Signs of Autism in Children: What Minnesota Parents Should Know

Autism Spectrum Disorder (ASD) is a developmental condition that affects how children communicate, interact with others, and experience the world around them. According to the CDC's most recent data, approximately 1 in 31 children in the United States are now identified with autism — a significant increase from previous years.

As a parent, you know your child better than anyone. If something feels different about the way your child communicates, plays, or responds to the world, that instinct matters. Recognizing the signs of autism in children early is one of the most impactful things you can do for your family, because early identification opens the door to therapies and support that can make a meaningful difference in your child's development.

This guide walks you through the signs to watch for at every age, explains what the screening and diagnosis process looks like in Minnesota, and helps you understand the next steps — whether you're just starting to wonder or you've already scheduled an evaluation.

Every child develops at their own pace, and no single sign on its own means a child has autism. However, the CDC and the American Academy of Pediatrics (AAP) have identified developmental milestones and patterns that may signal autism when they appear together or persist over time. Here is what to look for at different ages:

By 9 months:

• Does not respond to their name when called
• Shows limited facial expressions (happy, sad, surprised)
• Does not engage in simple back-and-forth interactions like smiling when you smile

By 12 months:

• Uses few or no gestures — for example, does not wave bye-bye or point at things
• Little or no babbling
• Does not play simple interactive games like pat-a-cake or peek-a-boo

By 18 months:

• Does not point to show you something interesting (called "joint attention")
• Very few spoken words
• Does not notice or respond when you point at something

By 24 months:

• Does not use meaningful two-word phrases (beyond repeating or echoing)
• Does not notice when others are hurt or upset
• Shows limited interest in other children

By 36 months and beyond:

• Does not engage in pretend play (e.g., pretending to feed a doll or be a firefighter)
• Has difficulty with back-and-forth conversation
• Prefers playing alone and shows little interest in joining other children

It is also important to know that approximately 25% of children later diagnosed with autism experience a regression — they lose previously acquired words or social skills, typically between 15 and 24 months. If your child was babbling or using words and then stops, this is worth discussing with your pediatrician right away.

Beyond social communication, children with autism often display restricted or repetitive behaviors and may respond to sensory input in unexpected ways. These patterns can look different from child to child, but common signs include:

• Repetitive movements: Hand flapping, spinning, rocking, or toe-walking
• Lining up objects: Arranging toys or household items in precise rows or patterns
• Echolalia: Repeating words, phrases, or entire scripts from shows, sometimes out of context
• Intense focus on parts of objects: Fascination with spinning wheels, opening and closing doors, or flipping light switches
• Rigid routines: Strong distress when a routine is changed, even in small ways (e.g., a different route to daycare)
• Unusual sensory reactions: Covering ears at sounds that don't bother other children, avoiding certain textures of food or clothing, or seeking out intense sensory input like crashing into furniture

Not every child who lines up toys or dislikes loud sounds has autism. What clinicians look for is a pattern — multiple signs occurring together across social communication and behavior — rather than any single indicator. If you are noticing several of these behaviors alongside the social and communication signs described above, it is worth pursuing an evaluation.

For a deeper look at how autism presents in everyday life, our Understanding Autism page offers additional context on the spectrum and how each child's experience is unique.

Autism is diagnosed in boys nearly four times more often than in girls — but researchers increasingly believe this gap reflects diagnostic bias, not actual prevalence. Many girls with autism present differently than boys, which can lead to later diagnosis or being missed entirely.

Girls with autism are more likely to:

• Mask or camouflage their differences by imitating the social behavior of peers
• Have intense but socially acceptable interests (e.g., animals, art, or books) rather than the more "stereotypical" focused interests associated with autism
• Appear socially engaged on the surface but struggle significantly with deeper friendships and understanding unwritten social rules
• Internalize their struggles, presenting with anxiety or withdrawal rather than the visible behavioral challenges more commonly flagged in boys

If your daughter seems to be working very hard to fit in socially, has meltdowns at home after "holding it together" at school, or struggles with friendships despite appearing outgoing, these can be signs worth exploring with a specialist. Advocacy for evaluation is especially important for girls, because the standard screening tools were largely developed based on how autism presents in boys.

If you have noticed signs of autism in your child, the next step is a professional evaluation. In Minnesota, families have several pathways to get their child screened and diagnosed.

Pediatric screening: The AAP recommends that all children receive autism-specific screening at 18 and 24 months, in addition to general developmental screening at 9, 18, and 30 months. The most commonly used screening tool is the M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised). Ask your pediatrician about these screenings — they are brief, free, and can catch early signs before they become more apparent.

Help Me Grow MN: Minnesota's Help Me Grow program connects families of children from birth to age 5 with free developmental screenings and evaluations. You can self-refer by calling 1-866-693-4769 or submitting a referral online. Services are free regardless of income or immigration status.

School district evaluations: Your local school district is required to provide free developmental evaluations for children of any age. These educational evaluations can qualify your child for special education services, though they are separate from a medical diagnosis.

Diagnostic evaluation: A formal medical diagnosis is typically conducted by a developmental pediatrician, psychologist, or neuropsychologist. In Minnesota, programs like Children's Minnesota Developmental Pediatrics and the University of Minnesota Autism and Neurodevelopment Clinic offer comprehensive evaluations. Wait times can range from a few weeks to several months, so starting the referral process early is important.

CMDE for EIDBI services: If your child is enrolled in Medical Assistance or another Minnesota Health Care Program, a Comprehensive Multi-Disciplinary Evaluation (CMDE) determines eligibility for EIDBI-funded services including ABA therapy. The Minnesota Autism Resource Portal can help you find CMDE providers in your area.

Waiting and wondering can be one of the hardest parts. If you are seeing signs that worry you, here is a clear path forward:

1. Trust your instincts. You do not need to have all the answers or be certain. If something feels off, that is reason enough to ask questions.
2. Talk to your pediatrician. Bring specific observations — what you have noticed, when it started, and how often it happens. Writing it down before the appointment can help.
3. Request a developmental screening. If your child has not had an autism-specific screening at 18 or 24 months, ask for one. You can also contact Help Me Grow MN directly.
4. Pursue an evaluation. Whether through your pediatrician, a specialist, or your school district, a formal evaluation is the only way to confirm or rule out autism.
5. Do not wait for a diagnosis to seek support. Many early intervention services in Minnesota are available to children with developmental concerns, even before a formal diagnosis is in place.

It is natural to feel a mix of emotions — concern, fear, even grief. Those feelings are valid. But it is also important to know that an autism diagnosis is not a limitation. It is the key that unlocks access to evidence-based therapies like ABA therapy and state-funded programs like EIDBI that are specifically designed to help your child build skills, confidence, and independence.

If you are unsure where to start, reach out to our team at Dakota Autism Center. We help Minnesota families navigate the evaluation process, verify insurance and Medicaid eligibility, and connect with the right services — at no cost to you.

Research consistently shows that children who receive early intervention for autism have significantly better outcomes in communication, social skills, and adaptive behavior compared to children who begin services later. The brain is most adaptable in the first few years of life, which means early therapeutic support can shape developmental pathways during a critical window.

According to the CDC, autism can be reliably diagnosed by age 2 by an experienced specialist — yet the median age of diagnosis in the United States is still around 4 years old. That gap represents years of potential intervention that many children miss.

In Minnesota, families have access to strong EIDBI-funded early intervention programs that provide intensive, evidence-based therapy — including ABA — at no cost for children enrolled in Medical Assistance. These programs are specifically designed to address the core developmental areas affected by autism: communication, social interaction, adaptive skills, and behavioral regulation.

Starting early does not mean rushing. It means giving your child the tools and support they need during the period when those tools can have the greatest impact. Even if your child is older, intervention at any age is beneficial — but the earlier you begin, the more time your child has to build the foundation skills that will support them throughout their life.

One of the reasons autism can be challenging to identify is that its signs often overlap with other developmental conditions. Understanding these differences can help you have more productive conversations with your child's care team.

Autism vs. ADHD: Both conditions can involve difficulty with focus, social challenges, and sensory sensitivities. Children with ADHD typically seek social interaction but struggle to regulate their behavior, while children with autism may have less interest in social engagement or difficulty reading social cues. Many children have both — studies suggest that 30-50% of autistic children also meet criteria for ADHD.

Autism vs. speech delay: A child with a speech delay may communicate effectively through gestures, facial expressions, and eye contact even though their words are delayed. A child with autism is more likely to have broader communication differences — limited gesturing, reduced eye contact, and difficulty with the back-and-forth flow of interaction.

Autism vs. anxiety: Social withdrawal in children can stem from anxiety rather than autism. However, autistic children may also develop anxiety as a secondary condition, especially if they are working hard to mask their differences in social settings.

A comprehensive evaluation by a qualified professional is the best way to distinguish between these conditions and identify any co-occurring diagnoses. The goal is not to "label" your child but to understand their unique profile so that support can be tailored specifically to their needs. For more on how insurance and funding work for these evaluations in Minnesota, visit our funding guide.