Early Signs of Autism: What to Look For and How to Seek an Assessment

What to know before you start

Early signs of autism can appear in the first years of life, but they do not always show up in the same way in every child. Some children show differences very early in communication, social contact, or the way they play. Others only raise concerns later, when school and social expectations become greater.

It is important to remember one thing: one isolated sign does not mean autism. What matters is the overall pattern of behaviour, whether it persists over time, and how much it affects the child’s daily life. It is also true that some children develop more slowly without having an autism spectrum disorder. For that reason, paying close attention and asking for an assessment when in doubt is a sensible and helpful approach.

This article explains what to look for, when it makes sense to seek help, and how assessment works in Portugal.

What autism is

Autism, or autism spectrum disorder, is a neurodevelopmental condition. It mainly affects the way a child communicates, relates to others, interprets social cues, and handles change, interests, or sensory input.

Talking about a “spectrum” means there are many different profiles. Some children need intensive support in several areas. Others have fluent language and do well at school, but still struggle with social interaction, flexibility, or sensory regulation.

There is no single sign that confirms a diagnosis. What professionals look for is a consistent pattern of developmental differences.

Early signs of autism in the first years

The signs may be more noticeable in some areas than in others. The most common include:

• Limited eye contact, or eye contact that seems brief and not spontaneous.
• Reduced response to their name, even though hearing appears to be normal in other situations.
• Limited sharing of interest, such as not showing toys, not pointing to share a discovery, or not seeking an adult’s attention.
• Differences in communication, such as delayed speech, language that is not used functionally, or repeated use of words and phrases.
• Repetitive play, with little pretend play or limited variety in how they play.
• Very intense or restricted interests.
• A strong need for routine and difficulty accepting even small changes.
• Strong sensory reactions, such as extreme discomfort with certain sounds, textures, lights, smells, or foods.
• Repetitive movements, such as hand-flapping, lining up objects, or walking on tiptoes in some situations.

In babies, the signs may be subtle. There may be less social smiling, less response to familiar voices, less interest in face-to-face interaction, or fewer gestures such as pointing, showing, and asking with eye contact.

Signs by age: what may stand out

Up to 12 months

At this stage, signs that may deserve attention include:

• little response to voices and faces;
• little social smiling;
• limited eye contact;
• little anticipation when an adult approaches to play or pick them up;
• few sounds or gestures.

Between 12 and 24 months

Concerns may arise when the child:

• does not point to ask for something or to show something;
• does not imitate simple gestures;
• does not use words to communicate needs or interest;
• seems to prefer playing alone in repetitive ways;
• does not respond consistently to their name;
• loses skills they already had, such as words, gestures, or social interest.

After age 2

It is common to notice:

• difficulty playing with other children;
• little conversation, or conversation focused very strongly on one topic;
• big frustration when routines change;
• more obvious repetitive behaviours;
• strong sensitivity to noise, clothing, food, or crowds;
• difficulty understanding facial expressions, social rules, or irony, especially in older children.

Signs that may also show up at school

At school age, autism can become more visible because social demands increase. The child may:

• have difficulty making friends or keeping friendships;
• seem to be “next to” the group, even when they want to join in;
• take everything very literally;
• struggle with group work;
• react with anxiety to changes in schedule, teachers, or rules;
• need instructions that are very clear and concrete;
• feel exhausted after long periods of social effort.

Some children go unnoticed for years, especially if they are very bright, speak well, or copy other people. Even so, they may feel a lot of inner strain. For that reason, a child’s distress should not be dismissed simply because they “seem fine.”

What should not be ignored

There are situations where it is worth seeking an assessment without waiting too long to “see how it goes.” These include:

• loss of language or social skills;
• persistent difficulties in communication and interaction;
• frequent meltdowns over small changes;
• very intense repetitive behaviours;
• strong sensory sensitivity that affects eating, sleep, clothing, or school;
• consistent concern from parents, nursery staff, or teachers.

Parental intuition matters. If something does not seem to be following the expected developmental path, it is reasonable to ask for professional advice.

What can be mistaken for autism

Not every social or language difficulty is autism. Some signs can also appear in:

• language delay;
• hearing problems;
• attention deficit hyperactivity disorder;
• anxiety;
• trauma or significant stress;
• temperamental differences;
• other developmental conditions.

That is why assessment should be broad. The goal is not to force a label onto the child, but to understand what is happening and what support may help.

How to seek an assessment in Portugal

In Portugal, the first step is usually to talk to the pediatrician or family doctor (médico de família). You can also reach out to school health (saúde escolar) if the concern comes up at school, or to a child mental health professional when available.

If there are signs of atypical development, the professional may refer the child for assessment in areas such as developmental pediatrics, child psychiatry (pedopsiquiatria), psychology, speech therapy, occupational therapy, or other specialties depending on the situation.

In practice, the assessment may include:

• developmental history;
• observation of the child;
• information from the family and the school;
• assessment of language, cognition, behaviour, and adaptive skills;
• specific tests or tools when indicated.

It helps to bring concrete examples: short videos of worrying behaviours, notes about difficult situations, developmental milestones, reports from nursery or school, and a list of questions.

How to speak with the health professional

It can help to say something simple and direct, such as:

“I’ve noticed that my child does not point, responds little to their name, and becomes very upset with changes. I’d like to understand whether this is part of development or whether they need an assessment.”

Try not to compare too much with other children. It is more helpful to describe observable behaviours than to draw conclusions. For example, instead of saying “I think he is autistic,” you can say “he does not show what he wants, does not imitate gestures, and has meltdowns when the routine changes.”

What to expect after requesting an assessment

Waiting times vary a lot. While you wait, it may be useful to start simple supports, even without a confirmed diagnosis. In many situations, early intervention helps the child, whatever the exact cause of the difficulty may be.

Some measures that may help:

• keep routines predictable;
• use short, clear sentences;
• prepare the child in advance for changes;
• use visual support, such as pictures or simple schedules;
• respect the child’s sensory sensitivity;
• observe what triggers distress and what helps them calm down.

If the child is at school, it is worth working with educators or teachers to adapt strategies and reduce distress.

How to support the family emotionally

Suspecting autism can bring relief, fear, doubts, or guilt. Many families go through a period of grief for the idea they had of their child’s development, even before there is a diagnosis. This is human, and it does not mean a lack of love.

Look for information from reliable sources, talk with professionals, and avoid carrying this process alone. It is also important to protect the relationship with your child: the goal is not to “fix” who they are, but to understand how they work and what they need to develop with more safety and well-being.

When to seek urgent help

Seek assessment more quickly if there is:

• clear loss of language or social skills;
• major isolation or intense distress;
• frequent self-harm or aggression;
• important food refusal linked to sensory issues;
• severe sleep problems with significant distress;
• concern about vision, hearing, or another medical issue.

In summary

Early signs of autism may appear in communication, social interaction, play, flexibility, and sensory sensitivity. They are not always obvious, and they do not all mean autism. But when several signs come together, persist over time, or worry the family and school, it is worth asking for an assessment.

In Portugal, start with the pediatrician or family doctor, bringing concrete examples and day-to-day observations. The earlier a child is understood and supported, the better they can benefit from strategies matched to their needs.