Welcome to the first installment of my four-part series “Diagnosing Autism at One-Year-Old“! Today’s post will discuss early signs of autism in toddlers age 1 and up, with a specific focus on the signs I saw in my daughter, Lina. (As usual, I’m using a pseudonym for my daughter for privacy.)
If you’ve visited the blog before, or seen me on social media, you know I like to focus on the funny side, or heck, even the positive. Although I might be a bit sarcastic, I have a longstanding policy against putting negative energy out into the internet/world. As a result, I feel I have to preface this post with a disclaimer: I love my daughter fiercely, and on a daily basis, my family focuses on her achievements, not her challenges. However, in order to provide some insight to anyone who might be struggling with the decision to have their toddler evaluated for autism, I am going to discuss some of Lina’s challenges and differences around the age of one. I absolutely do not mean to imply that there is anything *wrong* with Lina, or with anyone else. When I talk about “delays” or “signs of autism,” I purposefully avoid words like “red flags” or “warning signs.” Why? Because that language is scary as sh*t. It signals something bad is happening, and it isn’t helpful to view autism through a bad, scary lens. It’s something that can present significant challenges, yes, which autistic individuals and their families encounter on a daily basis. But saying that an individual faces challenges is VERY different from saying that there is something bad or wrong about the individual.
Okay, *phew* that’s out of the way! Let’s get started.
Early Signs of Autism: The Checklists
If you’re reading this post, you’ve probably already read some of the lists discussing signs of autism in toddlers. Here are some of the top early signs of autism in toddlers age 1, based on a few reputable sources (see UC San Diego Health, CDC, Kennedy Krieger Institute):
- Repetitive and unusual behaviors or body movements (flapping or twirling hands, for example)
- Minimal smiling in response to caregivers, and generally showing a more limited range of facial expressions
- Does not try to imitate sounds or actions
- Does not seem interested in games like peek-a-boo or pat-a-cake
- Delayed or minimal babbling and speech
- Often does not respond to their name
- Does not use gestures to communicate (pointing, lifting arms for “up”), and/or does not follow gestures (does not look where you point)
- Minimal eye contact
- Doesn’t seem interested in getting your attention
- Doesn’t show you objects
- Has unusual sensory responses or sensitivities (for example, over- or under-responds to temperature, pain, or textures)
- Little interest in toys, or plays with them in different ways (spinning the car wheel repeatedly)
- General delays in motor development
I encourage you to look through the links above for more specific information. Each source notes that if a caregiver has concerns about their child’s development, you should talk to a doctor about an autism evaluation or screening.
Another good resource is the Modified Checklist for Autism in Toddlers (M-CHAT). The M-CHAT asks simple questions and gives you a score indicating whether there is a low, moderate, or high probability that your toddler may be autistic. It is NOT a diagnosis, but only a screening tool indicating whether further evaluation may be necessary. One caveat, however, is that the M-CHAT specifically says it can be used to screen at age 16 months and older. I looked through it when Lina was around 13 months and saw that she scored fairly high, but I also assumed a doctor would dismiss my concerns because technically Lina wasn’t old enough for the M-CHAT. So, take it with a grain of salt, but a lot of factors addressed in the M-CHAT are the same as those discussed above. Again, the creators of the M-CHAT say that if you have concerns about your child’s development, regardless of their specific score, you should talk to your doctor and contact your state’s early intervention services.
Notice a theme about talking to your doctor? Okay good!
Early Signs of Autism: Our Story
Okay, that’s what the checklists say. What does a parent say? Specifically, a parent-who-saw-those-signs-and-still-hesitated-about-whether-she-should-reach-out-for-an-autism-evaluation-but-went-ahead-and-did-it-and-her-daughter-was-diagnosed-with-autism-at-fifteen-months? Me, in other words. What do I say?
I say remember that the purpose of these guidelines and checklists is to help you decide if your child needs an autism evaluation. It is not a diagnosis. It is not pass/fail, nor an exact science. Personally, I was analyzing and overanalyzing every little detail. I was calling Lina’s name twenty times in a row, and if she happened to turn my direction once, which happened to coincide with the cat meowing loudly in front of me…did that mean that she might respond to her name after all? I was paranoid about going into a doctor’s office about autism concerns and being dismissed as a crazy lady. (More about that in the next post on “Common Reasons for Delays in Autism Evaluations.”) I would think to myself, “Well, she doesn’t flap her hands or spin, so maybe I’m overreacting.”
But, really, there is no exact equation to decide whether your child could benefit from an autism evaluation. Whether Lina checked 70% or 100% of the boxes was not that crucial. She met a number of the criteria for early signs of autism in toddlers discussed above. Her facial expressions were generally neutral, including when I dropped her off and picked her up from daycare. She did not reach up to be lifted in the air by mommy or daddy. She did not point at the airplane flying overhead, or look when I pointed in the sky (although she did find staring up at unlit streetlights in the daytime absolutely fascinating — I still wonder what she saw). In fact, she didn’t point to anything, or generally try to get our attention in any form. She didn’t play much with toys (her Baby Einstein music toy being the major exception), or show much inclination to explore. She didn’t respond to our voices, either, to the point that my husband was pretty certain she was deaf. All in all, she was a very quiet, self-contained baby, then a quiet, self-contained toddler. I thought it was great that she was so well-behaved, even though I was simultaneously concerned about her well-being.
Lina’s motor skills were also delayed. She first began to crawl at twelve months old, an age where many kids are already starting to walk. She seemed to struggle with bringing food to her mouth, then with keeping it in her mouth. She also did her best to compensate for her motor challenges in ways that seemed unusual. For example, instead of learning to pull herself up from a kneeling position, she used all her arm strength to pull herself straight up from a sitting position, because she couldn’t figure out the kneeling part. My friends, that’s really impressive, but also not typical. (Side note: most people don’t think of motor skills when they think about autism, and I likewise wondered, “What does crawling have to do with communication/behavior?” But since autism is a neurological difference, it makes sense that it could affect the whole body.)
So, yes, Lina met quite a few of the signs of autism in toddlers noted above, and ultimately we moved forward to an evaluation. My advice to any parent reading this? Every autistic kid is different, and they will likely show some signs and not others. They probably won’t tick every single box on a list. If that’s what you’re waiting for — don’t. If your gut is concerned, and your child is showing some of these signs, that means you probably should request an evaluation from a doctor qualified to screen for autism. That’s the simple, important purpose of the checklist. You cannot diagnose anything on your own. But you’re a good parent for being concerned, and remember, you’re doing great! It will be okay!
If you’re still on the fence, I get it. My next post is going to discuss “Common Reasons for Delays in Autism Evaluations.” Nonetheless, remember what all the checklists say: talk to your doctor if you have concerns.