I’d say yes of course you can tell if a child is autistic before 2 years old. You absolutely can. It will depend upon the presenting needs of the child, of course. But if you believe that all children are born autistic, as I do, and understand that it’s going to (typically) show itself with developmental delays and differences, why is it still a strange concept to believe that seeing signs before the age of 2 can be evident?
“Can you tell a child is autistic before 2 years old?”
We still live in a time, where people want to poo-poo your concerns around what you are seeing with your child and especially when the subject of neurodiversity is raised. We get dismissive or gaslighting comments about “labeling”, and that we are “all a bit autistic”. And the old chestnut- “but all kids do that”. None of these comments are accurate, or true. A diagnosis supports for one thing against the labels comment- and without a diagnosis, they will also be labelled. Likely, labelled badly.It does seem that the majority of society need to catch up, in order to support others raising concerns that their child may need additional support. I’m here to say, if you are asking “Can you tell if a child is autistic before 2 years old?” my answer is very much, yes you can (with some caveats- like presenting needs.).
In this post, I’ll be talking specifically about how and why we knew LM was autistic, much before 2, to try and give other parents the confidence to pursue diagnoses if they think one is due. I can’t go into full details, as honestly we would need a book! But here is a rough overview of how things played out for him and for us.
How it all started
From 3/4 months old, I expected things to settle a bit for us. LM had had colic and extremely low sleep needs in those first few weeks. In the first few weeks, where standard baby books will tell you the child should sleep 14-17 hours, he slept 6 hours. 6 including naps. So he was already demonstrating extremes. I began googling for answers at 4 months, with prolonged periods of crying, wanting to be held all the time, extremely low pain threshold (was teething, but Calpol also appeared to do nothing for this and we were fraught). I decided he was simply highly sensitive at this point. In relation to the sleep, I did a course on “Orchid” or highly sensitive babies. It was lovely, but it didn’t help.
From 5 months, I was starting to become aware of extreme reactions to sensory aspects. Wind. Rain. Bathing. Clothing. Extreme reactions in social settings. Wouldn’t let anyone else hold him, didn’t always like others getting too close and would cry, and when I would meet other new mums for the first/second time with him, he would cry hysterically and I would literally run off down the streets, stressed, to get home. Only to arrive, whip out the paracetomol, and before giving it, he’d be content and relaxed again, smiling away! It was full on. I always said, LM behaved like a toddler as a baby! I was 38 when he was born, had at the drop of a hat held and looked after family and friends babies and I hadn’t seen this presentation before. Regarding these extreme reactions to sensory processing, at a very young age, they certainly played into us asking can you tell if a child is autistic before the age of 2 years old. 95% of autistic individuals have sensory processing difficulties. Intensity, frequency, duration: as usual, we are talking about different levels when talking with parents of neurotypical children.
At 6 months, he started waking in double digits, sometimes and often up to 20 times a night. He’d do rounds of waking every 15 minutes. He would take at least 2 hours of rocking before being able to sleep. And then often wake 15 minutes later, could be 30, but guaranteed at the 45 minute point. You would need to start the whole process over again. The double digit wakes continued until 2.5 years. Until 3, he was waking 6/7/8 times a night. And his difficulties with the pram- he fell asleep for the first time in the pram, age 2. It took a few more months before this started becoming consistent. Before then, if you were out when he was ready to nap (and this was all over the place because of the nights, you never knew when it would come) you were in trouble if this came when walking home for example. He wouldn’t be soothed by milk, or drop off however exhausted he must have been: he simply screamed and screamed until he was rocked. This showed a significant need for vestibular input. We just didn’t know that then.
Our first GP’s response
I spoke to our first GP practice by 8 months, regarding his sleep. The GP said we just had a bad sleeper. I went back to the same GP, to discuss missed milestones age 1. The GP said we should wait until 2 years before pursuing anything, that some children were just slow to catch up. You don’t need to wait until 2 to see someone if you are asking can you tell if a child is autistic before 2 years old and thinking that you are seeing signs. This GP just didn’t want to know. He gave me support groups for managing with poor sleep etc, but I never contacted them. The sleep really was a crisis for us, but we were struggling with many other aspects I knew also weren’t standard and could mean something like autism.
How starting at nursery would help us
The pinnacle moment for us came when LM started nursery age 15 months. We applied and did the starting process with baited breath. LM would follow me at home from room to room crying until 2.5 years and did not like other people holding him as mentioned. He also had to be rocked to sleep, whereas peers were telling us that their kids could be put down, with milk and parent time, but then drop off. We were really worried the nursery would say they couldn’t manage with all the extra support he needed. It took time, but they did. And at 17 months, when the nursery manager was telling me about LM’s tip toe walking, I seized the opportunity to share some of my concerns too. Concerns that the main society it feels, want to tell you aren’t true. Tip top walking- yes. Not responding to name. Not smiling at strangers. Following me at home crying. Struggling with transitions and changes- especially arriving to or leaving home. As well as the missed milestones on the Health Visitor form: no pointing. No waving etc etc. Speech delays and evidently not able to understand us. We were still deep within double digit wakes at this point and really struggling generally. Can you tell if a child is autistic before 2 years old? Luckily, the nursery manager indicated so. She agreed she’d refer LM onto their SENCO. And we discussed me switching GPs to try another attempt at a Paediatric referral.
Seeing the Paediatrician and getting a diagnosis
As soon as I switched GP practices, I got a new GP who instantly believed us and sent off a Paediatric referral based on LM’s missed milestones, the differences I had observed, and his sleep. Huge relief. We were seen in May 2022 when LM was 2. We received an unofficial diagnosis then. And I cried- with relief, but simply for being believed too. We took away melatonin for the sleep that day. And started our trajectory of potential supports and therapies. I was so glad for LM and for us. We were finally being heard. From being first referred to the Paediatrician, to the point of assessment and official diagnosis, it took 14 months and LM received his official diagnosis age 2 and 3/4, in March 2022. This would have been quicker had there not been some communication delays with the nursery.
How things are now
LM is now 3.5 years old. LM goes to bed often really late- approaching midnight, but largely sleeps- there may sometimes just be 1/2 wakes. There are still the split nights and super lates to bed. He is having Occupational therapy and further Speech and Language Therapies and we are on the waiting list for Physiotherapy. Once a week, he has a specialist worker once a week at nursery, and the amazing SENCO linked to the nursery, who’s always discussing courses and funding available to us. We don’t yet have an EHCP, but all of this information means when he starts school we are in a fantastic prime position to advocate for his needs. And I am careful to not let other people tell us this is the same as every child: it can’t be, it isn’t. I politely push back on generalising statements, thinking that if we don’t push back on people, our kids will hear the same kinds of platitudes that we have been listening to.
How can I explain to others, that my child’s autistic traits aren’t “the same as every other child?”
Autism which you’ll likely know if you are reading this, is generally assessed in the areas of speech and language (this isn’t just delays, someone can have very advanced speech and language for their age), social communication, rigid behaviors, and sensory processing difficulties. It, for many children but not all (especially girls who can really differ from this) can be characterised by developmental delays and neurological differences. As much as no neurotypical child is the same as another, we also know what standard development looks like. If your child is experiencing significant development delays, how can anyone compare that if they are not experiencing it?
Intention, frequency, duration, and reason for behaviour. If you are talking about your child being potentially autistic, these are the factors that come into it. We have had some parallels with sleep with parents of neurotypical children, though still typically not to the same levels or the same amount of time. And development wise, though every autistic child is of course totally different, we relate much more to autistic children generally, because across all elements of development, LM follows an autistic pattern and not a neurotypical one. He is doing so well.
The National Institute of Child Health and Human Development (NIH- November 2023) https://www.nichd.nih.gov/health/topics/autism/conditioninfo/symptoms-appear state that:
The behavioral symptoms of autism spectrum disorder (ASD) often appear early in development.1 Many children show symptoms of autism by 12 months to 18 months of age or earlier.2,3 Some early signs of autism include:4,5,6
- Problems with eye contact
- No response to his or her name
- Problems following another person’s gaze or pointed finger to an object (or “joint attention”)
- Poor skills in pretend play and imitation
- Problems with nonverbal communication
Many parents are not aware of these “early” signs of autism and don’t start thinking about autism until their children do not start talking at a typical age. (I’d wager also that some kids don’t present overtly, and in other circumstances many parents are gaslit by “well meaning” society, wanting to tell them we all have exactly the same challenges, which makes them hold back).
If you are reading this and thinking that any of it resonates, no you are very likely not crazy! You just need someone to believe you. For us, LM being within a nursery setting to back up our concerns really helped. Switching GPs to get someone who wasn’t instantly dismissive, really helped. I had low confidence during these initial processes, mostly because socially it feels that everyone wants to tell you what you are seeing isn’t true. I now know what’s what and have learned so much more about my child and neurodiversity along the way.
So if you are asking, “Can I tell my child is autistic before 2 years old”, I hope this clarifies and gives you more confidence that what you are thinking could certainly be correct.
If you have an autistic child, does any of this feel true for you?
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