When Do the Symptoms of Autism Start?
This article has been written by Jo Condon, our Service Director. Jo has a wealth of experience in the field of autism and has worked with NHS, national government, education and private sector both nationally and internationally.
A common question that we often hear from parents is ‘When do the symptoms of autism start?’.
Autism is a lifelong neurodevelopmental difference, which means that autism has been present from birth.
The way that autism impacts an individual varies, and so does the age at which autistic differences become apparent. For some children, indicators of autism can be seen in the first few months whereas for others it is only when social demands increase that signs are noticed.
Typically, an autism assessment can be carried out from around the developmental age of 18 months. By the age of 5 most autistic children have begun to deviate from their neurotypical peers developmentally; masking and camouflaging behaviours can sometimes mean that the differences are not always obvious.
The pattern of autistic children’s strengths and differences vary from that of their peers. Autistic differences include difficulties with social – emotional social exchanges, communication, play and relationships. Autistic children also engage in behaviours that are more restricted, less flexible or more repetitive than their neurotypical peers and may also process sensory information differently.
Development at 6 months old
Babies typically begin to deliberately make eye contact from around 2 months, and by 6 months they will be able to use eye contact during interaction and be beginning to follow their parent’s gaze to turn toward what they are looking at.
Typically developing babies will have been responding to their parent’s smile with a smile for a couple of months by now, and by 6 months will be beginning to respond to other people’s emotions by crying or laughing; others will be able to tell whether they are happy or annoyed from their facial expression.
They will have begun to babble using ‘ba’, ‘da’ and ‘ga’ sounds.
Gesture will be starting to develop and they may raise their arms to indicate they want to be picked up.
They will be beginning to enjoy parents engaging physically with them, such as laughing when being tickled or bounced, and will be excited when they see familiar people.
Indications of Possible Autism in 6 Month Olds:
- Avoiding eye contact
- Not responding to a parent’s smile with a smile
- Lack of facial expression
- Fussiness around less familiar people, or when people interact with them
- Lack of enjoyment in physical interaction such as bouncing or tickling
- Content to sit and watch items in the environment
- Does not turn in response to sounds
- Distress around sensory input, such as not liking loud noises, being dresses and undressed or being cuddles
Development at 12 Months Old
By 12 months old, typically developing babies will be pointing at objects and use ‘gaze checking’, that is looking toward their parent to check there are looking at what they are pointing at.
They will be making noises to gain their parent’s attention and will look toward their parent when they call their name.
Language is developing and they will be able to make meaningful sounds such as ‘baba’ or ‘dada’ and may have a few meaningful simple words.
By 12 months, babies typically will shake their head to mean ‘no’ and be able to wave. They will have a full range of facial expression and parents are able to recognise happiness, anger, surprise, fear and disgust from their facial expression.
They will enjoy playing interactive games such as ‘peek a boo’ and ‘round and round the garden’.
Possible Signs of Autism at 12 Months
- Lack of pointing
- Avoidance of eye contact, or not using eye contact to reference objects
- Not responding to name
- Lack of interest in people
- Dislike of unfamiliar people
- Babbling has not developed into meaningful sounds
- Not shaking head to mean ‘no’
- Lack of facial expression, or facial expression only indicates happiness and annoyance
- Lack of interest in, or distress at attempts to play social games
- Repetitive movements with hands or arms
- Engaging in the same activity or action, such as watching items spinning
- Fussy eating, spitting out certain food textures
Development at 18 Months Old
By 18 months, typically children will begin to pull at their parents hand or clothes to get their attention and will be able to direct their parent’s attention to things that they are interested in. They will be able to follow someone else’s point.
They will enjoy interaction and with parents and try to join in with nursery rhymes.
They will be able to say several meaningful words, such as ‘cup’, ‘dog’ or ‘bus’ and will be able to follow basic instructions relating to things that are out of sight, such as ‘fetch your coat’.
Gesture continues to develop and they will be able to clap, blow kisses, indicate ‘shh’ with a finger on lips and nod their head to mean ‘yes’.
At this age, children will be regularly offering toys to other people and will begin to execute pretend actions with their toys such as feeding a doll or acting out short scenarios with toy cars. They will begin to copy some of their parent’s actions, such as wiping the tray of their high chair.
Possible Signs of Autism at 18 Months
- Placing parent’s hands on things that they want rather than pointing or making noises; using parent’s hands to undertake actions rather than using their own.
- Seems uninterested in social interaction, prefers to occupy self
- Does not respond to name
- No single words
- Not using gesture to communicate
- Preferring to engage in repetitive actions with toys and objects such as spinning wheels, lining up or stacking them
- Interest in unusual objects such as shampoo bottles or plastic bags
- Repetitive whole body movements such as spinning self, bouncing whilst flapping hands
- Difficulty in transitioning to solid food or from bottle to beaker
- Distress around certain noises such as vacuum cleaners
- Insistence on doing things in certain ways such as sleeping with blankets in a specific way, using the same plate or sitting on a specific seat
Development at 2 Years Old
At around the age of 2 years, typically developing children will be able to put two or more words together and will ask two word questions for example, “Where daddy?”.
They will be able to follow simple commands and will use a range of non-verbal methods of communication, including gesture, eye contact and facial expression.
At this age, typically developing children will begin to engage in simple pretend play sequences. They will imitate their parents’ actions, such as pretending to use a toy vacuum cleaner.
They will begin to sow an interest in other children, though will be more likely to play alongside them at this age.
Possible Signs of Autism at 2 Years
- Delay in developing language / not using language to communicate
- Avoiding eye contact, or avoiding eye contact with unfamiliar people
- Not using gesture, or only using gesture when prompted to do so
- Not pointing
- Lack of, or reduced range of facial expressions
- Avoidance of, or lack of interest in other children of same age
- Engaging with toys in an unusual way, such as lining them up, stacking them or watching them move rather than engaging in pretend sequences
- Repeating words or phrases from others or television
- Repetitive body movements, such as spinning, flicking fingers or bouncing
- Not wanting to get dressed, or removing clothes, shoes and socks
- Food fussiness
- Sensitivity to particular noises such as motorbikes or hand dryers
- Wanting to smell, chew or taste objects in the environment, toys or clothes
Development at 5 Years Old
By the age of 5, typically developing children will be using sentences to communicate and will be able to tell their parents about their day and things that interest them. They will be keen to direct their parents’ attention to things they do and things that they see. They will use a range of verbal and non-verbal communication to interact with familiar and unfamiliar people.
Typically developing children will be able to identify and share their basic emotional state, for example, “I am sad…”
They will be enjoying a range of play, including pretend play, both on their own and with other children. They will be able to engage in group games such as ‘tag’.
Typically developing children will be showing more independence, will enjoy new experiences and will be able to leave their parents with little support to do so.
Possible Signs of Autism at 5 Years
Differences in verbal communication, for example:
- Delayed language development
- Decreased use of language, often quiet
- Avoiding communicating by using phrases such as “I don’t know”, “I don’t remember” or “I’m not sure”
- Using copied words and phrases
- Using language that makes them sound ‘older than their years’
Differences in non-verbal communication, for example:
- Not using, or not often using non-verbal means of communication
- Needing to be consistently prompted to wave goodbye or told to smile
- Does not point, or when pointing focusses eyes on whatever they are pointing to
- Avoiding eye contact, using eye contact briefly or eye contact appears intense
- Not using facial expression to show what they are thinking or feeling, or only directing facial expressions that relate to extreme emotions
Differences in Socio-Emotional Reciprocity, for example:
- Not understanding when someone is hurt or upset, or becoming upset in response rather than offering comfort
- Not seeming to want to engage in chat with others, talking over people or answering questions only
- Not showing enjoyment in social interactions, seems uncomfortable; not wanting others to join in their excitement
- Does not refer to their emotions
- Not always responding to other’s social approaches, or only responding to familiar people
- Not asking for help, or making demands rather than asking
- Making inappropriate comments without realising
Lack of spontaneous pretend play, for example:
- Does not create and act out scenes with toys
- Only plays pretend when told what role to take
- Controls play, telling others what they should do and say, opts out when not in control
- Acts out pretend play with toys but play is repeated or an enactment of something that has happened in real life / watched on television
- When dresses up does not take on the character’s role, or has fixed rules about this
Difficulties with friendships and relationships, for example:
- Lack of interest in other children
- Avoidance of or reluctance to approach unfamiliar children
- Difficulty playing in groups, prefers to engage one on one
- Shows no interest in seeing peers outside of school or activity based environment
Repetitive body movements or use of objects, for example:
- Spinning or running in circles
- Bouncing whilst flapping hands
- Repetitive hand movements, finger flicking, picking or fidgeting with objects
- Lining up items
- Wanting to watch the same TV programme or film over again
Preference for routines or sameness, for example:
- Not liking new places or activities, or needing much assurance around these
- Having particular ways of doing things
- Needing specific items placed in certain ways or places
- Having specific routines that must be followed
- Having particular difficulties with transitions, for example, starting school, going on holiday or staying with relatives
Highly fixated interests, for example:
- Spending much time engaged in one specific activity
- Being specifically interested in a specific subject and wanting to learn facts, collect objects, look at books or watch programmes relating to this
- Having an interest in / collecting unusual objects
Unusual Sensory interests or Sensory Aversions, for example:
- Disliking loud noise
- Wanting to smell, chew or taste objects in the environment, toys or clothes
- Enjoying the feel of certain textures
- Smelling or hearing things that others cannot
- Wanting to climb, swing or jump
- Disliking lifts, escalators or slides
- Being irritated by the feel of certain clothes or the labels in clothes
- Being fussy with food, not liking food mixed together or disliking food touching on plate
- Not seeming to feel the cold, or enjoying the sensation of cold temperatures
Development of Older Children
By the age of 10 – 12, typically developing children are able to engage in conversations about a wide range of subjects with a range of different people and enjoy engaging with people.
They now will be able to express their feelings with words and are aware of other people’s perceptions. They understand embarrassment and can think about what other people think about them. They have empathy towards others.
Friends and friendships groups are important and they can share secrets and jokes with their friends.
They are beginning to understand their own identity, interests and strengths.
Potential Signs of Autism in Older Children
Differences in verbal communication, for example:
- Avoiding communicating by using phrases such as “I don’t know”, “I don’t remember” or “I’m not sure”
- Having ‘stock phrases’ to boulder conversation, for example, “It was really fun”
- Using language that makes them sound ‘older than their years’
Differences in non-verbal communication, for example:
- Using less gesture
- Gesture appears exaggerated or copied
- Avoiding eye contact, using eye contact briefly or eye contact appears intense
- Not using facial expression to show what they are thinking or feeling, or only directing facial expressions that relate to extreme emotions
Differences in Socio-Emotional Reciprocity, for example:
- Appearing awkward when someone is hurt or upset, leaving situation or offering comfort in a way that appears copied
- Not seeming to want to engage in chat with others, talking over people or answering questions in brief manner. Only wanting to talk about subjects that interest them
- Not showing enjoyment in social interactions, seems uncomfortable or awkward
- Struggling to communicate their emotional state, frequent meltdowns
- Not always responding to other’s social approaches, or responding in an awkward way
Difficulties with friendships and relationships, for example:
- Struggles to manage more than one friendship
- Over reliant on a friendship to cope in school
- Arguments with other children over rules and what is right or wrong
- Struggle to understand why other children do not want to join in their interests
- Difficulty playing in groups, can lead to issues
- Shows no interest in seeing peers outside of school or activity based environment
Repetitive body movements or use of objects, for example:
- Repetitive hand movements, finger flicking, picking or fidgeting with objects
- Sorting items by colour, size or genre
- Wanting to watch the same TV programme or film over again
Preference for routines or sameness, for example:
- Wanting to know where, how and when often; needs to know the daily plan
- Not liking spontaneous activities or surprises
- Upset when things change or do not go to plan
- Having particular ways of doing things
- Have developed a range of daily routines and is upset when these cannot be followed
- Having particular difficulties with transitions, for example, change from primary to high school
Highly fixated interests, for example:
- Enjoys a specific hobby or interest
- Has a cyclical pattern of interests, needing to learn everything about an interest and then moving on to the next
- Has an encyclopaedic knowledge of facts relating to a specific subject
- Collects objects
Unusual Sensory Interests or Sensory Aversions, for example:
- Disliking loud noise
- Enjoying the feel of certain textures
- Smelling or hearing things that others cannot
- Difficulties sitting still
- Avoids lifts or escalators
- Being irritated by the feel of certain clothes or the labels in clothes
- Becoming overwhelmed in, or avoiding, busy environments
- Being fussy with food, not liking food mixed together or disliking food touching on plate
- Does not want to wear clothes appropriate to the weather
Older Adolescence and Adulthood
When autism is first identified in older adolescence or adulthood, individuals have usually developed masking, camouflaging and avoidant behaviours. Individuals often describe issues such as:
- High levels of anxiety, especially in relation to social interaction and unfamiliar activities
- Feeling as if they ‘don’t quite fit in’ or that they are different in some way
- Struggling to start a conversation or to engage in ‘small talk’ to keep a conversation going
- Feeling uncomfortable with eye contact
- Finding the social aspect of school, university or work difficult
- Needing to plan ahead, whether that is planning a journey, the days tasks or what to say to someone in conversation
- Copying social behaviours from others in order to ‘fit in’ or having a set of rules that are used to manage social situations
- Feeling exhausted after social interaction or busy environments
- Repressing behaviours that they engage in at home when in public
- Being overwhelmed by noise, smells and visual stimulation
- Struggling to play with children, or make up stories for them
- Not feeling empathy for others or feeling like that they experience other’s feelings intensely
- Having a strong sense of justice and fairness
- Having difficulty starting tasks or switching from one task to another; feeling as if they procrastinate
- Engaging in a hobby or interest brings intense focus, allowing them to not think about their worries and stressors
At Veritas our team of autism specialists have experience of assessing and supporting autistic children and adults across the range of presentations seen within the autism spectrum.
Whether you are seeking an assessment for yourself our your child, one of our clinical team will be more than happy to discuss signs and characteristics of autism with you and help you decide whether an assessment is right for you.
You can contact us by telephoning us on 01302 495128 or completing our enquiry form here.
Categorised in: Child Autism, Symptoms of Autism