Recognising autism spectrum conditions in the early years

This can be downloaded as a printable leaflet in our resources section here.

This is a guide for GPs, nurses, Health Visitors, Social Workers and other primary care workers who are likely to first come into contact with children on the autism spectrum and need to be alert to early signs and parental concerns. ASD’s are spectrum conditions so some overlap within these areas and diagnoses are inevitable.


The three main areas of difficulty which all children with autism share are sometimes known as the 'triad of impairments'. They are difficulties with:

  • Social Communication 
  • Social Interaction
  • Social Imagination

Some children with autism may have limited or no speech. They may repeat what the other person has said (echolalia). They may have great difficulty understanding body language and facial expressions. They may be unable to understand what others are feeling or thinking. They may have sensory problems.

Early signs of autism in young children may include:

  • Lack of pointing
  • Language delay / lack of speech
  • Behavioural problems / tantrums
  • Poor eye contact
  • Odd play (eg lining up cars or just spinning the wheels rather than playing with them as a car)
  • Insistence on routine / sameness
  • Seeming distant or poorly interacting
  • Repetitive behaviours

Asperger’s Syndrome

Children with Asperger’s Syndrome share the same areas of difficulty:

  • Social Communication
  • Social Interaction
  • Social Imagination

They may also have sensory problems and find it difficult to stray from routines. While there are similarities with autism, children with Asperger’s syndrome have fewer problems with speaking and are often of average, or above average, intelligence. They do not usually have the accompanying learning disabilities associated with autism, but they may have specific learning difficulties. These may include dyslexia and dyspraxia or other conditions such as attention deficit hyperactivity disorder (ADHD) and epilepsy.

Children with Asperger Syndrome also have difficulty recognising facial expressions, be very literal and find social ‘chit chat’ very difficult. Children with Asperger’s Syndrome may have an unusual interest in a subject and struggle making friends. They may find imaginative games very difficult in the playground.

Pathological Demand Avoidance Syndrome (PDA)

Children with PDA have an anxiety led need to be in control. They tend not to comply with the normal everyday demands of life. Parents find they can exhibit extreme ‘tantrums’ and sometimes violent behaviour over being asked to do simple things e.g. “Put your coat on”

Children with PDA have more social skills than other people on the autism spectrum but they do not have full empathy. At times they can appear to have no difficulties whatsoever. In reality they:

  • Are extremely anxious in response to the everyday demands of life.
  • Have mood swings, change in an ‘instant’, Jekyll and Hyde characters.
  • Are comfortable (sometimes over involved) in role play and pretending.
  • May have early speech / language difficulties with a good degree of catch up later on.
  • May have sensory problems.
  • Have obsessive behaviours, sometimes involving people.
  • Can be domineering in their play and strive to be in control at all times.

What to do 

If an autism spectrum condition is recognised or suspected a referral should be made to a Child Development Clinic (CDC) where assessments can be made for these disorders. (Not all clinics will be familiar with Pathological Demand Avoidance Syndrome so onward referral may be required if the local CDC is unfamiliar with the diagnosis).

Child and Adolescent Mental Health Teams (CAMHS) may need to be involved as the child gets older.


Parents will often be ‘at their wit’s end’. They may have already done a lot of research into what their child may be suffering from.

  • LISTEN to their concerns.
  • LOOK at the evidence before you.
  • TALK to other agencies involved.
  • REFER for multidisciplinary assessment.

Further information about all these disorders may be obtained at the National Autistic Society website.