Most Overlooked Signs of Autism in Children (And What Parents Can Do)

Autism is much more prevalent than it was 20 years ago. When I was growing up, I didn’t know a single person with autism. Now as an adult with my own children, I was highly concerned during the first few years of my children’s lives that they would show symptoms of autism.

I knew the signs of autism but there are also some overlooked symptoms of which all parents should be aware. Knowing these signs can help a parent seek earlier intervention, which leads to better treatment outcome for the child long term.

How common is autism in children?

Autism is a concern for every parent now, as the rates of children being diagnosed with autism has increased steadily since the year 2000.

In the year 2000, the CDC (Centers for Disease Control and Prevention) reported that autism was prevalent in 1 out every 150 children.^[1] In most recent reporting by the CDC (which was recorded in 2014), the rate of autism is now 1 out of 59 children.

Boys are far more likely to have autism–four times greater, to be exact. These are alarming statistics that have parents baffled by the increased numbers of children with this disorder.

The exact cause of autism is unknown. Researchers are hard at work trying to find the cure, caus and physical blood test that would make it easier to diagnose.

For now, parents must rely on clinicians to diagnose their child with autism based on their observations of the child’s behavior along with information relayed from the parent to the clinician regarding their child’s behavior and development.

Catching autism earlier

Parents must be the advocate for their child. It is imperative that all parents know the signs of autism, so they can seek intervention as soon as possible. Research, as cited by the American Psychological Association has found that early intervention and treatment of autism provides greater results in the long run.^[2] This is not a disorder where a parent should wait and see if the symptoms get worse over months and years.

Early intervention is the key to helping a child with autism. If you see early signs of autism in your child, immediate help should be sought in order to get your child the best chances for overcoming their symptoms long term. The APA stated the following regarding ages of children and the effectiveness of early intervention:

The latest findings are changing what we know about autism and in particular, stress the need for diagnosis and treatment before age 6 when treatment is known to be the most effective. The newest research suggests it’s even possible to reverse autism symptoms in some infants and toddlers or, more commonly, decrease the severity of the symptoms.

If you are concerned, then seek professional advice and medical support to have your child assessed. Even if they do not qualify for an autism spectrum diagnosis, you may be recognizing learning disabilities or behavioral abnormalities that can be addressed and treated.

It is remarkable how physical therapy, play therapy, occupational therapy and other modalities of therapy can provide a dramatic difference in improving abnormal or delayed behaviors when these treatments are provided over a dedicated period of time such as 6 months, a year or more.

Parents are responsible for recognizing the help that their child may need. Once recognized, the next step is finding reputable avenues for assessing and then treating the child.

Below are tips on how to recognize potential autism in your child, along with tips on what to do next if you do feel your child exhibits autistic symptoms.

Diagnosing autism

The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders Version 5) is the diagnostic tool that clinicians rely upon for diagnosing a child with autism. Their observation of the child, interactions and communications with the parent are all utilized for assessing a child for a potential autism diagnosis.

Parents should be aware of the diagnosing criterion because this can help parents to recognize the symptoms and behavior associated with autism early on. For many parents with autistic children, they notice that their child had motor skill difficulties as an infant and even difficulties with social interactions before 1 year of age.

The key is, parents noticed these behaviors. It is helpful to know what kind of behaviors to look for in a child that may indicate autistic tendencies.

Below are the diagnosing criterion for autism from the DSM- 5 so you as a parent can assess whether your child should be professionally assessed. These are found on the Autism Speaks website and are exactly as written in the DSM-5.^[3]

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with a known medical or genetic condition or environmental factor
  (Coding note: Use additional code to identify the associated medical or genetic condition.)
• Associated with another neurodevelopmental, mental, or behavioral disorder
  (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)

With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)

Red flags

The diagnosing criterion is helpful but it can also be cumbersome. It is a great deal of information and clinical wording, thus some basic red flags are also helpful for parents who are concerned that their child may be autistic.

Autism Speaks provides a list of red flags for parents to watch for concerning a potential autism diagnosis:^[4]

Possible signs of autism in babies and toddlers:

• At 6 months of age: Lack of smiling while socially interacting with people, lack of happy expressions when interacting with people, and/or lack of eye contact.
• At 9 months of age: Still a lack of smiling, failure to begin non verbal communications such as noises meant to get their care giver’s attention when wanting something, and/or failure to begin making vocal sounds for the purposes of interacting with other people.
• At 12 months of age: No babbling or attempts to form baby-talk and words for communicating with other, failure to begin use of non verbal motions to communicate their wants such as pointing or gesturing what they want or need, and/or does not respond when their name is said or called out.
• At 16 months of age: Failure to say any words. No attempts to begin verbal communication with actual words. There may be seen a disinterest in the child to learn or try to form words through babbling or making verbal noises that sound like the start of words. Caregivers will notice the lack of interest in verbalization by this age.
• At 24 months of age: Still lacking age appropriate verbal communications. They may have achieved the ability to say one word at a time such as ball, mom, or drink. However, they lack the ability to form phrases or put two words together.

There are also red flags to look for at any age:

• Loss of previously acquired skill. For example, a child who was once using phrases and almost forming sentences now only uses one word at a time to communicate their wants and needs.
• As early as toddler age, they appear to prefer being alone. They lack a general desire to interact with their peers. For example, when at a play setting with children their own age a caregiver will notice lots of children playing together while their child choses to play on their own and seems content to do so. If a child is playing on their own and expresses sadness by saying “nobody is playing with them” or “nobody likes them”, thus they play on their own, this child does not fit the category, as they are interested in playing with others. It is the lack of interest in playing with others that is a red flag at any age.
• The child not only prefers but requires a stringent routine. Any deviation by the caregiver of this routine will cause the child to become anxious, stressed, or even distressed. They don’t just “go with the flow” when changes arise. They show an emotional dependence on their routine, and when it is changed they are visibly upset.
• They exhibit echolalia. This is the repeating of words and phrases that they hear from others. What they are repeating does not seem to have significant meaning. For example, they may hear someone say “red ball” during a conversation. The child will repeat “red ball” over and over again, like a broken record. They can also imitate and repeat motions of others. Some autistic parents also report that their child fails to initiate their own words, instead their child only repeats words that they hear.
• Exhibiting repetitive behaviors. Some of the most common are flapping, rocking or spinning. Some of these behaviors are age appropriate, such as spinning. However, it is the continual repetition of the behavior that should be of concern to parents.
• Has difficulty understanding the feelings of others. To others it may seem that they are disconnected to people and their feelings in general.
• Has sensitivity with any of their senses. They will show a more intense than normal reaction to certain sounds, smells, textures, tastes, or lighting. Their reaction can range from very intense to unusual. The key for caregivers to note is the consistency of this reaction when the same sense is affected.
• Language delays of any kind combined with any of the other warning flags.
• Remaining nonverbal.
• The child has highly restricted interests. This can be shown by their fixation on only playing with one kind of toy to the exclusion of interest in any other toys.

Keep in mind that a child with autism can have just a few of these signs and difficulties. Other children who may have some of these difficulties, may not qualify for a clinical diagnosis of autism.

Again, it is the discretion of the clinician and their interpretation of the child’s behaviors aligning with the DSM-5 criterion.

The overlooked signs of autism

Some of the red flags listed above are actually often overlooked or misunderstood by parents. They should be understood by more parents in order to have children diagnosed earlier. Thus, more in depth explanation and understanding of the five most overlooked red flags is needed.

Like mentioned previously, earlier recognition, diagnosis, and treatment leads to better outcomes. This means a more well adjusted child in the long run, when treatment begins at the earliest possible time.

Below are those five red flags with greater explanation and examples:

1. Highly restricted interests

Children with autism can exhibit symptoms of restricted interests. This is sometimes not fully understood, because it is more than just having an interest in only a few toys or activities.

For example, I know one child with autism who is obsessed with Legos. You may be thinking, I know kids who are obsessed with Legos, but they are not autistic. You are right, not all kids obsessed with an interest are autistic. However, there are some defining behaviors that make an autistic child different.

A child obsessed who is autistic will likely be so enamored with their Legos to the exclusion of interest in playing with other toys. Their obsession can last for months or years, until they find a new interest to fill their obsession.

They also have a tendency to engage in play that in described by some parents as OCD (Obsessive Compulsive Disorder). The child wants things in a certain order or certain color scheme.

This interest is obsessive in nature and when others try to intercede in the play and alter the order of things, the autistic child will become highly anxious or upset.

Also, when an autistic child with highly restricted interests has their toy or object of interest taken away, they become anxious and even distressed.

Signs to be on the lookout with highly restricted interests include an obsession with a toy or activity to the exclusion of other toys and activities, anxiety when their interest is taken away, and play that is highly orderly and can be described by parents as obsessive in maintaining certain qualities of order. This order can include numbering, size, colors, etc.

2. Repetitive behaviors

One of the more familiar repetitive behaviors of some autistic children is head banging. This often begins when the child is younger and will repetitively bang their head against a wall or object.

While many of the repetitive behaviors are done for self soothing purposes, head banging can be harmful or dangerous to the child.

There are other repetitive behaviors associated with autism that are less well known. Some of these other behaviors include hand flapping, spinning, rocking and repeating words or phrases.

Repeating order also falls within this category. For example if a child lines up their cars in a particular color or number order and does this repeatedly, this is repetitive behavior.

It is important to note that some repetitive behaviors occur as part of normal development. Just because your child lines up their toys does not mean that they are autistic. It is the constant repetition of these behaviors and the number of repeated behaviors that the child exhibits is what a clinician will look at when assessing a child for autism.

Autistic children typically exhibit between four and eight different repetitive behaviors. The behavior is often described as self-soothing. Which also means, if their behavior is interrupted it can cause them stress and anxiousness.

3. Unusual or intense reaction to smells

It is common for children with autism to have strong reactions to loud noises. Many of these children are also sensitive to certain clothing on their bodies. Tags on clothing can often be a culprit of many an upset autistic child.

Smell is another sense that is affected by autism. Every autistic child varies on their sensitivities and their reactions to those sensitivities, but smell is one that is often overlooked.

Autistic children can have strong reactions to certain smells that cause them great distress and anxiety. For example, a normal child will smell a skunk and respond by saying “yuck” and plug their nose. An autistic child on the other hand may start crying and yelling loudly. They have a severe over-reaction to certain smells.

Parents can become so accustomed to their child’s outbursts that they themselves become anxious when they smell the offending odor that sets off their child, because they know it will result in such an awful outburst from their child.

Conversely, CNN reported that recent research has shown that children with autism will either show an exaggerated response (such as an outburst) to strong smells or a numbness to strong smells.^[5]

Many autistic children don’t show a differentiation in their response to good smells versus bad smells. They showed little reaction to extreme smells of any kind. They appear to have more of a numbness to smell. Not that they can’t smell, but that they don’t react to smells.

4. Routine changes disturb the child

Routines can be a good thing, which is why this symptom and red flag of autism is often overlooked. Parents may think that their child is just accustomed to things are certain way and like their particular routine.

However, if a child becomes so dependent on a routine that any changes cause them to react severely (such as outbursts or fits) or high levels of anxiety are exhibited, it may be an indicator of autism.

Some autistic children will have such awful reactions to any deviation from their routines that it quite disruptive to the rest of the household.

Routine can be good but when a child is so dependent on their routine that it causes emotional distress when it is changed in any way, it may be an indication of autism.

5. Difficulties understanding feelings of others

Children with autism often display emotions differently than others. They may show a lack of empathy or zero reaction to a distressful situation of others.

For example, they may witness a child break a bone on a playground and they appear completely unfazed. This does not mean that they did not emotionally process the situation or have feelings about what is happening in front of them. It simply means that their reaction is different than that of most of the population.

Their inability to show reactions to situations where most people would typically show reaction is common with autistic individuals. When they are unable to express their own emotions, it makes it more difficult for them to understand and process the expressions of emotions of others.

They lack the innate ability of normal emotional expression but this does not mean they do not feel on the inside. It is that they lack the ability to express emotions normally. Therefore, when others express their feelings and emotions to a person or child who is autistic the reaction may nothing.

The lack of reaction to the feelings and emotions of others is what is commonly missed by friends and family. They interpret the behavior as a lack of empathy. Parents may think their young child may just need to develop more to show empathy when difficult or sad situations arise.

However, it is not about development as even toddlers will show sadness when others are crying and upset. Even babies will often begin to cry when they hear other babies crying. The autistic child will often appear unfazed by these emotions expressed by other children. They remain neutral.

It is the lack of expression of their emotions that is misunderstood. Their own lack of expressing emotions makes it difficult for them to understand the expression of emotions of others.

Benefits of an official diagnosis

Some parents will steer clear of clinical diagnosing because they fear that their child will be labeled. Labels can carry a stigma.

However, there is great benefit to an official DSM-5 diagnosis from a clinician for a child. The child can receive help is the biggest benefit to getting a diagnosis.

If a child doesn’t have a diagnosis, it is difficult to get the proper help for that child. How can you get in to see a doctor that specializes in autism if you will not allow a diagnosis to happen? Your doctor will likely have great difficulty referring you to specialists such as occupational therapy without a diagnosis or reason for that referral.

Another benefit is planning for the child’s educational future. In the public education system within the United States, your child can receive an IEP (Individualized Education Plan) if your child has an autism diagnosis. This will be an educational plan that the teachers, counselors and other school staff implement with the parent involvement.

This plan provides for specialized services within the school and classroom, such as occupational therapy, physical therapy, reading specialists, etc. for better helping and serving the child in the school environment. An IEP plan will help the child get the services that the need and deserve. These services are typically free to the parents and are paid through the school district monies.

Another reason to have your child assessed for autism if they present any of the red flags previously listed is that you can rule out other diseases and disorders as the cause. Knowing what they have and having a path forward for treatment is empowering.

If your child is diagnosed with autism, you no longer have to wonder if it could be another disease or problem plaguing your child. You also now have a name for the cause and you know that there is help available for this specific disorder.

Your child is the same person they were before the diagnosis or label. Don’t allow a diagnosis to change the way you think of your child. The only thing that has changed is your ability to get them the help they need.

With a proper diagnosis you now have a starting point. You have a diagnosis and there are specialists around the globe who treat this disorder.

Knowing what your child has and being able to therefore proceed with help for them is loving them greatly. They are still the same child they were before and after the diagnosis was given to them.

What to do if you are concerned

You can access the Modified Checklist of Autism in Toddlers (Revised version) via this link free: M-CHAT-R. You can take this free online test and it will provide you with results and information regarding your individual child and their potential for having autism.

This information can be helpful if you are debating whether to contact your health care professional regarding your concerns. You can make an educated decision based on the results from the M-CHAT-R.

If your child is at risk, according to the results, you should immediately contact your health care provider, such as your pediatrician. They can help you in your next steps.

There is also a free download from the Autism Speaks website for parents: First Concern to Action Tool Kit. This kit provides concerned parents with a great deal of helpful information such as the following:

• Information on normal versus abnormal childhood development by age.
• Helpful tips on what do to if you are concerned about your child’s development.
• Information on how to get your child evaluated/ tested for autism.
• What treatment options are available for autism, if needed.

The download is completely free and will further help a parent who is concerned about their child and their development. The earlier the intervention, the better the child will respond to therapies in the long run.

Detection and treatment of autism early is of greater help to a child who may be affected. Don’t hesitate if you think your child may be affected.

Download the First Concern to Action Tool Kit above today if you have any concerns. The kit will provide you with direction, hope, and information you need to know if you think your child is autistic.

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