‘RED FLAGS’ AND EARLY SIGNS OF AUTISM SPECTRUM DISORDER (ASD)

WHAT IS ASD AND HOW IS IT DEFINED IN THE DSM-5?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in early childhood that is associated with a wide range of symptoms and ability levels. As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Autism Spectrum Disorder is a complex neurological disorder that affects individuals in two core areas:

Persistent deficits in social communication and social interaction across multiple contexts
Restricted, repetitive patterns of behavior, interests, or activities

Symptoms in the core domains of ASD usually emerge between 12 and 24 months. Initial presentations vary, and there is no one behavioral sign that rules an ASD diagnosis in or out. Parents’ initial concerns may include language delay, lack of response when the child’s name is said, and limited eye contact.

Early identification of developmental disorders is critical to the well-being of children and their families.

The American Academy of Pediatrics (AAP) recommends that developmental surveillance be incorporated at every health supervision visit. Any concerns raised during surveillance should be addressed promptly with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 24- or 30-month visits.

The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. There is increasing evidence that early detection and intervention can significantly enhance long term outcomes for children with ASD and related conditions

Early warnings signs in children at risk for Autism spectrum disorder (ASD)

Age (months)	Clinical presentation
6–12	• Reduced or limited smiles or other joyful expressions directed at people • Limited or no eye contact • Limited reciprocal sharing of sounds, smiles, or facial expressions • Diminished, atypical, or no babbling or gesturing (e.g., pointing, reaching, waving ‘bye-bye’) • Limited response to name when called
9–12	• Emerging repetitive behaviours (e.g., spinning or lining up objects) • Unusual play (e.g., intense visual or tactile exploration of toys)
12–18	• No single words • Absence of compensatory gestures (such as pointing) • Lack of pretend play • Limited joint attention (initiating, responding, sharing of interests)
15–24	• Diminished, atypical, or no spontaneous or meaningful two-word phrases
Any age	• Parental and other caregiver concerns about the possibility of ASD
Any age	• Developmental regression (loss of skills): reduced frequency or loss of social behaviours (e.g., directing eye gaze to others) and communication (words and gestures) relative to earlier age