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Diagnosing Infants 6 to 18 Months of Age

Dr. Ivy Chong looks at assessment practices for diagnosing autism in infants (defined as 6-17 months of age). Early signs of autism can often be detected in infants as young as 6-18 months. You can take advantage of treatment as soon as you suspect your child has developmental delays. Ask your doctor to refer you to early intervention services. Ivy Chong, Ph.D., BCBA-D, is Director of Autism Services and Training at The Scott Center for Autism Treatment and Associate Professor at the Florida Institute of Technology.

 Infants are children between the age of birth and 18 months. And although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. Symptoms and signs can sometimes be seen even earlier.

When autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity, or ability to adapt and change. If signs are detected by 18 months of age, intensive treatment, such as Applied Behavior Analysis, or ABA therapy, may help to reverse the symptoms of autism. 

Currently the official diagnoses of autism aren't usually given until kids reach age 2 or 3. But parents can be on the lookout for signs much sooner. Early discovery and intervention can make a huge difference, so be aware of any delays your infant is experiencing and discuss them with your pediatrician.

The earliest signs of autism involve the absence of normal behaviors—not the presence of abnormal ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.

I’ll summarize some of the warning signs in children from age 2 months to 18 months.  If you observe any of these, talk to your doctor, who will then decide whether more testing is necessary.

Don't fret if you occasionally see one or two of these—it could be another type of language, learning, or behavior problem, or even nothing at all.

These are some red flags to watch out for:

  • If by 2 to 3 month your baby isn’t making frequent eye contact
  • If by 3 months he isn’t smiling at you
  • By 6 months he doesn’t laugh
  • If by around 8 months he isn't following your gaze when you look away from him or crying when you leave him and at 9 months he hasn't begun to babble.
  • The 12 month mark is an important milestone. If any of the following behaviors are persistently absent, it warrants a visit to the pediatrician, including:
  • If by 1 year he isn't consistently turning to you when you call his name or hasn't begun to wave bye-bye. At this point he should also be making hand gestures like pointing and waving
  • By 12 to 14 months he hasn't said a single word, and by 14 months he isn't pointing to show interest.
  • By 16 to 18 months your baby should be laying pretend and if he isn’t that is a warning sign.  At 16 to 18 months if you have concerns, your child should complete the MCHAT, an autism screener for children 18 months or older.  Please refer to the Autism Advisor toolkit on diagnosing toddlers to get information on the MCHAT screener and for more detailed information on the signs of autism in infants.

In conclusion, there are several things you can, and should do, on an ongoing basis to watch for autism in your infant.

First, continuously monitor your infant’s development and take action if you’re concerned. Every child develops at a different pace—so you don’t need to panic if your child is a little late to talk or walk. When it comes to healthy development, there’s a wide range of “normal.” But if your infant is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child’s doctor immediately.

Second, don’t accept a wait-and-see approach. Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement.

And finally, trust your instincts. Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it’s telling you something is wrong and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.

Early diagnosis and intervention are critical for children with autism. The earlier a diagnosis can be made, the earlier intervention methods, such as Applied Behavior Analysis, or ABA therapy, can be implemented. If you suspect, don’t wait! Have your infant evaluated as soon possible during this critical developmental period. 

You should use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism or its associated medical conditions. The information in this Autism Advisor tool kit is solely for educational purposes, not medical advice.