Learn the signs, act early on autism

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Three years ago this national initiative was launched to help parents recognize the possible red flag signs of autism.

Research shows that the earlier children are diagnosed and the sooner treatment/therapy is started, the better the results for children.

Currently, the American Academy of Pediatrics recommends children be screened for autism twice before the age of 2.  But many parents say they can tell much earlier that something “is not quite right” simply by observing their child’s development.

Although all children may develop at their own pace, most children who are developing normally will achieve these milestones at the following ages:

At the end of 3 months:

* Social and emotional

Begins to develop a social smile

Enjoys playing with other people and may cry when playing stops

Becomes more expressive and communicates more with face and body

Imitates some movements and facial expressions

*Movement

Raises head and chest when lying on stomach

Supports upper body with arms when lying on stomach

Stretches legs out and kicks when lying on stomach or back

Opens and shuts hands

Pushes down on legs when feet are placed on a firm surface

Brings hand to mouth

Takes swipes at dangling objects with hands

Grasps and shakes hand toys

* Vision

Watches faces intently

Follows moving objects

Recognizes familiar objects and people at a distance

Starts using hands and eyes in coordination

* Hearing and speech

Smiles at the sound of your voice

Begins to babble

Begins to imitate some sounds

Turns head toward direction of sound

* Contact the doctor if your child:

Does not seem to respond to loud noises

Does not notice hands by 2 months

Does not follow moving objects with eyes by 2 to 3 months

Does not grasp and hold objects by 3 months

Does not smile at people by 3 months

Cannot support head well by 3 months

Does not reach for and grasp toys by 3 to 4 months

Does not babble by 3 to 4 months

Does not bring objects to mouth by 4 months

Begins babbling, but does not try to imitate any of your sounds by 4 months

Does not push down with legs when feet are placed on a firm surface by 4 months

Has trouble moving one or both eyes in all directions

Crosses eyes most of the time (occasional crossing of the eyes is normal in these first months)

Does not pay attention to new faces, or seems very frightened by new faces or surroundings

Experiences a dramatic loss of skills he or she once had

At the end of 7 months:

* Social and emotional

Enjoys social play

Interested in mirror images

Responds to other people's expressions of emotion and appears joyful often

* Cognitive

Finds partially hidden object

Explores with hands and mouth

Struggles to get objects that are out of reach

* Language

Responds to own name

Begins to respond to “no”

Can tell emotions by tone of voice

Responds to sound by making sounds

Uses voice to express joy and displeasure

Babbles chains of sounds

* Movement

Rolls both ways (front to back, back to front)

Sits with, and then without, support on hands

Supports whole weight on legs

Reaches with one hand

Transfers object from hand to hand

Uses hand to rake objects

* Vision

Develops full color vision

Distance vision matures

Ability to track moving objects improves

* Contact the doctor if your child:

Seems very stiff, with tight muscles

Seems very floppy, like a rag doll

Head still flops back when body is pulled to a sitting position

Reaches with one hand only

Refuses to cuddle

Shows no affection for the person who cares for him or her

Doesn't seem to enjoy being around people

One or both eyes consistently turn in or out

Persistent tearing, eye drainage, or sensitivity to light

Does not respond to sounds around him or her

Has difficulty getting objects to mouth

Does not turn head to locate sounds by 4 months

Does not roll over in either direction (front to back or back to front) by 5 months

Seems impossible to comfort at night after 5 months

Does not smile on his or her own by 5 months

Cannot sit with help by 6 months

Does not laugh or make squealing sounds by 6 months

Does not actively reach for objects by 6 to 7 months

Does not follow objects with both eyes at near (1 foot) and far (6 feet) ranges by 7 months

Does not bear weight on legs by 7 months

Does not try to attract attention through actions by 7 months

Does not babble by 8 months

Shows no interest in games of peek-a-boo by 8 months

Experiences a dramatic loss of skills he or she once had

At the end of 12 months:

* Social and emotional

Shy or anxious with strangers

Cries when mother or father leaves

Enjoys imitating people in his play

Shows specific preferences for certain people and toys

Tests parental responses to his actions during feedings

Tests parental responses to his behavior

May be fearful in some situations

Prefers mother and/or regular caregiver over all others

Repeats sounds or gestures for attention

Finger-feeds himself

Extends arm or leg to help when being dressed

* Cognitive

Explores objects in many different ways (shaking, banging, throwing, dropping)

Finds hidden objects easily

Looks at correct picture when the image is named

Imitates gestures

Begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver)

*Language

Pays increasing attention to speech

Responds to simple verbal requests

Responds to “no”

Uses simple gestures, such as shaking head for “no”

Babbles with inflection (changes in tone)

Says “dada” and “mama”

Uses exclamations, such as “Oh-oh!”

Tries to imitate words

* Movement

Reaches sitting position without assistance

Crawls forward on belly

Assumes hands-and-knees position

Creeps on hands and knees

Gets from sitting to crawling or prone (lying on stomach) position

Pulls self up to stand

Walks holding on to furniture

Stands momentarily without support

May walk two or three steps without support

*Hand and finger skills

Uses pincer grasp

Bangs two objects together

Puts objects into container

Takes objects out of container

Lets objects go voluntarily

Pokes with index finger

Tries to imitate scribbling

* Contact the doctor if your child:

Does not crawl

Drags one side of body while crawling (for over one month)

Cannot stand when supported

Does not search for objects that are hidden while he or she watches

Says no single words ("mama" or "dada")

Does not learn to use gestures, such as waving or shaking head

Does not point to objects or pictures

Experiences a dramatic loss of skills he or she once had

At the end of 24 months:

* Social

Imitates behavior of others, especially adults and older children

More aware of herself as separate from others

More excited about company of other children

* Emotional

Demonstrates increasing independence

Begins to show defiant behavior

Separation anxiety increases toward midyear then fades

* Cognitive

Finds objects even when hidden under two or three covers

Begins to sort by shapes and colors

Begins make-believe play

*Language

Points to object or picture when it's named for him

Recognizes names of familiar people, objects and body parts

Says several single words (by 15 to 18 months)

Uses simple phrases (by 18 to 24 months)

Uses 2- to 4-word sentences

Follows simple instructions

Repeats words overheard in conversation

* Movement

Walks alone

Pulls toys behind her while walking

Carries large toy or several toys while walking

Begins to run

Stands on tiptoe

Kicks a ball

Climbs onto and down from furniture unassisted

Walks up and down stairs holding on to support

* Hand and finger skills

Scribbles on his or her own

Turns over container to pour out contents

Builds tower of four blocks or more

Might use one hand more often than the other

*Contact the doctor if your child:

 Cannot walk by 18 months

Fails to develop a mature heel-toe walking pattern after several months of walking, or walks only on his toes

Does not speak at least 15 words

Does not use two-word sentences by age 2

By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)

Does not imitate actions or words by the end of this period

Does not follow simple instructions by age 2

Cannot push a wheeled toy by age 2

Experiences a dramatic loss of skills he or she once had

At the end of 36 months:

*Social

Imitates adults and playmates

Spontaneously shows affection for familiar playmates

Can take turns in games

Understands concept of "mine" and "his/hers"

*Emotional

Expresses affection openly

Expresses a wide range of emotions

By 3, separates easily from parents

Objects to major changes in routine

* Cognitive

Makes mechanical toys work

Matches an object in her hand or room to a picture in a book

Plays make-believe with dolls, animals, and people

Sorts objects by shape and color

Completes puzzles with three or four pieces

Understands concept of "two"

*Language

Follows a two- or three-part command

Recognizes and identifies almost all common objects and pictures

Understands most sentences

Understands placement in space (“on,” “in,” “under”)

Uses 4- to 5-word sentences

Can say name, age, and sex

Uses pronouns (I, you, me, we, they) and some plurals (cars, dogs, cats)

Strangers can understand most of her words

* Movement

Climbs well

Walks up and down stairs, alternating feet (one foot per stair step)

Kicks ball

Runs easily

Pedals tricycle

Bends over easily without falling

* Hand and finger skills

Makes up-and-down, side-to-side, and circular lines with pencil or crayon

Turns book pages one at a time

Builds a tower of more than six blocks

Holds a pencil in writing position

Screws and unscrews jar lids, nuts and bolts

Turns rotating handles

* Contact the doctor if your child:

Frequent falling and difficulty with stairs

Persistent drooling or very unclear speech

Cannot build a tower of more than four blocks

Difficulty manipulating small objects

Cannot copy a circle by age 3

Cannot communicate in short phrases

No involvement in “pretend” play

Does not understand simple instructions

Little interest in other children

Extreme difficulty separating from mother or primary caregiver

Poor eye contact

Limited interest in toys

Experiences a dramatic loss of skills he or she once had

At the end of 48 months:

* Social

Interested in new experiences

Cooperates with other children

Plays “Mom” or “Dad”

Increasingly inventive in fantasy play

Dresses and undresses

Negotiates solutions to conflicts

More independent

* Emotional

Imagines that many unfamiliar images may be "monsters"

Views self as a whole person involving body, mind and feelings

Often cannot tell the difference between fantasy and reality

* Cognitive

Correctly names some colors

Understands the concept of counting and may know a few numbers

Tries to solve problems from a single point of view

Begins to have a clearer sense of time

Follows three-part commands

Recalls parts of a story

Understands the concepts of "same" and "different"

Engages in fantasy play

* Language

Has mastered some basic rules of grammar

Speaks in sentences of five to six words

Speaks clearly enough for strangers to understand

Tells stories

* Movement

Hops and stands on one foot up to five seconds

Goes upstairs and downstairs without support

Kicks ball forward

Throws ball overhand

Catches bounced ball most of the time

Moves forward and backward with agility

* Hand and finger skills

Copies square shapes

Draws a person with two to four body parts

Uses scissors

Draws circles and squares

Begins to copy some capital letters

* Contact the doctor if your child:

Cannot throw a ball overhand

Cannot jump in place

Cannot ride a tricycle

Cannot grasp a crayon between thumb and fingers

Has difficulty scribbling

Cannot stack four blocks

Still clings or cries whenever parents leave

Shows no interest in interactive games

Ignores other children

Doesn't respond to people outside the family

Doesn't engage in fantasy play

Resists dressing, sleeping, using the toilet

Lashes out without any self-control when angry or upset

Cannot copy a circle

Doesn't use sentences of more than three words

Doesn't use “me” and “you” correctly

Experiences a dramatic loss of skills he or she once

At the end of 60 months:

* Social

Wants to please friends

Wants to be like her friends

More likely to agree to rules

Likes to sing, dance and act

Shows more independence and may even visit a next-door neighbor by herself

* Emotional milestones

Aware of gender

Able to distinguish fantasy from reality

Sometimes demanding, sometimes eagerly cooperative

* Cognitive milestones

Can count 10 or more objects

Correctly names at least four colors

Better understands the concept of time

Knows about things used every day in the home (money, food, appliances)

* Language

Recalls part of a story

Speaks sentences of more than five words

Uses future tense

Tells longer stories

Says name and address

* Movement

Stands on one foot for 10 seconds or longer

Hops, somersaults

Swings, climbs

May be able to skip

* Hand and finger skills

Copies triangle and other shapes

Draws person with body

Prints some letters

Dresses and undresses without help

Uses fork, spoon,and (sometimes) a table knife

Usually cares for own toilet needs

* Contact the doctor if your child:

Acts extremely fearful or timid

Acts extremely aggressively

Is unable to separate from parents without major protest

Is easily distracted and unable to concentrate on any single activity for more than five minutes

Shows little interest in playing with other children

Refuses to respond to people in general, or responds only superficially

Rarely uses fantasy or imitation in play

Seems unhappy or sad much of the time

Doesn't engage in a variety of activities

Avoids or seems aloof with other children and adults

Doesn't express a wide range of emotions

Has trouble eating, sleeping, or using the toilet

Can't tell the difference between fantasy and reality

Seems unusually passive

Cannot understand two-part commands using prepositions (“Put the doll on the bed, and get the ball under the couch.”)

Can't correctly give her first and last name

Doesn't use plurals or past tense properly when speaking

Doesn't talk about her daily activities and experiences

Cannot build a tower of six to eight blocks

Seems uncomfortable holding a crayon

Has trouble taking off clothing

Cannot brush her teeth efficiently

Cannot wash and dry her hands

Experiences a dramatic loss of skills he or she once

 Source: Centers for Disease Control and Prevention “Learn the Signs. Act Early” campaign