Worried About Autism - When and How to Screen
The short answer
The AAP recommends autism screening at 18 and 24 months for all children, using the M-CHAT-R/F questionnaire. If you have concerns before these ages, you can request screening earlier. Early signs of autism may include limited eye contact, no pointing by 12 months, no words by 16 months, no pretend play by 18 months, or loss of any previously acquired skills. Trust your instincts as a parent and raise concerns with your pediatrician.
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By Age
What to expect by age
Autism cannot be reliably diagnosed at this age, but some early signs may include reduced eye contact, limited social smiling, and reduced response to familiar voices. These signs overlap with many other conditions and with normal variation.
Possible early indicators include limited babbling, absent pointing, lack of response to name, reduced social engagement, and no back-and-forth gestures. These should be monitored but are not diagnostic at this age.
Autism screening can begin. Key concerns include no words by 16 months, no pointing by 12 months, no showing or waving, limited eye contact, and loss of any previously acquired skills.
Universal screening with M-CHAT-R/F is recommended at 18 and 24 months. This brief questionnaire identifies children who should be referred for comprehensive evaluation. Early identification leads to earlier intervention.
Autism can be reliably diagnosed by age 2 in many cases. If you have concerns, request a developmental evaluation. The diagnostic process typically includes observation, parent interviews, and standardized testing.
What Should You Do?
When to take action
- Your baby makes eye contact, responds to their name, and engages socially even if quieter than peers
- Your toddler has some quirks but is developing social communication skills on track
- Your child plays pretend, points to share, and shows interest in other people
- You have a gut feeling that your child's social development is different
- Your child shows several early signs like limited eye contact, absent pointing, and no words
- There is a family history of autism and you want proactive screening
- Your child has lost previously acquired skills like words, social smiling, or babbling
- Your child shows no social engagement, no communication, and no joint attention by 18 months
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Behavior Concerns
Early Signs of Autism in Babies and Toddlers
Autism spectrum disorder (ASD) can sometimes be identified as early as 12-18 months, though most children are not diagnosed until age 2-3. Early signs include limited eye contact, not responding to their name, lack of pointing or showing, limited social smiling, and absence of pretend play. Having one or two of these signs does not mean your child has autism - many typically developing children share individual traits. However, a pattern of multiple social communication differences warrants evaluation. Early intervention, regardless of eventual diagnosis, consistently leads to the best outcomes.
My Toddler Failed the M-CHAT Autism Screening
Failing the M-CHAT (Modified Checklist for Autism in Toddlers) does not mean your child has autism. It means additional evaluation is recommended. Many children who fail the initial M-CHAT screen do not receive an autism diagnosis after comprehensive evaluation. The important next step is to complete the follow-up interview (M-CHAT-R/F) with your pediatrician and, if indicated, pursue a developmental evaluation.
What Happens During an Autism Evaluation?
An autism evaluation typically involves multiple professionals including a developmental pediatrician, psychologist, or multidisciplinary team. The process includes parent interviews about developmental history, standardized observation tools like the ADOS-2, cognitive and language assessments, and review of development. The evaluation usually takes several hours and may be split across multiple sessions. Results lead to a clear diagnostic conclusion and recommendations.
Aggressive Play vs Normal Play
Rough-and-tumble play — wrestling, chasing, play-fighting, and superhero battles — is a normal and important part of child development, particularly for toddlers and preschoolers. It helps children develop physical coordination, social skills, self-regulation, and an understanding of boundaries. The key distinction between normal rough play and concerning aggression is whether both children are having fun, there is turn-taking in roles, and no one is intentionally trying to hurt the other.
My Toddler Is Aggressive Toward Pets
Toddlers being rough with pets is extremely common and almost never reflects true aggression or cruelty. Young children lack the motor control to be consistently gentle and do not yet understand that animals feel pain the way they do. With patient, consistent teaching about gentle touch and close supervision, most toddlers learn to interact safely with pets by age 3-4.
My Baby Doesn't Seem Attached to Anyone
By 7-9 months, most babies show clear preferences for their primary caregivers and some wariness of unfamiliar people. If your baby seems equally comfortable with everyone and shows no distress when separated from caregivers, it may simply reflect an easy-going temperament. However, if combined with other social differences, it can occasionally warrant further discussion with your pediatrician.