10 Early Warning Signs of Autism

It may seem like I am focusing on very young children in this and many other episodes. I do have a lot of important episodes for adults and older children with autism, however, I am really focusing on breaking denial and giving understanding to parents who may see these signs in their small children. In today’s episode, I reference 10 possible warning signs of autism from chapter two of Turn Autism Around.

Can these signs lead to an early diagnosis of autism?

Possibly yes, but they can also lead to toddler ADHD, speech delays, other disorders or even none at all. What is important is that my proven four-step approach related to these early signs is going to work and help no matter what the diagnosis is. 

10 Possible Early Warning Signs of Autism

  1. Lack of Pointing
  2. Speech and Language Delays
  3. Excessive Tantrums
  4. Unresponsive to Name
  5. Delayed Playing Behaviors
  6. Repetitive Behaviors
  7. Insistent and Excessive “Sameness”
  8. Sensory Issues
  9. Motor Delay and Toe Walking
  10. Poor Imitation Abilities

Turn Autism Around, Free Resources

If you are noticing these signs, have concerns, or just want to know more, I encourage you to check out the free book resources at TurnAutismAround.com. There you will have free access to templates, checklists, and tools to get started right away as well as access to the first two chapters of my book, Turn Autism Around, completely free. 

Early diagnosis of autism


  • How to tell if a young child has autism?
  • Is pointing a sign of autism ?
  • Is delayed speech a sign of autism?
  • Are motor delays and toe walking signs of autism?
  • Are tantrums related to autism?
  • Do sensory issues mean autism?
  • If your child has early signs, do they have autism?
  • What signs are important for an autism diagnosis?
  • Can delayed skills be taught? 
Want to get started on the right path and start making a difference for your child or client with autism?


Turn Autism Around Podcast Transcript

Transcript for Podcast Episode: 166
10 Early Warning Signs of Autism
Hosted by: Dr. Mary Barbera

Mary: You're listening to the Turn Autism Around podcast, episode number one hundred and sixty six. Your host, Dr. Mary Barbera, and I'm going to do a solo show today talking about the 10 early warning signs of autism. They can also be early signs of things like ADHD, speech impairment and even COVID isolation can make toddlers appear like they might have autism. So we're going to get to the 10 signs as covered in Chapter two of my book Turn Autism Around. My book came out in hardcover at the end of March 2021. It's coming out in paperback, so it's going to be available in hardcover, Audible and Kindle and now in paperback at the very end of March of Twenty Twenty Two. So in several ways to get the book, we're going to cover Chapter two and cover 10 early signs of possible autism. Let's get to it.

Narrator: Welcome to the Turn Autism Around podcast for both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, autism mom, Behavior Analyst and bestselling author, Dr. Mary Barbera.

Mary Barbera on the Turn Autism Around Podcast

Mary: Welcome back to another episode. If this is your first episode, a special welcome. I do this every week. Every Tuesday we drop a podcast, and a lot of times it is an interview with an expert or a parent or someone who's in the autism world or in the world of a toddler showing signs of autism. I was recently interviewed on the Psychiatry and Psychotherapy podcast with Dr. David Puder. I was on episode number one hundred and thirty six of his podcast, and that podcast is for medical professionals. And we talked about similar information there and really covered the information in Chapter two of my book. So we're going to link that in the show notes. We're going to have lots of links in the show notes. As you may or may not know, in addition to being a mom of two sons, one with autism, I am also a board certified behavior analyst and a registered nurse. I'm married to a physician, and so we come at everything from a very medical view. My family, a lot of my friends are nurse practitioners, physicians, and assistants. I've had a number of physicians on the podcast. I've had a couple developmental pediatricians, including Dr. James Copeland, who diagnosed Lucas when the day before he was three. And then I also have had on Dr. Cheryl Tierney-Avis, who is a developmental pediatrician, and we can link these in the show notes as well. We also had other kinds of physicians on Lucas's psychiatrist Dr. Michael Murray, which is one of my all time favorite episodes.

Mary: So we're going to cover today things that are in Chapter two of my book and these are not, you know, the 10 ultimate signs of autism. These are some of the signs that could indicate that your child might have a developmental delay, might have a language disorder, might have go on to get a diagnosis of ADHD or autism. Or maybe some of these kids are showing sensory issues and social delays, and they're going to end up to be gifted with High IQ. I've seen lots of kids who have autism and are gifted or have ADHD, and they get a diagnosis of autism. So one thing I've learned over the past two decades plus is that it's not very clear there's a big gray area when you're talking about delays and diagnoses and multiple diagnoses. So I do want you to know that these are just possible signs. I know many of you have older children with autism, and you might feel like I'm focusing a lot on younger kids. My new book, Turn Autism Around, is certainly focused on those kids ages one to five with or without a diagnosis, but showing signs of autism. And I am. I am focusing more so on the younger kids. And, you know, I still have lots of episodes and lots of things for older kids and even adults with autism. But my mission is really to get to those parents who might be like me in denial that there's anything wrong. And that's the way I was when Lucas first started showing signs of autism. So I want to help parents and early intervention. Riders really tackle the earliest signs of any delays to help kids get back on track as much as possible to help kids talk more, tantrum less frequently, and improve eating, sleeping, potty training, and so much more. So before I go over the first few signs, I do want to say that I've done a lot of work in this area. My number one viewed,top rated, viewed YouTube video is called "Is it speech delay or autism?" And that has been viewed by over one million people. And so we'll link that in the show notes, though that has basically the signs of speech delay versus autism. We're going to cover how you might tell, but you know, I am not qualified to actually diagnose autism. You need to be certain kind of physician or psychologist with training. I do have a lot of training, but as a registered nurse, I am not in a position where I can diagnose, but I can help parents and professionals really look at the signs. And another big thing I've learned over the years is it doesn't matter if it's autism or if it's going to turn out to be something else or nothing at all, that these techniques, these proven techniques and my four step turn autism around approach actually works no matter what we did a recent interview with a mom who happens to be a behavioral analyst and she has a son with Down Syndrome. And I know the procedures that I talk about in both of my books and both of my online courses work no matter what. So we can link them to show notes. We can also link a video blog on the MCHATT and the ADOS test. These are screening tools for autism, which can really point you in the right direction, and we can also link a couple shows that we did with surrounding COVID isolation and how sometimes that can really affect kids language and their social abilities. Thinking that most two and three year old children, most of their lives, all of their lives have been spent in isolation. Now, as I record this in early 2022. So you know, we can link to the the podcast episode with Dr. Catherine Lord, for instance, who really talked about the difficulties with even evaluating kids. When everybody has masks on and really getting to the bottom of whether it's it's autism or not. And we also have a podcast interview with Rachel Smith, who has a typically developing son who had some speech delays, and she was able to use the techniques to for him to overcome that. He also did start preschool, which which totally helped as well.

1. Lack of Pointing

Mary: OK. Number one, the first sign that is in Chapter two of my book is pointing and I say, you know, even even though I have a nursing background and I had no idea before Lucas was diagnosed with autism that pointing with your index finger, not reaching out with your whole hand, but pointing with your index finger by 15 months and 18 months at the latest is a very important milestone. So if I look at a little 18 month old or two year old who is very speech delayed and one is pointing and one is understanding the world around him and pointing with their index finger and the other one is not. That pointing really is a lack of pointing is a really big red flag for autism, not just pointing at the jar of cookies because I want a cookie, but also pointing at more abstract things to show you things like pointing up at the sky to point an airplane even if a child can't talk if the boy with her index finger to show you things. That's a really good sign that there's joint attention and that the social delays are not present. So pointing, lack of pointing by 18 months at the latest is a red flag for autism. Now, if you have a three or four year old who's pointing. We can't really use that as you know, OK, they're pointing and they're three or four, so they don't have autism. The point he needs to start after age one in some for some kids, even before that. But, you know, between one and 18 months, that point can't just be once in a while, too. It's got to be a regular thing, at least until words really start flowing. The other thing I want to point out, no pun intended, is that even if a child can point if they have a lot of these other signs. Pointing specifically doesn't rule out the fact that it could be autism, and I use an example from a guest that I had on the podcast who was a speech pathologist. And the other thing in my courses, I teach you how to teach kids to point. I have a video blog on. So it's a teachable skill. So if you work really hard on teaching, pointing and they have pointing by the time their evaluation. That doesn't mean that they're not going to get a diagnosis of autism, so it's just one of the side tests. The important thing is not just to look at one of these signs and latch onto it. It's got to be a few or a lot of signs, and it has to be an evaluation by somebody you can rule out or rule in autism.

2. Speech and Language Delays

Mary: The number two sign of possible autism is speech and language delays, not just the talking part expressive language, but also the understanding pointing to body part following directions like simple directions like Throw this in the trash can go get your shoes without a lot of gesture, showing kids touching body parts out of order like I in. In this example I use, I tell the story of how I thought when Lucas was three that he could touch his body parts and the early intervention people were like, he's not touching his body parts. Can you show us how you get him to touch his body parts? And I was like, Sure. And I sang this Barney song like, First we touch your head and then our toes and then our belly and then our nose. And that and I was showing him at the same time. So, yeah, learning things like head, shoulders, knees and toes and doing that. A great skill. That doesn't mean they understand. Touch your nose without any gestures. And so looking at both the expressive language, as well as the understanding of language or what we call receptive language is key. But lots of kids have speech delays just like Rachel Son ever had had major speech delays. He wasn't talking enough, but he also wasn't socializing because of COVID. And that, you know, sometimes happens and it could be a speech disorder such as apraxia. We've had a podcast episode on on that with BCBA, and SLP Tamara Kasper on that show we can link language is just so complex, but having social language delays is the hallmark sign of having autism. But it can be a big range. And depending if you're one and a half your for your 12, your 18, those kind of signs of what that social language delay looks like can be extremely wide. The range is just very wide. But if you have a young child who is not talking at all, not putting words together spontaneously know there's a lot of push, I think, in the whole world about getting kids to talk in sentences because parents and professional know that that's a big milestone. But when you rotely teach kids to put sentences together rotely doesn't really count for that natural, spontaneous language that they need. So that's the number to sign is speech and language delays.

3. Excessive Tantrums

Mary: The number three sign that not all kids have is excessive tantrums. And I know for Lucas, when he was a baby, an infant toddler, preschooler really didn't have any major tantrums. He was a very laid back child. He would transition easily from thing to thing. So that was confusing. Yet some children without autism can be very temperamental, and kids with language delays in general are much more at risk for more severe problem behaviors. Kids can have self-injurious behavior where they scratch themselves or hit themselves. They bang their head on hard surfaces. They can have aggression towards others where they're scratching, biting, kicking, and they can have property destruction or they're overturning chairs. And this is what I'm talking about when I say tantrums. Anything that's causing injury, of course, is more of a major problem behaviors. But kids can also have other, more minor problem behaviors, which gets into some of the other signs.

4. Unresponsive to Name

Mary: The next sign possible sign of autism early on would be not responding to a child's name. So when you call a name, not the child not responding. This was a big sign for Lucas. We actually ruled out him having being daft or being hard of hearing what he'd have selective hearing so he might not respond to Lucas Lucas Lucas, but he would respond if he heard the Barney theme song or he heard the Pennsylvania Lottery song going on the TV, and he was in another room he would run in. So there's easy ways where you can test a child's hearing. Of course, getting standard hearing tests is also a very good idea. Just like pointing, though, we can teach kids to respond to their name. I have a video blog on that. We can link that in the show notes as well. And the key with if a child is not responding to their name is not to overuse their name, especially when saying no or giving a demand. So I see this in schools. A lot are used to see it in schools. When I was in schools, consulting is the teacher would say, Johnny touch your nose. Johnny, come here, Johnny. Stand up. And every time you're using a child's name and demand, it's actually unpairing the name of making it more aversive. So we stop using the child's name, especially when saying no or are giving a demand, and then we pair up the name with positive reinforcement.

5. Delayed Playing Behaviors

Mary: OK, the next sign we have here is the delayed playing behaviors. When you see a young child with early signs of autism playing, it's often repetitive. One of my clients used to stick bottles,straws and a bottle over and over again. Some of my clients used to build blocks repetitively over and over again, line things up, move things a certain way. They're not incorporating language. They're not playing with a very wide variety of toys or not generalizing with a lot of variety of toys. And they're not developing pretend play, which surprisingly comes along in development very early on. And we're starting, you know, even before 18 months of age and in many cases, so that pretend play is very is very much missing and that joint attention of wanting to share in experiences. So those are some playing behaviors that are often delayed in kids with autism.

6. Repetitive Behaviors

Mary: The next sign is repetitive behaviors. A child with autism may flap their hands in front of their face again, lining up objects, spinning wheels on cars. And some of the repetitive behaviors can actually be major problem behaviors. I had a client once early on who was only two, and he was banging his head on hard and soft surfaces throughout the day. He was kind of very under stimulated and to get stimulation he would bang his head. And and the reason I was consulted early on it at the age when he was only two through the early intervention program in my county is because he was banging so much that he actually had an open lesion on his back of his head. So upon assessment, he was going to a home daycare situation and the provider. I asked the provider how much he was banging out of the nine hours that the child was there, and the provider said about three hours a day he was he was banging out of the nine hours and that's what caused the open area. So we came up with interventions right away. The child was being placed in a like a pack and play to take two naps. He was banging before he went to sleep, sleeping. Then he was waking up. He was banging again. He had a high chair situation going on, so he was banging his head while he was eating. So two quick interventions to get that repetitive behavior down and get the self-injurious behavior gone is we stop to naps a day and we kind of made it a rule like you'd have to be really tired to take his nap so you wouldn't have a lot of banging before he fell asleep. And as soon as he got up, the child care provider needed to pick him up. Also, we changed from highchair to a booster seat so that we didn't have so much banging. But the child needed major engagement, major therapy and we got that in place and we got the head banging pretty much gone, at least for that function of just stimulating his brain, which was pretty scary. So the repetitive behaviors can be very mild, like winding things up, or they can be major like headbanging.

7. Insistent and Excessive “Sameness”

Mary: OK, the next early sign is sameness, and insistence on sameness might be an indicator of autism. It might not be, though, because we all like routines and we all like to kind of go this park in the same spot at the mall and go the same way. For kids that end up being on the spectrum, this can be pretty extreme. They may tantrum if you're going in a different direction in the car or want to walk a different way in the mall or want to go. Just grab a couple of things at the grocery store and not go through the regular routine. They may not like to wear different clothing or eat different foods, and so this can be. Very kids can get very rigid, very quickly. So sameness is the next sign.

8. Sensory Issues

Mary: OK, the next sign is sensory issues, and kids with sensory processing disorder often get missed for autism. And we just like everything else, it's sensory issues, sensory defensiveness, sensory seeking, sensory avoiding is on a spectrum. I know for some people, my husband and my typically developing son, they would score more. They have more sensory issues than than even Lucas or than I do. You can't expect everybody just to be kind of joe normal in terms of sensory issues. And when I say sensory issues like picky eating don't like the look of foods have hearing sensitivity, Lucas has a lot of hearing sensitivity, so he wears headphones a lot and he even did when he was younger as well. And some kids don't like to be touched or bothered by tags in their clothing. This is all falling under the sensory issue side. Some kids are hyper sensitive, they are sensory seeking, they like to jump, they like to run into walls. They like to squish themselves into the sofa cushions, and then some kids are sensory avoided. They don't want to be touched. They don't like the tags. And then there's kids. Most of us in some areas where sensory seeking, in some areas where sensory avoidant, that's normal. But our kids that end up with a diagnosis of autism tend to have more sensory issues in general.

9. Motor Delays and Toe Walking

Mary: OK, we're getting through these very quickly. We only have two more signs. Number nine is motor delays and toe walking. So this isn't really I mean, if you look up signs of autism, rarely do people talk about motor delays and toe walking. But I wanted to put that in because over the past two decades since I've been in the autism world, this is really changed. In the past, when Lucas was diagnosed, there was thought to be no motor delays in children with autism. But over time there has been have been studies that have shown that kids on the spectrum tend to walk later than typically developing kids. So Lucas walked at 14 months. Spencer walked at 11 months. Spencer is not on the spectrum today. Walking is also can be a sign of autism. So we have kids, especially if they're barefoot, will walk on their toes. And there's all kinds of debate about why that is. And so walking doesn't have to be autism. I've seen typically developing kids toe walk. I've seen kids with other motor issues such as cerebral palsy and things like that to walk. It definitely can look like motor delays, motor planning problems. A number of my clients had physical therapy, occupational therapy in place before or after I got there. One of my clients, Cody and I talk about him in my book, and his mom was on the podcast a couple of years ago. Actually, he started at the age of one with physical therapy and occupational therapy. And he had motor issues. He walked. He didn't walk until he was two. Mom actually thought he might have cerebral palsy, and so when she got the diagnosis of autism, she was a little surprised. Cody did go on. Then when he was older, maybe seven or eight got a diagnosis of mild cerebral palsy on top of autism. So it doesn't mean that if you have some physical delays that it is autism. There have been studies that to show that kids do tend to have more motor delays and motor planning problems if they are on the spectrum. But I think Cody's case illustrates that it could be something else. More motor related. But if you couple all these signs together, you know, he had speech delays. He had a lack of pointing. He had sameness issues. He had excessive tantrums. He had sensory issues and he had motor delays. So it's not just like you can just hang on to one thing and say it's definitely autism or it's not autism. And a lot of ways it doesn't really matter.

10. Poor imitation Abilities

Mary: And our final sign sign number 10 is poor imitation abilities. I didn't realize early on how important imitation is. To typical development, but if you think about babies babbling back and playing patty cake and doing those baby kind of joint attention skills with an adult, kids on the spectrum tend to get off track. Some kids just never are on track. Some kids, like Lucas, have some regression kind of stop pointing, stop waving, stop the singsong back and forth, and they lose their imitation skills if they ever had them, and they need to be taught again. Just like pointing, responding to name and language delays we can teach imitation. Actually, it's one of the very first skills I teach because you get a lot of bang for your buck in terms of teaching imitation so that kids do tend to improve with their play skills, improve with their language abilities, improve with touching body parts and following directions if you can have them imitate. You can change a lot of their world.

Turn Autism Around, Free Book Resources

Mary: So those are the 10 signs that are documented in chapter two of my book Turn Autism Around. Let's just review them quickly. Side one is lack of pointing by 18 months at the latest sign. Number two is speech and language delays. Don't just look at talking or the expressive part. Also, look at receptive language, which is really important. Sign number three Excessive tantrums can happen with many of our kids, especially if they have severe language problems, because if you can't communicate, you tend to have more tantrums. Sign number four not responding to name, sign five is playing behaviors that are delayed. Sign six is repetitive behaviors. Seven is sameness insistence on routines and doing the same thing over and over again. Eight is sensory issues, nine motor delays and toe walking and the last sign saying No. 10 imitation. So I hope you enjoyed that if you did. I would love it if you would get a hold of my book, you can actually read the first chapter for free and listen to the audible of me reading the second chapter just by going to turnautismaround.com. You can also get all the free ebook resources the assessment form filled out. Sample assessment form the planning for the feeding grid, where you can literally take a piece of loose leaf and plot out what your child loves, what your child like, sometimes in terms of food and drink. And then what's really difficult? You can make a plan right away based on the information in my book and the book resources. So TurnAutismAround.com to get all your free book resources and get started listening to Chapter two, which we just review with me reading it just for free at TurnAutismAround.com. I hope you enjoyed this brief solo show on the 10 signs, possible signs of autism if you did love it, if you would leave a review on Apple Podcasts or wherever you're listening, that helps us spread the word to get more parents and professionals into our world, learning really positive strategies to increase talking, decrease tantrums and improve eating, sleeping, potty training and so much more. So that's it for this week. I hope you tune in next week for another episode of Turn Autism Around. Have a good one.

Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop, where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism, and you can learn more about joining my online course and community at a very special discount. Once again, go to MaryBarbera.com/workshop for all the details, I hope to see you there.