As occupational therapists at Red Door Pediatric Therapy, we often identify early sensory, motor, play, and self‑regulation patterns that can signal autism. Below is an age‑ordered, clinically informed list of common signs seen from birth through age 5, referral thresholds, and practical strategies for caregivers and medical providers.
Birth to 6 Months:
- Poor state regulation: prolonged fussiness, difficulty settling, or
extreme sleep/wake disruptions. - Hypo‑ or hyper‑responsivity to sensory input (overreacts to touch or avoids being held;
little response to sound or touch). - Limited spontaneous reaching or decreased interest in hands/hand regard.
- Low engagement in reciprocal movement/play (minimal visual tracking,
limited social smiling). - Atypical muscle tone (very floppy or unusually stiff) affecting positional comfort.
6 to 12 Months:
- Limited orientation to social stimuli (doesn’t turn toward caregiver voice
or name consistently). - Atypical mouthing patterns (excessive mouthing beyond expected age
or aversion to mouthing). - Reduced exploratory play with toys — less varied manipulation, banging,
or mouthing. - Difficulty with transitional movements (rolling, sitting) or asymmetrical
movement patterns. - Unusual sensory-seeking (spinning, flapping, intense interest in certain textures)
or sensory-avoidant behaviors (pulling away from touch, refusing certain clothes).
12 to 18 Months:
- Delayed motor milestones (late independent sitting, crawling, standing, or
inconsistent walking). - Limited imitation of simple actions or gestures during play.
- Restricted play repertoire — preferring parts of toys (wheels, doors) rather than functionally using toys.
- Strong sensory preferences or aversions (extreme picky eating textures, refusal
of messy play). - Difficulty with joint attention during play — does not point to share interest or
follow gestures.
18 to 24 Months:
- Poor bilateral coordination (difficulty clapping, banging two objects together, using both
hands together). - Persistent oral motor differences impacting eating and vocal play (chewing patterns,
gagging, limited variety of textures). - Repetitive motor movements (hand flapping, finger flicking, body rocking) that interfere
with play or learning. - Limited pretend play or symbolic play development.
- Difficulty with transitions and changes in routine; strong preference for sameness.
2 to 3 Years:
- Motor planning and praxis difficulties: trouble imitating multi‑step actions,
poor sequencing in self‑care tasks (dressing, feeding). - Poor postural control and endurance affecting sitting tolerance and participation in
group activities. - Fine motor delays (difficulty with pincer grasp, stacking blocks, scribbling) affecting
ability to engage in age‑appropriate play and pre‑writing tasks. - Significant sensory modulation issues: extreme over‑ or under‑responsiveness to sounds,
lights, touch, or movement that limit participation. - Narrow, repetitive play themes with limited progression to varied play schemes.
3 to 5 Years:
- Persistent deficits in motor coordination affecting playground skills (climbing, catching,
hopping) and peer play. - Difficulty with self‑care independence: prolonged delays in feeding, dressing, toileting
routines due to motor, sensory, or behavioral barriers. - Limited social play skills tied to motor and sensory differences (avoids group physical play,
poor turn‑taking with toys). - Continued stereotyped or repetitive movements that interfere with functional tasks.
- Difficulty with attention and arousal regulation in classroom-like settings — may appear
withdrawn or overly active.
Cross‑Age Red Flags
- Marked difficulties with sensory processing and modulation that limit daily function.
- Persistent deficits in motor planning/praxis and imitation across settings.
- Play that is restricted to parts of toys, repetitive actions, or lacks symbolic/pretend elements.
- Significant challenges with transitions, routines, and adaptability.
- Regression or loss of previously acquired motor, feeding, or play skills.
When to Refer
- Early: lack of social engagement, extreme sensory over/under‑responsiveness, or failure
to meet gross motor milestones (rolling, sitting, independent walking) warrants
OT evaluation. - By 12–18 months: limited functional play, poor imitation, or feeding concerns (refusal
of textures, choking) should prompt referral. - Any age: repetitive motor behaviors that limit participation, significant self‑care delays,
or regression of skills require interdisciplinary assessment (OT, SLP, developmental
pediatrics/psychology).
Practical Suggestions for Caregivers and Providers
- Provide predictable routines with gradual, supported transitions; use visual schedules
and countdowns. - Offer sensory‑based coping strategies: heavy work activities (pushing, carrying),
deep pressure, and proprioceptive input to support regulation—introduced by an
OT with individualized planning. - Scaffold play: model simple pretend play actions, expand children’s play scripts, and
pair movement with social interaction. - Adapt environments to reduce sensory overload (dim lighting, minimize auditory clutter)
and provide safe opportunities for sensory seeking. - Address feeding through graded exposure to textures with OT and SLP collaboration when
oral motor or sensory feeding concerns exist. - Refer early for interdisciplinary evaluation when multiple red flags across domains
are present.
Red Door Pediatric Therapy’s occupational therapy teams assess sensory processing, motor development, play, and daily living skills and partner with SLPs, pediatricians, and developmental specialists for comprehensive evaluation and intervention planning. We can create a printable, age‑based checklist or parent handout tailored to your clinic if helpful.