Signs of Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.
Social Communication and Interaction Skills
Social communication and interaction skills can be challenging for people with ASD. Examples of social communication and social interaction characteristics related to ASD can include:
- Avoids or does not keep eye contact
- Does not respond to name by 9 months of age
- Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age
- Does not play simple interactive games like pat-a-cake by 12 months of age
- Uses few or no gestures by 12 months of age (for example, does not wave goodbye)
- Does not share interests with others by 15 months of age (for example, shows you an object that they like)
- Does not point to show you something interesting by 18 months of age
- Does not notice when others are hurt or upset by 24 months of age
- Does not notice other children and join them in play by 36 months of age
- Does not pretend to be something else, like a teacher or superhero, during play by 48 months of age
- Does not sing, dance, or act for you by 60 months of age
Restricted or Repetitive Behaviors or Interests
People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by problems with social communication and interaction only. Examples of restricted or repetitive behaviors and interests related to ASD can include
- Lines up toys or other objects and gets upset when order is changed
- Repeats words or phrases over and over
- Plays with toys the same way every time
- Is focused on parts of objects (for example, wheels)
- Gets upset by minor changes
- Has obsessive interests
- Must follow certain routines
- Flaps hands, rocks body, or spins self in circles
- Has unusual reactions to the way things sound, smell, taste, look, or feel
Other Characteristics
Most people with ASD have other related characteristics. These might include
- Delayed language skills
- Delayed movement skills
- Delayed cognitive or learning skills
- Hyperactive, impulsive, and/or inattentive behavior
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Anxiety, stress, or excessive worry
- Lack of fear or more fear than expected
Developmental Milestones
3-Month-Old Milestones
Movement Milestones
- Raises head and chest when lying on stomach
- Supports upper body with arms when lying on stomach
- Stretches legs out and kicks when lying on stomach or back
- Opens and shuts hands
- Pushes down on legs when feet are placed on a firm surface
- Brings hand to mouth
- Takes swipes at dangling objects with hands
- Grasps and shakes hand toys
Visual and Hearing Milestones
- Watches faces intently
- Follows moving objects
- Recognizes familiar objects and people at a distance
- Starts using hands and eyes in coordination
- Smiles at the sound of your voice
- Begins to babble
- Begins to imitate some sounds
- Turns head toward direction of sound
Social and Emotional Milestones
- Begins to develop a social smile
- Enjoys playing with other people and may cry when playing stops
- Becomes more communicative and expressive with face and body
- Imitates some movements and facial expressions
Things to Watch For
Although babies develop at their own rate and there is a range of weeks to months to develop certain skills, not meeting milestones outside of the typical time frame may signal developmental and/or medical problems that require special attention. It is recommended to contact your child’s pediatrician if any of the following are noticed.
- Doesn’t seem to respond to loud sounds
- Doesn’t notice her hands by two months
- Doesn’t smile at the sound of your voice by two months
- Doesn’t follow moving objects with her eyes by two to three months
- Doesn’t grasp and hold objects by three months
- Doesn’t smile at people by three months
- Cannot support her head well at three months
- Doesn’t reach for and grasp toys by three to four months
- Doesn’t babble by three to four months
- Doesn’t bring objects to her mouth by four months
- Begins babbling, but doesn’t try to imitate any of your sounds by four months
- Doesn’t push down with her legs when her feet are placed on a firm surface by four months
- Has trouble moving one or both eyes in all directions
- Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
- Doesn’t pay attention to new faces, or seems very frightened by new faces or surroundings
- Still has the tonic neck reflex at four to five months
7-Month-Old Milestones
Language Milestones
- Responds to own name
- Begins to respond to “no”
- Distinguishes emotions by tone of voice
- Responds to sound by making sounds
- Uses voice to express joy and displeasure
- Babbles chains of consonants
Cognitive Milestones
- Finds partially hidden object
- Explores with hands and mouth
- Struggles to get objects that are out of reach
Social and Emotional Milestones
- Enjoys social play
- Interested in mirror images
- Responds to other people’s expressions of emotion and appears joyful often
Movement Milestones
- Rolls both ways (front to back, back to front)
- Sits with, and then without, support of her hands
- Supports her whole weight on her legs
- Reaches with one hand
- Transfers object from hand to hand
- Uses raking grasp (not pincer)
Visual Milestones
- Develops full color vision
- Distance vision matures
- Ability to track moving objects improves
Things to Watch For
- Things to discuss with your child’s pediatrician
- Seems very stiff, with tight muscles
- Seems very floppy, like a rag doll
- Head still flops back when body is pulled up to a sitting position
- Reaches with one hand only
- Refuses to cuddle
- Shows no affection for the person who cares for him
- Doesn’t seem to enjoy being around people
- One or both eyes consistently turn in or out
- Persistent tearing, eye drainage, or sensitivity to light
- Does not respond to sounds around him
- Has difficulty getting objects to his mouth
- Does not turn his head to locate sounds by four months
- Doesn’t roll over in either direction (front to back or back to front) by five months
- Seems inconsolable at night after five months
- Doesn’t smile spontaneously by five months
- Cannot sit with help by six months
- Does not laugh or make squealing sounds by six months
- Does not actively reach for objects by six to seven months
- Doesn’t follow objects with both eyes at near (1 foot) [30 cm] and far (6 feet) [180 cm] ranges by seven months
- Does not bear some weight on legs by seven months
- Does not try to attract attention through actions by seven months
- Does not babble by eight months
- Shows no interest in games of peekaboo by eight months
1 Year-Old Milestones
Language Milestones
- Pays increasing attention to speech
- Responds to simple verbal requests
- Responds to “no”
- Uses simple gestures, such as shaking head for “no”
- Babbles with inflection
- Says “dada” and “mama”
- Uses exclamations, such as “oh-oh!”
- Tries to imitate words
Cognitive Milestones
- Explores objects in many different ways (shaking, banging, throwing, dropping)
- Finds hidden objects easily
- Looks at correct picture when the image is named
- Imitates gestures
- Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
Social and Emotional Milestones
- Shy or anxious with strangers
- Cries when mother or father leaves
- Enjoys imitating people in play
- Shows specific preferences for certain people and toys
- Tests parental responses to his actions during feedings (What do you do when he refuses a food?)
- Tests parental responses to his behavior (What do you do if he cries after you leave the room?)
- May be fearful in some situations
- Prefers mother and/or regular caregiver over all others
- Repeats sounds or gestures for attention
- Finger-feeds himself
- Extends arm or leg to help when being dressed
Movement Milestones
- Gets to sitting position without assistance
- Crawls forward on belly by pulling with arms and pushing with legs
- Assumes hands-and-knees position
- Creeps on hands and knees supporting trunk on hands and knees
- Gets from sitting to crawling or prone (lying on stomach) position
- Pulls self up to stand
- Walks holding on to furniture
- Stands momentarily without support
- May walk two or three steps without support
Milestones In Hand & Finger Skills
- Uses pincer grasp
- Bangs two cubes together
- Puts objects into container
- Takes objects out of container
- Lets objects go voluntarily
- Pokes with index finger
- Tries to imitate scribbling
Things to Watch For
Talk to your child’s pediatrician if any of the following occur:
- Does not crawl
- Drags one side of body while crawling (for over one month)
- Cannot stand when supported
- Does not search for objects that are hidden while he watches
- Says no single words (“mama” or “dada”)
- Does not learn to use gestures, such as waving or shaking head
- Does not point to objects or pictures
2 Year-Old Milestones
Language Milestones
- Points to object or picture when it’s named for him
- Recognizes names of familiar people, objects, and body parts
- Says several single words (by fifteen to eighteen months)
- Uses simple phrases (by eighteen to twenty-four months)
- Uses two- to four-word sentences
- Follows simple instructions
- Repeats words overheard in conversation
Cognitive Milestones
- Finds objects even when hidden under two or three covers
- Begins to sort by shapes and colors
- Begins make-believe play
Social and Emotional Milestones
- Imitates behavior of others, especially adults and older children
- Increasingly aware of herself as separate from others
- Increasingly enthusiastic about company of other children
- Demonstrates increasing independence
- Begins to show defiant behavior
- Increasing episodes of separation anxiety toward midyear, then they fade
Movement Milestones
- Walks alone
- Pulls toys behind her while walking
- Carries large toy or several toys while walking
- Begins to run
- Stands on tiptoe
- Kicks a ball
- Climbs onto and down from furniture unassisted
- Walks up and down stairs holding on to support
- Milestones in hand and finger skills
- Scribbles spontaneously
- Turns over container to pour out contents
- Builds tower of four blocks or more
- Might use one hand more frequently than the other
Things to Watch For
Talk to your child’s pediatrician if any of the following occur:
- Cannot walk by eighteen months
- Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
- Does not speak at least fifteen words by eighteen months
- Does not use two-word sentences by age two
- Does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon) by fifteen months
- Does not imitate actions or words by the end of this period
- Does not follow simple instructions by age two
- Cannot push a wheeled toy by age two
4 Year-Old Milestones
Language Milestones
- Understands the concepts of “same” and “different”
- Has mastered some basic rules of grammar
- Speaks in sentences of five to six words
- Speaks clearly enough for strangers to understand
- Tells stories
Cognitive Milestones
- Correctly names some colors
- Understands the concept of counting and may know a few numbers
- Approaches problems from a single point of view
- Begins to have a clearer sense of time
- Follows three-part commands
- Recalls parts of a story
- Understands the concept of same/different
- Engages in fantasy play
Social and Emotional Milestones
- Interested in new experiences
- Cooperates with other children
- Plays “Mom” or “Dad”
- Increasingly inventive in fantasy play
- Dresses and undresses
- Negotiates solutions to conflicts
- More independent
- Imagines that many unfamiliar images may be “monsters”
- Views self as a whole person involving body, mind, and feelings
- Often cannot distinguish between fantasy and reality
Movement Milestones
- Hops and stands on one foot up to five seconds
- Goes upstairs and downstairs without support
- Kicks ball forward
- Throws ball overhand
- Catches bounced ball most of the time
- Moves forward and backward with agility
Milestones in Hands & Finger Skills
- Copies square shapes
- Draws a person with two to four body parts
- Uses scissors
- Draws circles and squares
- Begins to copy some capital letters
Things to Watch For
Talk to your child’s pediatrician if any of the following occur:
- Cannot throw a ball overhand
- Cannot jump in place
- Cannot ride a tricycle
- Cannot grasp a crayon between thumb and fingers
- Has difficulty scribbling
- Cannot stack four blocks
- Still clings or cries whenever his parents leave him
- Shows no interest in interactive games
- Ignores other children
- Doesn’t respond to people outside the family
- Doesn’t engage in fantasy play
- Resists dressing, sleeping, using the toilet
- Lashes out without any self-control when angry or upset
- Cannot copy a circle
- Doesn’t use sentences of more than three words
- Doesn’t use “me” and “you” appropriately
5 Year-Old Milestones
Language Milestones
- Recalls part of a story
- Speaks sentences of more than five words
- Uses future tense
- Tells longer stories
- Says name and address
Cognitive Milestones
- Can count ten or more objects
- Correctly names at least four colors
- Better understands the concept of time
- Knows about things used every day in the home (money, food, appliances)
Social and Emotional Milestones
- Wants to please friends
- Wants to be like her friends
- More likely to agree to rules
- Likes to sing, dance, and act
- Shows more independence and may even visit a next-door neighbor by herself
- Aware of sexuality
- Able to distinguish fantasy from reality
- Sometimes demanding, sometimes eagerly cooperative
Movement Milestones
- Stands on one foot for ten seconds or longer
- Hops, somersaults
- Swings, climbs
- May be able to skip
Milestones in Hands & Finger Skills
- Copies triangle and other geometric patterns
- Draws person with body
- Prints some letters
- Dresses and undresses without assistance
- Uses fork, spoon, and (sometimes) a table knife
- Usually cares for own toilet needs
Things to Watch For
Talk to your child’s pediatrician if any of the following occur:
- Exhibits extremely fearful or timid behavior
- Exhibits extremely aggressive behavior
- Is unable to separate from parents without major protest
- Is easily distracted and unable to concentrate on any single activity for more than five minutes
- Shows little interest in playing with other children
- Refuses to respond to people in general, or responds only superficially
- Rarely uses fantasy or imitation in play
- Seems unhappy or sad much of the time
- Doesn’t engage in a variety of activities
- Avoids or seems aloof with other children and adults
- Doesn’t express a wide range of emotions
- Has trouble eating, sleeping, or using the toilet
- Can’t differentiate between fantasy and reality
- Seems unusually passive
- Cannot understand two-part commands using prepositions (“Put the cup on the table”; “Get the ball under the couch.”)
- Can’t correctly give her first and last name
- Doesn’t use plurals or past tense properly when speaking
- Doesn’t talk about her daily activities and experiences
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