Early signs of autism in children: what parents in Pakistan should look for

If you are reading this at two in the morning because something about your child has been quietly worrying you for months, you are in very good company. Almost every family who walks into The Home of Hope describes the same thing: a feeling that something was different, which they carried for a long time before they said it out loud.

This article is meant to help you think clearly about that feeling. It is not a test and it cannot tell you whether your child is autistic. What it can do is describe what the early signs actually look like, so that you can decide whether to ask someone.

First, the reassuring part

Children develop at genuinely different rates, and a child showing one or two of the things listed below is not necessarily showing anything at all. Plenty of late talkers talk. Plenty of shy children are simply shy. Plenty of children line their toys up because lining things up is satisfying.

What raises the question is a pattern: several signs together, persisting over months, across different settings and with different people. One sign in one place on one bad week is not a pattern.

Signs in the first eighteen months

The earliest signs are mostly about connection rather than about speech, which surprises many parents. Autism affects how a child shares attention with other people, and that shows up well before words would have.

• Not responding to their own name by around twelve months, when hearing has been checked and is fine.
• Not pointing at things to show you. Pointing to request something often comes first, and pointing purely to share interest is the one that matters here.
• Not bringing objects over to show you, or not looking to your face to see your reaction to something.
• Little back-and-forth in early play: no peekaboo, no copying your expressions, few reciprocal smiles.
• Limited or effortful eye contact, particularly during moments of shared attention.
• Not babbling by around twelve months, or babbling that stops.

Signs between eighteen months and three years

By this age the picture usually becomes clearer, partly because more is expected of a child socially and partly because the differences become harder to attribute to age.

• Speech that is delayed, or that developed and then faded.
• Repeating phrases from cartoons or from adults rather than using language to say their own thing. This is called echolalia and it is common in autistic children. It is communication, not meaninglessness.
• Little interest in other children, or interest that does not translate into playing with them.
• Playing with parts of toys rather than with the toys: spinning the wheels rather than pushing the car.
• Lining up, sorting or arranging objects with real intensity, and distress if the arrangement is disturbed.
• Significant distress at small changes: a different route, a different cup, a different order of doing things.
• Repetitive movements: hand-flapping, rocking, spinning, walking on tiptoes.
• Unusual reactions to sensory input: covering ears at ordinary sounds, distress at certain clothing textures, or the reverse, seeming not to notice pain and seeking out crashing and spinning.
• Very intense interest in one specific topic or object, well beyond ordinary childhood enthusiasm.

What these signs are not

There are things families in Pakistan are told constantly, and it is worth being direct about them.

Autism is not caused by vaccines. The single study that claimed a connection was found to be fraudulent and was retracted, and its author lost his licence to practise medicine. Many large studies since, across several countries, have found no link. Both the World Health Organization and the Centers for Disease Control and Prevention state this without qualification. We repeat it because the myth is still widespread here and acting on it exposes children to serious preventable illness.

It is not caused by anything you did. Not by working, not by not working, not by screen time, not by cold parenting, not by anything that happened during pregnancy, and not by the evil eye. The theory that blamed parents was abandoned by researchers decades ago and it was cruel as well as wrong.

And an autistic child who does not speak is not a child who has nothing to say, or who does not understand. Speech and intelligence are separate things. Assuming otherwise is one of the most damaging mistakes the adults around a child can make.

Should you wait and see?

You will be told to. Relatives will tell you, and often so will doctors. Sometimes they are right, and some children do catch up entirely on their own.

But consider what each choice costs if it turns out to be wrong. If you seek an assessment and your child is developing typically, you have spent one appointment and gained real peace of mind. If you wait and your child did need support, you have spent one to two of the years in which early intervention does its most striking work, and those years do not come back.

The asymmetry is not close. Ask.

What to do next

Get hearing tested first, properly. A child who cannot hear clearly cannot learn to speak clearly, and glue ear, which is fluid behind the eardrum after repeated infections, is extremely common in young children and easy to miss. This is worth ruling out before anything else, because if it is the cause, treating it changes everything.

Then write things down. Not a diary, just notes: what you noticed, when, how often. Memory becomes unreliable under stress and a professional will ask you questions you will wish you had recorded the answers to.

Then talk to someone. You do not need a diagnosis, a referral, or the right vocabulary to start a conversation with us.