According to the US Centers for Disease Control and Prevention, there are warning signs of developmental delay, broken down into 3-month, 7-month, and 1-year of age categories.

Some signs of a possible developmental delay at 3 months of age are a baby’s lack of response to loud noises, or failure to notice his or her hands by 2 months. Not following a moving object with his eyes by 2 or 3 months and not smiling at people by 3 months are also “red flags.” Three months is also the age at which normally developing babies should support their heads and grasp and hold objects. Other signs of normal development are reaching for toys and babbling by age 3 to 4 months.

Normally developing babies should also be able to move one or both eyes in all directions and only occasionally cross their eyes. Not trying to imitate sounds a parent or caretaker makes by age 4 months and not paying attention to – or seeming frightened of – new faces, as well as a dramatic loss of skills once mastered are all signs of a possible developmental delay at ages 3 to 4 months.

Seven months is the next age for which developmental guidelines are evaluated. Some warning signs of a developmental delay at this age include a baby who seems to have tight muscles or who is stiff, or one who seems floppy (his or her head may flop back when you pull baby to a sitting position). A baby who reaches with just one hand, refuses to cuddle, or shows no affection for his or her caregiver may have a delay. Lack of response to sounds or a lack of enjoyment for being around people may be indicative of a delay, as may be sensitivity to light or eye drainage or tearing that is persistent.

Other delays include not laughing or squealing by 6 months, not actively reaching for objects by 6 to 7 months, not sitting with help by 6 months, and not smiling or rolling over by 5 months. Babies who seem impossible to comfort at night after 5 months or who do not bear weight on their legs by 7 months may also have a delay. No interest in “peek-a-boo” games or failure to babble by 8 months may also be signs of developmental delays. Again, a lack dramatic loss of skills once had at this age may be a warning sign of a delay or disorder.

At one year, normally developing babies should crawl and stand when supported. They should also search for objects that you hide while he or she is watching, and use gestures such as waving. Babies at this age who are developing normally should also be able to use single words like “dada” or “mama” and point to pictures or objects. At one year, any significant loss of previously mastered skills is again a warning sign that there may be a delay or disorder.

Knowing the warning signs of a developmental delay is important when it comes to seeing further screening. If you feel your child has any delays, talk to your child’s healthcare provider. He or she can order further screening and diagnosis if appropriate.

Addendum to Possible Warning Signs of Developmental Delay – Birth to 12 Months

Although not all delays are indicative of a developmental delay, if your child exhibits any of the following “red flags” for developmental delay at his or her first birthday, consult your pediatrician right away:

• Child does not crawl
• Child cannot stand when supported
• Child says no single words such as “Mama” or “Dada”
• Child does not learn to use gestures like shaking head or waving
• Child does not search for object hidden while he or she watches

Because there is no medical test for autism, diagnosis is made based on observation of behavior. Although developmental screening and evaluation relies on tests, the responses to the questions on those tests are behavior-related. It may seem, then, that autism is a subjective diagnosis, but it is not. While two children with the same diagnosis may not share the same symptoms, the broader categories of impaired communication and social functioning are hallmarks of autism.

Parents may realize that their child is not developing normally or seems to be “different” without being able to put their finger on a specific delay or deficit. It is important, then, for parents to understand how an autistic child may act, speak, talk, move, and interact. The sooner these observations are made, the sooner a child can be screened and evaluated, diagnosed and treated, so early observation of behaviors is critical.

Hallmark Behaviors

Hallmarks of autism are deficits in social interaction, deficits in communication, and repetitive behaviors. The autistic child may appear not to know how to play and not engage in the give-and-take of normal social interaction or be able to play pretend games. An autistic child may not, for instance, pretend to feed a doll or role-play with action figures or other toys.

Autistic children may speak very little, or not at all, or fail to meet developmental guidelines for language acquisition and use. The child may appear to be in his “own world” or appear not to be listening when spoken to. Babies who are not responding to their own names by around age 1 may be exhibiting a symptom of autism.

Repetitive behaviors like touching objects or repetitive gestures may be present in the autistic child. Autistic children may have limited interests and an inability to determine when their interest is not shared by others. For instance, an autistic child may know a great deal about airplanes but very little else, and talk continuously about airplanes to the exclusion of other topics even when his audience is clearly not interested.

Observe and Learn

For parents, reading about these behaviors is certainly useful since it can help parents to understand that their child’s behavior may have an underlying, treatable cause and that their child is not the only one affected by these behaviors. But actually seeing what these behaviors look like in diagnosed children can present a learning opportunity for parents.

Patricia Towle, Ph.D., a clinical child psychologist with the Westchester Institute for Human Development in Valhalla, New York, has produced a 90-minute DVD called “Autism Spectrum Disorder in Young Children: A Visual Guide/ Volume I: An Overview, Learning to Observe Across the Three Symptom Domains.” The DVD, as the name suggests, lets parents see what the behaviors associated with autism look like in young children. This visual guide presents a unique opportunity for parents to observe behaviors they may have observed in their own child. Seeing these behaviors “in action” may help parents to better understand their own child’s behaviors and help parents become better advocates for their child’s care.

The DVD is available for order here.

Autism has no one known cause and no known cure, but early detection of autism signs can lead to an early diagnosis. Early diagnosis is crucial in obtaining early intervention and treatment. Early intervention and treatment, in turn, can have a profoundly positive effect on the outcome of a child who has been diagnosed with autism.

So what should parents look for? Autism affects communication and social interaction. While delays in these areas are not the only signs of autism, they are hallmarks of the disorder. Very early signs of autism may include a baby’s failure to turn toward the source of sound or to be interested in looking at faces. Normally developing babies love to gaze at faces and will usually smile back at a smiling face around age 4 months.

A lack of joy in interacting with parents and caregivers, or failure to babble and coo when pleased, or cry when displeased, are early signs of autism.

Around 9 months, normally developing babies will make faces and sounds in reaction to those parents or caregivers make. If you baby is not interacting with you in this way, his failure to do so may be a sign of autism.

Most babies enjoy social games like peek-a-boo when they are around a year old, and they will use gestures to get your attention and make sounds to indicate that their needs are not being met. If you take away a favorite plaything and your baby does not verbally protest, he may have a delay in communication skills related to autism. If your baby does not look at you when you call him by name, he may be exhibiting a sign of autism.

By about 15 months, normally developing babies will use a few words, such as mama or dada or bye-bye. If your baby is not doing this, you may have cause to be concerned about his language development.

Baby’s use of language develops into using a gesture-and-verbalization combination to get what baby wants around age 18 months. Normally developing babies use about 10 words and start to engage in “pretend” games by this age as well.

If you baby is not understanding and using about 50 words by age 2, and using these words together in a telegraphic way (e. g. “more milk” or “want ball”), then this language delay may be a symptom of autism.

By age 3, the age by which most instances of autism are diagnosed, normally developing children will engage in more elaborate make-believe play, pretending to be various “actors” in scenarios and will start putting words together in ways that make sense.

Regardless of a child’s age, if he or she experiences a dramatic loss of skills he or she once had, you should be concerned that this loss of ability may be a sign of autism.

Certainly these items are not a comprehensive guide to autism symptoms, but they are hallmarks of normal development and what you should consider “red flags” of autism. If you sense that something just isn’t right about the way your child expresses herself, or if your child seems to lose skills he once had, then consult your pediatrician right away. Be prepared to provide specific examples of behaviors and to ask for a routine developmental screening. The more you know about autism and its symptoms, the better prepared you will be to obtain crucial early intervention and treatment for your child.

Because autism is a lifelong disorder, helping children with autism overcome obstacles in their ability to interact with and communicate with others is critical. If parents, educators, and health care providers work together early in a child’s life to identify, diagnose, and treat the behaviors associated with autism, then the child’s chances of educational and social success will be profoundly impacted.

According to Autism Speaks, research has shown that early detection, followed by early intervention and treatment, can result in significant differences in the lives of children affected by autism. Most autism diagnoses are made before a child is 3 years old, but research into diagnosis and intervention at earlier ages is ongoing. In short, early detection means early intervention, so the closer to birth a diagnosis can be made, the better the outcome for the child.

Autism Speaks reports that, if intervention services are implemented appropriately between the ages of 3 to 5, 20 to 50 percent of children with autism will be able to attend a mainstream kindergarten class. That window of opportunity then, is a small one, and early intervention remains the best option. Certainly intervention at any age or stage of development is far better than none at all.

Early intervention services, when appropriately applied, can help children to talk, develop fine and gross motor skills, and learn to communicate and interact with others. If you have any questions about your child’s development, talk to your child’s pediatrician right away. Securing an early diagnosis is the first step in getting the appropriate, early intervention that will assist your child.

Because of these discrepancies in development, there are developmental guidelines for normal childhood development for birth through age 5. It is important to keep in mind that these guidelines are just that: benchmarks for development, not hard and fast rules. Parents should familiarize themselves with these guidelines in order to determine if their child is lacking in certain areas, and then bring their concerns to the attention of their child’s pediatrician.

But what if your pediatrician tells you that children just develop differently and that some are slower than others? This may well be the case: generally, pediatricians have a vast range of experience and have “seen it all” and therefore can be expected to be reliable in their assessment of your child. But there may be more to it than a simple “he’ll catch up.” If you feel there is more going on, then act quickly to advocate for your child.

It can be difficult for parents to question their child’s doctor, but parents must also trust their instincts. A pediatrician, after all, sees a child for a brief time in an artificial setting. Parents, who know their child better than anyone, know how a child behaves on a daily basis and are therefore experts on their own child.

If you have concerns about your child’s development and feel your pediatrician’s assessment is just not right, then follow up with him or her. Review developmental checklists to see whether your child is meeting the milestones for his or her age. If your pediatrician has not performed a routine developmental screening, then ask for one. Pay close attention to and record your child’s behavior at home to determine whether you can detect any specific developmental delays.

Don’t be hesitant to ask for a follow-up appointment in which you can bring your concerns to your pediatrician’s attention. The more specific detail you can share, the better.

Not all developmental delays are indicators of autism, and an autism diagnosis is made only after much more in-depth assessment by a specialist. If you remain concerned that your pediatrician may be missing some of the signs about which you are concerned, then ask for a referral to a specialist.

Trust yourself here: remember that you are the expert on your child and his or her strongest advocate. If you are not convinced that your child’s development will catch up, or that he or she is just developing slowly, don’t be afraid to push for additional testing, referrals, or a second opinion regarding your concerns.

In the case of developmental delays, including autism, early and appropriate intervention can make a world of difference in the life of your child, and obtaining that intervention starts with you.

Your child’s pediatrician should be the first source you check with if you have concerns about your child’s development. He or she will likely offer an Ages and Stages Questionnaire (ASQ) to complete at regularly scheduled well-child visits. This parent-completed set of questions is a standard screening tool used to help pediatricians get a big picture of whether a child is meeting developmental milestones such as communication, gross motor, fine motor, problem solving, and personal-social skills at particular ages. While not a diagnostic tool, the ASQ can help pediatricians and parents to determine if further evaluation is needed.

If you are concerned about the results you report on the ASQ or about any aspect of your child’s development, you should ask your pediatrician for a developmental evaluation. Developmental evaluations go farther in detail than a routine developmental screening and go beyond the usual measurements of height, weight, and vital signs. These evaluations are designed to provide an in-depth assessment of how your child functions overall. Areas that are assessed include social / emotional functioning (how does your child interact with peers or adults; how well does he or she follow directions?); adaptive functioning (e. g. dressing oneself, feeding oneself, tending to one’s own bathroom needs); gross motor development, such as running, jumping, and skipping; fine motor skills, such as drawing and cutting; and communication skills (understanding language, expressing needs or wants).

Discuss with your pediatrician who will provide the evaluation and what each assessment entails. Being able to anticipate how long the process will take, who will be involved, and where the assessment will take place means that both you and your child will be more at ease about the evaluation. Find out how long it will take to get the results, and then what the next step should be after you receive the results. Once you’ve found out all you can, make sure your child understands what to expect to the extent that his or her age allows a detailed understanding.

Finally, don’t be afraid to be assertive as you advocate for your child. Developmental evaluations can certainly help parents understand and be prepared to treat any developmental delays your child may have. Because early intervention can have a profound effect the outcome for a child who has a developmental delay, establishing intervention and treatment as early as possible is crucial.

The evaluation should provide you an overview of the strengths and weaknesses in your child’s cognitive, physical, language, and emotional and social development. Although you may have concerns about just one of these areas, a thorough assessment should give you results in each area.

You may receive from the testing facility a packet of information explaining your child’s results, an explanation of any number the testing has identified (e. g. IQ scores), and recommendations for treatment and intervention.

While the results of the test are, of course, vital, what is more important is how they may be used to direct treatment and intervention services for your child. The test administrator should be able to help you obtain appropriate services, whether they be from private providers or, for older children, through the child’s school. Individualized instruction plans, referrals to tutors, speech therapists, occupational therapists, behavioral therapists, and developmental psychologists may be part of the treatment package appropriate for your child.

Make sure you have a clear understanding of everything the evaluation results report. Ask how the test administrator will communicate with treatment providers, and be sure to obtain copies of all results.

You should come away from the evaluation with a clear sense of your child’s development across all areas of development as well as a clear understanding of how these results will shape his or her future treatment.

In addition to these questions, you may be asked to complete an Ages and Stages Questionnaire (ASQ), which is a standard set of questions parents answer to determine, for instance, if a child is climbing stairs, stacking blocks, or finishing a sequence of numbers. The questions contained in ASQs are tailored to each age and designed to determine if a child is meeting developmental milestones appropriate to the age.

While the ASQ is a widely used and highly regarded tool, it relies on parental input and is not used to diagnose delays, but rather to determine whether a child may need further screening. Parents complete the questionnaire before a routine visit, and the child’s healthcare practitioner reviews the results during the office visit.

The results of the ASQ, your answers to your pediatrician’s questions, and your own concerns about your child’s development may lead to a developmental evaluation, which is a much more in-depth assessment of your child’s strengths and weaknesses for his or her chronological age.

Evaluations are usually conducted by a team of health care professionals that can include a developmental pediatrician, nurse practitioner, psychologist, speech-language pathologist, parent educator, and physical therapist. These evaluations usually include the administration of the Childhood Autism Rating Scale (CARS) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth edition) criteria checklist for autism. Providers may also administer other autism-specific tests.

During these visits, the child’s medical history is taken and a physical examination done, and, depending on the child’s age, assessments are done either with or without the parent present. For babies and younger children, the assessments are designed to feel like play. Older children may take a battery of tests. All of the assessment materials are used diagnostically to evaluate a child’s development.

Screening, then, is the precursor to evaluation and the results of the screening determine whether further, more in-depth evaluation is appropriate in order to obtain a diagnosis and a treatment plan for the child.

The tools used to screen for autism are designed specifically to detect autism spectrum disorders (ASDs). They focus all three of the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth edition) criteria for autism (impairment in social interaction, impairment in communication, repetitive and stereotyped patterns of behavior, interests and activities, and delays in social interaction, social language use, and/or imaginative play). Autism screening, in short, focuses on the communication and social development of children aged 18 months and older.

A combination of observation and screening questionnaires are used to screen for autism. One such questionnaire is the Modified Checklist for Autism in Toddlers (M-CHAT), which includes 23 yes or no questions, including those that address a child’s interest in other children, enjoyment of social games, sensitivity to noises, ability to maintain eye contact, and language comprehension. The Autism Spectrum Screening Questionnaire (ASSQ) is used to screen for ASDs in children aged 4 and older.

Asperger Syndrome screening tools are designed to differentiate between Asperger Syndrome and other ASDs or developmental disorders. These tools focus on social and behavioral impairment in children aged 4 and older. The high-functioning Autism Spectrum Screening Questionnaire (ASSQ) is used to assess symptoms of Asperger syndrome; a 27-item checklist, the questionnaire is used on children and adolescents.

The Social Communication Questionnaire (SCQ) is another ASD screening tool used on children aged 4 and older. The questionnaire is answered by parents and the questions are in a yes or no format.

The Australian Scale for Asperger Syndrome (ASAS) is a questionnaire for parents in which parents rate of a scale of 0 to 6, from rarely to frequently, questions about a child’s social and emotional, cognitive, movement, specific interests, and language skills and abilities.

Screening is designed to determine the need for additional evaluation, without which treatment cannot be implemented. The procedures for screening for autism are more detailed and time-consuming than those used to screen for developmental delays, but are critical in obtaining early, appropriate intervention.

Start by asking the team of professionals who evaluated and diagnosed your child to explain to you where he or she is on the autism spectrum. You may not get as straightforward an answer as you would like because each child’s autism disorder is unique. No two children with the same diagnosis will have the same symptoms, so finding out just what is specific to your child is important here. Your child’s treatments should be individualized to his or her needs.

Research into effective treatments in ongoing, so find out whether your child can receive the most up-to-date treatment options. Treatments are tailored to specific delays and are designed to be appropriate to your child’s chronological and developmental age. Find out what types of treatments your child can expect to receive now and which of those will be ongoing.

As a matter of practicality, check with your health insurance company to determine how treatments will be covered. Inquire about services in your community to determine what services, if any, you can receive at a reduced cost. Someone from the team who evaluated your child should be able to provide materials to your child’s school that can help you establish an Individualized Education Plan (IEP) for him or her.

Your child will likely receive a number of therapies simultaneously: speech, behavioral, and occupational therapy, for instance, will become a regular part of your routine. There may be pharmacological or dietary treatments as well, depending on your child’s symptoms.

You will likely receive a lot of information about how you can incorporate elements of treatment into your home routines, so expect some changes in the way your household runs. Inform your family members of how they can help your child’s therapy to extend beyond office visits.

Expect to work through a lot of emotions once you receive a diagnosis of autism. Certainly you may feel overwhelmed, confused, disappointed, guilty for being disappointed, anxious, or some combination of all of these and more. However, remember that getting an autism diagnosis is a positive step toward treatment. Autism is not curable, but early and effective treatment and intervention can make a tremendous difference in the life of a child with autism.