Signs and characteristics

Core characteristics of Autism Spectrum Disorder (ASD) include:

• Differences in social interaction and communication
• Restricted, repetitive patterns of behavior, interests or activities.

These characteristics typically appear early on in development (18 to 24 months), often before children enter grade school, but may not become fully noticeable until social demands increase (24 months to 6 years). See below for additional signs and characteristics.

Social interaction and communication

• Differences in interacting with other people and making or maintaining relationships
• Differences with back-and-forth conversation
• Differences using eye contact, gestures, facial expressions, and body language
• Differences reading social cues
• Limited meaningful or functional communication

Restricted, repetitive behaviors

• Differences in speech patterns (ex: saying the same things over and over in exactly the same way)
• Repeating behaviors like hand-flapping, rocking, jumping, or twirling
• Insistence on specific routines/strong resistance to minor changes
• Sensitivity to light, touch, and sound
• Strong interests in certain areas or objects
• Unusual interest in looking closely at objects, touching, smelling, or tasting objects

In very young children, the first characteristic of autism may include:

• Limited demonstration of emotions, eye contact, or gestures like waving or pointing
• No or inconsistent response to name
• Limited interest in sharing or playing with others
• Loss of speech
• Delayed speech and/or no social babbling

For more information, see Screening and Identification.

Autistic characteristics or traits must be present in early childhood. These traits may not become fully noticeable or impact daily life until social demands increase later in life. Therefore, even though ASD may be identified as early as 18 to 24 months of age, a person may receive a diagnosis at any age.

Autism is a lifelong diagnosis. It does not go away or develop over time. Therefore, a person is never too old to receive a diagnosis, but the traits must have been observed in early childhood. Relying on parent/ guardian report or childhood memories could help someone identify if they are autistic.

People on the spectrum may experience a range of abilities and characteristics. Some people may have very noticeable characteristics, others may not. Some people may require supports and accommodations and others may not. In order to qualify for a clinical diagnosis, characteristics must significantly impact daily life and functioning.

Many people with autism may also experience co-occurring conditions, such as ADHD, anxiety, depression or sleep disorders. These factors, as well as age, cognitive ability, adaptive skills, communication abilities and sensory support needs may impact the level of support needed and the types of services a person may choose to access.

Autism spectrum disorder (ASD) has no single known cause. We have learned that ASD involves environmental and/or genetic factors that result in biological and/or neurological differences in the brains of people with ASD. ASD is reported to occur in all racial, ethnic, and socioeconomic groups. Children who have a sibling with ASD are more likely to have ASD. ASD is more than 4 times more common among boys than girls.

Psychological influences, such as parenting, do not cause ASD. Currently no medical tests diagnose or reveal the cause of ASD. Some people have concerns that ASD might be linked to the vaccines children receive, but studies have shown that there is no link between receiving vaccines and developing ASD. Visit CDC: Autism and Vaccines and MN Department of Health: COVID-19 Vaccines for more information.

Research shows that certain early intervention treatment strategies can improve a child’s development and manage interfering behaviors. The earlier treatment and intervention begins, the more effective the outcomes. That’s why it’s important to identify signs and symptoms early.

The Early Intensive Developmental and Behavioral Intervention (EIDBI) is a Minnesota Health Care Program for children, youth and young adults up to age 21 with autism or related conditions. The benefit provides behavioral and developmental intervention services to manage challenging behaviors and teach functional social and communication skills. Services promote a person’s independence and participation in home, school and community life. Contact a Comprehensive Multi-Disciplinary Evaluation (CMDE) provider to determine eligibility and medical necessity for EIDBI services. Search the Minnesota Health Care Program (MHCP) Provider Directory by selecting “Autism-EIDBI” and then “CMDE” as the sub-type.

Boys are four times more common to be diagnosed with autism than girls. Several factors may cause girls to be misdiagnosed or undiagnosed until much later in life, missing or delaying opportunities for early intervention services and supports. This can lead to girls internalizing their symptoms, which often leads to more anxiety or mental health concerns.

Autism presents itself differently in each person. Common misconceptions or stereotypes may lead girls to go undiagnosed. Examples include:

• Stereotypes about typical male and female behaviors. For example, people may think that girls are naturally quieter or prefer to spend time alone, compared to boys demonstrating these behaviors.
• The misconception that communication and social differences must be significant in order to meet the diagnostic criteria.
• Anxiety, depression, personality disorders and other mental health conditions can all share characteristics with autism, which may cause a professional to misdiagnose it.

Signs of autism for girls:

• May rely on others (usually other girls) to guide them and speak for them throughout the day. May find it difficult to join conversations, initiate or respond quickly to social situations.
• May have "passionate" and limited interests that are very specific and restricted. For example, while many girls may be fans of a particular TV show, a girl with autism may collect information and talk about the characters, locations, props, or actors, but know little or nothing about the plot or storyline of the show.
• May have a flat affect or be overly expressive. May speak with a high pitch voice or unusual intonation.
• Conversations may be restricted to her topics of interest. She may share her opinions and interests, but have no interest in hearing another person's response. This may interfere with her ability to join groups or make friends.

Recommendations

• Listen to what your daughter is going through. Also, look for subtle clues in her body language and behavior.
• Therapists can help girls with co-occurring conditions, such as anxiety and depression. Girls with obsessive-compulsive disorder (OCD), eating disorders, or who have experienced trauma, may need specialists on their team. Therapists may help them build resiliency, improve self-esteem and develop effective coping strategies.
• Find a support group of like-minded people who are experiencing similar things.
• Do your research and speak to your doctor, therapist, counselor, or another health professional. Trust your intuition. Visit Healthcare and wellness to connect to health care services.

Visit Screening and Identification for information on scheduling an evaluation.

Setting: Have the conversation in person if you can, in a private, quiet space.

Timing: Allow at least 15–20 minutes so that you are not rushed.

1. Start with warmth and connection: Make sure there is already a foundation of trust. Share regular updates—both strengths and concerns—so that updates on developmental milestones doesn’t come out of the blue.
   “Thank you for taking a few minutes to talk today. I really enjoy having [child’s name] in our class—he brings such a unique energy, and we love getting to know him.”
2. Highlight the child’s strengths: Begin with sharing what the child does well. This shows the parent the child is seen as a whole person and not just as a list of concerns.
   “One of the things I really appreciate about [child’s name] is how curious he is about [example: puzzles, books, exploring outdoors]. He’s very focused when he’s engaged in something he enjoys.”
3. Introduce observations gently: Explain how these observations compare to typical developmental milestones gently.
   “Along with those great things we’re seeing, I’ve also noticed a few areas where [child’s name] might benefit from a little extra support. I wanted to share those with you, since we both care about helping him thrive.”
4. Share specific, objective observations: avoid labels or assumptions. Describe what you are seeing using neutral language.
   “For example, I’ve noticed that he doesn’t always respond when his name is called, and he tends to play on his own rather than with other kids. During group activities, he seems most comfortable repeating phrases or actions instead of using his own words or gestures to communicate.”
5. Relate to developmental expectations: Explain how these observations relate to typical developmental milestones.
   “At this age, most children are starting to use more back-and-forth communication—like gestures, short sentences, and social play. Every child grows differently, of course, but it’s helpful to notice when some milestones aren’t quite lining up yet.”
6. Invite the parent’s perspective: Frame it as a shared effort to support the child—not a final diagnosis.
   “I’d love to hear what you’re seeing at home—sometimes children show different things in different environments. Have you noticed anything similar, or anything that feels concerning to you?”
7. Offer next steps and support: Come prepared with support options, like early intervention contacts or developmental milestone tracking tools.
   “It might be helpful to connect with an early childhood specialist who can do a more in-depth look at how [child’s name] is developing. This doesn’t mean anything is wrong—it just helps us make sure we’re giving him all the support he may need.”
   “If you’re open to it, I can help you get in touch with [Early Intervention program or screening resource]. They’re wonderful at walking families through the process.”
8. Reassure and stay supportive: Parents may be overwhelmed, defensive or emotional. Give them space and offer to continue the conversation later.
   “We’ll continue to support [child’s name] here with care and encouragement every day. We really value our partnership with you and want to keep working together to help him grow in the best way possible.”