Tag: diagnosis

Autism Spectrum Disorder in a Toddler – How Might They Look Different?

About Me

young child

I am a developmental-behavioral pediatrician in training.  I am often asked to see children for concern about autism spectrum disorder (ASD). During my visit, I watch how children behave.  I then decide if ASD is the diagnosis that best fits their behavior.  I see children of all ages. This is about children less than age 3.

 Why Toddlers are Different

Children with ASD tend to respond better to treatment when they are diagnosed early. (National Research Counsel, 2001). Many children can be diagnosed as young as 18 months of age. But most children are diagnosed between 3-4 years of age (Filipek, 1999).

One reason is because the early symptoms are hard to see.  Some of the best-known symptoms may not show up until a child is older. These include flapping their hands and repeating parts of TV shows.

Toddlers with ASD often don’t learn the skills they need to interact with others. Children who are behind in just their ability to use language still try to interact. They will often use eye contact and gestures to work around their struggles. Children with ASD have trouble with this.

Here are some free websites and videos to help anyone who cares for young children. This information shows what we call the “red flag signs” for ASD.

Symptoms of Autism Spectrum Disorder

The website Autism Navigator talks about the early signs of autism. There is a free course with videos about toddlers with ASD. You have to register to use the site. They also have a list of red flag signs for toddlers. These include:

  • not looking at someone when their name is called;
  • not showing others objects they like;
  • not sharing their interests with the ones they love;
  • not making eye contact; and/or
  • not using gestures to let people know what they want.

There are other resources on this website. However, not all of them are free.

How a Toddler with ASD Might Look

Here are some videos from the Centers for Disease Control (CDC) showing how a toddler with autism spectrum might look. There are also toddlers that do not have the warning signs of autism. This enables you to see how they differ. All the videos are on the CDC video library.  Some of the videos are linked below.

Looking at someone when their name is called

Here is a video of a 12-month-old who responds to his name by looking at his mother and smiling. He also points at her. This is what we expect a toddler to do when their name is called.

12-month-old looking when called

Here is a video of an 18-month-old not looking at his mother when his name is called. A toddler who can hear should look when his name is called.

18-month-old child not looking when called


This video shows a 13-month-old stacking cups. He involves his father and gives him the cups. Many toddlers seek out their loved ones when playing.

13-month-old toddler playing with father

Here is a 17-month-old toddler who is not showing pretend play with a phone. He also does not copy the adult when she tries to show him how to use it. These are both warning signs of ASD.

17-month-old toddler not showing pretend play

Twins and a train

The last video shows a set of twins, who are 19 months old.

  • The first one does not have signs of ASD. He likes to push the train back and forth with his mother.
  • The second twin does have signs of ASD. He needs to be asked to push the train. He also does not seem to enjoy playing with his mother.

19-month-old twins pushing train

The Importance of Those Who Care for Children

Parents and early-childhood workers interact with young children the most. They often are the first to know something is wrong. They can be important to get a child with ASD the help they need. These links and videos can help anyone who is interested better know the warning signs for ASD.

Works Cited

Filipek, P. e. (1999). The screening and diagnosis of autism spectrum disorders. Journal of Autism and Developmental Disorders, 439-484.

National Research Counsel. (2001). Educating children with autism. Washington, DC: National Academy Press.


Sensory Processing Disorder What is it? What to look for? What to do?

I am a therapist.  I am certified to give the Sensory Integration and Praxis Test.  I score the

Little boy sobbing
A little boy sobbing. Intensely upset and overcome with emotion.

test and tell parents what the results mean. Praxis means motor planning.

What is it?

The body’s senses get information. The brain receives the information. The brain processes the information wrong.

The senses that might show symptoms are any or all of the following:

– Taste.                    – Touch.                             – Smell.

– Sight .                    – Sound.                            – Pressure.

– Knowing where your body is in space.             – Balance.

– Able to feel warm, hot, cold, etc.

What should caregivers look for?

Each child may show different symptoms.  Ayers (1979) states to look for:

  • behavior problems;
  • slowness to speak;
  • clumsiness;
  • easily distracted;
  • trouble learning; and/or
  • trouble at school.

The severity of the symptoms can look different from child to child.

How can you help?

Parents can help.

  • NOTICE: Is your child having difficulty at school, home, or with friends?
  • DOCTOR: Is your child having difficulty? Contact their doctor.
  • THERAPY: Bring your child to a therapist. Make sure the therapist is trained in sensory integration.

Caregiver Resources


Ayers, A. J. (1979). What is sensory integrative dysfunction.  In Sensory integration and the child (pp. 56-58).  Location: Western Psychological Services.

Autism Spectrum Disorder: The Gray-Zone

cartoon of a person with question mark

Butterflies. Anxiety. Sigh… What will their response be? Will they be extremely upset and not agree? Or will it make sense to them?

…Another not so clear-cut diagnosis of autism spectrum disorder (ASD).  Yes, I agree that his behavior was not typical for his age, but does it really fulfill diagnostic criteria?  Let’s see.  He has language delay… check.  He takes a long while to respond to his name… check.  Yes, but he does respond after the 6th time and was usually distracted with a toy.  I had to work to make eye contact… check.  Yes, but he was so interested in all our toys.  He would look at me when I got on his level.  Oh, he did point to request! Yea, but my colleague says that it was to meet his needs only. Ok, so he may have some delays in his social communication. 

Repetitive behaviors?  Well, he did flap and jump a few times when we brought out the bubbles.  Does that count?  Yes… check.  What about his restricted interests?  He did play with the cars, but what toddler boy doesn’t like cars?  Sometimes I did even get him to play with something else.  Well, he needed a lot of prompting for pretend play; he really only pushed the car and crashed it into other cars.  Repetitive play and restricted interests… check.  No reported or observed sensory concerns… no check.

Ok, so he was referred for evaluation for possible Autism Spectrum Disorder (ASD).  His Early Intervention (EI) team is concerned, but his parents aren’t so much.  However, he did score high on his Autism Diagnostic Observation Schedule (ADOS) and meets DSM-5 criteria. Then why are you questioning it?

“Why are you questioning it?”  This is a common query in my head.  Sometimes it is clear, but other times it is not.   Sometimes when you speak to his EI team, they may convince you that he has ASD.  However, the child may show interest in you and others that makes you question it.  Sometimes, he just seems like a busy kid that makes you work for his attention.  This may make you more concerned for early signs of ADHD.  Or you may wonder if it is just delays in all his skills, especially his intelligence.  If we really think about it, a child whose brain is younger than he is, may appear younger socially and need a lot of effort to get his attention. The reasoning often becomes circular.

As a new Developmental-Behavioral Pediatrician, I have struggled with this worry.  With each child, I find myself asking: “Are all toddlers who flap, toe walk, and take just a little too long to respond to your request really autistic? Or could it be something else?”  I have relied on my colleagues to help me answer these questions, but the question has not gone away.

Most recently, I read an article about some children incorrectly being called autistic.  Although the article suggested that “these children were less likely to be diagnosed by a specialist,” it did make me wonder if I am not the only one with these questions.  It also made me ask, could children that live in this gray-zone be called something else that we may or may not yet know about?

As the amount of children who are called autistic increased over the past 2 years, I began to wonder how many of those children fall into this gray-zone.  I wonder how many people are still in the gray-zone without any label.  I also wonder if I will ever be able to answer these questions without any doubt.

For more information about the article, please see: Autism May Be Over diagnosed in the United States

What’s in a Diagnosis? The Neuro-diversity Movement

neurodiversityToday I sat in a feedback session, giving news to a family that their child met the criteria for having an autism spectrum disorder. I took in their mixed sense of grief and relief, because in many ways they had already suspected this diagnosis. I went on to talk about the unique strengths of that particular child and how specific services would address his challenges. I have gone through this process now many times with many different families; however, with each family, I ask myself again “What’s in a diagnosis” for this particular child? For this particular family?

I am a pediatrician who works with children who have an autism spectrum disorder and their families. Our first contact is often one where the family describes the behavioral concerns that led them to seek an evaluation. The simpler part of what I do is to pull together these concerns and my testing results to provide a diagnosis. The more challenging and rewarding part is to walk with families through their journey of recognizing and building upon the unique strengths of their child as they advocate for him through a myriad of systems.

We often express the need to define a diagnosis for the purposes of initiating services. A diagnosis can also help families, educators, and community members appreciate the neuro-developmental basis for seemingly ‘negative’ and difficult behaviors. By explaining why certain behaviors happen, we can start to identify specific areas to work on with the child and family.

I bring up the strengths of that particular child, and emphasize the uniqueness of every child with an autism spectrum disorder. I acknowledge the spectrum, and how even the ‘strengths’ that I defined are through the lens of what should be ‘neuro-typical,’ rather than a true recognition and celebration of uniqueness. It is exactly this spectrum of diversity and the remarkable strengths of individuals with autism spectrum disorders that have brought about the neuro-diversity movement. The neuro-diversity movement, although controversial, celebrates that autism, as well as other developmental disabilities, are less about disorders/illnesses to be cured, than they are about different ways of being. This movement, however, is challenged because in its extreme form, it undermines the value of research and interventions aimed at curing autism and minimizes the problems and struggles that an individual with autism faces.

The neuro-diversity movement is only one aspect of how autism has perhaps catapulted change in policies and practice among several social systems, including education, employment, and healthcare. The broader reaching implications of these changes may then have an impact across all disabilities. Ultimately, the social changes initiated by a better understanding of autism spectrum disorders, may be leading those of us caring for individuals with disabilities down a path of better inclusion, more appropriate accommodations in education and employment, and comprehensive access to healthcare services.