Early Signs of Autism in Communication: What Parents Can Watch For

Maybe your toddler doesn't turn when you call their name. Maybe they have plenty of words for trucks and letters but never point to show you the airplane overhead. Or maybe a relative asked, half-joking, whether you'd "had them checked." This post walks through what pediatric and public health organizations describe as early communication signs, what screening involves, and what to do if you have questions. It can't tell you whether your child is autistic. Only a qualified professional who knows your child can help answer that.

Why is communication often where parents first notice a difference?

The CDC describes autism spectrum disorder (ASD) as "a developmental disability caused by differences in the brain," and notes that autistic people "often have problems with social communication and interaction, and restricted or repetitive behaviors or interests."^[1]

The American Academy of Pediatrics (AAP) explains why communication differences can stand out to families, while other differences slip by: "children on the autism spectrum usually sit, crawl, and walk on time. So, the subtler differences in the development of gestures (pointing), pretend play and social language often go unnoticed by families and doctors."^[2]

What is joint attention, and why do pediatricians ask about pointing?

If there's one term worth knowing, it's joint attention. The AAP defines it as "looking back and forth between an object or event and another person and connecting with that person," and calls it "a building block for later social and communication skills." It also lists a delay in or lack of joint attention as the first of three early signs of autism.^[2]

The AAP describes what joint attention typically looks like at different ages, and how it may look different in autistic toddlers:^[2]

• By 12 months: "Most children can immediately look in the direction of an object a parent is pointing at." An autistic child "may appear to ignore the parent."
• By 15 months: "Most children can point to out-of-reach objects that they want." An autistic child "may instead take a parent's hand and lead the parent to the object without making much, if any, eye contact."
• By 18 months: "Most children point at objects they find interesting." An autistic child may point "because they want a parent to get it for them, not because they want the parent to enjoy looking at the object with them."

That last difference is subtle. A child who points to get a snack is communicating, and that matters. The question is whether they also point just to share something interesting with you.

What communication signs does the CDC list by age?

The CDC gives examples of social communication and interaction characteristics related to autism. Several are tied to ages:^[1]

• "Does not respond to name by 9 months of age"
• "Does not show facial expressions such as happy, sad, angry, and surprised by 9 months of age"
• "Does not play simple interactive games like pat-a-cake by 12 months of age"
• "Uses few or no gestures by 12 months of age (for example, does not wave goodbye)"
• "Does not share interests with others by 15 months of age (for example, shows you an object that they like)"
• "Does not point to show you something interesting by 18 months of age"
• "Does not notice when others are hurt or upset by 24 months (2 years) of age"

The CDC also lists "Avoids or does not keep eye contact" and, among repetitive behaviors, "Repeats words or phrases over and over (called echolalia)."^[1]

Two important caveats come straight from the CDC. First, "some people without ASD might also have some of these symptoms." Second, "children with ASD may not have all or any of the behaviors listed as examples here."^[1] A list like this is a reason to ask questions, not a way to reach an answer at home.

What about words, repeating, and talking "like a little adult"?

The AAP says that "Almost all children on the autism spectrum show delays in nonverbal communication and spoken language," and describes a few patterns parents may notice:^[2]

• Labeling more than asking. A child "may have words they use to label things, for example, but not to ask for things. They may use words for objects before using words for people or family members."
• Echoing and repeating. "Most young children go through a phase when they repeat what they hear. Children on the autism spectrum may repeat what they hear for a longer period." This can include repeating "dialogue from movies or conversations with the tone of voice they heard them in."
• Unusual language use. Some children "will seem to have met language milestones during the toddler years. However, their use of language may be unusual. For example, they may talk more like an adult than a toddler."

The National Institute on Deafness and Other Communication Disorders (NIDCD) adds that language development in autistic children is often uneven: "they may develop a strong vocabulary in a particular area of interest very quickly."^[5] It also notes that children "may not respond to their own names" and "As a result, these children are sometimes mistakenly thought to have a hearing problem."^[5]

What if my child stopped using words they used to say?

Losing skills deserves prompt attention. The AAP reports that "About 25% of children later diagnosed with autism may develop some language that they suddenly or gradually stop using. Typically, this may happen between the ages of 15 and 24 months." Children "might also become more socially withdrawn."^[2]

Lost words don't automatically mean autism, but any loss of skills is something to raise with your child's doctor rather than wait on.

When is my child screened for autism?

The AAP "recommends that all children be screened for autism at their 18- and 24-month well-child checkups, in addition to routine developmental surveillance."^[2] The CDC adds that the AAP recommends general developmental screening at 9, 18 and 30 months, and that "Additional screening might be needed if a child is at high risk for ASD (e.g., having a sibling with ASD) or if symptoms are present."^[4]

Screening often starts with a questionnaire you fill out. The CDC lists the Modified Checklist for Autism in Toddlers (M-CHAT) as a "Parent-completed questionnaire designed to identify children at risk for autism in the general population."^[4]

A screen isn't a diagnosis. In the CDC's words, "Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment."^[4]

How is autism diagnosed, and where does a speech-language pathologist fit in?

The CDC explains that "there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child's behavior and development to make a diagnosis." It adds that "By age 2 years, a diagnosis by an experienced professional can be considered reliable."^[3]

According to NIDCD, when a doctor suspects autism or another developmental disability, the child is usually referred to several specialists, "including a speech-language pathologist." The SLP "will perform a comprehensive evaluation of the child's ability to communicate" and "might make a referral for a hearing test to make sure the child's hearing is normal."^[5] Ruling out hearing loss matters because, as noted above, not responding to a name can look like a hearing problem. Our post on hearing and speech covers that side.

On support, the CDC says "Early intervention services can greatly improve the development of a child with ASD,"^[3] and the AAP says research shows that starting early "can improve outcomes for many children on the autism spectrum."^[2] These describe groups of children; no one can promise a particular result for one child. NIDCD also notes that some autistic children communicate using sign language or picture-based systems, including "sophisticated electronic devices that generate speech."^[5]

What can I do right now in Arizona?

• Ask about screening. You don't have to wait for the 18- or 24-month visit if you're concerned. The CDC tells families to "Contact your child's doctor if you have any concerns about your child's development."^[1]
• For children under 3, our guide to AzEIP, Arizona's early intervention program explains how referrals work.
• For a closer look at communication, learn about our speech and language evaluations and our neuro-affirming support for autistic children.

A note on words: the AAP notes that language preferences in the autistic community vary, and that HealthyChildren.org is moving toward identity-first language ("autistic children") to align with neuroaffirming practices.^[2] We mostly use it here too, and we follow each family's preference.

The bottom line

Many early communication differences linked to autism show up in pointing, sharing interest, responding to a name, and how a child uses words, not just in how many words they have. None of these signs alone means a child is autistic, and autistic children don't all show the same ones. Pediatricians screen all children for autism at 18 and 24 months, but you can raise concerns at any age. If something about your child's communication worries you, talk with your pediatrician or a speech-language pathologist. You know your child best.

Speech Me Therapy

Pediatric Speech-Language Therapy · Phoenix, AZ

Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.