Autism symptoms: Common signs of ASD in children

While autism might sound like an obvious thing to notice about your child, it isn't always. Because autism is a spectrum, called autism spectrum disorder (ASD), symptoms can be very noticeable or not noticeable at all. The symptoms are also highly varied. No two individuals with ASD will behave in exactly the same way.

If you notice the following in your child, it is worth speaking to your health provider for a potential assessment.

In babies (0-12 months), signs of autism spectrum disorder can include:

• rarely smiling, including when smiled at
• making little or no eye contact
• not responding to a sound or facial expression
• little or no babbling
• an aversion to being cuddled or touched
• not interested in back-and-forth games like peekaboo
• not responding to their name (by around 12 months of age)
• not engaging in back-and-forth gestures, like pointing or waving with someone else (by around 12 months of age)
• seeming especially sensitive, or having intense reactions, to certain sensory stimuli (like an itchy clothing label, bright light or noise)
• seeming insensitive, or not reacting, to certain sensory stimuli (such as not noticing pain or discomfort)
• making repetitive movements, like hand-flapping, rocking or spinning, particularly when stressed

In toddlers (13-24 months), signs of ASD can include all of the above, plus:

• speaking late or not at all, or losing speech abilities a child previously had
• experiencing extreme distress when a routine changes
• struggling to follow simple instructions
• walking primarily or exclusively on their toes
• engaging in repetitive or highly systematic behaviors, like lining up toys or driving a toy truck into a wall over and over
• being physically aggressive (i.e. hitting, biting, scratching) when upset or overwhelmed
• seeking out or seeming to benefit from some specific sensory experiences (like very tight hugs or chewing on a toy)
• aversive to some specific sensory experiences (like spitting out food with certain textures, or hating the feeling of hair being gently brushed)

In small children (2-5 years), signs of ASD can include all of the above, plus:

• repeating certain words or phrases (called echolalia)
• having specific interests, or fixations, that seem to take up most of their attention
• showing little interest in pretend or imaginative play
• struggling with meltdowns and tantrums
• experiencing difficulty with social situations – for example, "freezing" around other children, or avoiding interaction – and seeming to prefer to be on their own
• extremely picky eating, or ARFID

In school-aged children and adolescents, signs of ASD can include all of the above, plus:

• needing time to recover after social situations, or seeming to shut down
• feeling frequently misunderstood by the people around them, or "lonely in a crowd"
• experiencing intense anxiety, anger, distress, and/or overwhelm
• being more direct and opinionated than expected in social situations, sometimes mistaken for rudeness
• often taking things literally – for example struggling to understand irony, sarcasm, teasing, or metaphors
• having difficulty with the turn-taking aspect of usual social interactions; for example, they might not understand when someone is pausing to take a breath, and might appear to interrupt other people frequently
• having difficulty imagining what it might be like to be someone else, or with taking into account someone else's perspective
• preferring clear rules and guidelines, and having difficulty navigating situations when these are not made obvious or when not everyone is following them, sometimes interpreted by others as being rigid or inflexible
• being bullied by peers or classmates
• having difficulty managing and sustaining friendships or other relationships
• having difficulties at school, and/or not wanting to go to school
• experiencing mental health challenges, including anxiety, depression, burnout or suicidal thoughts

It is important to recognize that everyone is different. Some people may have some of these tendencies and not be on the autism spectrum at all. Other people may have only a few, and have ASD.

If your child shows any of these signs, it is important to speak with your healthcare provider to determine if further assessment is needed.