Autism in children: early signs, assessment and support

The NHS says autism, also called autism spectrum disorder, affects how a person communicates with and understands others, and how they think, learn and pay attention, and respond to light, sounds, smells, tastes and touch. Some autistic people have a learning disability and some have average or above average intelligence. The National Autistic Society says it is a lifelong neurodivergence and disability, and that the spectrum does not mean a line from more to less autistic: each autistic person has a unique combination of characteristics.

Autistic people are more likely to have conditions such as epilepsy, anxiety, eating disorders or depression, and ADHD is more common, according to the NHS. The National Autistic Society says autism is not itself a learning disability or a mental health condition, though around a third of autistic people also have a learning disability.

The NHS says signs might be noticed at a very young age, or not until later, and that every autistic child is different. In communication, autistic children may:

• start to speak later or take longer to understand what others say

• not respond to their name, or use few words or single words

• speak in a flat or different tone, or repeat words and phrases

• talk a lot about things that interest them, or at other people without listening

• use less eye contact, and fewer facial expressions and gestures

The NHS says autistic children may find it hard to join in play with other children, may not take part in pretend play, enjoy repetitive actions such as opening and closing doors, and do repetitive movements called stimming, such as rocking, spinning or hand flapping. They may have very strong interests and be worried or upset by changes in routine or new situations.

Sensory differences include reacting very strongly, or not at all, to lights, sounds, smells, tastes or textures, disliking bright or noisy rooms or certain clothes, only eating certain foods or in a certain way, and finding it hard to describe feelings such as hunger, pain or anger.

The NHS says some signs can be harder to see in girls because of masking, which means not showing the signs; autistic girls may copy how other children behave and play, be quiet in difficult situations, appear to cope socially, show fewer repetitive behaviours than boys and be more likely to have anxiety, depression or an eating disorder. Autistic boys can mask too. Masking can make everyday activities feel exhausting.

Older children and young people may have few close friends, say or do things that seem rude, use advanced vocabulary and a formal way of speaking, take things literally or not understand sarcasm, need rules followed, and find transitions such as moving from primary to secondary school difficult.

The NHS says to speak to a GP, who can often refer children to a local autism team. For children the school may need to make the referral, and for pre-school children a health visitor may. You can also speak to a school's SENCO. If a referral is accepted, the NHS says it can take a few months or longer, and a GP or education professional can tell you what support is available while you wait.

The NHS says a child may have one or more appointments with a team of professionals who ask about development, such as when the child started talking, medical history, observe how the child plays and communicates, look for conditions that commonly occur with autism such as ADHD or epilepsy, read reports from the GP, nursery or school and may visit the school. After the assessment, a report should say whether the child is autistic, what they are good at, what they may need help with and whether other conditions were found.

In England the NHS says you can choose which NHS service carries out the assessment, known as Right to Choose, and may find a clinic with shorter waiting times. If you disagree with the result, the NHS suggests asking the assessment team why, and asking the GP or team to refer you to another team for a second opinion, or paying for another assessment from a professional outside the NHS. The NHS says that sometimes a child may be asked to wait until they are a bit older for reassessment because the signs may not yet be clear.

The NHS says a diagnosis may come with a care plan or information, including any support parents, family or carers might need. The National Autistic Society says disability is a protected characteristic in UK law, so autistic people have legal protection from discrimination and are entitled to the support they need in education, at work and in accessing services. The charity also points out that most autistic people see being autistic as central to who they are and that the barriers society creates are the issue, not being autistic.