Early Signs of Autism: When to seek an ASD Evaluation

As parents, you know your child better than anyone. You notice the little things: the way they smile, communicate, play, and interact with the world around them. While every child develops at their own pace, there are certain developmental milestones that help us understand whether a child’s growth is on track.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects communication, social interaction, behavior, and sensory processing. Research shows that signs of autism often appear during the first two years of life, often before a child’s second birthday. The earlier concerns are identified, the sooner families can access support and intervention services that help children build important skills during critical developmental years.

The challenge is that early signs can sometimes be subtle. Knowing what to look for can help you decide when it’s time to seek an evaluation.

Early Signs During Infancy

Many of the earliest signs of autism involve social communication skills. Babies naturally seek connection with the people around them through smiles, eye contact, facial expressions, and interactions. When these skills aren’t developing as expected, it is worth discussing your concerns with your child’s health care provider.

By 6 Months

By six months, most babies are engaging socially with their caregivers. Some early signs that may warrant closer attention include:

Few or no big smiles or warm, joyful expressions
Limited or no eye contact

While one sign alone does not mean a child has autism, these social engagement skills are important developmental markers.

By 9 Months

As babies grow, they typically begin participating in back-and-forth social interactions. Potential signs of concern include:

Little or no sharing of sounds, smiles, or facial expressions
Not responding consistently to their name

Parents often describe this stage as feeling like their child is “in their own world” or less interested in social interaction than expected.

By 12 Months

Around a child’s first birthday, communication skills are usually becoming more noticeable. Some signs that may indicate the need for further evaluation include:

Little or no babbling
Little or no use of gestures such as pointing, showing, reaching, or waving
No response to their name

Gestures are an especially important developmental milestone because they often serve as the foundation for later communication skills.

Signs During the Toddler Years

Autism signs often become more apparent during toddlerhood as language and social expectations increase.

By 18 Months

Some common signs are:

Very few or no spoken words
A lack of imitation
Repetitive or unusual use of objects like (lining up toys, containers etc)
Toe walking is common when accompanied by other symptoms on this list

While these skills develop at different rates for every child, significant delays in language and play development should always be discussed with a healthcare professional.

By 24 Months

By age two, most children are beginning to combine words into simple phrases. Signs of concern may include:

Very few or no meaningful two-word phrases (not including repeated or imitated speech)

At this age, many parents begin noticing differences not only in language but also in play skills, social interactions, and flexibility with routines.

Signs That Can Appear at Any Age

While some autism signs are linked to specific developmental milestones, others can become more noticeable as children grow. Every autistic child is different, but there are some common characteristics that parents may observe over time.

Social and communication differences are often among the first concerns families notice. A child may avoid eye contact, prefer to play alone, have difficulty understanding other people’s feelings, or experience delayed language development. Some children may also repeat words or phrases they hear, a behavior known as echolalia.

Other signs may include:

Becoming very upset by small changes in routine
Developing highly focused or restricted interests
Repetitive behaviors such as hand-flapping, rocking, or spinning

Many autistic children also experience sensory differences. They may be unusually sensitive to sounds, smells, tastes, textures, lights, or other sensory input. For example, a child might cover their ears in response to everyday noises, avoid certain clothing fabrics, or become overwhelmed in crowded environments.

One sign that should never be ignored is the loss of previously acquired skills. If your child stops using words they once said, loses social skills they had developed, or stops engaging with others in ways they previously did, contact your pediatrician right away. Developmental regression can occur at any age and should always be evaluated as soon as possible.

When Should You Schedule an Evaluation?

One of the most common things parents hear is, “Let’s wait and see.”

While developmental differences do not automatically mean autism, waiting can sometimes delay access to important services. If you notice concerns, it’s usually better to gather information sooner rather than later.

Consider scheduling an evaluation if:

Your child is missing any of the age-specific milestones described above
Your child is showing multiple signs from the broader list of autism characteristics
Your instincts tell you something feels different about your child’s development

Most importantly, if your child loses skills they previously had, whether that’s speech, social engagement, gestures, or other developmental abilities, contact your pediatrician immediately. Developmental regression is considered a significant concern and should be evaluated as soon as possible.

Formal autism evaluations are generally available beginning at 18 months of age. Even if no concerns are present, the American Academy of Pediatrics recommends autism-specific screening for all children at 18 and 24 months during routine well-child visits.

Parents are often the first people to recognize developmental differences. Trusting your instincts can be an important first step toward getting answers.

How to Start the Evaluation Process

If you’re concerned about your child’s development, start by talking with your pediatrician. Be as specific as possible about what you’ve observed. Videos of behaviors or developmental concerns can also be helpful during appointments.

You can then request a referral to a professional qualified to diagnose autism. This may include a developmental pediatrician, child psychologist, child neurologist, psychiatrist, or a multidisciplinary evaluation team. Many autism evaluations involve input from multiple specialists to get a complete picture of a child’s strengths and needs.

At the same time, don’t wait to begin exploring support services. If your child is under age three, you can contact your state’s Early Intervention program directly without needing an autism diagnosis first. If your child is age three or older, contact your local school district’s special education department to request an evaluation.

Because waiting lists for both evaluations and services can be lengthy, starting the process early can make a significant difference. At STEPS Behavioral Health, we have highly trained and talented psychologists who have years of experience evaluating children with ASD. If you have any questions or suspect your child has ASD, we are able to evaluate your child through insurance to determine if he or she meets the criteria.

If you feel your concerns are being dismissed, don’t be afraid to seek a second opinion. Families know their children best, and many parents report recognizing developmental differences long before receiving a formal diagnosis.

Getting Answers Early Matters

Seeking an evaluation doesn’t mean you’re putting a label on your child. It means you’re gathering information that can help you better understand their needs and access appropriate support.

Whether an evaluation results in an autism diagnosis, identifies another developmental concern, or simply provides reassurance, the information can help guide next steps for your family.

At STEPS Behavioral Health, we understand that navigating developmental concerns can feel overwhelming. That’s why we’re excited to now offer both in person and virtual diagnostic evaluations for children under age five! Our team is committed to helping families gain clarity, access resources, and feel supported throughout the evaluation process.

If you’ve been wondering whether your child should be evaluated, remember: it’s always okay to ask questions. When it comes to your child’s development, getting answers sooner can open the door to support, services, and peace of mind.

References

Centers for Disease Control and Prevention. (2025, April 15). Clinical screening for autism spectrum disorder. U.S. Department of Health and Human Services. https://www.cdc.gov/autism/hcp/diagnosis/screening.html

Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(7), 580–587.

Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), Article e20193447. https://doi.org/10.1542/peds.2019-3447

National Behavioral Assessments. (n.d.). Who is qualified to diagnose autism spectrum disorder? Retrieved June 25, 2026, from https://nbatests.com/who-is-qualified-to-diagnose-autism-spectrum-disorder/

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