sure to let your doctor or nurse know about any conditions that your child’s family members have, including ASD, learning disorders, intellectual disability, or attention deficit/hyperactivity disorder (ADHD).

Developmental Screening

Developmental screening takes a closer look at how your child is developing.

Developmental screening is more formal than developmental monitoring. It is a regular part of some well-child visits even if there is not a known concern.

The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening for all children during regular well-child visits at these ages:

9 months
18 months
30 months

In addition, AAP recommends that all children be screened specifically for ASD during regular well-child visits at these ages:

18 months
24 months

Screening questionnaires and checklists are based on research that compares your child to other children of the same age. Questions may ask about language, movement, and thinking skills, as a well as behaviors and emotions. Developmental screening can be done by a doctor or nurse, or other professionals in healthcare, community, or school settings. Your doctor may ask you to complete a questionnaire as part of the screening process. Screening at times other than the recommended ages should be done if you or your doctor have a concern. Additional screening should also be done if a child is at high risk for ASD (for example, having a sibling or other family member with ASD) or if behaviors sometimes associated with ASD are present. If your child’s healthcare provider does not periodically check your child with a developmental screening test, you can ask that it be done.

View and print a fact sheet on developmental monitoring and screening pdf icon[657 KB, 2 Pages, Print Only]

Developmental Diagnosis

A brief test using a screening tool does not provide a diagnosis, but it can indicate whether a child is on the right development track or if a specialist should take a closer look. If the screening tool identifies an area of concern, a formal developmental evaluation may be needed. This formal evaluation is a more in-depth look at a child’s development and is usually done by a trained specialist such as a developmental pediatrician, child psychologist, speech-language pathologist, occupational therapist, or other specialist. The specialist may observe the child give the child a structured test, ask the parents or caregivers questions, or ask them to fill out questionnaires. The results of this formal evaluation highlight your child’s strengths and challenges and can inform whether they meet criteria for a developmental diagnosis.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately; autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. Your doctor or other healthcare provider can help you understand and navigate the diagnostic process.

The results of a formal developmental evaluation can also inform whether your child needs early intervention services. In some cases, the specialist might recommend genetic counseling and testing for your child.

References

Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A. Autism from 2 to 9 years of age. Arch Gen Psychiatry. 2006 Jun;63(6):694-701.
Hyman SL, Levey SE, Myers SM, Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020 Jan;145(1).

How to understand if your child has autism: six tips for parents

Elena Vladimirovna, the parents of kids are most afraid of something going wrong with their child? Suddenly autism? How to recognize it?

Elena Orekhova: Autism is now diagnosed solely by behavior. Before the age of one, it is almost impossible to say with certainty whether a child has autism. Until that time, a small child can behave in exactly the same way as all other babies, look into the eyes, react to people. Scientists in the West are doing research trying to understand what are the earliest signs of autism. Parents who already have older children diagnosed with autism are invited to participate in such studies. The risk of autism in younger children in such families is increased, which gives scientists the opportunity to trace the early development of children with this diagnosis. At one time I worked in London in one of the laboratories where such research was carried out. There have been suggestions that children with autism do not need to communicate from birth. But it turned out that this was not the case. At three months, they looked into the eyes of another person even more than ordinary babies. As I got older, eye contact became less and less.

What signs will tell moms and dads that something is wrong with a child?

Elena Orekhova:

1. An important feature: speech delay, which is observed in almost all children with autism. Before a year, a child should be babbling, after a year he says separate words, a little later - sentences. If none of this is present before the age of two, it is not necessarily autism, but there is cause for concern. Most children with autism, although late, begin to speak, but their intonation suffers.

2. Ordinary children raise or lower their tone to emphasize what is being said, while children with autism are often perceived as strange: they either speak monotonously or misplace accents in speech. At the MEG Center, we recently conducted a study in which we found that the left 'verbal' hemisphere of children with autism processes complex sounds differently from ordinary children. Now we want to find out how this disorder affects the development of speech. We invite both families of children with autism and children with typical development to participate in our study.

3. Another early sign of autism, oddly enough, is the suspicion of deafness. Parents often think that their child has a hearing impairment. They turn to him: "Kolya! Petya! Look ..." But he does not react. In a recent study conducted at the MEG Center, we found that half of the parents of autistic children during the first year and a half of life suspected that the child was not all right with hearing. In fact, his hearing is all right. But he does not respond, because he is completely immersed in the occupation that interests him.

Excuse me, but if a bucket falls with a roar next to an autistic child, will he react to this noise?

Elena Orekhova: Maybe yes, maybe no. These children often react in atypical ways to their environment.

4. The child may be annoyed by a slight noise outside the window, a light touch, a bright light. At the same time, he may not react to the roar, be insensitive to pain.

5. Another hint for parents: it is difficult for a child to ask you for something. Let's say he needs a pencil. He can take your hand and use it to try to get a pencil.

6. An autistic child does not have a pointing gesture. He won't point his finger at his favorite toy and ask for it.

It still happens that mothers in maternity hospitals are sometimes advised: abandon the child, he will not even recognize you. Does a child with autism understand that he has significant adults - parents, does he feel affection for them?

Elena Orekhova: Yes, the child is attached to his parents. He will feel sorry for his mother, because she is in pain, but it is difficult for him to understand feelings of a "higher order" - resentment, insult.

Can a child with autism be sent to a regular school?

Elena Orekhova: Such children often have sensory problems - the school environment can be simply unbearable for them. Flickering, screaming, noise, fuss: all this can cause a lot of stress, not at all contributing to normal learning. To calm down, the child may want to plug his ears, crawl under the desk.

Another problem is the unpredictability of the environment. For a child with autism, it is important that he knows what follows what and in what order. If the daily routine or sequence of events is disturbed in an unpredictable way, this also causes stress. Being among people is also difficult for them because people are often unpredictable. It is difficult for such children to understand the school rules, and they may not behave as the teacher wants. Maybe parents are pleased when such a child goes to a regular school, but, in the final analysis, one must also think about the child himself, create sparing conditions for him. Although, of course, everything is individual. Some children with autism and good speech and cognitive abilities (formerly known as Asperger's syndrome) can go to a regular school. But you need to carefully monitor how the child feels at school. Often such children can be not only uncommunicative, but also clumsy, becoming the object of ridicule and bullying from classmates.

Children are cruel... And not only to special peers

Elena Orekhova: It is necessary to tell schoolchildren that people are different and that this is normal. In Sweden, for example, ordinary schools hold lessons where children are offered to try to ride in a wheelchair, read Braille texts for the blind, and learn some words in the language of the deaf and dumb. They are told that there are people with special needs and that everyone should be treated with respect and no one should be offended. At the same time, correctional classes and schools have been preserved there. And in Sweden, the diagnosis of autism is by no means a sentence. There was a case in Gothenburg when a girl graduated from a technical university, then a medical one, and got a job in an ambulance as a doctor. And then she had a nervous breakdown: it turned out to be extremely difficult for her to work with people. She went to a psychiatrist, who diagnosed her with autism. This turned out to be a great relief for her, as she finally understood the source of her problems. I must say that after that she successfully engaged in science, studying the work of the brain in people with mental disorders. Our brain is a real puzzle. This is what scientists have already figured out.

Early childhood autism exclusion

July 30, 2018

Voronin Nikolai

Neuropsychologist, Ph.D.

Autism is manifested by the lack of ability to interact with the outside world, communication disorders.

Most often, childhood autism manifests itself at 2.5-3 years. It is during this period that speech disorders and isolation in children are more pronounced.

However, the first signs of autistic behavior are often seen at an early age, before 1 year of age. It can be difficult for parents to independently distinguish the signs of autism, so it is no coincidence that children at the age of one year are recommended to consult a psychiatrist.

Do not be afraid to consult a psychiatrist! When parents of adolescents with behavioral problems come to us, we most often reveal that in childhood they could have had a developmental distortion of the autistic type, and with timely treatment, difficulties could have been avoided.

What should parents pay attention to? Symptoms of autism in children.

1. Violations of social contacts and interaction with others

The child practically does not ask to be held, it is more comfortable for him to lie in the crib.
The child does not assume a physiological position when breastfeeding.
The child is inactive, not as lively as peers.
The child does not respond to new toys, sounds, can stare at one point for a long time.
The child does not respond to his name (usually the first thing parents go to is an audiologist to check their hearing; if everything is fine with hearing, a psychiatrist should be consulted).
When adults or other children try to make contact with the child, he either removes his hands or moves to the side, or reacts aggressively, may throw something, cry.
The child throws the toy instead of handing it to avoid contact.
As the child grows older, he can go deeper into his inner world; he does not know how and does not want to communicate with family members, rarely seeks help, starts trying to serve himself early, does not use the word “give”, it is easier for him to take it himself or achieve his scandal.
Often children do not respond to discomfort, such as a full diaper; don't cry or draw attention to themselves.
There is no eye contact, the child does not fix his gaze on objects, toys.

2. Limited interests and features of the game

The child chooses one toy and plays only with it for a long time. Can choose as a toy something that is not intended for the game - ropes, rags.
The stereotypical nature of the game: placing toys in the same order, playing with a certain number of toys, and if one is lost, a scandal can occur.
Another example - a girl can not play with dolls, like the rest - not to change clothes, not to put her to bed, but simply carry her with her, maximum - iron her.
Games that require fantasy and imagination rarely captivate autistic children.
Children often prefer quieter games (eg puzzles, building blocks).

3. Tendency to repeat actions, the so-called stereotypy

Rocking the whole body from foot to foot, stereotypical head turn, stereotypical shoulder clamping.
Stereotypes observed in speech are called echolalia. It can be manipulations with sounds, words, phrases. At the same time, children constantly repeat words, cliches, cliché phrases that they heard from adults or on TV without realizing their meaning.
Stereotypical games - turning on / off the light, pouring water from glass to glass, pouring sand, cereals. It is difficult for a child to switch from this activity.
The child gets acquainted with the outside world not through interaction with others, but independently. He can lick, sniff objects.
Clothes: the child chooses certain things and wears only them, the sequence of dressing and undressing may be important for him.
Eating behavior: the child is selective in food, chooses only a certain range of products. In the most severe cases, this may be a complete refusal to eat. In mild cases - rituals: eats food in a certain order, at certain hours. He chooses dishes not by taste, but by shape, by color. Often, for example, a child only eats a certain shape of pasta.

4. Intellectual disorders

The main feature of the disease is selective intelligence. Autistic people may excel in math, art, and music, but lag far behind in other subjects. Savantism is a phenomenon where an autistic person is very pronouncedly gifted in one specific area. Some autistic people are able to play a tune accurately after hearing it only once, or to calculate the most complex examples in their minds.

5. Violation of the instinct of self-preservation

Autoaggression occurs in 1/3 of children with autism. Aggression is one of the main forms of response to what is happening, and since children are not inclined to communicate with others, they show this aggression towards themselves (they can beat themselves, bite, bang their heads against the crib).
Very often these children lack a "sense of edge". This can be observed even in early childhood, when the child hangs from the side of the crib, tries to get out of the stroller - the child has no fear.
Can run far from parents without looking back. If parents specifically hide in order to test the reaction, this reaction is often not.
Can climb a slide on a playground that is too old for him.
What is especially dangerous, children can run out onto the roadway, climb onto the windowsill with the window open.

6. ADHD

More often than other children, autistic children have hyperactive behavior. They are disinhibited and disorganized. Such children are in constant motion, they can hardly stay in one place, they do not respond to requests during classes, there are difficulties in controlling movements (“like on hinges”).

7. Verbal communication disorders

Speech disorders occur in all forms of autism. Speech may develop with a delay or not develop at all. Also, at the initial stages of development, speech may appear earlier than among peers, but at 1.5-2 years there is a regression - the child stops talking to others, but at the same time can fully speak to himself.
A peculiar intonation with a predominance of high tones at the end of a sentence, or the so-called "bird speech" or its own language, when the child talks to himself "under his breath."
Often children do not talk to others, but speech is present in the game. The reason is the unwillingness to interact with the outside world.

With speech delays, you can contact a speech pathologist. If a defectologist suspects autistic disorders, he refers to a psychiatrist. The main thing is to contact a specialist, and not be alone with this problem and not wait for everything to normalize by the age of three. It is better to immediately exclude the disease.

What to pay attention to in kindergarten? (symptoms of early autism in children after 1 year)

Aggression towards others, especially when the child's personal space is violated.
The child plays away from the others.
Children and caregivers complain about the child because he cannot interact with others, his play is destructive, he can interfere with other children's play.
Compulsive behavior - the intentional performance of actions according to certain rules, even if they go against the generally accepted ones.

Modern methods of diagnosing autism in children

Psychiatric consultation . This is a conversation with parents and observation of the child in free play. The doctor watches how the baby behaves, how it interacts with parents, whether it looks into the eyes, whether it puts objects in its hands, whether it throws it on the floor. If the child speaks, pay attention to speech, intonation, construction of phrases. The doctor carefully collects the history of the life and development of the child, the history of the mother's pregnancy. It is important when he began to utter the first sounds, when he stood up, crawled, began to walk, what was his gait.
Speech therapist consultation to rule out autistic speech. The doctor determines whether speech delay is related to autism or other disorders. Children with autism have a peculiar development of sound pronunciation, and an experienced speech therapist will immediately distinguish it.
Consultation with a neuropsychologist to identify which developmental milestones the child may have missed.
Screening with tests (Autism Diagnosis Scales) :

D. Wexler intelligence test

Tests (cards, tasks for children) aimed at assessing general awareness, stock of knowledge and ideas about the world, the ability to assimilate and process information, and cognitive abilities.

Kaufman intelligence test

Tests to determine the strengths and weaknesses of information processing processes: visual and auditory memory, assimilation of instructions, planning a sequence of actions.

Raven Progressive Matrices

Allows you to determine the level of intellectual development of the child. Each series of tables contains tasks of increasing difficulty. Raven's progressive matrices are designed to determine the level of mental development in primary school children with any level of speech development.

Questionnaires for parents :

Sensorimotor scales (ages 0-5)

To be completed during a conversation with parents and observation of the child. They allow you to evaluate various aspects of motor and psychological development in accordance with age standards.

Vanderbilt ADHD symptom questionnaire

Allows you to assess the severity of symptoms of hyperactivity, inattention and impulsivity in various areas of the child's life.

CARS Autism Rating Scale

One of the most commonly used tests for autism symptoms. The scale includes 15 categories.

Tests by defectologist and psychologist :

ADOS

The "gold standard" for diagnosing autism. Allows in a playful way to determine deviations in the communication skills of the child. The child is offered "communicative provocations" in which an ordinary child behaves in a "normal" way, a child with autism behaves differently. After the observation, a calculation is made of which behavior was more common or "autistic". According to the results of the calculation, a diagnosis is established.

ADI-r

A detailed survey that provides all the information needed to establish a diagnosis of autism and assess related mental disorders.

PEP scale

Identification of the child's individual characteristics, characteristics of his communication capabilities, cognitive activity, emotional-volitional sphere, working capacity, etc. The identified features are taken into account when drawing up an individual plan for corrective and developmental work with the child.