Many parents notice something first and then spend months wondering whether they are worrying too much. This checklist pulls together the signs the Centers for Disease Control and Prevention (CDC) lists for autism and its developmental milestones by age, so you can see where your child is today and decide on a next step. It is not a test. Only a qualified professional can diagnose autism, and many children who miss one item on a list are not autistic. But you never need a diagnosis, or a doctor's permission, to ask for help in Florida.
What do early signs of autism look like?
The CDC groups autism signs into two areas, which match how autism is diagnosed:
- Social communication and interaction. How your child uses eye contact, facial expressions, gestures, sounds and words to connect with you and share interest.
- Restricted or repetitive behaviors and interests. Lining up toys and getting upset when the order changes, repeating words or phrases (echolalia), playing with toys the same way every time, focusing on parts of objects such as wheels, getting upset by small changes, needing certain routines, flapping hands, rocking or spinning, and unusual reactions to how things sound, smell, taste, look or feel.
The CDC also lists other features that are common in autistic children but are not part of the diagnosis itself, such as delayed language, movement or learning skills, unusual eating and sleeping habits, stomach problems like constipation, anxiety, and more or less fear than expected.
One important point: CDC milestones describe what most children, 75% or more, can do by a given age. A child who is a little behind on one milestone is not automatically a concern. A pattern of several social communication signs, or a skill your child had and lost, is worth acting on.
Signs to watch for by age
The table below combines the CDC's autism sign list with its milestone checklists. The left column is what the CDC flags as an autism sign at that age. The right column is what most children of that age do, from the CDC milestone pages.
| Age | Possible autism sign (CDC) | What most children do by this age (CDC milestones) |
|---|---|---|
| 9 months | Does not respond to their name; does not show facial expressions such as happy, sad, angry and surprised | Looks when you call their name; smiles or laughs at peek-a-boo; lifts arms up to be picked up |
| 12 months | Does not play simple back-and-forth games like pat-a-cake; uses few or no gestures (for example, does not wave goodbye) | Waves bye-bye; calls a parent mama, dada or another special name; understands no |
| 15 months | Does not share interests with others (for example, does not show you an object they like) | Shows you an object they like; tries to say one or two words besides mama or dada; points to ask for something or to get help |
| 18 months | Does not point to show you something interesting | Points to show you something interesting; tries to say three or more words besides mama or dada; follows one-step directions without gestures |
| 24 months | Does not notice when others are hurt or upset | Notices when others are hurt or upset; says at least two words together, like more milk; uses more gestures than waving and pointing |
| 36 months | Does not notice other children and join them in play | Plays next to other children and sometimes with them (from 30 months) |
Checklist for about 12 months
- Does your baby look at you when you call their name?
- Do they wave, reach to be picked up or use other gestures?
- Do they play simple games with you, like pat-a-cake or peek-a-boo?
- Did they make lots of different babbling sounds, like mamama and bababa, by about 9 months?
Checklist for about 18 months
- Does your toddler point to show you something interesting, like a dog or a plane, and then look back at you?
- Do they try to say at least three words besides mama or dada?
- Do they follow a simple direction, like give it to me, without you pointing?
- Do they bring you things just to show you?
Checklist for about 24 months
- Do they notice when someone is crying or hurt, for example by pausing or looking sad?
- Do they put two words together, like more milk?
- Do they look at your face to see how to react in a new situation?
- Do they play with toys in more than one way, or mostly line them up, spin them or watch parts move?
If you answered no to several questions for your child's age, or you checked items in the repetitive behavior list above, write down what you see, with examples and dates. That record makes your next conversation with the doctor much more useful.
When should I call my pediatrician?
The CDC's advice is simple: do not wait. If your child is not meeting one or more milestones, has lost skills they once had, or you have any other concern, talk with your child's doctor, share what you have seen and ask about developmental screening.
Screening is also part of routine care. The American Academy of Pediatrics (AAP) recommends general developmental screening at the 9, 18 and 30 month well-child visits, and autism-specific screening at 18 and 24 months. A common autism screening tool is the M-CHAT, a parent questionnaire; you can read more in our guide to the M-CHAT-R/F screening. Under federal rules, most health plans must cover autism screening at 18 and 24 months as preventive care, generally at no cost when you use an in-network provider. Florida's autism insurance law also requires covered group plans to pay for well-baby and well-child autism screening.
Call sooner than the next scheduled checkup if:
- your child has lost words, babbling, eye contact or social skills they used to have, at any age;
- your child does not respond to their name by about 9 months or does not use gestures by about 12 months;
- you have a strong feeling that something is different, even if you cannot name it.
A screening result is not a diagnosis. If a screen raises a concern, the next step is usually a full diagnostic evaluation by a specialist such as a developmental pediatrician or a child psychologist. The CDC notes that by age 2, a diagnosis by an experienced professional can be considered very reliable.
Can I refer my child to Early Steps without a doctor?
Yes. Early Steps is Florida's early intervention program for children from birth to 36 months, run by the Florida Department of Health. Anyone, including a parent, can make a referral, and no doctor's referral is needed. You can call the statewide line at 1-800-218-0001 or use the online referral form at floridaearlysteps.com.
A few facts that help parents decide to call now rather than later:
- It does not cost you anything out of pocket. Early Steps does not charge families for evaluation, service coordination or the family plan, and has no income requirement. With your consent it can bill your insurance, but services do not depend on that consent.
- It moves on a clock. The local program must complete the evaluation and the first Individualized Family Support Plan (IFSP) within 45 calendar days of receiving the referral.
- You do not need a diagnosis first. A child can qualify through a measured delay in one or more areas, including communication and social or emotional development. If your child is diagnosed with autism, that diagnosis is itself a qualifying condition.
- Timing near age 3 matters. If a referral arrives fewer than 45 days before the third birthday, Early Steps refers the child to the school district instead of evaluating.
Step-by-step help is in how to refer your child to Early Steps. You can refer to Early Steps and ask your pediatrician for an autism evaluation at the same time; one does not have to wait for the other.
What if my child is already 3 or older?
From age 3, Florida's public school districts take over free developmental evaluations through Child Find. Your local FDLRS center (Florida Diagnostic and Learning Resources System) can screen children from age 3 to kindergarten entry, and you can ask your school district in writing for an evaluation. Under Florida's rule, the district then has 30 days to ask for your consent or explain in writing why it refuses. See FDLRS and Child Find for ages 3 to 5.
Some signs are easier to see in older children, such as difficulty with back-and-forth conversation, trouble making friends, very intense interests, distress at changes in routine or strong sensory reactions. The CDC notes that some people are not diagnosed until adolescence or adulthood, so it is never too late to ask.
What should I bring to the appointment?
- Your written notes, with examples and dates (for example, stopped saying ball and bye in March).
- Short phone videos of the behavior that worries you, since children often act differently in a doctor's office.
- Any daycare, preschool or Early Steps reports.
- A list of questions: Is this screening result positive? Who will do a full evaluation? How long is the wait? Should we also check hearing?
Hearing deserves a mention. A hearing problem can look like not responding to a name or slow speech, so doctors often check hearing as part of the workup.
Where Hope Center fits
If your child is diagnosed with autism, ABA therapy is one option families consider, often alongside speech therapy and other support. Hope Center for Behavior Change provides ABA in centers, homes, schools and daycares in several Florida regions, with no waitlist. We also offer diagnostic evaluations through our clinical director working with a supervising licensed psychologist. Read about early intervention ABA and the guide on why early intervention matters.
When you are ready, request a free consultation or call 561-337-8865. We can answer questions about next steps and check your insurance benefits for free.