- Early Signs of Autism in Babies
- What is Autism?
- Signs of Autism in Babies
- Autism Signs: Your Month-by-Month Guide
- By 3 months
- By 7 Months
- By 12 Months
- By 24 Months
- Autism spectrum disorder and early development
- About early signs of autism spectrum disorder
- Social communication: red flags for autism spectrum disorder
- Behaviour: red flags for autism spectrum disorder
- Age-Related Signs of Autism
- 8 Signs of Autism in Infants
- 1. Excessive-Passivity
- 2. Excessive-Activity
- 3. Resistance to Eat/Feed
- 4. Lack of Direct Eye Contact with People
- 5. Lack of Reaction to the Voice or Presence of a Parent
- 6. Withdrawal from Parental Touch (or Touch of any Other Person)
- 7. Delayed Motor Development
- 8. Accelerated Growth of the Circumference of the Head in Relation to its Starting Point
- Signs of autism in children
- Autism in young children
- Autism in older children
- Autism in girls and boys
- Dear Mama of a Nonverbal Child
- Signs of autism in babies younger than 12 months old
- Signs of autism in toddlers 12 to 24 months old
- Signs of autism in children 2 years old and up
- Classic sign of autism appears in early infancy, study says
- Altered trajectory:
- Subtle signs:
- Is it normal for my baby to crawl backward?
Early Signs of Autism in Babies
Watching your baby grow is an unforgettable experience. But while every child develops at her own level, failing to reach certain milestones could raise red flags. Some parents recognize signs of autism spectrum disorder (ASD) when their baby is around 6-12 months – and maybe even earlier, says Thomas Frazier, PhD, a clinical psychologist, autism researcher, and chief science officer of Autism Speaks. Here are the early signs of autism in babies, and why prompt diagnosis is key to treating the condition.
What is Autism?
Autism is a complex developmental disability that affects social skills like playing, learning, and communicating. Individual cases of autism fall on a spectrum ranging from mild to severe. A December 2018 report from the American Academy of Pediatrics estimated autism affects one in 40 U.S. kids today.
- RELATED: Preventing Autism in Pregnancy: Is it Possible?
Doctors don’t know exactly what causes autism, but it’s believed to be a combination of environmental and genetic factors. Certain circumstances also raise a child’s chance of developing autism. For example, “if you have a sibling with autism, your risk of developing it increases to about 20% on average,” says Dr. Frazier. He states that other risk factors include premature birth, low birth weight, delivery complications, and having older parents.
Signs of Autism in Babies
Some parents recognize autism signs when their child is 6-12 months old, depending on the symptoms and their severity. “Pay attention to whether or not the baby is reacting to social information and the environment. Within the first year of life, babies start to babble and use gestures like pointing,” says Dr. Frazier, adding that babies may also smile at their caregivers. “Baby noises should have some social function as well, and they should try communicating with parents.” Babies with autism sometimes fail to communicate through sounds or gestures, and may not respond to social stimulation.
Here are other early signs of autism, according to the Centers for Disease Control and Prevention (CDC).
- RELATED: Signs of Autism in Toddlers
Autism Signs By 3 Months
- She doesn’t follow moving objects with her eyes: “Babies at high risk for autism don’t follow caregivers as they move in the visual field,” says Dr. Frazier. “They may be more intrigued by something like a blanket.”
- She doesn’t respond to loud noises.
She doesn’t grasp and hold objects.
She doesn’t smile at people.
She doesn’t babble.
She doesn’t pay attention to new faces
Autism Signs By 7 Months
- She doesn’t turn her head to locate where sounds are coming from.
She shows no affection for you.
She doesn’t laugh or make squealing sounds.
She doesn’t reach for objects.
She doesn’t smile on her own.
She doesn’t try to attract attention through actions.
She doesn’t have any interest in games such as peekaboo.
Autism Signs By 12 Months
- She doesn’t crawl.
She doesn’t say single words.
She doesn’t use gestures such as waving or shaking her head.
She doesn’t point to objects or pictures.
She can’t stand when supported.
It’s important to note that these criteria aren’t conclusive evidence of autism. “They’re simply things we look for to determine if we need to further assess the baby,” says Mandi Silverman, PsyD, MBA, senior director of the Autism Center at the Child Mind Institute. Another social or developmental factor may be to blame.
What If My Child Has Autism?
If your child has signs of autism, Dr. Frazier advises scheduling a visit to your pediatrician right away. You’ll discuss developmental concerns, and the doctor will evaluate your baby for autism. “We have evidence that suggests the quicker you can get a diagnosis, the earlier you can enroll in developmental and behavioral interventions,” says Dr. Frazier.
- RELATED: Does Your Child Need Early Intervention?
Early intervention is meant help your baby cope with his autism symptoms and possibly even reverse them. As your child gets older, intervention might include speech therapy, occupational therapy, mental health counseling, and whatever else experts believe will help your child thrive. The ultimate goal is “making the symptoms more manageable and enhancing life as much as possible,” says Silverman.
- By Nicole Harris
Autism Signs: Your Month-by-Month Guide
By 3 months
Early diagnosis of autism can make a dramatic difference. Here are some signs that may indicate your baby should have a developmental evaluation, according to the Centers for Disease Control and Prevention:
- She doesn’t respond to loud noises.
- She doesn’t follow moving objects with her eyes.
- She doesn’t grasp and hold objects.
- She doesn’t smile at people.
- She doesn’t babble.
- She doesn’t pay attention to new faces.
By 7 Months
- She doesn’t turn her head to locate where sounds are coming from.
- She shows no affection for you.
- She doesn’t laugh or make squealing sounds.
- She doesn’t reach for objects.
- She doesn’t smile on her own.
- She doesn’t try to attract attention through actions.
- She doesn’t have any interest in games such as peekaboo.
By 12 Months
- She doesn’t crawl.
- She doesn’t say single words.
- She doesn’t use gestures such as waving or shaking her head.
- She doesn’t point to objects or pictures.
- She can’t stand when supported.
By 24 Months
- She can’t walk.
- She doesn’t speak more than 15 words.
- She doesn’t use two-word sentences.
- She doesn’t seem to know the function of common household objects, such as a telephone, fork, and spoon.
- She doesn’t imitate your actions or words.
- She can’t push a wheeled toy.
- She doesn’t follow simple instructions.
Hallie Levine Sklar is a freelance health and fitness writer who lives in New York City with her husband, Jamie.
Originally published in American Baby magazine, November 2006.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.
- By Hallie Levine Sklar
Autism spectrum disorder and early development
Children all develop at different rates. Health professionals like GPs and child and family health nurses check children’s development by looking at whether children are achieving various important milestones. These can be physical, emotional, social, linguistic or behavioural milestones.
In the first year of life, children’s social communication development is an important area to watch for early signs of autism spectrum disorder (ASD). Behaviour – or the lack of behaviour – like smiling, eye contact, and the use of gestures can show whether a child is developing in a typical or atypical way.
When my son was 18 months old, a friend brought her nine-month-old baby to our house. I had so much fun with the baby – there was this constant interaction between us. I realised this was completely absent from my own little boy.
– Anna, mother of Lachlan, aged four
About early signs of autism spectrum disorder
Some early signs of autism spectrum disorder (ASD) are usually seen in the first two years. These are listed below.
Some children have many of these early warning signs, whereas others might have only a few. Some behaviour signs can change over time, or become clearer as children get older. Also, any loss of social or language skills during this period is cause for concern.
The number of signs a child has from each list varies according to the age of the child and how severe the child’s ASD is.
If your child is showing some or many of the signs from the lists of red flags below, talk to your health professional about a developmental assessment as soon as possible. Getting a diagnosis is the first step towards helping your child and getting services and support.
Social communication: red flags for autism spectrum disorder
- doesn’t point to or hold up objects to show people things, share an experience or show that she wants something – for example, she doesn’t point to a dog and look back at you to make sure you’ve seen it too, or she drops a toy in your lap and walks away instead of holding it up and looking at you
- doesn’t consistently respond to her name
- doesn’t sound like she’s having a conversation with you when she babbles
- copies what she hears from others or from the TV – for example, when you ask if she wants more drink, she echoes back ‘more drink’
- doesn’t understand simple one-step instructions – for example, ‘Give the block to me’ or ‘Show me the dog’.
The child doesn’t:
- use gestures on his own – for example, he doesn’t wave bye-bye without being told to, or without copying someone else who is waving
- use eye contact to get someone’s attention – for example, he doesn’t look at a parent then at a snack to show he wants it
- smile at caregivers without first being smiled at or tickled.
Relationships and play
Your child doesn’t:
- show interest in other children
- start games like peekaboo or pat-a-cake
- do pretend play – for example, she doesn’t feed her teddy bear.
I thought that maybe he was just incredibly smart, as he would remember everyone’s name and the alphabet and numbers, and mimic newsreaders and kids’ characters. He spoke like an adult and was reading signs at shopping centres when he was only two. Perhaps he didn’t want to mix with the other children because they weren’t at his intellectual level? He loved to sit and talk to the mums rather than go and play.
– Sonya, mother of Jack, aged seven
Behaviour: red flags for autism spectrum disorder
- has an intense interest in certain objects and gets ‘stuck’ on particular toys or objects – for example, he’ll flick the light switch off and on repeatedly, or will play only with cars
- interacts with toys and objects in only one way, rather than more broadly or in the way toys were intended to be played with – for example, he only turns the wheels of a toy car rather than pretending to drive the car along the floor
- is very interested in unusual objects or activities – for example, drains, metal objects or specific TV ads
- focuses narrowly on objects and activities, like lining up objects
Your child is easily upset by change and needs to follow routines – for example, she needs to sleep, eat or leave the house in the same way every time.
Your child repeats body movements or has unusual body movements, like back-arching, hand-flapping, arm-stiffening and walking on his toes.
- is extremely sensitive to sensory experiences – for example, she gets easily upset by certain sounds, or will eat only foods with a certain texture
- seeks sensation – for example, she rubs objects on her mouth or face, or seeks vibrating objects like washing machines, or flutters her fingers to the side of her eyes to watch the light flicker.
Age-Related Signs of Autism
First giggles, first words, and first steps are exciting milestones for parents and baby. But what if your baby doesn’t seem to be reaching them? Are these possible warning signs of autism?
Autism and Missed Milestones
Autism is a developmental disability that typically appears before age 3 and can be diagnosed in children as young as 18 months old. Signs of autism focus on key problem areas including delayed or difficult communication, problems playing and interacting with others, and certain behavioral problems.
Parents and caregivers are most likely to spot the warning symptoms of autism in babies by carefully tracking development and milestones. Of course, no child hits every developmental milestone at exactly the same time. But if you notice delays that are consistent with other signs of autism, your child should be screened.
Here are some developmental milestones, broken down by age, that if missed could signal a concern about autism:
By around age 3 to 4 months, a child should be able to smile, start playing, begin speaking in baby babble, and be able to pay attention to interesting movements and objects. Warning signs of autism at this stage include:
- No interest in hands or feet — a lack of self-awareness
- No smiling
- No babbling or attempt to imitate noises you make
- No grabbing or gripping objects, poor head support, and difficulty following or focusing on objects
- No attempt to place objects in the mouth
- A regression in certain skills
By about 7 months, a child should be very curious about the world around him, using his hands and mouth to check out everything. He should be playful, laughing, and responsive to your emotions. At this stage, your baby should even begin to pick up on verbal communication, including recognizing his name and the word “no.” Warning signs of autism at this stage include:
- Movements that seem too rigid or too loose
- Not wanting to show physical affection (for example, if you have difficulty getting the baby to cuddle)
- No response to emotions, physical contact, or sounds
- Difficulty soothing your baby
- Physical delays like the inability to roll over, hold up the head, or sit with help from an adult
- No participation in simple games
- No babbling
- A regression in certain skills
By about 12 months old, a child should start to become a bit more emotional — crying when you leave and acting a little uncomfortable around people he doesn’t know. He should become more aware of your presence (and the lack of it), play games, and use words and other ways of communicating. Warning signs of autism at this stage include:
- Physical delays like not standing up with help, no crawling, or crawling with one side of the body dragging
- Not pointing to things, like a food or a toy he wants
- Lack of physical communication or gestures, including waving
- Lack of participation in games like hiding toys; for instance, he doesn’t try to look for something you hid
- Can’t say individual words like “dada,” “mama,” or “cookie”
- A regression in certain skills
By the time a child is about 2 years old, he should start enjoying the company of and interaction with other kids. Slowly, a toddler will become more independent and maybe a bit feistier as well. Skills like improved verbal communication, recognizing colors and shapes, and being able to play pretend should begin developing. Warning signs of autism at this stage include:
- Not speaking in phrases (at least two words at a time)
- Knowing fewer than 15 words
- Inability to follow basic directions
- Not imitating others’ activities or words
- Doesn’t know what to do with a toothbrush, hairbrush, eating utensils, or a toy phone (can’t play with or use them)
- Physical delays like not walking by 18 months old, or only walking on tiptoes
- A regression in certain skills
By 3 years old, a child should be able to interact appropriately with other children and enjoy it. He should understand basic concepts of fairness and appropriate social behaviors, like understanding how games work, taking turns, and recognizing other people’s property. A child should certainly be a little independent person now, experiencing many different emotions. He should be starting to get the hang of numbers and certain objects, and be able to “pretend” and play. Warning signs of autism at this stage include:
- Avoiding eye contact with others
- No interest in “make-believe” or pretend play
- Not wanting to play with toys or even other children
- Can’t speak even in short phrases
- Speech that is slurred or difficult to understand, accompanied by frequent drooling
- Difficulty copying objects; for instance, being unable to draw a shape like a circle
- Can’t work simple toys or objects
- Severe problems with separation from parent or caregiver
- A regression in certain skills
Autism: As Your Child Gets Older
The warning signs of autism can be pretty clear by about the age of 3, but you can still see signs as your child gets older. By the time he is 4 or 5, for instance, you should be concerned if he is extremely shy or withdrawn, or very aggressive. Not wanting to play with others and not having creative play alone are other warning signs. Speech is always a good indicator; by age 4 or 5, your child should be able to communicate effectively and use the appropriate person (saying “I” to refer to himself) and verb tense.
Milestones are only guidelines; don’t be concerned if your child is a few weeks or months off on a couple of developments. Your child is a unique individual, and that’s what you love about him! But if you notice a consistent pattern of delays and that your child is significantly behind others in his age group, it’s a good idea to get an evaluation from a doctor.
8 Signs of Autism in Infants
Lack of crying, lack of movement, and lack of interest in surroundings – often the baby seems comfortable, showing no sign of distress, hunger etc. Sleeping all night long during the initial months of life.
Continuous crying, lack of physical tranquility (unrelated to any medical cause). Research has found that babies who cry a lot during their first year are more likely to become hyperactive during childhood.
3. Resistance to Eat/Feed
A high percentage of children within the autistic spectrum exhibit eating difficulties at different levels: refusal to breastfeed, refusal to transition to bottle feeding, or to transition from liquid to solid foods. In many cases these difficulties can already be seen during the first months of life.
4. Lack of Direct Eye Contact with People
A baby with an attachment and communication developmental disorder has no difficulty watching an object but does have difficulty forming direct eye contact with people. Nevertheless, there are babies who need a longer period for the maturation of their channels of vision (at the age of 4-5 months).
5. Lack of Reaction to the Voice or Presence of a Parent
There is no turning of the head, no response to his/her name, no smile or babbling. A distinction should be drawn between a lack of reaction to a voice and lack of reaction to the presence of a parent: even if a baby does not hear, he/she will react to the presence of a parent. In any case, a hearing test should first be conducted before drawing conclusions.
6. Withdrawal from Parental Touch (or Touch of any Other Person)
Some babies experience sensory-overload, so that any physical contact may disturb them. This obviously engenders very difficult feelings for the parents, but it is important to explain that the baby is not rejecting them, but has real difficulty with his tactile sense and regulation.
7. Delayed Motor Development
There are babies with attachment and communication development disorders whose motor development is swift, but very often babies exhibit hypotonia (low muscle tension) and their motor development is delayed. This sign is not conclusive for autism.
8. Accelerated Growth of the Circumference of the Head in Relation to its Starting Point
A study conducted by Courchesne (2003) found that, in certain cases, children diagnosed with autism were born with small head circumferences, but within two years the circumference grew rapidly so that it reached larger dimensions of head circumference in comparison to typical development of children. This sign is not conclusive for autism.
It is important to note that each of these symptoms may indicate other disorders not related to autism! It is therefore imperative to first and foremost conduct medical examinations to negate these possibilities. Once this has been done and two of the above-mentioned symptoms persist over time, the possibility of a development disorder linked to autism should be investigated.
Signs of autism in children
Autism in young children
Signs of autism in young children include:
- not responding to their name
- avoiding eye contact
- not smiling when you smile at them
- getting very upset if they do not like a certain taste, smell or sound
- repetitive movements, such as flapping their hands, flicking their fingers or rocking their body
- not talking as much as other children
- repeating the same phrases
Autism in older children
Signs of autism in older children include:
- not seeming to understand what others are thinking or feeling
- finding it hard to say how they feel
- liking a strict daily routine and getting very upset if it changes
- having a very keen interest in certain subjects or activities
- getting very upset if you ask them to do something
- finding it hard to make friends or preferring to be on their own
- taking things very literally – for example, they may not understand phrases like “break a leg”
Autism in girls and boys
Autism can sometimes be different in girls and boys.
For example, autistic girls may be quieter, may hide their feelings and may appear to cope better with social situations.
This means autism can be harder to spot in girls.
Non-urgent advice: Get advice if:
- you think your child might be autistic
You could speak to:
- a GP
- a health visitor (for children under 5)
- any other health professional your child sees, such as another doctor or therapist
- special educational needs (SENCO) staff at your child’s school
Getting diagnosed can help your child get any extra support they might need.
Find out how to get diagnosed
Dear Mama of a Nonverbal Child
Heather is an autism mom, writer and coffee devotee. Her poems have been published in literary journals such as Illuminations, Birmingham Arts Journal, Ruminate, and others.
I just wanted to sit beside you, green-sleeved lattes in hand, and talk. I know talking to me is no substitute for the conversation you long to have; I know you’ve gone years upon years waiting for a voice. I know you’d gladly give up coffee for the rest of your life—or books, or music, or whatever gets you through the day—if it meant you could hear his little voice. Her little voice.
I know the twisted, breathless feeling you feel, deep inside, when someone casually asks, “You sure you want him to talk? I can’t get mine to shut up!” Clenched fists hidden in the pockets of a fleece jacket. And—as if taking a cue from your baby—you say nothing.
Like you, I’ve hesitated in checkout lines when well-meaning cashiers kindly question my son: “And how old are you, young man?” Like you, I smile—as if waiting, too—before replying for him.
I’ve hunkered down to face my child, tears racing from my eyes and his, echoing, “I don’t know what you want, baby” before going through the daily show-and-tell of objects:
“Apple? App-app-apple?” (red fruit in hand)
“Movie? M-m-movie?” (holding out a favorite DVD)
“Drink? D-d-drink?” (pouring water into a sippy cup)
I’ve marveled while talking with kids my son’s age—asking such simple questions, just to hear their answers. “What’s your favorite color?” “Blue! No, orange. No, blue!” For just a minute, I imagine what it would be like to ask my own child these questions and hear his reply.
I’ve heard kids in Target singing along with Idina Menzel: “Let it go! Let it go! Can’t hold it back anymore!”The embarrassed mom sees me, a kindred spirit with her own littles in tow. “They haven’t stopped since the DVD came out!” A shared joke between moms. She thinks I’ve been there, too. My story is too long to tell between aisles of home decor and bath towels, so I just smile and nod.
There have been times I hit the tiny “x” on my newsfeed when Facebook friends bragged about their genius toddlers. Ignorance is bliss, they say, and I don’t know if it’s bliss, but sometimes it’s better. I think you’ve probably hit that tiny “x” a few times, too.
You know what else I know?
I know the indescribable feeling of watching another child approach my son and stacking blocks, one by one, beside him. “You want to help me, Milo? Let’s build a tower!” The total joy that comes from knowing that my child is seen.
I’ve heard the pure laughter of children, my son’s friends, when they chase him. “We’re gonna get you, Milo!”
I’ve watched patient therapists capture my son’s attention and work so diligently, week after week, to elicit even a vowel sound from him.
I’ve been blessed by high school students who give up their Sunday mornings to serve as aides for my little boy. Every week, I sit beside my husband and soak in Gospel truths because of their sacrifice.
We’ve known sadness, but we’ve also known acceptance and unconditional love. I hope you have, too.
We are in this together.
It can be hard to tell if a child has autism because many children without the condition have some of the same behavior. Most children with autism spectrum disorder don’t get a diagnosis until they’re 4 or older.
But the U.S. Centers for Disease Control says that it’s possible to get a reliable autism diagnosis as early as age 2. And many parents notice early signs before their child’s first birthday and realize something is different by the time their child is 18 months old.
The earlier a child with autism begins treatment, the better the outcome. If you notice any of these signs or have concerns about your child’s development, talk with his doctor.
Signs of autism in babies younger than 12 months old
At this age, picking up on signs of autism involves paying attention to whether your child is meeting developmental milestones. Here are some things to watch for:
- Doesn’t show interest in faces.
- Doesn’t make eye contact, doesn’t smile, and may even seem to look right through you.
- Doesn’t always react to sounds. Doesn’t respond to his name, doesn’t turn around to see where a sound is coming from, or doesn’t appear startled when he hears a loud noise. In other situations, his hearing may seem fine.
- Doesn’t like being cuddled or touched.
- Doesn’t show interest in typical baby games, like peekaboo.
- Doesn’t babble or show other early signs of talking.
- Doesn’t use gestures, like reaching for you when she wants to be held.
Read more about milestones for ages 1 to 6 months and 7 to 12 months.
Signs of autism in toddlers 12 to 24 months old
- Doesn’t use gestures. Doesn’t shake his head yes or no. Doesn’t wave goodbye or point to things he wants.
- Doesn’t point out objects to show interest in the world around her. By 14 to 16 months, most kids point to get your attention to share something they’re interested in, such as a puppy or new toy.
- Doesn’t use single words by 16 months or two-word phrases by 24 months.
- Loses verbal or social skills. Used to babble or speak a few words, or showed interest in people, but now he doesn’t.
- Withdraws. Seems to tune people out and be in her own world.
- Walks on his toes or doesn’t walk at all.
Read more about milestones for ages 13 to 24 months.
Signs of autism in children 2 years old and up
- Has a language delay. May struggle to express her needs. Some children with autism don’t talk at all, while others develop language but have trouble participating in a conversation.
- Has unusual speaking patterns. Might speak haltingly, in a high-pitched voice or a flat tone. Might use single words instead of sentences or repeat a word or phrase over and over. Might repeat a question rather than answer it.
- Doesn’t seem to understand what people are saying to her. May not respond to her name or may be unable to follow directions. May laugh, cry, or scream inappropriately.
- Narrowly focuses on a single object, one thing about an object (like a wheel on a toy car), or one topic at a time.
- Engages in limited imitation. Rarely mimics what you do and doesn’t engage in pretend play.
- Seems content to play alone. Appears to have little interest in other children and usually doesn’t share or take turns.
- Displays rigid behavior. May be very attached to routines and have difficulty with transitions. For example: A change in the usual route home from daycare can throw her into despair or result in a tantrum. She’s very particular about what she will and won’t eat. Or she wants to follow strict rituals at snacks and meals.
- Plays with objects or toys in unusual ways. For example: He spends a lot of time lining things up or putting them in a certain order. He enjoys repetitively opening and closing a door. Or he becomes preoccupied with repeatedly pushing a button on a toy or spinning the wheels of a toy car.
- Engages in self-injury, such as biting or hitting herself.
- Exhibits repetitive actions, such as flapping his arms or hands.
- Is overly sensitive to various kinds of stimulation. May resist touch, get agitated by noise, be extremely sensitive to smells, or refuse to eat many foods. He may want to wear only clothes without tags or made of a certain material.
- May overreact to some types of pain and underreact to others. For example, she may cover her ears to block loud noises but not notice when she skins her knee.
- May be fearful when it’s unnecessary or fearless when there’s reason to be afraid. For example, he may be afraid of a harmless object, like a balloon, but not frightened of heights.
- Has sleep disturbances. Many children with autism have trouble falling asleep and wake up frequently in the night or are very early risers.
- Exhibits behavior problems. May be resistant, uncooperative, or overly active. May be hyperactive, impulsive, or aggressive.
Read more about milestones for ages 25 to 36 months.
- Learn key terms explained in our autism glossary.
- Review timelines for reaching major milestones.
- Find out more about developmental delays.
- Learn about development assessments.
- Share support and resources with other parents in BabyCenter Community groups.
And unlike healthy babies who usually learn to sit up at 6 months, even while turning the torso or head, some of the infants whose autism was diagnosed later on toppled easily, falling to one side ”like a log” and failing to break the falls with their hands.
Dr. Teitelbaum, who described his findings in a recent issue of the Proceedings of the National Academy of Sciences, also noted anomalies in the way the autistic babies in the tapes learned to crawl and walk.
Babies typically start to crawl at about the same time they begin to sit, holding their bodies symmetrically with arms vertical at shoulder width, palms on floor, fingers pointed forward. Thighs are vertical and hip-width apart with knees on the ground and lower legs and feet resting on the floor pointing backward. Weight is commonly distributed equally on all four limbs.
The autistic children in the study showed an asymmetrical lack of support in the arms or legs, Dr. Teitelbaum said. One baby supported himself on his forearms rather than his hands. He raised his pelvis high in the air, bird-dog fashion, but could not move forward. Another baby crawled by scooting his left knee on the floor but used his right foot to push himself forward.
Dr. Teitelbaum said that every autistic child showed some degree of asymmetry in walking. Many tended to shift their weight at the wrong moment, which made their walking appear slightly stiff. Others kept their arms in a more infantile position, arms extended forward. Interestingly, many autistic children walk more slowly and with shorter steps, like Parkinson’s disease patients whose motor skills are damaged, Dr. Teitelbaum said.
Early diagnosis has long been a goal of autism researchers, who theorize that the condition results from brain abnormalities that develop before birth. Some researchers think the glitch occurs as early as the 20th to 24th day of gestation, long before women know they are pregnant. Others believe the injury, which could be a mutation or environmental insult, occurs later on, perhaps in the second trimester of pregnancy.
In any event, researchers say that in autistic people, most of the brain forms normally but that some basic scaffolding of nerve fibers is incomplete or improperly developed. Because the human brain grows rapidly in the first year of life — literally constructing circuits that will last a lifetime — this is the best time to intervene.
The goal of intervention would be to stimulate the baby’s brain to circumvent the bad wiring or develop connections to compensate for a defect, Dr. Donnellan said. By correcting movements through some form of physical therapy, it may be possible to use feedback to help correct abnormal brain development.
Classic sign of autism appears in early infancy, study says
Double takes: Identical twins tend to look at the same facial features in a video.
Baby boys who will later be diagnosed with autism show a loss of interest in other people’s eyes between 2 and 6 months of age, according to a study published today in Nature1. This is the earliest behavioral marker of autism found to date.
The researchers found that the steeper the decline in eye fixation over the first two years of life, the greater the level of social and communication impairment at 2 years old.
“Now we know that it is possible to develop a quantitative assay in early infancy that is predictive of both autism and level of social disability,” says lead investigator Ami Klin, director of the Marcus Autism Center in Atlanta, Georgia.
The study is the latest in a surge of research on the younger siblings of children with autism, dubbed ‘baby sibs,’ who have a one in five chance of developing the disorder.
Researchers have found that some baby sibs have distinctive brain-wave patterns and a loss of interest in faces beginning as early as 6 months of age. The new study uncovers changes in brain development even earlier.
“We’re most excited about the fact that these are some of the earliest signs of autism we’ve ever observed,” says co-investigator Warren Jones, director of research at the Marcus Autism Center. “We’re measuring what babies see, but more importantly, what they don’t see.”
Klin and Jones recruited 59 baby sibs and 51 controls at ten different time points between 2 and 24 months of age.
They used eye-tracking equipment to track the infants’ gaze as they watched videos of a woman addressing the camera as if it were a child, cooing and playing pat-a-cake. “We really wanted to do videos that were as close to natural, real life as possible,” Jones says.
The researchers calculated the proportion of time that each infant looked at the woman’s eyes, mouth, body and other objects in the surroundings.
Over the course of the study, 12 of the babies went on to be diagnosed with autism by age 3. Only 2 of the 12 are girls,so the researchers restricted their analyses to boys. They compared 11 boys diagnosed with autism (10 from the baby sibs group and 1 from the controls) with 25 typically developing controls.
The children with autism showed a steady loss of interest in eyes beginning in early infancy, looking instead at other parts of the face or body, the study found. In contrast, babies who were not later diagnosed with the disorder become more interested in eyes over the same period.
By 24 months, the gaze time of the autism group was about half that of the controls, the study found. Their attention to objects also declined in the first year, but then increased in the second, rising to about double that of controls by 24 months.
The study offers a developmental perspective on autism. That is, it found significant differences in how the children’s gaze changes over time, but not when comparing the children at a single age in infancy.
“At any single time point from 2 until 6 months, infant looking is highly variable,” Jones says. “When viewed developmentally, however, as month-to-month rate of change in looking, the differences are quite clear.”
This is a bit like watching someone age, he adds. “On a daily basis, you hardly notice any changes. But if you see two photographs, taken years apart, the differences are obvious.”
Growing pains: Between 2 and 24 months, babies later diagnosed with autism (red) steadily lose interest in eyes, whereas typically developing babies (blue) gain interest.
It’s not yet clear whether these early changes in social gaze are markers of autism per se, notes Mayada Elsabbagh, assistant professor of psychiatry at McGill University in Montreal, who was not involved in the work. Two studies have found, for example, that babies who show more attention to the mouth region relative to the eyes have superior language skills as toddlers2. “The literature suggests that this increased looking to different areas is not unique to autism,” Elsabbagh says.
The new study found that children whose gaze declines most rapidly until 2 years of age have the most severe scores on the ‘social affect’ domain of the Autism Diagnostic Observation Schedule at age 2.
“It’s hard to say what that means,” notes Helen Tager-Flusberg, professor of psychology at Boston University, who has studied baby sibs but was not involved in the new study. “The sample size is very small and correlations are notoriously susceptible to small sample sizes.”
Tager-Flusberg also points out that studies of typically developing babies have shown “striking sex differences” in the developmental trajectory of social gaze. “So I think that needs to be looked at in autism.”
Warren and Jones agree, and are planning to study a larger sample of girl baby sibs.
The researchers say their study has an optimistic message: that at 2 months old, the gaze patterns of babies with autism aren’t all that different from those of their peers, pointing to a window of opportunity for early intervention.
“Our ultimate goal is to translate this discovery into community-viable tools for early identification,” Klin says.
Klin and Jones’ study is a good example of the novel discoveries that can come from the baby sibs approach, notes Daniel Messinger, professor of psychology at the University of Miami, who was not involved in the study. “This is a big step, looking at kids before 6 months.”
Autism is generally diagnosed in the clinic around 3 or 4 years of age. Researchers began following baby sibs’ development around ten years ago, looking for early signs of the disorder, as well as to track its developmental trajectory.
The first studies found that these high-risk babies show subtle behavioral differences from controls in their first year of life. This research also clarified the disorder’s recurrence in families, estimating that about 19 percent of baby sibs develop autism, compared with 1 percent of the general population.
Subsequent work has uncovered more nuanced patterns. For example, a study published 21 September in the Journal of Autism and Developmental Disorders showed that 15-month-old baby sibs — whether they go on to be diagnosed with autism or not — tend to do less ‘social smiling’ while looking at someone’s eyes than controls do. Intriguingly, though, the baby sibs who don’t have autism show typical levels of eye contact and non-social smiling3.
Another study, published in August, found that 6-month-old baby sibs later diagnosed with autism pay less attention to faces compared with baby sibs who develop typically.
“I think baby sibs is reaching its golden age — just reaching it,” Messinger says.
Is it normal for my baby to crawl backward?
Definitely. When your baby starts crawling — which usually happens between the ages of 7 and 10 months — she’ll choose the most energy-efficient way to do it, says pediatrician Tanya Remer Altmann, editor of The Wonder Years: Helping Your Baby and Young Child Successfully Negotiate the Major Developmental Milestones.
If your baby’s arms are initially stronger than her legs, she’ll push or scoot backward. This is common, says Altmann, and doesn’t mean that your baby’s skipping a developmental milestone.
Backward crawling will keep your baby busy, and she probably won’t be bothered by it as long as she can move to where she wants to go. As her legs get stronger, she’ll probably learn to crawl forward on her own.
However, some backward crawlers need enticement to get things moving in a forward direction. To encourage your baby, put her favorite toy in front of her but just out of arms’ reach.
The struggle to get there might frustrate your little one, but give her a few moments to try to reach the toy without your help. This will help strengthen the muscles she needs to crawl forward.
Note: It’s okay if your baby never crawls forward or skips crawling altogether. The important thing is that she gets mobile. Find out more about the fundamentals of crawling and babies who don’t crawl.