Curated by Claudia Shannon / Research Scientist / ishonest

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders that affect the brain.

Autistic children learn, think, and experience the world differently than other children. They can face varying degrees of socialization, communication, and behavioral challenges.

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Some autistic children don’t need much support, while others will need daily support throughout their lives.

Signs of autism in 4-year-old children should be evaluated immediately. The earlier a child receives support, the better their outlook.

While signs of autism can sometimes be observed in children as young as 12 months old, most autistic children receive a diagnosis after the age of 3 years old.

What are the signs of autism in a 4-year-old?

Most signs of autism become more apparent as children age.

Social skills

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An autistic child who needs more support in social situations may exhibit some of the following signs:

• does not respond to their own name
• avoids eye contact
• prefers playing alone over playing with others
• does not share well with others or take turns
• does not participate in pretend play
• does not tell stories
• is not interested in interacting with or socializing with others
• does not like or actively avoids physical contact
• is not interested in making or does not know how to make friends
• does not make facial expressions or makes inappropriate expressions
• cannot be easily soothed or comforted
• has difficulty understanding other people’s feelings
• has difficulty expressing or talking about their own feelings

Language and communication skills

An autistic child who needs more support in developing language and communication skills may exhibit some of these signs:

• cannot form sentences
• repeats words or phrases over and over
• does not answer questions appropriately or follow directions
• does not understand counting or time
• reverses pronouns (for example, says “you” instead of “I”)
• rarely or never uses gestures or body language such as waving or pointing
• talks in a flat or singsong voice
• does not understand jokes, sarcasm, or teasing

Repetitive or restrictive behaviors

An autistic child who has adopted certain repetitive or restrictive behaviors may exhibit some of these signs:

• performs repetitive motions, such as flapping their hands, rocking back and forth, or spinning
• persistently or repeatedly lines up toys or other objects in an organized fashion
• gets upset or frustrated by small changes in their daily routine
• has to follow certain routines
• plays with toys the same way every time
• likes certain parts of objects (often wheels or spinning parts)
• has obsessive interests

Other signs of autism in 4-year-olds

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These signs are usually accompanied by some of the other signs listed above:

• hyperactivity or a short attention span
• impulsivity
• aggression
• self-injury, which may include punching or scratching
• temper tantrums
• unusual reactions to sounds, smells, tastes, sights, or textures
• irregular eating and sleeping habits
• inappropriate emotional reactions
• showing a lack of fear or more fear than expected

What does it mean to be on the spectrum?

ASD encompasses a broad range of signs and symptoms. An autistic child may need minimal support in some aspects of their life and more significant support in other aspects.

An autistic child who needs minimal support may have:

• little interest in social interactions or social activities
• difficulty initiating social interactions or maintaining conversations
• trouble with appropriate communication (such as volume or tone of speech, reading body language, or social cues)
• trouble adapting to changes in routine or behavior
• difficulty making friends

An autistic child who needs a moderate amount of support, or who needs daily support, may have:

• difficulty coping with a change to their routine or surroundings
• a significant lack of verbal and nonverbal communication skills
• severe and obvious behavioral challenges
• repetitive behaviors that interfere with their daily life
• an unusual or a reduced ability to communicate or interact with others
• narrow, specific interests

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An autistic child who needs significant support on a daily basis may:

• have nonverbal or significant verbal impairment
• have a limited ability to communicate, only when requires needs to be met
• have a very limited desire to engage socially or participate in social interactions
• have extreme difficulty coping with unexpected changes to their routine or environment
• have great distress or difficulty changing their focus or redirecting their attention
• have fixed interests or obsessions that cause significant impairment
• exhibit repetitive or restrictive behaviors that cause significant impairment

How is autism diagnosed?

Doctors diagnose children as autistic by observing them at play and interacting with others.

There are specific developmental milestones that most children reach by the time they’re 4 years old, such as having a conversation or telling a story.

If your 4-year-old has signs of autism, your doctor may refer you to a specialist for a more thorough examination. A specialist will observe your child while they play, learn, and communicate. They’ll also interview you about behaviors you’ve noticed at home and may request input from your child’s teachers or other adults who interact with your child.

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While the ideal age to diagnose and treat the symptoms of autism is 3 years old or younger, the sooner your child receives support, the better.

Under the Individuals with Disabilities Education Act (IDEA), all states and Washington, D. C., are required to provide an adequate education to school-age children with developmental issues. Contact your local school district to find out what resources are available for preschool-age children in your area.

Autism questionnaire

The Modified Checklist for Autism in Toddlers (M-CHAT) is a tool that doctors, parents, and caregivers can use to screen children to help determine if they may be autistic.

This questionnaire is typically used to screen toddlers up to 2.5 years old, but it may still be helpful for children up to 4 years old. It doesn’t offer a diagnosis, but it may give you an idea of where your child stands.

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If your child’s score suggests they may be autistic, visit their doctor or an autism specialist. The doctor or specialist can confirm a diagnosis.

Keep in mind that this questionnaire is often used for younger children. Even if the questionnaire results suggest that your 4-year-old is neurotypical, they may still be autistic or have another developmental disorder. It’s best to take them to a doctor.

What are the next steps?

Signs of autism are usually evident by 4 years old. If you’ve noticed signs of autism in your child, it’s important to talk with their doctor to get them screened as soon as possible.

You can start by going to their pediatrician to explain your concerns. The pediatrician can give you a referral to a specialist in your area.

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Specialists who can diagnose autism in children include:

• developmental pediatricians
• child neurologists
• child psychologists
• child psychiatrists

If your child receives an autism diagnosis, you will get support immediately. You’ll work with their doctors and school district to map out a plan that supports them and helps them thrive.

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