There are a number of things that parents, teachers, and others who care for children can look for to determine if a child needs to be evaluated for autism.  The following “red flags” could be signs that a doctor should evaluate a child for autism or a related communication disorder.

• The child does not respond to his/her name.
• The child cannot explain what he/she wants.
• Language skills or speech are delayed.
• The child doesn’t follow directions.
• At times, the child seems to be deaf.
• The child seems to hear sometimes, but not others.
• The child doesn’t point or wave bye-bye.
• The child used to say a few words or babble, but now he/she doesn’t.
• The child throws intense or violent tantrums.
• The child has odd movement patterns.
• The child is hyperactive, uncooperative, or oppositional.
• The child doesn’t know how to play with toys.
• The child doesn’t smile when smiled at.
• The child has poor eye contact.
• The child gets “stuck” on things over and over and can’t move on to other things.
• The child seems to prefer to play alone.
• The child gets things for him/herself only.
• The child is very independent for his/her age.
• The child does things “early” compared to other children.
• The child seems to be in his/her “own world.”
• The child seems to tune people out.
• The child is not interested in other children.
• The child walks on his/her toes.
• The child shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants).
• Child spends a lot of time lining things up or putting things in a certain order.

Doctors should do a “developmental screening” at every well-baby and well-child visit, through the preschool years. In this screening, the doctor asks questions related to normal development that allow him or her to measure a specific child’s development. These questions are often more specific versions of the "red flags" listed above, such as Does the child cuddle like other children? Or, Does the child direct your attention by holding up objects for you to see? The doctor will also ask if the child has any features that were listed earlier as definite signs for evaluation for autism.

If the doctor finds that a child either has definite signs of autism, or has a high number of red flags, he or she will send the child to a specialist in child development or another type of health care professional, so the child can be tested for autism. The specialist will rule out other disorders and use tests specific to autism. Then he or she will decide whether a formal diagnosis of autism, autism spectrum disorder, or another disorder is appropriate.

In most cases, the symptoms of autism are measurable by certain screening tools at 18 months of age. However, parents and experts in autism treatment can usually detect symptoms before this time. In general, a formal diagnosis of autism can be made when a child is two, but is usually made when a child is between two and three, when he or she has a noticeable delay in developing language skills. 

Recent studies show that at least 20 percent of children with autism experienced a “regression,” as reported by their parents.  This means that the children had a mostly normal development, but then had a loss of social or communication skills. To date, however, there is little information about this type of regression, such as the age it seems to start, how severe it is, and what, if anything, triggers it. NICHD researchers are looking into a variety of possible causes for both early onset and regressive autism.

The current service systems in many states are struggling to adjust to the increasing number of children diagnosed with autism. In many cases, however, the existing systems can’t provide the level of care that families of people with autism want for their child, teenager, or adult with autism. There are a number of parents’ organizations, both national and local, that can provide information about education and treatment services and how to get these services for a child.  For a listing of these organizations, go to http://www.nlm.nih.gov/medlineplus/autism.html, or check the local phone book."

AutismWeb commentary: See our EDUCATION page for reviews of the most widely used teaching methods for young children with autism. Several excellent resources include:

Could It Be Autism?: A Parent's Guide to the First Signs and Next Steps, by Nancy Wiseman, explains what to do to find out if your child is developmentally delayed as early as four months of age. Wiseman provides checklists, discusses screening tests, and, if your child has autism, tells you how to design an effective treatment program. She says taking action is better than a wait-and-see approach. We agree.

The National Research Council has published Educating Children With Autism, which identifies the characteristics of an effective educational program and ways to better prepare teachers, schools and parents to teach children with autism and PDD.

Does My Child Have Autism: A Parents Guide to Early Detection and Intervention in Autism Spectrum Disorders by Wendy Stone and Theresa DiGeronimo. Tells you what symptoms to look for by age 2 or younger and what to do if you suspect autism or PDD.

Catherine Maurice's Let Me Hear Your Voice: A Family's Triumph Over Autism is a mother's account of discovering that her son and daughter had autism and how both recovered through intensive behavioral therapy. A classic for parents of newly-diagnosed children. She discusses the range of emotions she felt, from grief and fear to hope.

What if the doctor doesn't refer my child to early intervention?

AutismWeb Commentary: Sometimes a pediatrician will disagree with you about whether there is a developmental problem or he may have a "wait and see" philosophy about delays. If you believe there's a problem, you may refer your child yourself to your local early intervention office for evaluation. You can find this office by calling your local health department or school system. Or, you can check this list of state early intervention offices: click on your state at the bottom of the page to locate Early Intervention in your community. The developmental evaluation is free. It is better to start treatment earlier rather than later to give your child the best chance. Whether or not your child eventually will be diagnosed with autism or PDD, the Early Intervention Office can start helping him or her with his/her speech or other delays now.

For video clips of autism signs, please see this site.

The information within quotation marks is reprinted from portions of Autism Facts by the National Institute of Child Health and Human Development. The resource information and labeled commentary are by AutismWeb.

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