Signs of Autism
You’re doing the right thing
Noticing early is a gift, not an alarm
Trusting your instinct and looking early is one of the kindest things you can do for your child. Early signs are not a diagnosis, and noticing them does not mean something is wrong. It simply means a gentle check can bring answers or reassurance, and where support helps, starting early makes a real difference.
What to look for
What early signs can look like
Autism shows up differently in every child. These are areas parents often notice. Seeing one or two is common and frequently nothing to worry about.
Social connection
Less interest in sharing smiles, cuddles or back-and-forth play than you might expect.
Eye contact & name
Not turning to their name by the first birthday, or limited eye contact during play and feeding.
Gestures & pointing
Slow to babble, point, wave or use gestures to show you things they want or have noticed.
Play & imagination
Preferring to line up or spin objects over pretend play, or playing the same way each time.
Routines & senses
A strong need for sameness, big upset at small changes, or unusual reactions to sound, texture or light.
Language
Late to first words or short phrases, or losing words and skills they once had.
Is it a concern?
Normal, or worth a closer look?
Many of these behaviours are part of ordinary childhood. Here is how everyday variation tends to differ from what deserves a check.
Talking and language
Usually normal
Late talkers who understand you well, use gestures, and connect socially often catch up with time.
Worth a look
Little babble or pointing, not responding to their name, or losing words they once used.
Eye contact and play
Usually normal
Shy or deeply focused children who still share smiles, look to you, and enjoy pretend play.
Worth a look
Consistently limited eye contact, little shared attention, and no pretend or imaginative play.
Routines and repetition
Usually normal
Toddlers who love routine and favourite things, and dislike some changes.
Worth a look
Extreme distress at any change, and repetitive movements that take over much of the day.
Overall development
Usually normal
Uneven progress, ahead in some areas and slower in others, but moving forward over time.
Worth a look
A clear plateau, or losing skills like words, gestures or social interest, at any age.
Guidance only, not a diagnosis. When something feels off, a check brings clarity.
When to seek a check
Signs that deserve a prompt check
Most children with one or two of the earlier signs are developing typically. A few, though, are worth acting on sooner. Consider a developmental check if your child shows any of these:
No response to their name by 12 months of age
No babbling, pointing or waving by 12 months
No single words by 16 months
No meaningful two-word phrases by 24 months
Any loss of speech, babbling or social skills, at any age
Little interest in other children or in shared, back-and-forth play
Very repetitive movements, or intense fixation on parts of objects
Strong, lasting distress at any small change in routine
Any loss of skills, or a strong feeling that something is not quite right, is reason enough to come in. Early support changes outcomes.
Screening ages
When autism screening is meant to happen
You should not have to think of this yourself. Screening has set ages, and they are early on purpose. If it has not been offered, you can ask for it.
16 to 30 months
The age window the M-CHAT-R/F screening questionnaire is validated for. A Malay version has been validated for Malaysian toddlers, so language is not a barrier to being screened.
18 months
The first autism-specific screen recommended by the American Academy of Pediatrics, done at the same visit as the general developmental screen.
24 months
The second autism-specific screen. Repeating it matters, because some children screen negative at 18 months and positive at 24.
In Malaysia
Ministry of Health child health clinics screen with the M-CHAT at the 18-month and 36-month visits. If your child has not been screened, you can ask for it.
Any age, if you are worried
Screening ages are a floor, not a ceiling. A parent’s concern at any age is a reason to check, and losing words, gestures or social interest is a reason to check now.
What a positive screen means
That a closer look is needed, not that your child is autistic. Many children who screen positive turn out to have a different developmental difference, or none at all.
The assessment pathway
What an autism assessment actually involves
Autism is not diagnosed from one test or one visit. International guidance describes a staged pathway, and knowing the stages tells you exactly where your child is in it.
1
Developmental surveillance
At every well-child visit a paediatrician asks about milestones, watches how your child plays and communicates, and records what you have noticed. The American Academy of Pediatrics treats a parent’s concern as a screening result in its own right.
2
Standardised screening
A validated questionnaire at set ages. The AAP recommends autism-specific screening at 18 and 24 months, alongside general developmental screening at 9, 18 and 30 months. The most widely used tool is the M-CHAT-R/F, validated for toddlers aged 16 to 30 months.
3
Hearing and medical checks
A hearing test comes first when speech is delayed, because hearing loss and glue ear can look like autism at this age. Vision, growth and, where indicated, other medical causes are considered before anything is concluded.
4
In-depth diagnostic assessment
A positive screen is not a diagnosis. Diagnosis is made against DSM-5-TR criteria by an experienced clinician or a multidisciplinary team, using a structured developmental history with parents and structured observation of the child, such as the ADI-R and the ADOS-2. NICE guidance says this should begin within 3 months of referral.
5
Support starts before the label
You do not wait for a diagnosis to start help. AAP guidance is that intervention should begin as soon as a developmental concern is identified, because what is being treated is the delay, not the label.
6
A written report, and the next step
You leave with the findings in writing: what was seen, what it means, and what to do next, whether that is monitoring, speech or occupational therapy, early intervention, or referral for a full diagnostic assessment.
What happens in this clinic: Dr Nisa takes the developmental history, runs the standardised screening, observes your child, arranges hearing and medical checks where needed, writes the report, and refers on for a full diagnostic assessment when one is warranted. She will tell you plainly which stage your child is at.
Important
Signs are not a diagnosis
Many children with some of these signs are simply growing on their own timeline. Only a full assessment can tell. And whatever the outcome, understanding your child early is never a bad thing: it opens the door to the right support, and to seeing your child clearly, exactly as they are.
About Dr Nisa
A paediatrician who takes your worries seriously
Dr Nisa Khalil is a Consultant Paediatrician at ParkCity Medical Centre, Kuala Lumpur, with a special interest in child development. She holds an MBBS from the International Islamic University Malaysia and a Master of Paediatrics from Universiti Malaya, and has over 18 years in paediatrics. She has guided many families through developmental worries, and knows how much reassurance, or the right early support, can mean. Her approach is calm, careful and free of judgement.
MBBS (IIUM) · MPaeds (Universiti Malaya) · MMC 49282 · ParkCity Medical Centre, Kuala Lumpur · English & Bahasa Malaysia
Questions parents ask
Autism signs, common questions
At what age can autism be spotted?
Some signs can appear from around 12 to 18 months. The American Academy of Pediatrics recommends autism-specific screening at 18 and 24 months, and Ministry of Health child health clinics in Malaysia screen with the M-CHAT at the 18-month and 36-month visits. If you have a concern, it is never too early to ask.
Who can assess a child for autism in Kuala Lumpur?
What is the difference between screening and a diagnostic assessment?
Does my child need screening if they seem fine?
Does having some signs mean my child is autistic?
My child makes eye contact and is affectionate, can it still be autism?
What happens after an assessment?
Do I need a referral to see Dr Nisa?
Clarity brings peace of mind.
Whether it turns out to be nothing, or the start of helpful support, you will leave understanding your child better. Book a developmental consultation with Dr Nisa.
Evidence
The guidance this page follows
The screening ages, early signs and assessment stages described on this page follow published paediatric guidance, not opinion. Where countries differ, both positions are given.
Ministry of Health Malaysia. Clinical Practice Guidelines: Management of Autism Spectrum Disorder in Children and Adolescents, 2014.
Medically reviewed by Dr Nisa Khalil, Consultant Paediatrician
This page is general information for parents and does not replace a personal assessment. If you are worried about your child’s development, please see a doctor. Validated developmental screening tools are used within the clinical assessment, not on this page.