Autism: early signs, diagnosis and support
Autism is a lifelong difference in how a person communicates, relates to others and experiences the world, often with repetitive behaviours, intense interests and sensory sensitivities. Early signs include not responding to their name by about 9 months, not pointing to share interest by 18 months, and little back-and-forth babbling or play. A specialist team diagnoses it; there is no blood test. Speech and language therapy and parent-led social communication programmes help. Autism is not caused by vaccines or parenting, and treatments sold as cures, such as chelation or stem cells, are unproven and can be dangerous.
Health writers · Aslam Clinic
is a lifelong developmental difference in how a person communicates, relates to other people and experiences the world. Autistic children often find back-and-forth communication and social play difficult, prefer sameness and routine, have intense interests, repeat movements or words, and are unusually sensitive — or unusually unbothered — by sounds, textures, lights or pain. It is present from early childhood, although it may not be recognised until later.
Autism is not caused by parenting, by screens, by a mother working, by nazar or by vaccines. It is not a disease to be cured, but many autistic children need real support to learn to communicate, and early help makes a difference. Some people prefer 'autistic person', others 'person with autism'; this page uses both, and the best guide is what the person or family prefers.
Early signs by age
No single sign means autism. A pattern of several, especially in social communication, is what matters. These are from the US Centers for Disease Control and Prevention's list of social communication signs.
| By about | Signs that may point to autism |
|---|---|
| 9 months | Does not respond to their name; few facial expressions such as smiling back |
| 12 months | Does not play simple back-and-forth games like peek-a-boo; uses few or no gestures such as waving bye-bye |
| 15 months | Does not show you things they are interested in |
| 18 months | Does not point to show you something interesting |
| 24 months | Does not notice when others are hurt or upset |
| 36 months | Does not join other children in play |
| 48 months | Does not pretend, such as playing at cooking or being a teacher |
Alongside these, parents often notice restricted or repetitive behaviour:
- Lines up toys and becomes very upset if the line is disturbed
- Repeats words or phrases, including lines from cartoons (echolalia)
- Plays with toys the same way every time, or focuses on parts, such as spinning wheels
- Gets very upset by small changes in routine
- Flaps hands, rocks or spins
- Strong reactions to sounds, smells, tastes, textures or lights — for example covering ears at a pressure cooker or refusing most foods
NICE also warns professionals not to rule out autism just because a child makes good eye contact, smiles, is affectionate with family, or has some pretend play. Autism looks different in every child.
Screening: the M-CHAT-R/F
The M-CHAT-R/F is a questionnaire of 20 yes/no questions about everyday behaviour, answered by parents of toddlers aged 16 to 30 months. If the score suggests risk, a clinician goes through a structured follow-up interview. It is free to use for families and clinicians, and an Urdu translation exists.
A positive screen is not a diagnosis. In the main validation study of more than 16,000 toddlers, about half of those who still screened positive after the follow-up interview were diagnosed with autism — but almost all of them (about 95%) had some developmental delay or concern that deserved help. Either way, a positive screen means 'get this child assessed', not 'wait and see'.
A late talker, or autism?
Many children talk late and turn out fine, and many autistic children talk on time. What helps distinguish them is how a child communicates without words.
| Speech delay on its own | More suggestive of autism |
|---|---|
| Points, waves and uses gestures to make up for missing words | Few gestures; may lead your hand to what they want instead of pointing |
| Looks at you and shares enjoyment, brings toys to show you | Rarely shows you things or checks your face to share excitement |
| Responds to their name and to simple instructions | Often does not respond to their name, as if not hearing |
| Pretend play develops | Play is repetitive, focused on lining up, spinning or sorting |
| Enjoys other children, even without words | Seems uninterested in other children, or does not know how to join in |
Every child with delayed speech should have a hearing test first — a child with glue ear or hearing loss can look like an autistic child. Growing up with two or three languages at home, as many Pakistani children do with Punjabi, Urdu and English, does not cause autism or significant delay; NICE advises clinicians not to explain away a language delay on these grounds.
How autism is diagnosed
There is no blood test or brain scan for autism. Diagnosis is made by a specialist — ideally a team including a paediatrician or child psychiatrist, a speech and language therapist and a psychologist — using the criteria in or .
- A detailed developmental history from parents, including pregnancy, milestones and when concerns began
- Structured observation of the child's communication and play; tools such as the ADOS may be used, but NICE says no single tool should decide the diagnosis
- Information from nursery or school
- A physical examination, hearing test and sometimes genetic tests to look for associated conditions
- Considering other explanations: language disorder, intellectual disability, ADHD, anxiety, hearing or visual impairment, and rare conditions such as Rett syndrome or epilepsy syndromes
Diagnosis can be uncertain in children under 2, and a good team will sometimes say 'let us review in six months'. Start support for the child's needs in the meantime; you do not have to wait for a label to begin speech therapy or parent coaching.
A spectrum of support needs
The word 'spectrum' does not mean mild to severe in a straight line. Some autistic people speak fluently, study and work but find social life exhausting; others use few or no words and need support every day. describes three levels of support need, and a child's profile changes as they grow.
- Many autistic people also have ADHD, , sleep problems, epilepsy, feeding difficulties or constipation. These are treatable and often explain sudden changes in behaviour.
- Some have an intellectual disability; many do not.
- Girls are more likely to 'mask' — copying other children's behaviour to fit in — which delays diagnosis and often leads to anxiety and exhaustion in adolescence.
Support that has evidence behind it
- Speech and language therapy — for understanding and using language, and for alternative communication such as pictures, signs or devices when speech is limited. Using pictures does not stop a child learning to speak.
- Parent-mediated social communication programmes — NICE recommends play-based strategies with parents, carers and teachers to increase joint attention and back-and-forth communication. In the PACT trial, children whose parents received this coaching still showed fewer autism symptoms six years later. The WHO Caregiver Skills Training programme uses the same idea and has been tested in Pakistan.
- Occupational therapy — for sensory difficulties, feeding and daily living skills.
- Structure and visual supports at home and school — visual timetables, warnings before change, a quiet space.
- Treating co-existing problems — sleep, anxiety, ADHD, epilepsy and pain.
The ABA debate
Applied behaviour analysis (ABA) uses rewards to teach skills and reduce harmful behaviour, and early intensive versions can involve many hours a week. A Cochrane review found low-quality evidence that early intensive behavioural intervention may improve IQ and language skills in young children, but no clear evidence that it reduces autism symptoms, and only a handful of small studies.
Many autistic adults criticise traditional ABA for training children to look 'normal' — suppressing harmless stimming, forcing eye contact, demanding compliance — rather than supporting their wellbeing. Newer, play-based 'naturalistic' approaches blend behavioural and developmental ideas and follow the child's interests. If you are offered any programme, ask: what are the goals and who chose them? Does my child seem happy there? Can I watch sessions? Are harmless behaviours being targeted? Is it teaching communication, or just compliance?
Medicines
No medicine treats autism itself. NICE advises against using , antidepressants or anticonvulsants for the core features of autism. Specialists may still use medicine for co-existing conditions such as ADHD, epilepsy or sleep problems, and sometimes for severe behaviour that challenges when other approaches have not been enough.
What does not work, and what can harm
Families of autistic children are targeted by expensive 'cures' online and in some clinics. The evidence on these is clear.
- Chelation (removing 'heavy metals') — NICE says never use it for autism. It can dangerously lower blood calcium and has caused deaths.
- Stem cell injections — no stem cell product is approved to treat autism, and unregulated clinics have caused infections and other serious harm.
- Hyperbaric oxygen and secretin — NICE advises they should not be used for autism in any context.
- Gluten-free, casein-free or other exclusion diets as a cure — NICE advises against them for the core features of autism. A child with a genuine allergy or gut problem needs a proper medical diagnosis; restricting a picky eater's diet further risks poor nutrition.
- Neurofeedback and auditory integration training for speech — not recommended by NICE.
Autistic adults
Autism does not end in childhood. Many adults — especially women and people with good speech — are recognised only later, often after years of being labelled shy, difficult or anxious. A diagnosis in adulthood can bring relief and self-understanding. The WHO notes that autistic adults often face unmet health needs and discrimination; practical adjustments at work, clear communication from health services, and treatment for co-existing anxiety or matter a great deal.
Faith, family and stigma
In Pakistan, families often hear that the child is spoilt, that the mother is to blame, or that it is nazar or a test. Prayer can be a real source of strength for parents, and it is not in conflict with therapy. But nothing a parent did caused autism, and a child who is not talking needs speech therapy as well as dua. Talk openly with grandparents and relatives, because a child's progress is faster when the whole joint family uses the same approach. Many autistic children can attend mainstream schools with support; ask the school what adjustments it can make.
What you can do now
- Write down what worries you, with examples and ages, and take it to your child's doctor. Do not accept 'wait until he is five' for a child who is not pointing or responding to their name.
- Ask for a hearing test.
- Get your child on the list for a developmental assessment and speech and language therapy.
- At home, follow your child's lead in play, get face to face, name what they are doing, and pause to give them a turn to respond.
- Keep routines predictable and warn before changes.
- Before paying for any treatment, ask what evidence it has and whether NICE or the WHO recommend it.
- Look after yourself and find other parents; you are going to be your child's most important therapist.
Common questions
Still not sure what to do?
Reading about a symptom only goes so far. A doctor who can ask you questions and examine you will get further in ten minutes than any article can.
