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How will I know if my child needs an autism evaluation?

By Dr. Sanaa Mrabet

Autism… or not?

At one point or another, you may come to question whether your child needs an autism evaluation: either due to behavioral concerns, developmental milestones he or she is not meeting, or a combination of the two.

Symptom emergence

The characteristics of autism can vary from child to child; some children show clear signs very early on, while others have more subtle traits that are easily missed until much later.

Other considerations

It’s important to keep in mind that autism also manifests differently in girls and boys, with the condition often going undiagnosed (or resulting in misdiagnoses) among girls. The abilities and needs of autistic people also vary and can evolve over time; some children reflect uneven skills, with very advanced development in specific areas but challenges in others.

Specific autism characteristic to be aware of

For reference, here is a list of features associated with autism and how they manifest across unique developmental stages.

Before 24 months:

·       Difficult to get your child’s attention

·       Does not share enjoyment with you

·       Does not respond to his/her name

·       Uses few to no gestures (e.g., showing or pointing)

·       Does not combine gestures, sounds and eye contact to communicate

·       Does not imitate simple games or engage in pretend play

·       Pulls your hand as a tool to communicate his/her needs

·       Does not notice people and is more interested in objects

·       Plays by engaging in repetitive actions, filling and emptying, lining up objects, and knocking over and rolling on a continual basis

·       Becomes very upset over changes in routine or if stopped from engaging in repetitive behaviors

Age 3 to 5 years:

·       Exhibits delayed speech or stops using words he/she used to say

·       Produces odd vocalizations and has an unusual tone of voice and/or difficulty modulating his/her voice

·       Repeats others’ words and phrases from favorite shows

·       Is very sensitive and reactive to sound, light, touch, and texture

·       Displays a strong interest in unusual sensory experiences such as licking/smelling objects and/or looking out of the corner of the eyes

·       Does not use many facial expressions indicating surprise, happiness, sadness, and/or anger

·       Has difficulty expressing feelings and discussing experiences

·       Prefers to play alone and has difficulty initiating play and joining other children

·       Experiences frequent emotional dysregulation and takes longer to recover than other children

·       Exhibits a strong desire for and insistence on consistency with respect to clothing, food, toys, etc.

·       Finds it difficult to transition from one activity to another

·       Experiences digestive issues, insists on a restricted diet, and engages in stool withholding

School age and adolescents:

·       Finds it difficult to make and maintain friendships

·       Unaware of personal space and may get too close during conversations

·       Finds it difficult to engage in back-and-forth conversations

·       Mainly interested in discussing his or her own interests

·       Finds it difficult to shift to a new perspective, becoming stuck on a specific topic

·       May not understand sarcasm, humor, and figures of speech

·       Becomes easily overwhelmed and distressed in new situations or when facing change

·       Resists any change to his/her environment (places, people, objects)

·       Typically exhibits a high or low pain tolerance


Most parents have mixed feelings about receiving an autism evaluation and formal diagnosis, fearing that the diagnosis or label will limit their child (understandably so). What is important to understand here is that receiving a diagnosis does not change anything about your child. What it does do, however, is provide you with clarity and validation. It also guides intervention and support to ultimately improve your child’s quality of life. It is important to seek out an autism specialist to ensure a comprehensive, inclusive approach to assessment and subsequent recommendations.


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