Early Signs and Red Flags for Infants and Toddlers at Risk for an Autism Spectrum Disorder

There are currently no publicly available screening instruments for use with children under the age of 18 months. There has been considerable recent research into early markers or “red flags” that indicate the need for serious and immediate follow-up with a pediatrician or team of healthcare professionals experienced with autism spectrum disorders in infants and toddlers.

6-12 Month Markers:

• Infrequent eye contact
• Failure to orient to name
• Does not smile in response to
     smiles from others
• Social and emotional passivity
• Fixation on objects

By 12 Months:

• Poor or no eye contact
• Failure to orient to name
• Poor imitation
• No babbling by 12 months
• No gesturing by 12 months

By 16 Months:

• No single words by 16 months
• No pointing to objects or events
      of interest in an effort to share

By 24 Months:

• No spontaneous two-word phrases
• Loss of any language or social skills at any age

If some of these behaviors are present, an immediate follow-up appointment should be made with the child’s pediatrician. Additionally, you should contact the special services department in the child’s school district and enquire about how to make an appointment with their Early Intervention services coordinator. Request an immediate evaluation, which will be at school district expense.

Intervention for Infants and Toddlers at Risk for an Autism Spectrum Disorder:

The following information regarding intervention comes, in part, from the autism team at the University of Washington's Autism Center led by Dr. Geraldine Dawson:

There are four Core Principles of intervention with infants and toddlers:

Principle #1: Social Engagement

Intervention focuses on shared activities including social sensory and joint attention routines. Shared activities is where language and communication develop.

Principle #2: Development

Skills are carefully adjusted to match or slightly exceed the child's developmental level. Strategies are modeled after normal patterns of interaction and development.

Principle #3: Naturalistic Applied Behavior Analysis (ABA)

Naturalistic ABA approaches are emphasized such as Pivotal Response Training. Other naturalistic approaches include Stanley Greenspan's DIR Floortime Model for establishing joint attention. These approaches are designed to promote communication development, motivation, and positive affect. (see: Effective Intervention Programs) Link to this page.

Principle #4: Partnership with Parents

Parents are partners and the experts about their child. Parents are key to their child's development and generalization of new skills to multiple settings. Other elements of a comprehensive learning model include a comprehensive developmental curriculum; interdisciplinary to include speech and language, occupational therapy and pediatrics. Intervention should consist of 20-25 hours per week and slowly transition from one-to-one to small group activities.

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