Learn the signs, act early on autism
Three years ago this national initiative was launched to help parents recognize the possible red flag signs of autism.
Research shows that the earlier children are diagnosed and the sooner treatment/therapy is started, the better the results for children.
Currently, the American Academy of Pediatrics recommends children be screened for autism twice before the age of 2. But many parents say they can tell much earlier that something “is not quite right” simply by observing their child’s development.
Although all children may develop at their own pace, most children who are developing normally will achieve these milestones at the following ages:
At the end of 3 months:
* Social and emotional
Begins to develop a social smile
Enjoys playing with other people and may cry when playing stops
Becomes more expressive and communicates more with face and body
Imitates some movements and facial expressions
*Movement
Raises head and chest when lying on stomach
Supports upper body with arms when lying on stomach
Stretches legs out and kicks when lying on stomach or back
Opens and shuts hands
Pushes down on legs when feet are placed on a firm surface
Brings hand to mouth
Takes swipes at dangling objects with hands
Grasps and shakes hand toys
* Vision
Watches faces intently
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
* Hearing and speech
Smiles at the sound of your voice
Begins to babble
Begins to imitate some sounds
Turns head toward direction of sound
* Contact the doctor if your child:
Does not seem to respond to loud noises
Does not notice hands by 2 months
Does not follow moving objects with eyes by 2 to 3 months
Does not grasp and hold objects by 3 months
Does not smile at people by 3 months
Cannot support head well by 3 months
Does not reach for and grasp toys by 3 to 4 months
Does not babble by 3 to 4 months
Does not bring objects to mouth by 4 months
Begins babbling, but does not try to imitate any of your sounds by 4 months
Does not push down with legs when feet are placed on a firm surface by 4 months
Has trouble moving one or both eyes in all directions
Crosses eyes most of the time (occasional crossing of the eyes is normal in these first months)
Does not pay attention to new faces, or seems very frightened by new faces or surroundings
Experiences a dramatic loss of skills he or she once had
At the end of 7 months:
* Social and emotional
Enjoys social play
Interested in mirror images
Responds to other people's expressions of emotion and appears joyful often
* Cognitive
Finds partially hidden object
Explores with hands and mouth
Struggles to get objects that are out of reach
* Language
Responds to own name
Begins to respond to “no”
Can tell emotions by tone of voice
Responds to sound by making sounds
Uses voice to express joy and displeasure
Babbles chains of sounds
* Movement
Rolls both ways (front to back, back to front)
Sits with, and then without, support on hands
Supports whole weight on legs
Reaches with one hand
Transfers object from hand to hand
Uses hand to rake objects
* Vision
Develops full color vision
Distance vision matures
Ability to track moving objects improves
* Contact the doctor if your child:
Seems very stiff, with tight muscles
Seems very floppy, like a rag doll
Head still flops back when body is pulled to a sitting position
Reaches with one hand only
Refuses to cuddle
Shows no affection for the person who cares for him or her
Doesn't seem to enjoy being around people
One or both eyes consistently turn in or out
Persistent tearing, eye drainage, or sensitivity to light
Does not respond to sounds around him or her
Has difficulty getting objects to mouth
Does not turn head to locate sounds by 4 months
Does not roll over in either direction (front to back or back to front) by 5 months
Seems impossible to comfort at night after 5 months
Does not smile on his or her own by 5 months
Cannot sit with help by 6 months
Does not laugh or make squealing sounds by 6 months
Does not actively reach for objects by 6 to 7 months
Does not follow objects with both eyes at near (1 foot) and far (6 feet) ranges by 7 months
Does not bear weight on legs by 7 months
Does not try to attract attention through actions by 7 months
Does not babble by 8 months
Shows no interest in games of peek-a-boo by 8 months
Experiences a dramatic loss of skills he or she once had
At the end of 12 months:
* Social and emotional
Shy or anxious with strangers
Cries when mother or father leaves
Enjoys imitating people in his play
Shows specific preferences for certain people and toys
Tests parental responses to his actions during feedings
Tests parental responses to his behavior
May be fearful in some situations
Prefers mother and/or regular caregiver over all others
Repeats sounds or gestures for attention
Finger-feeds himself
Extends arm or leg to help when being dressed
* Cognitive
Explores objects in many different ways (shaking, banging, throwing, dropping)
Finds hidden objects easily
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
*Language
Pays increasing attention to speech
Responds to simple verbal requests
Responds to “no”
Uses simple gestures, such as shaking head for “no”
Babbles with inflection (changes in tone)
Says “dada” and “mama”
Uses exclamations, such as “Oh-oh!”
Tries to imitate words
* Movement
Reaches sitting position without assistance
Crawls forward on belly
Assumes hands-and-knees position
Creeps on hands and knees
Gets from sitting to crawling or prone (lying on stomach) position
Pulls self up to stand
Walks holding on to furniture
Stands momentarily without support
May walk two or three steps without support
*Hand and finger skills
Uses pincer grasp
Bangs two objects together
Puts objects into container
Takes objects out of container
Lets objects go voluntarily
Pokes with index finger
Tries to imitate scribbling
* Contact the doctor if your child:
Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he or she watches
Says no single words ("mama" or "dada")
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures
Experiences a dramatic loss of skills he or she once had
At the end of 24 months:
* Social
Imitates behavior of others, especially adults and older children
More aware of herself as separate from others
More excited about company of other children
* Emotional
Demonstrates increasing independence
Begins to show defiant behavior
Separation anxiety increases toward midyear then fades
* Cognitive
Finds objects even when hidden under two or three covers
Begins to sort by shapes and colors
Begins make-believe play
*Language
Points to object or picture when it's named for him
Recognizes names of familiar people, objects and body parts
Says several single words (by 15 to 18 months)
Uses simple phrases (by 18 to 24 months)
Uses 2- to 4-word sentences
Follows simple instructions
Repeats words overheard in conversation
* Movement
Walks alone
Pulls toys behind her while walking
Carries large toy or several toys while walking
Begins to run
Stands on tiptoe
Kicks a ball
Climbs onto and down from furniture unassisted
Walks up and down stairs holding on to support
* Hand and finger skills
Scribbles on his or her own
Turns over container to pour out contents
Builds tower of four blocks or more
Might use one hand more often than the other
*Contact the doctor if your child:
Cannot walk by 18 months
Fails to develop a mature heel-toe walking pattern after several months of walking, or walks only on his toes
Does not speak at least 15 words
Does not use two-word sentences by age 2
By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
Does not imitate actions or words by the end of this period
Does not follow simple instructions by age 2
Cannot push a wheeled toy by age 2
Experiences a dramatic loss of skills he or she once had
At the end of 36 months:
*Social
Imitates adults and playmates
Spontaneously shows affection for familiar playmates
Can take turns in games
Understands concept of "mine" and "his/hers"
*Emotional
Expresses affection openly
Expresses a wide range of emotions
By 3, separates easily from parents
Objects to major changes in routine
* Cognitive
Makes mechanical toys work
Matches an object in her hand or room to a picture in a book
Plays make-believe with dolls, animals, and people
Sorts objects by shape and color
Completes puzzles with three or four pieces
Understands concept of "two"
*Language
Follows a two- or three-part command
Recognizes and identifies almost all common objects and pictures
Understands most sentences
Understands placement in space (“on,” “in,” “under”)
Uses 4- to 5-word sentences
Can say name, age, and sex
Uses pronouns (I, you, me, we, they) and some plurals (cars, dogs, cats)
Strangers can understand most of her words
* Movement
Climbs well
Walks up and down stairs, alternating feet (one foot per stair step)
Kicks ball
Runs easily
Pedals tricycle
Bends over easily without falling
* Hand and finger skills
Makes up-and-down, side-to-side, and circular lines with pencil or crayon
Turns book pages one at a time
Builds a tower of more than six blocks
Holds a pencil in writing position
Screws and unscrews jar lids, nuts and bolts
Turns rotating handles
* Contact the doctor if your child:
Frequent falling and difficulty with stairs
Persistent drooling or very unclear speech
Cannot build a tower of more than four blocks
Difficulty manipulating small objects
Cannot copy a circle by age 3
Cannot communicate in short phrases
No involvement in “pretend” play
Does not understand simple instructions
Little interest in other children
Extreme difficulty separating from mother or primary caregiver
Poor eye contact
Limited interest in toys
Experiences a dramatic loss of skills he or she once had
At the end of 48 months:
* Social
Interested in new experiences
Cooperates with other children
Plays “Mom” or “Dad”
Increasingly inventive in fantasy play
Dresses and undresses
Negotiates solutions to conflicts
More independent
* Emotional
Imagines that many unfamiliar images may be "monsters"
Views self as a whole person involving body, mind and feelings
Often cannot tell the difference between fantasy and reality
* Cognitive
Correctly names some colors
Understands the concept of counting and may know a few numbers
Tries to solve problems from a single point of view
Begins to have a clearer sense of time
Follows three-part commands
Recalls parts of a story
Understands the concepts of "same" and "different"
Engages in fantasy play
* Language
Has mastered some basic rules of grammar
Speaks in sentences of five to six words
Speaks clearly enough for strangers to understand
Tells stories
* Movement
Hops and stands on one foot up to five seconds
Goes upstairs and downstairs without support
Kicks ball forward
Throws ball overhand
Catches bounced ball most of the time
Moves forward and backward with agility
* Hand and finger skills
Copies square shapes
Draws a person with two to four body parts
Uses scissors
Draws circles and squares
Begins to copy some capital letters
* Contact the doctor if your child:
Cannot throw a ball overhand
Cannot jump in place
Cannot ride a tricycle
Cannot grasp a crayon between thumb and fingers
Has difficulty scribbling
Cannot stack four blocks
Still clings or cries whenever parents leave
Shows no interest in interactive games
Ignores other children
Doesn't respond to people outside the family
Doesn't engage in fantasy play
Resists dressing, sleeping, using the toilet
Lashes out without any self-control when angry or upset
Cannot copy a circle
Doesn't use sentences of more than three words
Doesn't use “me” and “you” correctly
Experiences a dramatic loss of skills he or she once
At the end of 60 months:
* Social
Wants to please friends
Wants to be like her friends
More likely to agree to rules
Likes to sing, dance and act
Shows more independence and may even visit a next-door neighbor by herself
* Emotional milestones
Aware of gender
Able to distinguish fantasy from reality
Sometimes demanding, sometimes eagerly cooperative
* Cognitive milestones
Can count 10 or more objects
Correctly names at least four colors
Better understands the concept of time
Knows about things used every day in the home (money, food, appliances)
* Language
Recalls part of a story
Speaks sentences of more than five words
Uses future tense
Tells longer stories
Says name and address
* Movement
Stands on one foot for 10 seconds or longer
Hops, somersaults
Swings, climbs
May be able to skip
* Hand and finger skills
Copies triangle and other shapes
Draws person with body
Prints some letters
Dresses and undresses without help
Uses fork, spoon,and (sometimes) a table knife
Usually cares for own toilet needs
* Contact the doctor if your child:
Acts extremely fearful or timid
Acts extremely aggressively
Is unable to separate from parents without major protest
Is easily distracted and unable to concentrate on any single activity for more than five minutes
Shows little interest in playing with other children
Refuses to respond to people in general, or responds only superficially
Rarely uses fantasy or imitation in play
Seems unhappy or sad much of the time
Doesn't engage in a variety of activities
Avoids or seems aloof with other children and adults
Doesn't express a wide range of emotions
Has trouble eating, sleeping, or using the toilet
Can't tell the difference between fantasy and reality
Seems unusually passive
Cannot understand two-part commands using prepositions (“Put the doll on the bed, and get the ball under the couch.”)
Can't correctly give her first and last name
Doesn't use plurals or past tense properly when speaking
Doesn't talk about her daily activities and experiences
Cannot build a tower of six to eight blocks
Seems uncomfortable holding a crayon
Has trouble taking off clothing
Cannot brush her teeth efficiently
Cannot wash and dry her hands
Experiences a dramatic loss of skills he or she once
Source: Centers for Disease Control and Prevention “Learn the Signs. Act Early” campaign
Research shows that the earlier children are diagnosed and the sooner treatment/therapy is started, the better the results for children.
Currently, the American Academy of Pediatrics recommends children be screened for autism twice before the age of 2. But many parents say they can tell much earlier that something “is not quite right” simply by observing their child’s development.
Although all children may develop at their own pace, most children who are developing normally will achieve these milestones at the following ages:
At the end of 3 months:
* Social and emotional
Begins to develop a social smile
Enjoys playing with other people and may cry when playing stops
Becomes more expressive and communicates more with face and body
Imitates some movements and facial expressions
*Movement
Raises head and chest when lying on stomach
Supports upper body with arms when lying on stomach
Stretches legs out and kicks when lying on stomach or back
Opens and shuts hands
Pushes down on legs when feet are placed on a firm surface
Brings hand to mouth
Takes swipes at dangling objects with hands
Grasps and shakes hand toys
* Vision
Watches faces intently
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
* Hearing and speech
Smiles at the sound of your voice
Begins to babble
Begins to imitate some sounds
Turns head toward direction of sound
* Contact the doctor if your child:
Does not seem to respond to loud noises
Does not notice hands by 2 months
Does not follow moving objects with eyes by 2 to 3 months
Does not grasp and hold objects by 3 months
Does not smile at people by 3 months
Cannot support head well by 3 months
Does not reach for and grasp toys by 3 to 4 months
Does not babble by 3 to 4 months
Does not bring objects to mouth by 4 months
Begins babbling, but does not try to imitate any of your sounds by 4 months
Does not push down with legs when feet are placed on a firm surface by 4 months
Has trouble moving one or both eyes in all directions
Crosses eyes most of the time (occasional crossing of the eyes is normal in these first months)
Does not pay attention to new faces, or seems very frightened by new faces or surroundings
Experiences a dramatic loss of skills he or she once had
At the end of 7 months:
* Social and emotional
Enjoys social play
Interested in mirror images
Responds to other people's expressions of emotion and appears joyful often
* Cognitive
Finds partially hidden object
Explores with hands and mouth
Struggles to get objects that are out of reach
* Language
Responds to own name
Begins to respond to “no”
Can tell emotions by tone of voice
Responds to sound by making sounds
Uses voice to express joy and displeasure
Babbles chains of sounds
* Movement
Rolls both ways (front to back, back to front)
Sits with, and then without, support on hands
Supports whole weight on legs
Reaches with one hand
Transfers object from hand to hand
Uses hand to rake objects
* Vision
Develops full color vision
Distance vision matures
Ability to track moving objects improves
* Contact the doctor if your child:
Seems very stiff, with tight muscles
Seems very floppy, like a rag doll
Head still flops back when body is pulled to a sitting position
Reaches with one hand only
Refuses to cuddle
Shows no affection for the person who cares for him or her
Doesn't seem to enjoy being around people
One or both eyes consistently turn in or out
Persistent tearing, eye drainage, or sensitivity to light
Does not respond to sounds around him or her
Has difficulty getting objects to mouth
Does not turn head to locate sounds by 4 months
Does not roll over in either direction (front to back or back to front) by 5 months
Seems impossible to comfort at night after 5 months
Does not smile on his or her own by 5 months
Cannot sit with help by 6 months
Does not laugh or make squealing sounds by 6 months
Does not actively reach for objects by 6 to 7 months
Does not follow objects with both eyes at near (1 foot) and far (6 feet) ranges by 7 months
Does not bear weight on legs by 7 months
Does not try to attract attention through actions by 7 months
Does not babble by 8 months
Shows no interest in games of peek-a-boo by 8 months
Experiences a dramatic loss of skills he or she once had
At the end of 12 months:
* Social and emotional
Shy or anxious with strangers
Cries when mother or father leaves
Enjoys imitating people in his play
Shows specific preferences for certain people and toys
Tests parental responses to his actions during feedings
Tests parental responses to his behavior
May be fearful in some situations
Prefers mother and/or regular caregiver over all others
Repeats sounds or gestures for attention
Finger-feeds himself
Extends arm or leg to help when being dressed
* Cognitive
Explores objects in many different ways (shaking, banging, throwing, dropping)
Finds hidden objects easily
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)
*Language
Pays increasing attention to speech
Responds to simple verbal requests
Responds to “no”
Uses simple gestures, such as shaking head for “no”
Babbles with inflection (changes in tone)
Says “dada” and “mama”
Uses exclamations, such as “Oh-oh!”
Tries to imitate words
* Movement
Reaches sitting position without assistance
Crawls forward on belly
Assumes hands-and-knees position
Creeps on hands and knees
Gets from sitting to crawling or prone (lying on stomach) position
Pulls self up to stand
Walks holding on to furniture
Stands momentarily without support
May walk two or three steps without support
*Hand and finger skills
Uses pincer grasp
Bangs two objects together
Puts objects into container
Takes objects out of container
Lets objects go voluntarily
Pokes with index finger
Tries to imitate scribbling
* Contact the doctor if your child:
Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he or she watches
Says no single words ("mama" or "dada")
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures
Experiences a dramatic loss of skills he or she once had
At the end of 24 months:
* Social
Imitates behavior of others, especially adults and older children
More aware of herself as separate from others
More excited about company of other children
* Emotional
Demonstrates increasing independence
Begins to show defiant behavior
Separation anxiety increases toward midyear then fades
* Cognitive
Finds objects even when hidden under two or three covers
Begins to sort by shapes and colors
Begins make-believe play
*Language
Points to object or picture when it's named for him
Recognizes names of familiar people, objects and body parts
Says several single words (by 15 to 18 months)
Uses simple phrases (by 18 to 24 months)
Uses 2- to 4-word sentences
Follows simple instructions
Repeats words overheard in conversation
* Movement
Walks alone
Pulls toys behind her while walking
Carries large toy or several toys while walking
Begins to run
Stands on tiptoe
Kicks a ball
Climbs onto and down from furniture unassisted
Walks up and down stairs holding on to support
* Hand and finger skills
Scribbles on his or her own
Turns over container to pour out contents
Builds tower of four blocks or more
Might use one hand more often than the other
*Contact the doctor if your child:
Cannot walk by 18 months
Fails to develop a mature heel-toe walking pattern after several months of walking, or walks only on his toes
Does not speak at least 15 words
Does not use two-word sentences by age 2
By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
Does not imitate actions or words by the end of this period
Does not follow simple instructions by age 2
Cannot push a wheeled toy by age 2
Experiences a dramatic loss of skills he or she once had
At the end of 36 months:
*Social
Imitates adults and playmates
Spontaneously shows affection for familiar playmates
Can take turns in games
Understands concept of "mine" and "his/hers"
*Emotional
Expresses affection openly
Expresses a wide range of emotions
By 3, separates easily from parents
Objects to major changes in routine
* Cognitive
Makes mechanical toys work
Matches an object in her hand or room to a picture in a book
Plays make-believe with dolls, animals, and people
Sorts objects by shape and color
Completes puzzles with three or four pieces
Understands concept of "two"
*Language
Follows a two- or three-part command
Recognizes and identifies almost all common objects and pictures
Understands most sentences
Understands placement in space (“on,” “in,” “under”)
Uses 4- to 5-word sentences
Can say name, age, and sex
Uses pronouns (I, you, me, we, they) and some plurals (cars, dogs, cats)
Strangers can understand most of her words
* Movement
Climbs well
Walks up and down stairs, alternating feet (one foot per stair step)
Kicks ball
Runs easily
Pedals tricycle
Bends over easily without falling
* Hand and finger skills
Makes up-and-down, side-to-side, and circular lines with pencil or crayon
Turns book pages one at a time
Builds a tower of more than six blocks
Holds a pencil in writing position
Screws and unscrews jar lids, nuts and bolts
Turns rotating handles
* Contact the doctor if your child:
Frequent falling and difficulty with stairs
Persistent drooling or very unclear speech
Cannot build a tower of more than four blocks
Difficulty manipulating small objects
Cannot copy a circle by age 3
Cannot communicate in short phrases
No involvement in “pretend” play
Does not understand simple instructions
Little interest in other children
Extreme difficulty separating from mother or primary caregiver
Poor eye contact
Limited interest in toys
Experiences a dramatic loss of skills he or she once had
At the end of 48 months:
* Social
Interested in new experiences
Cooperates with other children
Plays “Mom” or “Dad”
Increasingly inventive in fantasy play
Dresses and undresses
Negotiates solutions to conflicts
More independent
* Emotional
Imagines that many unfamiliar images may be "monsters"
Views self as a whole person involving body, mind and feelings
Often cannot tell the difference between fantasy and reality
* Cognitive
Correctly names some colors
Understands the concept of counting and may know a few numbers
Tries to solve problems from a single point of view
Begins to have a clearer sense of time
Follows three-part commands
Recalls parts of a story
Understands the concepts of "same" and "different"
Engages in fantasy play
* Language
Has mastered some basic rules of grammar
Speaks in sentences of five to six words
Speaks clearly enough for strangers to understand
Tells stories
* Movement
Hops and stands on one foot up to five seconds
Goes upstairs and downstairs without support
Kicks ball forward
Throws ball overhand
Catches bounced ball most of the time
Moves forward and backward with agility
* Hand and finger skills
Copies square shapes
Draws a person with two to four body parts
Uses scissors
Draws circles and squares
Begins to copy some capital letters
* Contact the doctor if your child:
Cannot throw a ball overhand
Cannot jump in place
Cannot ride a tricycle
Cannot grasp a crayon between thumb and fingers
Has difficulty scribbling
Cannot stack four blocks
Still clings or cries whenever parents leave
Shows no interest in interactive games
Ignores other children
Doesn't respond to people outside the family
Doesn't engage in fantasy play
Resists dressing, sleeping, using the toilet
Lashes out without any self-control when angry or upset
Cannot copy a circle
Doesn't use sentences of more than three words
Doesn't use “me” and “you” correctly
Experiences a dramatic loss of skills he or she once
At the end of 60 months:
* Social
Wants to please friends
Wants to be like her friends
More likely to agree to rules
Likes to sing, dance and act
Shows more independence and may even visit a next-door neighbor by herself
* Emotional milestones
Aware of gender
Able to distinguish fantasy from reality
Sometimes demanding, sometimes eagerly cooperative
* Cognitive milestones
Can count 10 or more objects
Correctly names at least four colors
Better understands the concept of time
Knows about things used every day in the home (money, food, appliances)
* Language
Recalls part of a story
Speaks sentences of more than five words
Uses future tense
Tells longer stories
Says name and address
* Movement
Stands on one foot for 10 seconds or longer
Hops, somersaults
Swings, climbs
May be able to skip
* Hand and finger skills
Copies triangle and other shapes
Draws person with body
Prints some letters
Dresses and undresses without help
Uses fork, spoon,and (sometimes) a table knife
Usually cares for own toilet needs
* Contact the doctor if your child:
Acts extremely fearful or timid
Acts extremely aggressively
Is unable to separate from parents without major protest
Is easily distracted and unable to concentrate on any single activity for more than five minutes
Shows little interest in playing with other children
Refuses to respond to people in general, or responds only superficially
Rarely uses fantasy or imitation in play
Seems unhappy or sad much of the time
Doesn't engage in a variety of activities
Avoids or seems aloof with other children and adults
Doesn't express a wide range of emotions
Has trouble eating, sleeping, or using the toilet
Can't tell the difference between fantasy and reality
Seems unusually passive
Cannot understand two-part commands using prepositions (“Put the doll on the bed, and get the ball under the couch.”)
Can't correctly give her first and last name
Doesn't use plurals or past tense properly when speaking
Doesn't talk about her daily activities and experiences
Cannot build a tower of six to eight blocks
Seems uncomfortable holding a crayon
Has trouble taking off clothing
Cannot brush her teeth efficiently
Cannot wash and dry her hands
Experiences a dramatic loss of skills he or she once
Source: Centers for Disease Control and Prevention “Learn the Signs. Act Early” campaign
Copyright © 2002-2008 Lincoln Journal Star. All rights reserved.