You may notice that your toddler communicates, plays, or responds to routines differently than other children. They may point less, develop language differently, become intensely focused on certain objects, or react strongly to changes.
These differences do not automatically mean autism. Children develop at different rates, and no single behavior can diagnose autism.
What matters more is the pattern over time. If you notice consistent differences in areas such as social communication, play, repetitive behaviors, or sensory responses, discuss them with your pediatrician or another qualified developmental professional.
Important:
If your child loses words, communication, or other skills they previously used, raise that concern with a healthcare professional promptly.
What Early Signs Look Like at 12, 18, 24, and 36 Months
These age-based examples can help parents notice patterns worth discussing with a healthcare professional. They are not a diagnostic checklist, and one sign alone does not mean a child is autistic.
The American Academy of Pediatrics recommends autism-specific screening for all children at 18 and 24 months, alongside ongoing developmental surveillance. Concerns can and should be raised at any age.
Not every child who shows one or more of these patterns will receive an autism diagnosis. Development varies, and similar signs can have other explanations. A qualified developmental professional can help determine what the pattern means for your child.
Communication Signs Parents Notice First
Social communication is about more than spoken words. Toddlers also communicate through gestures, pointing, shared attention, facial expressions, and back-and-forth interaction. In autism, it is often the overall communication pattern, rather than speech delay alone, that matters.
Joint Attention
Joint attention means sharing interest in something with another person — for example, pointing to a bird and checking whether you noticed it too.
Differences worth discussing may include rarely pointing or showing objects simply to share interest, or less frequently shifting attention between a person and an object.
Gestures and Language
Other patterns may include:
- Fewer gestures such as waving, pointing, or showing
- Inconsistent response to name
- Less back-and-forth with sounds, gestures, or words
- Echolalia or other unusual language patterns
Late talking alone does not mean autism. Speech delays can have many causes, and hearing or speech-language evaluation may also be appropriate. What matters clinically is the broader pattern of communication and social interaction.
Social and Play Signs
Differences in shared enjoyment, imitation, and back-and-forth play can be part of the broader autism picture.
Examples worth discussing include:
- Shared enjoyment: Less often bringing or showing objects to share interest
- Imitation: Less frequent copying of simple actions, sounds, or routines
- Back-and-forth play: Less sustained turn-taking in games or play
- Pretend play: Differences in emerging pretend or symbolic play
- Peer awareness: Less interest in or different ways of engaging with other children
Eye contact is only one part of nonverbal communication. Autistic children vary widely in how they use it, so it should never be treated as a pass/fail sign on its own.
Autistic children can form strong attachments and meaningful relationships. Autism does not mean a child lacks affection, empathy, or connection with others.
Repetitive Behaviors and Sensory Differences
Autism can include repetitive behaviors, strong preferences for sameness, focused interests, and sensory differences. Many toddlers show some of these behaviors, so the frequency, intensity, developmental context, and overall pattern matter more than any single sign.
Repetitive Behaviors and Routines
Examples may include:
- Repetitive movements such as hand flapping, rocking, or spinning
- Repetitive use of objects
- Strong preference for routines or sameness
- Distress when familiar sequences change
Focused Interests
Some children develop unusually intense interests in particular objects, topics, or parts of objects.
Sensory Differences
Some autistic children respond differently to sounds, textures, lights, smells, movement, or touch. They may be highly sensitive to certain input or actively seek particular sensations.
Many toddlers have strong preferences or sensory reactions. These become more clinically meaningful when they appear alongside other developmental differences.
Repetitive self-regulatory movements, often called stimming, are not inherently harmful and should not be targeted simply because they look different. The focus should remain on the child’s overall wellbeing and functional needs.
What Is Usually Not a Sign of Autism by Itself
Many behaviors associated with autism can also occur as part of typical toddler development. No single trait confirms autism on its own.
Examples include:
- Late talking without other social communication differences
- Shyness around unfamiliar people
- Occasional reduced eye contact
- Frequent tantrums or strong emotions
- Lining up or arranging toys sometimes
- Preferring independent play in some situations
- Disliking certain sounds, textures, or sensations
- Enjoying repetitive books, songs, or routines
What matters is the broader developmental pattern over time, not one isolated behavior.
This article cannot diagnose or rule out autism. A qualified developmental evaluation considers developmental history, observation, communication, behavior, and clinical judgment. The goal here is to help parents recognize patterns worth discussing with a healthcare professional.
What To Do If You Recognize These Signs
If you notice a consistent pattern of developmental differences, you do not need to wait for the next routine screening visit to raise your concerns.
Practical Next Steps
- Write down what you notice: Include specific behaviors, when they occur, and whether any previously used skills have changed or disappeared.
- Talk with your pediatrician: Share your concerns and ask whether further developmental screening or evaluation is appropriate.
- Ask about screening and related evaluations: Depending on the concern, hearing or speech-language assessment may also be recommended.
- Request a referral if needed: A developmental pediatrician, child psychologist, or multidisciplinary team may provide a more comprehensive evaluation.
- Explore early intervention: In the U.S., children under age 3 may qualify for state early intervention services based on developmental needs. Parents can contact their state’s early intervention program directly to request an evaluation — a physician referral or confirmed autism diagnosis is not required just to request that evaluation.
When to Ask About a Developmental Evaluation
Consider asking about a developmental evaluation when:
- You notice consistent differences across communication, social interaction, play, behavior, or sensory responses.
- A developmental or autism screening identifies a concern.
- Your child loses words, communication, play, or other skills they previously used.
- A pediatrician, childcare provider, speech therapist, or another professional raises developmental concerns.
- Your concerns continue even after a screening result appears reassuring.
What to Bring to a Developmental Appointment
Parents do not need to arrive with a diagnosis in mind. It can help to bring:
- Specific examples of communication, play, or social differences
- When you first noticed the pattern
- Any words, play skills, or other abilities your child has stopped using
- Observations from daycare, preschool, or other caregivers
- Previous speech, hearing, developmental, or medical evaluations
- Short videos of behaviors or interactions when they help illustrate a concern
A screening tool does not diagnose or rule out autism. If concerns persist, further evaluation may still be appropriate.
Early evaluation is not about rushing to a diagnosis. It gives families a clearer understanding of their child’s development and can help them access appropriate support sooner.
How Screening and Full Evaluation Differ
Screening, developmental monitoring, and diagnostic evaluation serve different purposes. A screening result can identify concerns, but it does not diagnose autism.
What About the M-CHAT-R/F?
The M-CHAT-R/F is a two-stage parent-report screening tool used to assess likelihood for autism in toddlers. It is a screening tool, not a diagnostic test. Parents can find official information at mchatscreen.com.
Diagnostic Evaluation vs. ABA Assessment
A diagnostic evaluation determines whether a child meets criteria for autism. An ABA assessment happens for a different purpose: to understand the child’s current needs and develop individualized treatment goals.
BridgeCare’s initial ABA assessment serves a different purpose from an autism diagnostic evaluation. A BCBA uses the ABA assessment to understand the child’s current needs and develop individualized treatment recommendations and goals.
What Comes Next When You Have Concerns
If you are noticing consistent developmental differences, the next step is to discuss them with your child’s pediatrician or another qualified developmental professional.
Document what you are seeing, including specific examples and any changes in previously used skills. You do not need to wait for the next routine visit if concerns are already present.
Have Questions About What Comes After an Evaluation?
If your child has received an autism diagnosis and you are exploring ABA services, BridgeCare can explain its intake process, service settings, insurance questions, and next steps.
BridgeCare’s ABA assessment is used to understand treatment needs and develop individualized goals, not to diagnose autism. Autism diagnostic evaluations are completed by qualified developmental or clinical professionals.
Request a consultation to ask about availability, insurance, and what documentation may be needed to begin the ABA intake process.
