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If your child has autism, you will probably notice things that are different about them between the ages of 18 months and 2 years. But the signs may become clear even sooner than that. Or you may not notice them until later, when your child starts school.

Even very early on, you may notice that your child:¹

• Doesn't look when you call their name, even if they seem to hear other sounds
• Doesn't look you in the eye much or at all
• Doesn't notice when you enter or leave a room
• Seems to be in their own world
• Doesn't look where you do or follow your finger when you point to something
• Doesn't point at things.

Usually, children will follow your finger when you point to something at about 9 months of age. And typically, children point to something they want at about 1 year of age.²

Some other things you may notice are that your child:¹

• Doesn't smile back at you
• Leads you by the hand to tell you what they want
• Can't do simple things you ask them to do
• Has a lot of tantrums
• Wants to always hold a certain object, such as a flashlight
• Prefers to play alone
• Doesn't play with toys in the usual way
• Doesn't play pretend (if they are older than 2 years).

Doctors look for three main problems if they think your child might have autism.^{3 4 5} Some children without autism have problems in these areas too. So you doctor will look at your child's overall pattern and how bad the problems are.

Even small babies take part in social activities. Within the first few months, babies look at faces and begin to smile, especially when they are smiled at. Babies also like to be cuddled and comforted with words, sounds and singing.

If your child has autism, they may be much less eager than normal about these activities.⁶ Some children don't like to be picked up or cuddled.⁷ A child with autism may prefer to just lie in their crib or sit in a familiar chair rather than get attention. They usually won't want to play with other children.

Children normally become very close to the main person who cares for them, usually their mother. And they get upset when this person leaves them. But children with autism may not react in this way. In fact, they may not even have much interest in their parents. This can upset you a lot if you are a parent. So can having a child who doesn't seem to give or need affection in the usual way. Children with autism can show affection, but it's in their own way.

Communication is a big word. It's just a term for telling other people what we mean. We tell others what we mean in lots of different ways.

One way people communicate is by speaking. How much children with autism speak varies a lot. Some children say just a few simple phrases over and over, while others speak almost normally. A few children don't speak at all.

About 1 in 6 children with autism speak only a word or two, once in a while.^{8 9} And unlike children with some other kinds of problems, such as a hearing problems, children with autism don't try to make signs either.

The other 5 in 6 children do learn to speak, but usually at a slower pace than normal. Most children without autism can use simple phrases of two or more words by the age of 2 years.¹⁰ But if your child has autism, this might take much longer. Children with autism who are going to speak usually begin to do so by the age of 5 years. But they may only talk about their interests or say the same things over and over.⁷

Your child with autism may often say back words or phrases they have heard you say. This can be right after hearing it or later. (But some children without autism do this too.) And your child may also have problems using the words "I" and "you" in the right way.

Some children with autism learn to speak a bit in their first year. But then they lose that speech in their second year. In other words, they seem to go backward. To learn more, see Autism and speaking.

People communicate in other important ways too. For example, we look each other in the eye and show an interest in what others are saying. If your child has autism, they may not be able to do this naturally. And they may speak with a flat voice. Also, your child may cut in when someone is talking or may not know when to give others a turn.

If your child has autism, they may have set ways of behaving that they do over and over. And they may be interested in only a few things. You can see this in the way that your child plays. For example, your child may want to send a toy car up and down the ramp of their toy garage over and over. They won't want to play pretend. So your child won't want to imagine going on a trip with his toy car.

If your child has autism, they may also need to have the same routines every day. The routine can have many steps, and they have to be done in the same order. Changing the routine in any way can upset your child a lot, more than you expect.

Some children with autism are fascinated with things that work in complex ways, such as toys that are like machines. Drawing, playing computer games or building with Lego blocks may be fun for some children with autism. But they often do or make the same thing over and over.

Older children with autism may be unusually interested in very detailed facts. For example, they may get very focused on schedules for trains or on topics such as astronomy. Many children without autism have particular interests too. But in children with autism, the interest is more than you expect.

There are other ways your child might be affected by autism too.

More than 1in 4 children with autism have intelligence that is below normal.¹¹ This means they have problems with learning.¹² Some children do well on intelligence tests, but they may not be able to pay attention, to hold on to an idea while doing something else and to make a decision quickly.¹²

Some children with autism are very sensitive to sound. Your child may get upset by everyday noises, such as the sound of a vacuum cleaner. Or they may be able to hear sounds, such as airplanes in the sky, long before others in the same room.

Your child may have a strong sense of smell or taste. And they may be a very picky eater, eating only a few foods or only foods made in a certain way.

Some children with autism don't seem to feel pain. But this may be because they don't know how to tell you when they are hurt or they won't come for comfort.

If your child gets excited, they may flap their hands and arms. Or they might move their arms with their elbows bent and fingers in front of their face. Your child may be a bit clumsy. And they may rock, spin or bounce over and over.

Many children with autism are very active. You may hear this called hyperactive. This means it's hard for your child to focus or pay attention for very long. Your child may not be able to sit still and may act before thinking. They may have problems sleeping too.

Some children with autism get anxious or depressed. Usually, this happens in older children and young adults. Also, some children with autism hurt themselves. For example, they may bang their heads against a wall or bite their wrists.⁵

All these problems can upset you and tire you out.

Children with autism may have a hard time writing with a pen or pencil. This can be very frustrating for your child. Using a computer may help them get past this.¹¹

About 1 in 4 people with autism get seizures.⁵ But there are good treatments that can usually keep seizures under control.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.