Recognizing Early Signs of Autism in 2-Year-Olds: What Parents Should Watch For

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition. Characterized by social and communication differences, patterns of repetitive behaviors, and restricted interests, what ASD looks like can differ from person to person. While ASD is something you are born with, people with ASD can get diagnosed at nearly any age. Some, but not all, kids will show clear signs of ASD by age two.

Early detection and intervention for ASD are highly recommended because they are linked to positive outcomes such as better quality of life and improved skills in the long term. If your child may have ASD or a related condition, pursuing a diagnosis matters.

Let’s talk about common developmental milestones in two-year-olds first. Then, we’ll review common early signs of ASD, the importance of parental observation, and what to do if you suspect that your toddler has ASD. 

Developmental Milestones in 2-Year-Olds

Developmental milestones refer to common behaviors and skills children tend to develop when they are within certain age ranges. Some autistic children will have developmental differences, but this is not always the case. Looking out for developmental delays is important, even if they are not due to ASD, as they could be indicative of other concerns.

Typical behaviors and skills for 2-year-olds

Some developmental milestones relate to communication, whereas others are physical, social-emotional, or cognitive. Here are some typical developmental milestones providers and parents generally look for in kids around age two.

• Using non-verbal gestures, such as pointing or waving to others.
• Social imitation (e.g., copying parents or older children).
• Saying phrases that involve two or more words.
• Responding to their name.
• Saying their name when asked.
• Social babbling and chatting.
• Greeting others (saying "hi!").
• Imaginative play.

In addition to developmental monitoring at 9, 18, and 30 months, the American Academy of Pediatrics recommends that providers screen for ASD at 18 and 24 months. Not all kids with ASD get diagnosed at this time.

Red flags for potential Autism

Since many kids with ASD meet expected developmental milestones, knowing other possible warning signs can be helpful. Toddlers with ASD may display symptoms such as: 

• Sensory sensitivities, which can include both hyper or hypo-sensitivity to stimuli.
• Limited facial expressions or exaggerated facial expressions. 
• Delayed speech or atypical language development.
• Lack of eye contact or appropriate gaze.
• Lining up or grouping toys and objects.
• Limited or no response to name.
• Unusual tone of voice.
• Lack of social smiling.

Although family history (whether the family member is diagnosed or not), Fragile X syndrome, and other factors may increase the likelihood that a child has ASD, anyone can have ASD. Learning more about ASD in early childhood can help your child get the most comprehensive assessment possible. 

Early Signs of Autism in 2-Year-Olds

Poor eye contact, sensory sensitivities, and verbal or non-verbal communication difficulties like lack of response to one’s name are among some of the most well-known possible signs of ASD. What else can you look for? Let's go over early signs of ASD in two-year-olds you may notice.

Social communication deficits

All autistic children will meet ASD criteria in different ways. In addition to those noted above, possible signs of social communication and interaction differences in a young child with ASD may include but aren't limited to:

• Little interest in developing peer relationships (e.g., low interest in playing with other kids).
• Scripted speech (e.g., answering a question with a "script" they have heard before rather than organically).
• Difficulty using or following joint attention skills (e.g., pointing).
• Using or playing with toys in an unexpected way.
• Trouble understanding body language.
• Lack of expressions like "uh oh."
• Use of "pop-up" words.
• Echolalia.

Some social interaction differences may become more apparent in some kids a little bit later as they are exposed to more social situations. Other times, a two-year-old will display enough marked differences in social interactions and language skills, alongside other ASD symptoms, to get diagnosed.

Repetitive behaviors and restricted interests

In addition to social communication and interaction symptoms, one must experience symptoms in at least two of the following areas to get a diagnosis. Like with social communication and interaction symptoms, these signs can vary in presentation.

Repetitive movements or gestures

Unusual body movements, hand movements, or gestures are common in people with ASD. Examples of repetitive movements and behaviors in a two-year-old could include:

• Repeating small rituals involving unusual body movements (without a marked purpose) in specific contexts.
• Repeating words, phrases, tangents, or “speeches.”
• Picking skin, biting nails, or similar behaviors.
• Stepping from one foot to the other.
• Excessive teeth grinding. 
• Rocking or swaying. 
• Flapping hands.
• Spinning objects.
• Flicking fingers.

These are only some examples of how repetitive movements and gestures can present in ASD. It is not a comprehensive list. Often, these are called stimming (self-stimulatory) behaviors. 

Fixation on specific objects or topics

Autistic people often have special interests. A special interest is an intense interest in a certain subject. Special interests can relate to any topic, whether a specific animal, a cartoon character, dinosaurs, history, math, cars, a TV show, or something else. Young children with ASD may start to develop special interests. They may also fixate on or become unusually attached to certain objects. Some kids with ASD will fixate on more common objects, like blankets, toys, or figurines. Others may become attached to less common objects or start a collection of certain items. 

Resistance to change or routine disruptions

Change can be extremely hard for autistic children. In a two-year-old, this could look like:

• Difficulty with transitions.
• Feeling distressed by small changes in daily routines or activities.
• Unusual eating habits, which may be due to sensory sensitivities.

Kids with ASD can be attached to specific routines, activities, objects, and patterns. Structured routines and knowing what to expect can help children with ASD emotionally and functionally. 

Over or under-sensitivity to stimuli

The majority of autistic people have sensory processing differences of some kind. Examples of what these look like can include but aren’t limited to the following. 

• Extreme distress caused by certain fabrics, clothing tags, or not wanting to be touched by specific objects and textures.
• Extreme distress caused by certain sounds (this could be loud noises and places or specific sounds, like the vacuum cleaner).
• Significant aversion to having fingernails or toenails cut, hair and teeth brushed, getting wet, etc. 
• Aversion to other sensory stimuli, like bright lights and scents.
• High pain tolerance or lack of awareness for bodily needs.
• Indifference to hot or cold. 

Young children and toddlers with ASD may get fixated on specific stimuli, like watching wheels on toys spin (this can be linked to atypical play or use of objects, which is common in ASD), running water, and fans. Other sensory-seeking behaviors can also be common. 

Importance of Parental Observation

Early intervention for ASD can occur as young as two years old. Some forms of support that could benefit your child can begin before they get an official diagnosis or during the diagnostic process. For example, a two-year-old child who would benefit from speech therapy can get it even without an official diagnosis. Parents play an important role in observing their children and advocating for support as needed.

Role of parents in monitoring their child's development

Parents who notice developmental delay or possible signs of ASD should bring it to a healthcare provider's attention. Certain symptoms, like speech delay, may or may not be due to ASD and can require thorough evaluation and treatment. A provider may refer your child for an evaluation now, or they may suggest that you continue to monitor your child's development and symptoms so that a comprehensive assessment can be conducted a little bit later. 

If Autism symptoms aren't yet clear enough for a diagnosis when a child is about two years old, it doesn't mean that they don't have ASD. Parents should continue monitoring their child’s development closely as they age and are exposed to new environments. An ASD evaluation will entail an extensive review of symptoms and medical history. 

Benefits of early intervention for children with Autism

Research on early intervention for ASD shows that it is linked to a wide variety of positive outcomes. Knowing that your child has ASD can be helpful because it means that you can create a supportive environment for them at home, advocate for their needs, and understand their needs better. Early intervention services for a child with ASD can also support:

• Verbal and non-verbal social communication skills.
• Education and work outcomes.
• Long-term daily living skills.
• Access to school accommodations.
• Motor skills.
• Quality of life.

Many older children and adults with ASD say that getting diagnosed has helped them better understand themselves. There are friendship groups and events for kids with ASD, as well as support groups and other resources for parents. Awareness matters and can help you connect with your local ASD community. 

What Should Parents Do If They Suspect Autism?

Parents can use online screening tools to help them detect possible ASD symptoms. For example, the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised) is free and applicable to kids between 16 and 30 months old. Screening tools do not replace a diagnosis but can be valuable for parents and providers as a precursor to an evaluation. If you suspect that your child could have ASD, the next step is to talk with a professional.

Seeking professional evaluation and diagnosis

An official Autism diagnosis requires a formal assessment from a qualified provider. Medical providers qualified to diagnose Autism in children include developmental pediatricians, neurologists, child psychologists, or child psychiatrists with specialized training. However, the process leading up to an official Autism diagnosis can be a team effort. Some parents will need to take their child to one or more additional providers to identify other symptom causes or co-occurring conditions—for example, a hearing test or an assessment from a speech-language pathologist. 

Many parents start the diagnostic process by collecting a list of their child’s symptoms and talking with their pediatrician. You can take several routes to find a provider who can diagnose Autism. Young children can often get diagnostic and early intervention support through their local school district. You can also find an ASD testing center near you through resources like the Autism Society, a Google search, or by calling your insurance company to inquire about testing services covered by your plan.

Exploring early intervention services and therapies

The types of therapy, accommodations, and other modes of support applicable to a child with ASD will be unique to their needs and symptoms. For example, one child may need more help with motor skills or spoken language than others. Common early interventions for ASD may include but aren’t limited to:

• Parent training and education.
• Applied Behavior Analysis (ABA).
• Occupational therapy.
• Social skills training.
• Speech therapy.

The Centers for Disease Control (CDC) website can help you locate early intervention programs in your US state or territory. The Autism Society website and Psychology Today can be helpful for finding ASD therapy resources. Like with evaluations, calling your insurance company may help you find treatment services covered by your health insurance plan.

Conclusion

Autism Spectrum Disorder (ASD) is one of the most common neurological and developmental disorders, affecting around 1 in 36 kids. The way ASD presents can differ, and some autistic people are able to get a diagnosis sooner than others. 

Possible early warning signs of ASD include but aren’t restricted to limited eye contact, lack of social smiling, or not responding to one’s name. You may also notice symptoms like trouble with nonverbal communication skills, difficulty with change or transitions, or sensory sensitivities.  

Parents who suspect ASD in their children should trust their instincts by continuing to look out for signs of ASD. If you believe your child could have ASD or if they meet symptom criteria, inquire about an evaluation. Treatment for ASD is highly individual, but the proper support can be crucial for long-term success and well-being.