Autism’s Early Childhood Red Flags

Signs that may call for early intervention.

Posted Jan 22, 2020

Autism Spectrum Disorders (ASD) are prevalent in all human populations—the current estimated prevalence is higher than 1 percent in the United States. “Red flags” are signs portending threats to the healthy progression of child development.

Autism is challenging to detect in the first year. From 12 to 24 months, red flags appear that can suggest substantial difficulties. At 18 months, a diagnosis can be made by a health care professional, and the child can be followed to observe whether the diagnosis progresses and becomes more definable.

Social Skills Impairment

In normal or neurotypical child development, language sounds are heard as “cooing” by eight weeks and “babbling” by eight to 12 months. Single words appear at about 12 months and two-word phrases by 24 months. 

Autism spectrum difficulties are suggested when no cooing or babbling or words appear by the second year of life. An infant typically responds to their name by age 1, but one with ASD usually does not.

Social interaction is another significant measure of developmental progression. At eight months, an infant can make babbling sounds, can point, make eye contact, wave, and begin engaging in games like pat-a-cake and peek-a-boo. These social interactions are ordinarily absent in ASD. “Social referencing,” looking to a caregiver for help and guidance, is usually seen by 10 months.

In autism, many of the aforementioned developmental milestones are absent. What language is present lacks pragmatic suitability and is more a monologue than a dialogue. Difficulty making sustained eye contact sets up social communication difficulties, making the child emotionally distant.

Red Flags That May Signal Developmental Difficulties

  • No cooing or babbling by 12 months
  • No single words by 16 months
  • No two-word phrases by two years
  • No budding social gestures by 12 months, e.g., pointing, eye contact, waving, peek-a-boo, and pat-a-cake
  • No response to own name by one year
  • No hint of pretend play by 18 months

Repetitive, Restrictive Behaviors

On a foundation of communicative and social-skill impairment, rigid mindsets show up as repetitive, restrictive behaviors. Those with ASD strive for sameness, routine, and expectable regularity. This need may be difficult to comprehend because their emotional expression remains constricted. Perspectives are narrow and tend to over-focus on a few objects, usually inanimate: e.g., flags, wheels, vacuum cleaners, train schedules, etc. Atypical gestures may appear and include hand flapping, rocking, or skin picking and biting.

Red Flags Can Become Targets of Therapeutic Interventions

While no therapy cures ASD, several interventions are used to change its progressive severity and to boost developmental potentials. Families can engage as soon as the diagnosis is made, and children can be brought in at an early age, depending on chronological and developmental needs. A few types of intervention include:

  • Speech therapy
  • Occupational therapy 
  • Applied Behavioral Analysis (ABA)
  • Social Skills Training with Emotional Intelligence Enhancements
  • Therapeutic Horseback Riding (for older children, adolescents, and adults)
  • Parent, Caregiver, and Family Skills Enhancement

Applied Behavioral Analysis has several subdivisions. Some of these are:

1. Discrete Trial Training (DTT): This segmenting breaks the desired behavior into simple steps.

2. Early Intensive Behavioral Intervention (EIBI): This form of ABA is designed for young children under age 5.

3. Pivotal Response Treatment (PRT): The focus here is on essential areas of a child’s development, like self-management, awareness of social situation rules, and taking charge in social contexts.

4. Verbal Behavior Intervention (VBI): Improving a child’s verbal skills—such as language (e.g., identifying and labeling emotions) and social communication—is the goal.

Along with psychosocial and behavioral interventions, the judicious use of psychopharmacological medications can be helpful. These medications specifically target anxiety and irritability.

The goals of treatment for children with ASD are:

1. To minimize deficits in social communication and restricted, repetitive behaviors

2. To maximize functional independence by facilitating learning and the acquisition of adaptive skills

3. To eliminate, reduce, or prevent problem behaviors that may interfere with practical skills. As children with ASD get older, anxiety and irritability (e.g., aggression, temper tantrums, and self-injurious behaviors) become prominent; proper medication helps to modulate this dysregulation.

The range of providers who can work with the child and parents includes educators, health professionals, and the community. These efforts create meaningful and effective care. Ongoing and clear communication facilitates cooperation and therapeutic optimism.


Volkmar, Fred (2019). Autism and Pervasive Developmental Disorders (edition 3). Boston, MA: Cambridge University Press.

Ninivaggi, Frank John (author) and Volkmar, Fred (Foreword). (2013) Biomental Child Development: Perspectives on Psychology and Parenting. Lanham, MD: Rowman & Littlefield

Ninivaggi, Frank John (2017). Making Sense of Emotion: Innovating Emotional Intelligence. Lanham, MD: Rowman & Littlefield.