Noticing the Early Signs: What Every Parent Should Know About Autism in Babies and Toddlers
By Judy Salamon, M.A., CCC-SLP, Ph.D., Autism Specialist
A Gentle Place to Start
With twins come twice the hugs, twice the kisses, and twice the worries. Maybe you have noticed that one of your sweeties doesn't interact with you like the other does. Maybe he doesn’t imitate your sounds and words, while your other twin picks them up easily and is progressing forward. Maybe your toddler doesn't quite meet your eyes when you call his name. Maybe it's just a feeling.
I want you to know something before we go any further: noticing these differences doesn't mean something is wrong with your child. It means you're paying close, loving attention, and that matters more than you know. You’ve probably been told not to compare your twins, but when you notice one falling significantly behind the other, you are right to be concerned.
As a speech therapist, I've spent years sitting on living room and center floors with babies and toddlers, evaluating how they babble, point, play, and connect. I've also sat across from parents who were scared, unsure, or grieving an uncertain future. This information is for you. My hope is to offer information with warmth, not worry, and to remind you that whatever you learn about your child, he is completely whole and worthy of celebration for each milestone achieved.
What Autism Looks Like in the First Years
Autism is a spectrum, which means it looks different in every child, from high functioning to low functioning. There is a phrase often repeated about autism: When you meet one child with autism, you’ve met ONE child with autism.
Each autistic child is an individual with a unique personality, level of specific developmental achievements, and specific challenges. The medical definition of autism has determined three levels of autism, with each level describing specific strengths, challenges, and needs for support.
Autism often shows up in two major areas: Behavior and Communication.
Behavior
Meltdowns: The child is on overload and cannot express his needs; this often includes throwing themselves on the floor, screaming, and crying.
Kicking or biting himself or others: The child is trying to express himself but can only hurt himself or others to show his distress.
Throwing objects or food: The child is trying to express something regarding a challenge that has presented itself.
Communication
Social communication: How a child shares attention, emotion, or interest with others.
Eye contact and facial expression: Often an autistic child will not look the conversation partner “in the eye,” but rather look above her or at something off to the side.
Joint attention: The back-and-forth of “look what I see!” that babies typically develop early.
Play patterns: How a child explores toys and uses imagination; many autistic children line up toys and become distressed when the line is broken. Limited interest in types of play is often seen with autistic children.
Sensory responses: How a child reacts to sounds, textures, lights, or movement; this can include weather, food, liquids, hot, cold, smells. Almost anything that you react to may cause a rejection from an autistic child.
If some of these feel familiar, take a breath. Noticing is not diagnosing; it's the beginning of understanding your child a little more deeply.
Remember, every child is unique.
What causes challenges to one autistic child may be a creative gift to another. And the information presented previously is a very wide and general look at what might be involved in a child who is being challenged. If your child is not using words by 12 months, there is no cause for concern. However, if she is not talking by 20 months, you might want to speak with your pediatrician.
Each child is different. Keep in mind that with everything you do. That’s doubly difficult with twins.
Developmental Stages by Age
These milestones are from the American Speech-Language-Hearing Association Developmental Milestones Handout.
ASHA Developmental Milestones Handouts
Remember, they are VERY general guidelines for developmental milestones.
What did I already tell you: EACH child is UNIQUE!!!
While we’re talking about guidelines, many children diagnosed with autism have extremely advanced strengths in specific areas. Some children with autism do not go through the developmental stages of speaking, but rather do not use words until about five years of age and they begin speaking in complete sentences. And some never learn to speak functionally.
Each child is unique.
Why Early Communication Matters So Much
I care so much about early communication because it's so closely tied to a child's whole world: their relationships, their emotional regulation, their sense of being understood.
The early years are also when a child's brain is remarkably adaptable, so the earlier a child receives the support needed, the better. This isn't about rushing to “fix” anything. It's about meeting a child where they are, as early as possible, so they have every tool available to succeed.
What to Do If You Notice These Signs
First: trust yourself. You know your child better than any chart or checklist ever could. If something feels different, it's worth exploring, not because something is wrong, but because you deserve answers and support either way.
Your next step might be talking with your twins’ pediatrician. Explain to her the concerns you are having, telling her the differences between your twins’ development. She will be able to determine if your child is developing as expected, or she may refer your child to a professional who will assess him.
This professional may be a developmental pediatrician, a developmental psychologist, or a local autism center (these are often located at universities).
After an initial evaluation, the examiner may refer your child to other specialists; speech therapists, occupational therapists, physical therapists, and behavior therapists are often asked to conduct evaluations. After all the data is collected and studied, a report will be prepared for you with the results of all the testing and recommendations for your next steps.
Everyone on the team is typically kind and supportive, as they are aware of all the new information that is being provided to you. This process can feel slow and emotional. Be patient with yourself and with the system. You are not overreacting by seeking answers.
Coordinating all this testing from all these professionals takes time, but it will provide you with a picture of how your child is functioning in all the areas assessed.
Gentle Reminders for Parents
If one or both of your twins are diagnosed with autism, this is just the beginning of all the support you will be provided when and if you and your family need it.
Some thoughts to keep in mind:
A diagnosis does not limit your child; it provides a map of where support is required until the goal can be accomplished.
Early intervention is not going to change the way you raise your child. It’s going to provide you with additional support where your child is facing challenges.
Every child's timeline is different from every other child; try not to compare, even if there is a big difference in their strengths.
Regardless of the results of the testing, your child hasn't changed. He's still the child he was before the testing. Only now, you may have assistance in helping him meet his goals.
Welcome to Holland
If your child does receive a diagnosis, you may feel your world is spinning around, as this is not what you expected. I would like to share this poem with you to help with these feelings:
Welcome to Holland by Emily Perl Kingsley
A Closing Thought
Wherever you are on this twin journey, just noticing something, waiting for an evaluation, or holding a new diagnosis, please know that you're not walking it alone. Your job isn't to have all the answers. It's to keep showing up with love, curiosity, and advocacy, which you're already doing simply by reading this.
Your child doesn't need to be “fixed.” He needs to be understood. And that work, beautiful, sometimes hard, and always worthwhile, starts with you.
If you have questions about your child's communication development or would like to schedule a consultation, I'd love to talk with you. Please leave a comment on this website and I will get back to you.
