Signs of Autism in Toddlers
Signs of Autism in Toddlers can become more obvious to parents and professionals than they may have during infancy. Physical developmental milestones such as sitting, crawling and walking are often achieved at expected ages in children with autism. These areas are less likely to be impacted on by signs of autism and so parents may not be expecting concerns to arise in other areas of development.
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However, “More is expected” of a child from 2 years. We are expecting their play skills, talking skills and ability to understand expected behaviours to show rapid development during the toddler period. This is when signs of autism can become more apparent. Developmental milestones in areas such as play, speaking skills and behavioural expectations may begin to show atypical progression. Difficulties in these areas can be warning signs of Autism in Toddlers.
Autism also known as Autism Spectrum Disorder (ASD) Can be diagnosed from two years of age.
Diagnosis usually involves many specialists and professionals assessing for signs of autism in toddlers – this is called a multidisciplinary assessment (paediatrician, speech pathologist, psychology).
One toddler with autism will not have exactly the same symptoms as another child with autism—the number and severity of signs symptoms can vary greatly.
As a parent of a toddler is it important to observe and check milestone development in areas of speech, understanding, play and behaviour. The earlier the signs of autism in toddlers can be detected, the quicker essential early intervention support can begin.
Key signs of Autism in Toddlers to look for.
Our What is Autism page highlights that atypical communication, interaction and repetitive & restricted behaviours are the key signs of autism. Let’s look at what these signs of autism might look like in toddlers.
Many of the red flags or warning signs of Autism in Babies will continue to be present in the toddler period. Some other signs that begin emerge are discussed below. Children with Autism generally have several signs in each of the areas. Children may have some of these signs but not a sufficient number to obtain an Autism Diagnosis. If you have questions about Autism, contact your GP and/or obtain a Speech Pathology developmental assessment.
Communication Signs of Autism in Toddlers (talking and gesturing):
Do Toddlers with Autism speak?
Autism by definitions involves difficulties communicating. Therefore, all toddlers with autism will have communication issues. There is a lot of variation in the severity of signs of Autism in Toddlers. Some children develop spoken language, others have severe delays in using spoken language and some will require alternative means of communicating other than talking (iPad talkers, picture boards, sign language).
Is being a late talker a sign of Autism in Toddlers?
- Not all late talking toddlers have autism.
- Late talking has however been identified as an early warning sign for autism.
- If a child is not saying single words by 16 months a Speech Pathologist may need to be consulted. By two years of age a child saying less than 50 words would be considered a late talker and consultation with a Speech Pathologists is highly recommended. 2 years old toddlers typically can be saying over 200 words! An assessment for the presence of other signs of autism could be warranted if a child is presenting as a late talker.
- A 2017 study by Chenausky et.al noted that a number of studies have documented toddlers with ASD tend to have lower vocalisation rates (talk less) and delays in learning how to say sounds (consonant acquisition) in speech. This further suggests signs of autism in toddlers may be reduced speech sound development resulting in reduced spoken words that can be understood.
If my Toddler is talking can I relax that they do not have signs of Autism?
- Some toddlers with autism can say words and they can be quite clear. This does not rule out autism. It is necessary to see if they are using their talking to communicate with others.
- A sign of autism in toddlers that “appear to be talking” is that they frequently repeat exactly what others say without understanding the meaning (often called parroting, echoing or echolalia). They are not using talking skills in the typical developmental manner to “chat” with parents and peers.
- A child’s understanding skills are typically a step ahead of their talking skills. It can be a sign of autism in toddlers when this is not the case (e.g., a child is imitating words over heard from parents, strangers or a favourite TV show but is not really able to understand questions or follow instructions). Davidson & Weismer (2017) concluded that relatively more delayed comprehension than production (talking) may be an age-specific marker of ASD in toddlers. This sign of autism in toddlers was strongest at about the 30 months-age mark (2 ½ years of age).
- Signs of autism in toddlers that are actually saying words can include “mixed up sentences”. The words in their sentences may be mixed up or they make grammatical errors such as incorrect pronouns. For example, a toddler with autism may refer to themselves as “you” and use I to refer to other people.
- The inability to start and maintain conversations with others can be a sign of autism in toddlers. They are happy to continue with their own activities and do not seek out others to interact with. This doesn’t mean they will not come to you for help to open a packet or fix a toy. However, they rarely use words to ask for help even if they have said the word/s before. They often do not seek eye contact as they are asking for help and may just give the object to the adult.
- They may have a good memory and say lots of rote things, even at high levels e.g., recite the alphabet, counting out loud, singing favourite songs or the sayings from ads/TV, the long names of all the dinosaurs or other area of high interest. However, they often cannot use these skills functionally e.g., use sounds of the letters to read or spell.
Other communication signs of Autism in Toddlers
- Response to spoken language (e.g., their name being called) may be minimal however they can be highly responsive to the sounds of toys, pets or other sounds around them (e.g., dog bark, a horn honking)
- Another sign of autism in toddlers is the loss of communication skills they had acquired in infancy. Some children may have shown some communication development in infancy, but around the age of 24 months they may then begin to lose both their language and social-interaction skills (i.e., their communication skills regress).
- Symbolic play is still often not developed in toddlers with signs of autism. Their play is often atypical (e.g., preferring to push toys under a chair) than interacting with the toys (e.g., feed a teddy)
Chenausky, K., Nelson, C, Tager-Elusbuerg, H. (2017). Vocalization Rate and Consonant Production in Toddlers at High and Low Risk for Autism. J Speech Lang Hear Res, Apr 12; 60(4): 865-876.Davidson, M. & Weismer, S (2017). A Discrepancy in Comprehension and Production in Early Language Development in ASD: Is it Clinically Relevant? J Autism Dev Disorder. Apr 26.
Social Signs of Autism in Toddlers
- Poor eye contact frequently continues to be present in toddlers with autism.
- By 2 years children will often “guess” if mummy or daddy is happy, sad or mad based on their facial expressions. “I just need to look at her and she knows she shouldn’t touch it”. However, children with autism often do not react to parents’ facial expressions. In fact they often have poor use of facial expression themselves.
- Participating and seeking out joint attention is often not present in children at risk of ASD. For example, a sign of autism in toddlers is when they do not look at objects or events a parent is looking at or pointing to. They do not bring toys or point to objects to get other people to look at what is interesting them.
- They may be unaware or uninterested in what other people around them are doing or feeling (e.g., seemingly limited reaction or empathy for others).
- Toddlers may have difficulties finding and maintaining friendships. A sign of autism in toddlers can be a total lack of interest in even trying to make friends.
Behavioural signs of Autism in Toddlers (Repetitive & Restrictive Behaviours)
- Sensory concerns have been identified as signs of autism in toddlers. Toddlers may be highly sensitive or not sensitive at all to smells, sounds, lights, textures, and touch. They be over sensitive or under sensitive to temperatures or pain.
- Often a sign of autism is how they interact & look at toys. They frequently lift the object to the corner of their eye or bring it very close to their face.
- Some children with find it hard to change routines. It may be hard to establish new routines if they start daycare. They might set up “rituals” e.g., blue cup before bed and can extremely upset if this ritual is broken.
- Repetitive behaviours that have little function except some feed back to the child may begin to emerge e.g., rocking, spinning, twirling fingers at the corner of their eyes, walking on toes for long periods of time or flapping their hands or arms.
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