Early signs of autism in Singapore: what to look for and where to go

Most early signs of autism show in how your toddler connects with you. Does your child look at you, turn when you call their name, point at things and wave bye-bye? KKH says signs can be noticed from as young as 12 months. In Singapore your polyclinic, GP or paediatrician is the first stop, and they can refer your child to KKH or NUH for an assessment. Signs are a reason to ask a doctor, and only an assessment can tell you whether it's autism.

What to do if you notice these signs, step by step

1. Write down what you've noticed, including when it started, how often it happens and how long it has gone on, as KKH suggests. Short phone videos help, and NUH asks parents to look through older videos too.
2. Fill in the developmental checklist in the Child Health Booklet, which HealthHub says should be done before each well-baby visit (pages 5 to 28). Our child health screening guide lists every check, and the milestone tracker helps in between.
3. Try the M-CHAT-R/F, a parent checklist for children aged 16 to 30 months that KKH links on its autism page. If the result is negative and you're still worried, KKH says to keep asking your child's doctor.
4. Book a visit with your polyclinic, GP or paediatrician instead of waiting for the next scheduled check, since NUH says to tell a healthcare professional as soon as possible.
5. Ask the doctor for a referral to KKH's Department of Child Development or NUH's Child Development Unit, which KKH says take children aged 6 and below or not yet in Primary 1.
6. Expect a hearing test with an audiologist, which NUH says doctors may order so that hearing loss can be ruled out as the main reason.
7. Plan for 3 to 4 hours of assessment over about three sessions, which NUH says is typical. KKH suggests packing snacks, a favourite toy and a jacket.
8. Ask what help you can get while you wait. ECDA says the KKH and NUH child development clinics offer consultations and interim therapy, and MSF says early intervention centres support families from the point of referral.
9. Start early intervention once it's recommended, with our early intervention guide for EIPIC, DS-LS, who qualifies and fees.

Early signs of autism in toddlers, by age

NUH's Child Development Unit prints the skills to raise with a doctor at each age on its milestones poster. The table below keeps the social and language items from it. NUH says to speak with your child's doctor straight away if you see any of them.

CDC gives the same early markers, such as few or no gestures by 12 months and no pointing to share something interesting by 18 months. It also says some children who aren't autistic show some of these signs, so one item on its own means it's time to ask the doctor. For all the skills at each age, see baby milestones month by month and toddler milestones.

What the signs can look like at home

KKH lists signs for children aged 1 to 3. Here they are in everyday terms.

• Connecting: KKH lists brief eye contact most of the time and a weaker response to their name. Your child may rarely smile at you or use gestures like a point, a wave goodbye or a nod. NUH adds not smiling back and not looking where you look or point.
• Talking: little or no speech used to communicate, and little copying of your words or actions (KKH). Older or more verbal children may repeat lines from shows or call themselves "you" instead of "me".
• Play: your child may line up toys, open and shut doors over and over, or focus on one part of a toy, like the wheels of a bus (KKH). They may also show less interest in play with other children.
• Routines: a hard time with changes, such as a new route to the void deck playground or a different seat at the hawker centre (KKH).
• Senses: some sounds, like a grass cutter downstairs, may upset your child a lot. KKH also lists fussiness with food, a habit of sniffing objects, and close interest in things that spin. Our guide to sensory processing in children explains these differences.
• Movement: your child may flap their hands, walk on tiptoe or spin round and round (KKH).

A late talker isn't always autistic. NUH says doctors may test hearing to rule out hearing loss, and that autism can be hard to tell apart from a wider developmental delay in very young children. Our guide to toddler speech milestones and delay covers speech on its own, and our ADHD guide covers the toddler who can't sit still.

Children KKH recommends screening

KKH says some children have a higher likelihood of autism, and recommends screening for them:

• An older brother or sister with autism, or several family members with autism. NUH puts the chance of an autistic child having an autistic sibling at about 20%.
• Born before 35 weeks, or under 2.5 kg at birth.
• A known genetic condition such as Down syndrome.
• A mother who took antiepileptic medicine during pregnancy.
• Parents who were over 40 when the child was born.

If one of these fits your child, mention it at the next developmental check and ask about the M-CHAT-R/F.

What happens at an autism assessment

NUH says no blood test can diagnose autism. The team pieces the picture together from your account of your child's development, reports from teachers or therapists and a psychologist's own observation. It may include a developmental paediatrician and a psychologist, plus a speech or occupational therapist.

Much of it is play. NUH describes the ADOS, a common tool, as a play observation, and KKH says your child gets toys and activities during the session. NUH says screening can start from 18 months and a diagnostic assessment from 31 months, but your doctor picks the right age for your child.

KKH usually gives you the report 4 to 6 weeks after the session. You decide who sees it, and your child won't need the assessment again. The report supports a place in early intervention and applications such as AIC's Caregivers Training Grant and tax relief.

Support once you have answers

KKH says that with the right education and early intervention, children on the autism spectrum can build their communication and interaction skills. NUH says early intervention can improve a child's language, thinking, social and motor skills.

ECDA matches early intervention to how much support a child needs. Children who need a little help may get it inside their own preschool, while those who need more go to EIPIC at an early intervention centre. MSF says centres train caregivers from referral, so you can practise skills with your child at home. Our guide to enrichment and early support for special needs children covers activities alongside therapy, and learning through play has ideas for any toddler.

For school, KKH says some autistic children learn in mainstream schools and others in SPED schools. NUH says a diagnosis lets schools plan support, such as an allied educator. KKH points out that children on the spectrum have their own strengths, and that they can grow up to be happy and healthy adults.

When to see a doctor

See your polyclinic, GP or paediatrician soon if you notice any of these:

• Your child loses words, babble or social skills they had, at any age (NUH).
• No pointing or other gestures, such as waving, nodding or clapping, by 12 months (NUH).
• No single words used with meaning by 18 months (NUH).
• Limited, inconsistent or absent eye contact at any age (NUH Child Development Unit).
• Your child doesn't respond to their name, or doesn't look where you look or point (NUH).
• Any worry about how your child talks, behaves, plays or gets along with others (NUH).

None of these signs needs Children's Emergency, and KKH notes that your polyclinic or family doctor can refer your child to KKH. Save KKH or NUH Children's Emergency, or a 995 call, for emergencies such as a seizure or loss of consciousness, both on KKH's emergency list.

Frequently asked questions

What are the early signs of autism in toddlers?

KKH's list for ages 1 to 3 starts with little speech, a weaker response to their name and brief eye contact. Few gestures, little copying and less interest in other children are on it too, along with repetitive play, trouble with changes and strong reactions to sounds or food. KKH says signs can be noticed from 12 months.

Can autism be diagnosed at 18 months in Singapore?

NUH says screening can start from 18 months and a diagnostic assessment from 31 months. Your doctor decides when your child is assessed. While you wait, ECDA says the KKH and NUH child development clinics offer consultations and interim therapy.

Is the M-CHAT-R/F a diagnosis?

No. KKH describes it as a parent checklist that shows the likelihood of autism in children aged 16 to 30 months. You take the result to your child's doctor. Only an assessment by a doctor and a specialist team can diagnose autism.

Did I cause my child's autism?

No. KKH says parenting styles and vaccines do not cause autism, and NUH says it isn't caused by a child's upbringing. KKH also says there's no evidence that special diets or supplements improve autism symptoms.

My child is already in Primary 1. Where do we go?

KKH says school-age children can be referred to the Child Guidance Clinic at the Health Promotion Board or at Sunrise Buangkok. Start with your GP or polyclinic for the referral, and bring your notes on what you've seen.