Autism Symptoms: Early Signs and Assessment in Autism Spectrum Disorder

What are the symptoms of autism and when are they noticed? Read about early signs of autism spectrum disorder, diagnosis and steps families can take.

"He doesn't turn to look when I say his name", "Her peers are chatting and she still hasn't said a single word", "Instead of playing with his toys, he always lines them up the same way." These observations bring the same question to the minds of many parents: "Could my child be autistic?" Lists of autism symptoms found online can sometimes lead to unnecessary worry and sometimes to waiting around on the assumption that "they'll grow out of it". Yet in autism spectrum disorder, noticing early and reaching the right assessment offers an important opportunity for the child's development. In this article, we look at what autism spectrum disorder is, early signs by age, how and by whom the diagnosis is made, and what families can do during this process.

What Is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects the development of the brain. It shows itself mainly through marked differences in two areas:

• Social communication and interaction: Difficulties with eye contact, joint attention, the use of gestures and facial expressions, reciprocal conversation and building relationships.
• Restricted and repetitive behaviours and interests: Repetitive movements, strong attachment to routines, excessive focus on particular subjects and unusual responses to sensory stimuli.

The word "spectrum" describes how autism can appear in very different forms and at different intensities in each child. One child may not speak at all, while another may speak fluently but struggle in social relationships. Some children need intensive support, while others can manage daily life with less.

The exact cause of autism cannot be traced to a single factor. Research shows that genetic predisposition plays an important role and that various biological factors affecting brain development act together. The idea that parenting style or not giving a child enough attention causes autism is not scientifically valid. Similarly, the claim that vaccines cause autism is not supported by scientific research. This information is important for the many parents who blame themselves.

What Are the Symptoms of Autism? Early Signs by Age

The signs below are not a diagnostic checklist. One or several of these behaviours can also be seen in children who are not autistic. However, if more than one sign appears together and persists, it is important to seek a developmental assessment.

6–12 months

• Little or no eye contact
• Limited social smiling
• Not responding to their name, or responding only rarely
• Little vocal communication (cooing, babbling) and little exchange of sounds
• Showing no interest in turn-taking games such as peekaboo

12–18 months

• Not pointing at an object with the index finger (to ask for it or to share interest)
• Not using gestures such as waving or nodding
• Lack of joint attention: not looking at an object you point to, or not showing you something that interests them
• Not using a single word, or losing words they had gained
• Instead of playing with toys for their intended purpose, lining them up, spinning them or focusing on a single part

18–36 months

• Not putting together meaningful two-word phrases
• Repeating words they have heard or lines from adverts (echolalia) instead of speaking spontaneously
• Not engaging in pretend play (feeding a doll, talking on a toy phone)
• Showing no interest in peers, staying in their own world even when beside them
• Reacting intensely when the routine changes
• Repetitive movements such as hand flapping, spinning around or walking on tiptoe
• Overreacting to particular sounds, touch, lights or clothing textures, or, on the contrary, being insensitive to pain and sound

Pre-school and school age

• Difficulty keeping up a reciprocal conversation; talking only about their own area of interest
• Difficulty understanding figures of speech, jokes and implied meanings
• Difficulty making and keeping friends
• Unusually intense interest in a particular subject (trains, maps, planets, numbers)
• An unusual tone of voice or speech rhythm
• Difficulty adjusting to changes and transitions

In children who speak more fluently, signs of autism may not be noticed until school age. In some girls in particular, social difficulties can be hidden by imitating others or by appearing withdrawn.

No single sign on its own means autism. But instead of saying "let's wait, it will pass", consulting a professional is one of the most valuable steps you can take for your child.

How, and by Whom, Is Autism Diagnosed?

A diagnosis of autism spectrum disorder is not made with a single test, blood test or brain scan. The diagnosis is made as a result of a comprehensive clinical assessment based on the child's detailed developmental history, direct observation and, where needed, standardised assessment tools.

In Turkey, this assessment is generally carried out by child and adolescent psychiatrists. Developmental paediatrics units and paediatric neurology may also take part in the assessment process. In some cases, a hearing test, genetic evaluation or other medical examinations may be requested, because conditions such as hearing loss can cause similar symptoms.

The general steps of the process can be summarised as follows:

1. First noticing: A parent, paediatrician, or nursery or kindergarten teacher notices a difference.
2. Screening: The paediatrician can carry out developmental screening during routine check-ups and refer on if needed.
3. Comprehensive assessment: A detailed assessment is carried out in a child psychiatry or developmental paediatrics unit.
4. Diagnosis and report: If a diagnosis is made, a Special Needs Report for Children (Çocuklar İçin Özel Gereksinim Raporu, ÇÖZGER) can be issued so that the child can access special education rights.
5. Educational assessment: The child's educational needs are identified through the Guidance and Research Centre (Rehberlik ve Araştırma Merkezi, RAM), and referral is made to suitable support education programmes.

Psychologists can carry out developmental observation during this process, provide information to parents and, when needed, refer the family to child psychiatry for diagnosis. However, making the diagnosis of autism and managing the medical side of the treatment plan is the doctor's responsibility. For more information on this distinction, you can read our article on the difference between a psychologist and a psychiatrist.

Conditions That Can Be Confused with Autism

Some conditions can look similar to the symptoms of autism. Differential diagnosis is therefore important:

• Hearing loss: Not responding to their name and delayed speech can result from a hearing problem.
• Speech and language disorders: Some children show a delay only in the language area, while their social interest and use of gestures are appropriate for their age. We cover this subject in our article on speech delay.
• Attention deficit and hyperactivity: Difficulties with attention and impulse control can affect social relationships.
• Anxiety and shy temperament: Shy children may avoid eye contact in new settings; however, their social interaction with familiar people is usually typical.
• Heavy screen exposure and lack of stimulation: Language and social development can be affected in children who spend long periods in front of a screen at an early age or who do not have enough opportunities for interaction. This is not the same thing as autism; however, it is taken into account in the assessment.

Making these distinctions requires an assessment by an experienced professional.

What Can Parents Do When They Notice Symptoms of Autism?

1. Do not wait; seek an assessment

If you have concerns, talk to your child's doctor and ask for a child psychiatry assessment. Support education started early offers an important opportunity for developing the child's communication and social skills.

2. Note down your observations

Before the assessment appointment, write down your child's behaviours, first words, style of play and the situations that worry you. Short videos can also help the professional see the child in their natural setting.

3. Increase interaction at home

There are things you can do at home while the diagnosis process continues:

• Face-to-face play: Get down to your child's eye level and join in with what interests them.
• Joint attention games: Play simple turn-taking games such as blowing bubbles or rolling a ball.
• Simplify your language: Use short, clear sentences and describe what the child is doing ("You're pushing the car").
• Reduce screen time: Especially at young ages, spend time on one-to-one interaction instead of screens. Rather than banning screens completely, reducing the time gradually and replacing it with activities you do together is more workable.
• Create routines: Predictable daily routines can reduce the child's anxiety. Picture-based daily schedules can help.

4. Observe sensory needs

Notice the sounds, lights or textures that bother your child. Gradually getting them used to crowded places, or adjustments such as headphones, can make daily life easier.

5. Talk to those close to you and to siblings

In Turkey, the extended family is often part of the process, and well-meaning comments ("His father started talking late too", "Don't pick at it so much") can increase a parent's uncertainty. Sharing the result of the assessment and the roadmap set for your child with close relatives in plain language makes it easier for everyone to support in the same direction. Explain things to siblings in a way suited to their age: "Your brother's brain learns some things differently. He has teachers who help him learn to talk and to play." Remember that siblings also need attention; even short times spent alone with them matter.

6. Look after yourself

The process of an autism diagnosis can be emotionally tiring for parents. It is natural to experience feelings such as sadness, denial, anger, guilt and anxiety. It is important to cooperate with family members, to meet other parents and to make room for your own emotional needs.

When Should You Seek Professional Support?

In the following situations, you are advised to go without delay to a child psychiatrist or a unit that carries out developmental assessments:

• If, by one year of age, they are not using gestures such as pointing or waving
• If they are not using a single word at around sixteen to eighteen months
• If they are not putting together meaningful two-word phrases at around two years
• If at any age they lose language or social skills they had previously gained
• If they do not respond consistently to their name or have marked difficulty making eye contact
• If you receive repeated feedback about social interaction from nursery or school

Loss of skills (regression) is a situation that must always be assessed, at any age. For a general roadmap, you can also read our article on when to take a child to a child psychologist.

How Is Autism Approached in Therapy and Intervention?

Autism is not a condition one "gets over" like an illness; however, with the right and early support, a child's communication, social and daily living skills can improve markedly. The support process generally requires multidisciplinary teamwork:

• Child psychiatrist: Makes the diagnosis, monitors the process and carries out the medical assessment if there are accompanying conditions (sleep problems, attention difficulties, intense anxiety).
• Special education specialists: Deliver individual education programmes using evidence-based behavioural and developmental methods.
• Speech and language therapists: Work on communication and language skills.
• Occupational therapists: Provide support with sensory regulation and fine motor skills.

The psychologist's role within this team is more limited and complementary. Psychological support can be especially helpful in the following areas:

• Parent counselling: Guiding families on accepting the diagnosis, communication within the family, siblings' needs and everyday behaviour management.
• Accompanying emotional difficulties: Anxiety, difficulties in social relationships and self-confidence problems, particularly in children and adolescents who speak and are of school age.
• The parent's own mental health: Coping with the caring load, burnout and grief-like feelings. At this point, individual therapy can be a space of support for parents.

It is important to know that psychological support does not replace special education, which is the core intervention for autism, or medical follow-up, but complements them.

Frequently Asked Questions

At what age do autism symptoms appear?

Symptoms are often first noticed in the first two years of life. In some children early signs become clear around one year of age, while in children who speak more fluently symptoms may not be noticed until school age. It is possible to ask for an assessment at any age at which you have concerns.

Is every child who does not make eye contact autistic?

No. Reduced eye contact can also be seen with a shy temperament, anxiety or other causes. A diagnosis of autism rests not on a single behaviour but on observation across many areas and the developmental history. For this reason, the diagnosis can only be made through assessment by a professional.

Does autism go away completely?

Autism is a lifelong neurodevelopmental condition. However, with early and appropriate support, many children's communication, social and daily living skills can improve markedly. Each child's developmental path is different.

What does a psychologist do in autism?

A psychologist can carry out developmental observation, refer the family to suitable units for diagnosis, provide counselling to parents and offer support for accompanying anxiety or emotional difficulties. The diagnosis is made by a child psychiatrist; the core intervention is carried out through special education and the relevant therapists.

• #autism
• #autism spectrum disorder
• #early intervention
• #child development

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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