Early signs of autism, and what to do next
If you are reading this at eleven at night with a search history you would rather nobody saw, you are not overreacting. You are paying attention.
The clearest early signs are about connection rather than milestones: not responding to their name, little pointing or showing, limited eye contact, not copying what you do, and losing words or skills they already had. Any one of them is a reason to ask, not a diagnosis. Talk to your pediatrician, ask directly for a developmental screening, and start the referral, because the wait for an evaluation is the long part.
Read this part first
This page cannot diagnose your child and neither can any page. Autism is diagnosed by a qualified professional who spends real time with a child, and the signs below overlap with hearing loss, with speech delays that resolve on their own, with a hundred ordinary variations in how children develop, and with nothing at all.
What this page is for is deciding whether to make the call. That is a lower bar, and the answer is usually yes.
What to look for, by age
- Around 9 to 12 monthsDoes not respond to their name even when you know they hear you. Does not follow your gaze or look where you point. Little back and forth of smiles, sounds or expressions. Does not wave, reach up to be picked up, or show you things.
- Around 15 to 18 monthsFew or no single words. Does not point at something across the room to share it with you, which is different from pointing to get it. Does not copy simple actions like clapping or stirring a cup. Prefers to play alone in a way that feels different from shy.
- Around 24 monthsNo two word phrases. Little pretend play, no feeding the doll or driving the toy car as a car. Strong distress at small changes in routine. Lining up or sorting objects for long stretches rather than playing with them.
- At any ageLosing words, gestures or social skills the child previously had. This one is different from the others and it is worth a call the same week, not the same month.
Some traits get treated as red flags when they are not. Lining up toys, spinning wheels, flapping hands when excited, being intensely into one subject, walking on tiptoe. On their own, none of these means anything is wrong. They matter as part of a picture, and the picture is a professional's job to read, not yours.
If your home speaks two languages
Growing up bilingual does not cause autism, does not cause a speech delay, and does not make either one worse. This gets said to families in Miami constantly and it is wrong. A bilingual child may mix languages and may have fewer words in each one while having the same total, and that is typical.
Do not stop speaking your language to your child. The advice to switch to English at home is not supported and it costs the child the language of their family. What you should insist on instead is an evaluation by someone who can assess in both languages, or with a qualified interpreter.
The exact steps, in order
- 1. Write down what you have noticedSpecific moments with dates beat a general worry. Take a short video if a behaviour is hard to describe. Fifteen minutes of preparation makes a ten minute appointment twice as useful.
- 2. Ask your pediatrician for a developmental screening, by nameScreening at 18 and 24 months is standard practice. If you are told to wait and see and your concern has not changed in a month, ask again and ask for the referral in writing. Being persistent here is not being difficult.
- 3. Start Early Steps or the school district in parallelIn Florida, Early Steps serves children under three and does not require a diagnosis to evaluate. From three onward it is your school district. Both are free and both run on their own timeline, so start them while you wait for the medical evaluation rather than after it.
- 4. Get on the waiting list nowThe diagnostic evaluation is the long pole. Waits of several months are normal in South Florida. Get on the list the week you decide, because you can always cancel and you cannot get the months back.
- 5. Verify your insurance while you waitCoverage checks do not need a diagnosis to begin. Knowing what your plan requires means the day the diagnosis arrives you are ready to start rather than starting the paperwork.
Why the waiting and seeing costs more than it saves
The brain is at its most changeable in the first years, which is why early support does more with less. That is the clinical argument. The practical one is simpler: the queue for an evaluation is months long, so waiting six months to make the call means waiting a year to start.
And if the evaluation finds nothing, you have lost an afternoon and gained an answer. Nobody has ever regretted that trade.
Quick questions
My pediatrician said to wait and see. Should I?
You can ask for a screening anyway, and you should if your concern has not gone away. Wait and see is reasonable advice for a single mild delay and poor advice for a cluster of social communication signs or for lost skills. Asking twice is normal.
Do I need a diagnosis before starting any therapy?
For insurance to pay for ABA, yes, in nearly every case. But Early Steps and school district services do not wait for a diagnosis, and speech or occupational therapy often does not either. Start what you can start.
Can you diagnose my child?
No. We provide behavior analysis and mental health services, not diagnostic evaluations. Call us anyway and we will tell you what your plan requires and point you toward where the evaluations happen, which is often the hardest information to find.
You do not have to figure the next part out alone
Call us and we will tell you what your insurance requires, what the steps are in the order they actually happen, and where families in Miami go for evaluations. No diagnosis needed to have that conversation, and it costs nothing.