Parents often notice developmental differences long before a formal evaluation happens. The early signs of autism in toddlers often appear before age 3, showing up in how a child communicates, connects, and responds to the world around them. This checklist can help North Carolina parents understand what to look for and what steps to consider next.
What Are the Early Signs of Autism in Toddlers?
The early signs of autism in toddlers include limited eye contact, delayed spoken language, reduced pointing or gesturing, and little interest in shared play. These signs often appear between 9 and 18 months of age. According to the DSM-5, the diagnostic standard for autism spectrum disorder, these differences show up in social communication and in repetitive or restricted patterns of behavior.
Most children with autism do not show delays in motor skills. They sit, crawl, and walk on schedule. What tends to differ are the subtler social and communication milestones like the back-and-forth babbling, the social smiling, shared attention during play, and the ability to follow another person’s gaze or gestures.
These are also the differences that are easiest to miss during a brief well-child visit. One thing BCBAs frequently hear from North Carolina parents is that concerns first become noticeable during ordinary routines such as mealtimes, transitions, bath time, or unstructured play, rather than during short pediatric visits. Children who appear calm and regulated in a clinic setting may show much clearer communication, joint attention, or sensory differences at home.
That is precisely why in-home ABA therapy in North Carolina can play such an important role in early identification. Therapists who work in the home see children in their real environment, where developmental differences are more likely to surface.
The CDC’s autism signs and symptoms guide is a reliable starting point for understanding the full range of early signs across different ages.
Toddler Autism Checklist by Age: 12, 18, 24, and 36 Months
This toddler autism checklist is organized by age to help North Carolina parents track developmental milestones at home. If your child is consistently missing several of these markers, it does not confirm a diagnosis. It is, however, a clear reason to speak with your child’s doctor or request a developmental screening.
Use the checklist below as an observation tool, not a test. Check what applies, and bring your notes to your child’s next appointment.
Autism Signs at 12 Months: What to Look For
By 12 months, most babies are already engaged in a quiet but constant back-and-forth with the people around them. They track faces, respond to their name, and begin using simple gestures to communicate. When several of these behaviors are consistently absent, it is worth paying attention.
- Does not make eye contact during feeding or play
- Does not respond to their own name when called
- Does not wave goodbye or use other gestures
- Does not show objects or toys to a caregiver
- Does not babble or take turns making sounds with a caregiver
- Shows little interest in other people’s facial expressions
Autism Signs at 18 Months: The Most Commonly Missed Window
Eighteen months is one of the most important checkpoints in a child’s development. It is also the age when many early warning signs of autism are visible but frequently overlooked. The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child visits. One of the most commonly used screening tools is the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F).
If your child’s pediatrician has not mentioned this screening, it is completely appropriate to ask for it.
- Does not point to show something interesting to a caregiver
- Does not say at least one word with a clear meaning
- Does not follow a caregiver’s gaze or pointed finger toward an object
- Does not engage in simple pretend play, such as feeding a doll or talking on a toy phone
- Repeats words or sounds without communicative purpose (echolalia)
- Shows strong distress at minor changes in routine
Many parents initially assume speech delay is the only concern, but differences in joint attention, imitation, and social engagement are often what raise concerns during developmental evaluations.
Autism Red Flags at 24 Months
By age 2, most children are beginning to combine words, show interest in other children, and engage in imaginative play. When these skills are absent or inconsistent, they may point to differences in social communication that are worth exploring further.
Language loss is also worth noting here. Research indexed by the National Library of Medicine suggests that roughly one-third of young children with ASD experience developmental regression, most often involving language or social skills. This often happens between 15 and 24 months and is one of the clearest autism red flags parents describe.
- Does not use two-word phrases spontaneously, such as “more juice” or “daddy go”
- Shows little interest in other children or parallel play
- Has lost previously gained language or social skills
- Lines up objects or plays with toys in a repetitive, non-functional way
- Shows unusual reactions to sounds, textures, lights, or touch
- Rarely makes eye contact during shared play or conversation
If several of these signs feel familiar, iCare Therapy’s care coordinators are available to help you talk through your child’s development, insurance options, and what next steps might look like for your family.
Developmental Signs to Watch at 36 Months
At 3 years old, some children are diagnosed with autism for the first time, even though signs were often present much earlier. This gap between early signs and later diagnosis is one of the biggest barriers to timely support. Research shows that children who begin early intervention before age 3 tend to have stronger developmental outcomes over time.
- Speech is difficult for unfamiliar adults to understand
- Does not engage in cooperative or interactive play with other children
- Insists on very specific routines and becomes dysregulated when they change
- Shows intense interest in one or two narrow topics to an unusual degree
- Rarely uses language to make requests or comment on the environment
What Should North Carolina Parents Do If They Notice These Signs?
If your child is showing several signs from this checklist, the most important thing you can do is act now rather than wait. North Carolina families have access to free developmental evaluations through the Children’s Developmental Services Agency for children under age 3. Parents can self-refer, and no doctor’s order is required.
Here is the recommended pathway for families in North Carolina.
Step 1: Speak with your child’s pediatrician. Ask for a developmental screening at your next visit. The M-CHAT-R is the standard tool used at 18- and 24-month well-child checkups. If your child is already past those ages, a referral for a full developmental evaluation is the appropriate next step.
Step 2: Contact the Children’s Developmental Services Agency (CDSA). North Carolina’s CDSA provides free early intervention evaluations and services for children under age 3. You do not need a referral from a doctor to get started. The Autism Society of North Carolina maintains a list of local CDSA contacts and family support resources across the state.
Step 3: Ask about a TEACCH evaluation. The TEACCH Autism Program at UNC-Chapel Hill is one of North Carolina’s most respected autism evaluation resources. TEACCH provides comprehensive diagnostic assessments and ongoing support for autistic children and their families.
Step 4: Reach out to an ABA therapy provider. An ABA intake conversation can happen before a formal diagnosis is complete in many cases. Many families are surprised to learn they can begin that conversation early. iCare Therapy’s care coordinators can walk you through your child’s needs, explain how North Carolina Medicaid covers ABA therapy, and help you understand what the process looks like from start to finish.
Many North Carolina families are surprised to learn that they can self-refer to CDSA without waiting for a pediatrician referral. In practice, this misunderstanding alone can delay evaluations by several months, especially for families waiting to see whether speech or social differences improve on their own. Many families also do not realize that an ABA intake conversation can begin before a formal diagnosis is complete. Starting early does not mean rushing. It means giving your child more time to benefit from support.
Why Early Action Matters More Than Waiting for a Diagnosis
You do not need a confirmed autism diagnosis to begin exploring support for your child. Research shows that early intervention, particularly when it begins between 18 and 24 months, produces the greatest improvements in communication, social skills, and daily living skills for many autistic children.
The NICHD notes that most children with autism are not diagnosed until after age 3, even though health care providers can often observe developmental differences much earlier. The gap between noticing early warning signs and taking action is where outcomes are most affected.
One of the most common things families share when they first reach out is that they waited, sometimes six months, sometimes over a year, hoping their child would catch up. That instinct is understandable. But early identification and early support do not change who your child is. They give your child more tools and more time to build on them.
If you are in North Carolina and wondering whether your child’s development warrants a closer look, you can explore your options for ABA therapy and support without any commitment. A conversation with a care coordinator is a good first step.
How iCare Therapy Helps North Carolina Families With Early Signs of Autism
The early signs of autism in toddlers are real, they are observable, and they are worth acting on, even before a diagnosis is confirmed. This checklist gives North Carolina parents a starting point: age-by-age signs to watch, a clear local pathway through CDSA, pediatrician referrals, and TEACCH evaluations, and an understanding of why earlier support leads to stronger outcomes. Noticing something different about your child’s development is not a reason to panic. It is a reason to ask questions and take the next step.
iCare Therapy provides in-home ABA therapy for children and young adults with autism across North Carolina. Our care coordinators help families navigate evaluations, insurance approvals, and NC Medicaid, and our BCBAs and RBTs deliver individualized therapy in the environment where your child learns best: home. If you are ready to take that first step, contact iCare Therapy to learn more about in-home ABA therapy for your child.
