Is your preschooler on the autistic spectrum?

Your child’s pediatrician has a primary role in the identification of children with developmental delays or disabilities, including Autism Spectrum Disorder (ASD). Find out more about these disorders here.

Current research indicates that many children with ASD can be identified as early as toddlers. It is best to identify children with ASD early so that appropriate education programs and services may be provided at an early age to support learning and development.

The terms Autism and Pervasive Developmental Disorders (PDD) are often used synonymously. The literature refers to ASD as a wide continuum of associated cognitive and neuro-behavioral disorders including, but not limited to, three core-defining features:

  • impairment in socialization,
  • impairment in verbal and non-verbal communication,
  • and restrictive repetitive patterns of behavior.
    There are five disorders associated with ASD or PDD. These include the following:
  • autistic disorder
  • Asperger disorder (also sometimes termed Asperger’s Syndrome)
  • childhood disintegrative disorder
  • Rett disorder and pervasive developmental disorder – not otherwise specified (PDD-NOS)
  • atypical autism
    During well-child visits or through parent reported concerns regarding their child’s development, the pediatrician may determine that your child needs further evaluation.

    Below are developmental milestones for communication and social skills, two of the developmental areas that define autism. The items listed are developmental milestones that children following a typical developmental sequence should exhibit by the time they reach a specified age. Failure to achieve a developmental milestone is a clinical clue that raises concerns that the child may have autism or some other developmental delay or disability. 15 month developmental milestones


  • Makes eye contact when spoken to
  • Reaches to anticipate being picked up
  • Shows joint attention (shared interest in object or activity)
  • Displays social imitation (such as a reciprocal smile)
  • Waves “bye-bye”
  • Responds to spoken name consistently
  • Responds to simple verbal request
  • Says “Mama, Dada,” specific
    18 month developmental milestones
    Same as 15 month milestones, plus the following:
  • Points to body parts
  • Speaks some words
  • Has pretend play (such as symbolic play with doll or telephone)
  • Points out objects
  • Responds to spoken name consistently
  • Responds when examiner points out object
    If you are concerned that ASD or another developmental disability may be present in your child and needs diagnostic confirmation, your child’s doctor should provide a referral to a developmental pediatrician, child neurologist, child psychiatrist or child psychologist skilled in issues of ASD. As a parent, you are encouraged to seek a developmental or educational evaluation as soon as possible.

    The critical issue in the identification of ASD in early childhood is recognition of impairment in socialization. Kids with ASD often has difficulty forming, maintaining and expanding relationships. This is reflected by problems in reading social cues, including tone of voice, inflection, intensity, facial expression, body language and social setting, and the child being unaware of others and their social circumstances.

    A frequent hallmark of ASD is restrictive, repetitive patterns of behaviors seen in non-functional and poor imaginative play. For example:


  • A child with ASD does not play like a typical child.
  • Toys are often not used for their intended purpose, but usually for a repetitive, mechanical, tactile exploration with lack of imagination.
  • The child’s anxiety and need for repetition or ritualistic behavior are frequently evident during play.
    Impairment in verbal and non-verbal communication may be noted when efforts at communication are different from typical children, for example:


  • The child shows poorly developed or inconsistent attention to others.
  • The child may not look to people for approval, look at other people’s faces while trying to communicate or talk, point to objects and look where others have pointed, or acknowledge when spoken to.
  • The child does not understand what is said to him/her consistent with what is expected for the child’s age.
    Concerned about your son or daughter? Call your pediatrician soon and schedule an evaluation appointment. Then, read up on autistic spectrum disorders on this site and others, or even check out some books on the topic.

    No matter the result of the evaluation — or evaluations — don’t lose hope. Your child hasn’t changed just because of a diagnosis. Furthermore, although every child is different, many children have made fantastic progress toward being able to interact with the world with the help of their parents, doctors and teachers.

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