How do I know if my baby has autism?

how do I know if my baby has autism

April is Autism Awareness Month. Here are some signs which may be indicative of autism in your infant. Later this month, we will bring you information about what to look for in toddlers.
Drs. Kardos and Lai

Autism is a communication disorder where children have difficulty relating to other people. Pediatricians watch for  speech delay as a sign of autism. Even before your child is expected to start talking, around a year old
, you can watch for communication milestones. Problems
attaining these milestones may indicate autism or other disorders such as hearing loss, vision loss, isolated
language delay, or other developmental delays:

By six weeks of age, your baby should smile IN RESPONSE TO YOUR SMILE. This is not the phantom smile that you see as your baby is falling asleep or that gets attributed to gas. I mean, your baby should see you smile and smile back at your smile. Be aware that babies at this age will also smile at inanimate objects such as ceiling fans, and this is normal for young babies to do.

By 2 months of age, babies not only smile but also coo, meaning they produce vowel sounds such as “oooh” or “aaah” or “OH.” If your baby does not smile at you by their two month well baby check up visit or does not coo, discuss this delay with your child’s health care provider.

By four months of age, your baby should not only smile in response to you but also should be laughing or giggling OUT LOUD. Cooing also sounds more expressive (voice rises and falls or changes in pitch) as if your child is asking a question or exclaiming something.

Six-month-old babies make more noise, adding consonant sounds to say things like “Da” and “ma” or “ba.” They are even more expressive and seek out interactions with their parents. Parents should feel as if they are having “conversations” with their babies at this age: baby makes noise, parents mimic back the sound that their child just made, then baby mimics back the sound, like a back and forth conversation.

All nine-month-olds should know their name. Meaning, parents should be convinced that their baby looks over at them in response to their name being called. Baby-babble at this age, while it may not include actual words yet, should sound very much like the language that they are exposed to primarily, with intonation (varying voice pitch) as well. Babies at this age should also do things to see “what happens.” For example, they drop food off their high chairs and watch it fall, they bang toys together, shake toys, taste them, etc.

Babies at this age look toward their parents in new situations to see if things are ok. When I examine a nine month old in my office, I watch as the baby seeks out his parent as if to say, “Is it okay that this woman I don’t remember is touching me?” They follow as parents walk away from them, and they are delighted to be reunited. Peek-a-boo elicits loud laughter at this age. Be aware that at this age babies do flap their arms when excited or bang their heads with their hands or against the side of the crib when tired or upset; these “autistic-like” behaviors are in fact normal at this age.

By one year of age, children should be pointing at things that interest them. This very important social milestone shows that a child understands an abstract concept (I look beyond my finger to the object farther away) and also that the child is seeking social interaction (“Look at what I see/want, Mom!”). Many children will have at least one word that they use reliably at this age or will be able to answer questions such as “what does the dog say?” (child makes a dog sound). Even if they have no clear words, by their first birthday children should be vocalizing that they want something. Picture a child pointing to his cup that is on the kitchen counter and saying “AAH AAH!” and the parent correctly interpreting that her child wants his cup. Kids at this age also will find something, hold it up to show a parent or even give it to the parent, then take it back. Again, this demonstrates that a child is seeking out social interactions, a desire that autistic children do not demonstrate. It is also normal that at this age children have temper tantrums in response to seemingly small triggers such as being told “no.” Unlike in school-age children, difficulties with “anger management” are normal at age one year.

As an informal screen for autism, children below one year of age should be monitored for signs of delayed or abnormal development of social and communication skills. Home videos of children diagnosed with autism reveal that even before their first birthdays, many autistic children demonstrate abnormal social development that went unrecognized.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®
modified from the original  2/3/2010 post

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  • Reply Terry April 15, 2013 at 10:24 am

    Just last night, I was sharing this very concern about my six month old daughter. She didn’t start to smile until she turned two months. Since then, she’s gotten very smiley in response to me, but she still isn’t REALLY giggling. She will laugh in response to me laughing, but I have to prompt it and it’s usually always just one laugh at a time (i.e. it’s a back and forth between me and her…I go “ha”, she goes “ha”, etc.).

    As far as cooing, between 3 and 4 months she was definitely saying “ah-goo” and “oooh”. Since then, “ah-goo” has completely disappeared. She only says “OH”. But she does say it a lot and varies the pitch. At 5 months, she started screech squealing (I called it singing) but that’s disappeared now too.

    I can tell that she’s very aware of her environment. She’s an extremely observant baby. She follows me around the room, definitely turns to hear my voice (and her name, sometimes).

    Physically, I’m concerned too. She’s not really rolling. She’ll occasionally go tummy to back (i.e. once a week even though we do tummy time several times a day). But she’s never gone back to belly yet. In tummy time, she holds her torso up really well though (she pushes up onto her hands and is almost at a 90 degree angle). She’s recently started grabbing her feet and rolling towards her side when on her back. She can sit up (pretty well) assisted. And she does grab a toy when it’s handed to her/passes toys back and forth between hands.

    I should mention that she’s adopted. As far as I know, there’s no history of autism from the birth family. But I don’t have much medical history unfortunately.

    Clearly from what I’ve described about her, I know in my head I shouldn’t be overly concerned. She is developing. She just seems to be developing a bit slower than what I’ve been hearing is “normal”. But I am super interested to hear if what I’ve described sounds concerning to you?

    Thank you for this post! The information you share is always really, really top notch. I wish we lived nearby…without doubt if we did you would be my daughter’s pediatricians. (And I LOVE the name of your blog!)

  • Reply Dr Walder April 15, 2013 at 12:13 pm

    Well stated, ladies! Very concise and accurate information, once again.

  • Reply Two Peds in a Pod April 15, 2013 at 1:22 pm

    While not every baby develops at exactly the same pace, the important thing is that a baby attains expected milestones. We enourage you to discuss specific concerns about your daughter with her pediatrician who knows her best and can continue to monitor her development along with you.
    Thank you for writing and for your kind words.
    Drs. Kardos and Lai

  • Reply How do I know if my toddler has autism? | Two Peds in a Pod® June 27, 2015 at 3:56 pm

    […] About half of all children in the United States with an autistic spectrum disorder are diagnosed at age five or older according to a May 2012, NCHS (National Center for Health Statistics) data brief. However, many parents are suspicious much sooner. As part of autism awareness month, we bring you clues in toddler development that can alert you to a potential issue. This post follows up on our earlier post “How can I tell if my baby has autism?” […]

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