Top 5 Red Flags That Prompt Me to Refer a Child for an Autism Evaluation
Top 5 Red Flags That Prompt Me to Refer a Child for an Autism Evaluation
As a professional working closely with children and their families, one of my key responsibilities is recognizing when a child’s development might warrant a closer look. While every child develops at their own pace, certain behaviors can signal that an autism spectrum evaluation may be helpful. Early identification can make a significant difference in providing the right support at the right time.
Here are five red flags that consistently prompt me to recommend an autism evaluation:
1. The Child Uses Hand-Over-Hand Guidance Instead of Words or Gestures
One of the most striking signs is when a child consistently guides a parent’s hand to an object rather than using words, gestures, or eye contact to communicate their needs. For example, a child might pull a parent’s hand toward a cabinet to get a snack rather than pointing or making a sound. While this can occasionally occur in typical development, when it is a child’s primary way of communicating, it can suggest delays in social communication, a core area affected in autism.
2. The Child Shows No Interest in Imaginative Play
Pretend play is a crucial developmental milestone. By the toddler years, most children begin to imitate adult behaviors ~ feeding a doll, pretending a block is a phone, or making animal sounds while playing with figurines. When a child shows little to no engagement in imaginative play, it may signal difficulty with abstract thinking, creativity, and social role-playing, all areas that can be impacted in autism spectrum disorder.
3. The Child Does Not React to Smiles or Peek-a-Boo
Responsive social behaviors, such as smiling back at a caregiver or enjoying interactive games like peek-a-boo, typically emerge early in development. If a child does not smile in response to joyful interaction or seems indifferent to playful engagement, it could indicate challenges with social reciprocity ~ a hallmark feature of autism.
4. The Child Does Not Look to a Caregiver When Surprised or Startled
A typical reaction to something startling, like a loud noise or a new environment, is to look toward a trusted adult for reassurance or understanding. This behavior, often referred to as “social referencing,” shows that a child is attuned to others’ emotional cues. If a child does not look toward a caregiver during such moments, it may indicate difficulties in joint attention and emotional connectivity, both important early social skills.
5. The Child Appears Disinterested in Other People
While some children are naturally more reserved, a consistent disinterest in other people, not noticing when others enter the room, not seeking out social interaction, or not attempting to share experiences may raise concerns. Social curiosity and a desire to connect are typically strong even in very young children. A lack of these behaviors can be an early indicator of autism.
Final Thoughts
It is important to note that no single behavior confirms or rules out autism. These red flags are simply signals that a more in-depth developmental evaluation may be warranted. When I notice several of these signs, especially if they persist over time, I encourage families to seek a comprehensive assessment. Early identification opens the door to early intervention, which can make a meaningful impact in helping a child reach their full potential.
If you are a parent or caregiver noticing any of these behaviors in your child, or if you are a professional working with young children and unsure whether to refer, I always recommend trusting your instincts and seeking guidance from a qualified developmental pediatrician or the child’s pediatrician.
