Autism In A Three-Year-Old: Signs, Diagnosis, And Management

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Autism or autism spectrum disorders (ASDs) are developmental disorders that include various conditions affecting social interactions and behavioral skills in a child (1) (2). Autism in a 3-year-old could significantly impact the development of these skills. As per the World Health Organization reports, one in 160 children in the world has ASD (3). At the same time, based on the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network, the estimated prevalence of autism spectrum disorder (ASD) in the US is approximately 1 in 36 children.

There is no single, well-known cause of autism, and it might occur due to various environmental and genetic factors. However, you may notice signs of this condition in your child by the age of two or three years. Although there is no known cure for autism, the condition can be effectively managed with techniques designed to enhance the quality of the child’s life.

Explore more about the symptoms, diagnosis, and management options for autism in a three-year-old.

Signs And Symptoms Of Autism In A Three-year-old

According to the American Academy of Pediatrics (AAP), babies could display early signs of autism before their first birthday (4). The more typical signs emerge before the age of two years or by three years. The signs and symptoms of autism usually present in three domains — social skills, communication skills, and behavior.

Lack of social skills is a common sign of an autistic child at age 3. You may notice the following shortcomings in social skills (5).

• Doesn’t respond to name
• Avoids eye contact
• Does not share with others
• Plays alone
• Doesn’t take turns during activities
• No interest in socializing or inclusion with others
• Avoids physical contact with others
• Inappropriate facial expressions or no expression at all
• Not able to express feelings
• Not empathetic
• Difficult to soothe or comfort

Language and communication skills could be below the expected levels in three-year-olds with autism. You may notice the following issues (5).

• Delayed language development and speech
• Repeating words or phrases (Echolalia)
• Inappropriate answers to questions
• Repeats what others say
• Does not point at objects of interest
• Does not respond to others pointing to an object
• No gestures or body movements, such as waving hands to say goodbye
• Talks in a flat voice
• Do not pretend play
• Lack understanding of jokes or do not respond when teased
• Reverses pronouns, such as saying “I” instead of “You”

Behavioral issues are common in three-year-olds with autism. You may notice the following behavioral attributes (5).

• Line up toys or place objects in an organized way

• Become upset, frustrated or has meltdowns if there is a small change in the structure of their daily routine
• Stimming, i.e., making repetitive motions, such as spinning, flapping hands, or rocking back and forth
• Play with a specific part of an object or a toy, such as spinning the wheels of a toy car repeatedly
• May have odd routines, such as always wanting to shut the doors
• Shows obsessive interests
• Short attention span or a complete attention deficit
• Hyperactivity
• Aggression and anxiety
• Self-harming, such as self-scratching or punching
• Severe tantrums and depression
• Lack of fear in situations where it is natural and expected
• Irregular eating patterns and sleeping habits

James Guttman, a father of two, one of whom is non-verbal with autism, shares his observations of early symptoms in his son (with autism). He says, “I remember wincing as he would spin a toy on the ground and begin waving his hand above it. To relatives, friends, and outsiders, though, he was fine.”

He also emphasizes that his son’s participation in music classes was limited, “When the class would start, he would do very little in terms of participation. Kids half his size crawled over to strum the guitar while looking at their parents with a smile. My son would dart for the door or lay down on the floor with his hands cradling his head as if he was about to fall asleep (i).”

Some of these symptoms may even occur in three-year-olds who do not have ASD. However, consult a pediatrician if your child shows any of these symptoms. Many of these signs and symptoms may also occur in other conditions, such as a developmental delay. Speech delay and lack of eye contact may need more prompt care to determine the presence of hearing or vision problems. 

Difference Between Autism Symptoms In Girls And Boys

Autism symptoms can be similar in both boys and girls. However, autism is often easily identified in boys due to their behavioral and playing habits. Girls may try to mimic the language and social skills of their surroundings. Thus, it may go unnoticed in girls for more time.

Boys can be more interested in spinning parts or wheels of a toy than girls. In comparison, girls tend to arrange objects, such as toys, in a specific way. Nevertheless, both boys and girls with autism show an obsession for keeping objects in a preferred way and may throw tantrums when the order is changed (6).

Difference Between Mild And Severe Symptoms Of Autism

The severity of autism disorder may vary in each child from mild to severe. It means some children with ASD have advanced learning skills, whereas others may require assistance for daily activities.

Depending on the severity and the support required, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines three levels of autism (7).

Severity	Symptoms and signs
Level 1: Requiring support	Social interaction challenges No interest in social activities Difficult to initiate social interactions Speech or language troubles Hard to adapt to a new routine Problems to make friends Can manage independently
Level 2: Requiring substantial support	Problems adjusting to new surroundings or routine Noticeable issues with nonverbal and verbal communication skills Obvious behavioral problems Repetitive behaviors interfering with everyday life Reduced skills to interact with others Specific interests Need daily support
Level 3: Requiring very substantial support	Impairment of verbal and nonverbal communication Language and speech is limited Limited interest in socialization Extreme issues to cope with new routine or surroundings Inability to focus Obsessions and repetitive behavior Fixed interest Requires significant support for daily activities

Autism or autism spectrum disorder (ASD) are treated based on the level of severity. Children with mild ASD (level 1) may have better treatment outcomes than severe (level 3) cases. 

Autism Diagnosis In Three-year-olds

There is no specific imaging or laboratory test to diagnose autism. Observation of behaviors and developmental skills can indicate the presence of ASD in three-year-old children. Medical tests to exclude hearing and vision problems are performed before confirming the diagnosis (8).

Doctors may play and interact with the toddlers to assess them and see if they have sensory processing issues, such as difficulty with sensory integration, which often causes sensory overload. Parents may also be asked to fill questionnaires regarding their child’s behaviors and skills. After the initial evaluation, a pediatrician may refer suspected cases to specialists for detailed examination.

Management Of Autism

There is no cure for autism spectrum disorder. Thankfully, there are several therapies and intervention techniques to manage autism. These management techniques can reduce symptoms and enhance the child’s abilities, thus making them perform daily activities with minimal difficulty.

The following are the various management therapies for ASD (9).

• Applied behavior analysis (ABA) is the method to teach speech, life skills, and language to the autistic child.

• Behavioral management therapy helps reduce unwanted behaviors and reinforce good behaviors.

• Cognitive behavior therapy (CBT) helps modify the thoughts to change the child’s mood or behavior.

• School-based therapies are important for autistic children to learn about social interactions and activities.

• Nutrition therapy is recommended for autistic children with digestive issues and nutritional deficiencies.

• Joint attention therapy teaches the use of nonverbal communications, such as gaze and gestures to communicate.

• Parent-mediated therapy involves interventions that parents can teach the child. Parents are trained by experts, and they should continue to train the child at home as recommended.

• Social skills training aims to develop social skills in a structured manner.

• Occupational therapy (OT) helps children learn the skills required for performing daily activities.

• Speech and language therapy helps deal with communication difficulties and expression.

Therapies are chosen based on each child’s specific requirement since disorders, such as ADHD, may overlap with ASD in some children. Early interventions during preschool or before are shown to have positive effects. Depending on the severity of ASD, doctors may suggest special education centers with visual aids and assistive technology for children with autism.

Acquaint yourself with the initial indicators of autism through this enlightening video. Gain expertise in identifying these cues and understanding the steps toward assistance.