Reduced eye contact or facial expressions may be early signs of autism in babies. Recognizing them is a first step towards diagnosis.

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Having a baby can be an exciting and enjoyable time, even with the sleepless nights or seemingly endless diaper changes.

However, along with joy, parenthood also brings with it worries about your baby’s health and well-being — especially if you begin to notice anything that seems different with your child’s development.

For example, maybe your baby doesn’t seem to smile at you anymore or isn’t babbling like other babies. And despite others telling you there’s nothing wrong, you just can’t get this one nagging question out of your mind — could it be autism?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects about 1 in 44 children in the United States.

It’s characterized by a wide range of behavioral, social, and communication difficulties. These difficulties affect each autistic individual differently.

For example, some autistic people may exhibit advanced language abilities and need minimal support in daily activities, while others are nonspeaking and require more significant support.

Still, autistic traits, such as sensory processing challenges or difficulty with changes in routines, may exist in both people.

Autism can be reliably diagnosed at 2 years of age. However, many children are diagnosed later, sometimes into adolescence or adulthood.

Although autism can be identified in children 18 months old or younger, detecting it in babies is often challenging because language and social skills have yet to develop.

Identifying autism in young children and infants usually involves careful monitoring of the child’s developmental milestones.

Since there’s currently no medical test available to diagnose autism, medical professionals rely on parent observations and look at developmental records and behavior to determine the presence of ASD.

Currently, the American Academy of Pediatrics (APP) recommends screening for autism during well-child visits at 18 and 24 months. Additional screenings are recommended if the infant has risk factors for autism, including:

  • low birth weight
  • preterm birth
  • having an autistic parent or sibling

However, the most reliable screening may be parent observation.

According to the Centers for Disease Control and Prevention (CDC), research has shown that parents are often the first to notice signs of developmental delays. And their concerns correctly identify 70 to 80% of children with disabilities.

Screening tools used to assess autism in children include:

Still, the U.S. Preventative Services Task (USPSTF) reports that the most common screening tests used for children younger than 30 months are the M-CHAT and M-CHAT-R/F.

According to a 2019 study, in 41.9% of autistic children, symptoms were first noticeable between 7 and 12 months. In addition, language delay was one of the most common reasons for prompting an evaluation for ASD.

Still, because young babies are in the earliest stage of development, signs of autism can be hard to spot. Here are some signs to look out for.

Less eye contact

Babies begin to make eye contact when they’re around 2 months old. An older study suggests that declining eye contact between 2 and 6 months may indicate autism.

Deficits in communication

Research suggests that reduced or absent communication, including lack of response to their name, lack of gesturing, and language delays, are strong indicators of autism. For example:

  • At 4 months of age, a baby should begin to make sounds, babble, or coo.
  • At 6 months, babies often begin to respond to their name.
  • Pointing at objects should begin to emerge at the age of 9 months.

Reduced engagement with caregivers

At around 4 months of age, babies may show interest in other people and respond to affection. If these behaviors are absent or it seems like your baby is often “in their own world,” it might indicate the need to talk with a health professional about screening.

Lack of eye tracking

According to the CDC, 2-month-old babies should begin to follow movement with their eyes. Reduced eye tracking can be an early sign of autism or other developmental disability.

Reduced facial expression including smiling

Also appearing around the age of 2 months is baby’s first smile. So, if your infant seems delayed in their smiling ability or you notice progressively less smiling, you may want to bring it to the attention of your child’s doctor.

Regression of skills

Any noticeable loss of skills can be a sign of ASD. For example, a baby who was babbling may seem to babble less over time, or an infant who regularly looks at caregivers may not engage as much anymore.

As the child grows older, autism signs may be easier to identify. Things to look for include:

  • delayed or absent speech
  • echolalia or repeating words or phrases without intent to communicate
  • repetitive movements including hand flapping, spinning, or rocking
  • intense interest in objects other than toys, or lining up toys in orderly rows instead of playing with them as they’re intended
  • difficulty with changes in routine
  • delays in toilet training
  • ongoing gastrointestinal issues

If you notice any of these signs, it doesn’t necessarily mean your child has ASD. To find out for sure, consider discussing your concerns with your child’s health care professional.

Based on your observations and their clinical examinations, the doctor may decide to refer your child for further assessments with a specialist.

Evidence suggests that early diagnosis and treatment of autism leads to better long-term outcomes.

Most recently, research published in JAMA Pediatrics found that infants with early signs of autism who received preemptive therapy intervention had a reduction in autism severity across early childhood. They also had lower odds of being diagnosed with ASD at 3 years of age.

In addition, receiving an early diagnosis can also eliminate the guesswork, so you can focus on getting the help you, your family, and your child needs.

If you’re concerned your baby might be showing signs of autism, it’s important not to jump to conclusions without first consulting your child’s medical professional. Just because an infant has some indicators of autism doesn’t mean they will receive an ASD diagnosis.

However, a parent or caregiver knows their child best. So, if something still seems off even after a healthcare professional says there’s nothing to worry about, don’t be afraid to get a second opinion.

If your child is diagnosed with ASD, you may feel sadness, anger, or go through a grieving process. You may also worry about your child’s future and whether they’ll live happy and productive lives.

However, autistic people do have fulfilling and productive lives. They also have great strengths and abilities non-autistic people may not possess.

With the right support, empathy, and understanding, autistic people can enjoy everything life has to offer — just like anyone else.

For more information on developmental milestones, the CDC’s “Learn the Signs. Act Early.” program has information and a Milestone Tracker APP that can help monitor your child’s developmental progress. This program also has helpful resources and information on what to do if you think your child may have autism.