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How Do I Recognize the Early Signs of Autism?

Posted Date: 4/1/2015
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Staten Island Parent – April, 2015
Dr. Clifford Mevs, M.D.

How Do I Recognize the Early Signs of Autism?

One of the most important things you can do as a parent or caregiver is to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching.

The U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 68 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years. This increase is partly explained by improved diagnosis and awareness. Studies also show that autism is four to five times more common among boys than girls.

There is often nothing about how children with autism look that sets them apart, but they may communicate, interact, behave, and learn in ways that are different from most other children. The learning, thinking, and problem-solving abilities of those with autism can range from gifted to severely challenged.

Recent research confirms that appropriate screening can determine whether a child is at risk for autism as young as one year. While every child develops differently, we also know that early treatment improves outcomes, often dramatically. Studies show, for example, that early intensive behavioral intervention improves learning, communication and social skills in young children with autism spectrum disorders (ASD).

The following "red flags" may indicate your child is at risk for an autism spectrum disorder:


  • No big smiles or other warm, joyful expressions by six months or thereafter.
  • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter.
  • No babbling by 12 months
  • No gesturing (pointing, waving bye-bye) by 12 months.
  • No words by 16 months.
  • No two-word meaningful phrases (without imitating or repeating) by 24 months.
  • Any loss of speech or babbling or social skills at any age.



  • Doesn’t make eye contact (e.g. look at you when being fed).
  • Doesn’t smile when smiled at.
  • Doesn’t respond to his or her name or to the sound of a familiar voice.
  • Doesn’t follow objects visually.
  • Doesn’t point or wave goodbye or use other gestures to communicate.
  • Doesn’t follow the gesture when you point things out.
  • Doesn’t make noises to get your attention.
  • Doesn’t initiate or respond to cuddling.
  • Doesn’t imitate your movements and facial expressions.
  • Doesn’t reach out to be picked up.
  • Doesn’t play with other people or share interest and enjoyment.
  • Doesn’t ask for help or make other basic requests.


Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving "bye bye.” Typical toddlers also show interest in social games, like peek-a-boo and pat-a-cake. But a young child with an ASD might have a very hard time learning to interact with other people.

ASD begins before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with ASD show hints of future problems within the first few months of life. In others, symptoms may not surface until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an ASD noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age. It is important to note that some people without ASD might also have some of these symptoms.

It is essential to remember that missing any individual milestone by itself—for example, how a child manages transitions, engages in meaningful interactions with adults, or uses her imagination—can be typical. However, a pattern of unusual behaviors and constant use of certain behaviors over time or problems with communication or social skills are cause for concern. Presently, we don’t have a medical test that can diagnose autism. Instead, specially trained physicians and psychologists administer autism-specific behavioral evaluations.

Parents know their children best. If you have any other concerns about your child's development, don't wait. Speak to your doctor now about screening your child for autism.

Dr. Clifford Mevs, M.D. is Board Certified in Pediatrics & Developmental-Behavioral Pediatrics. He is the Section Chief of Developmental-Behavioral Pediatrics at Richmond University Medical Center and the Medical Director of the Elizabeth W. Pouch Center for Special People. For more information visit the health library, which offers articles, quizzes, videos and more at