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title: "Early Signs of Autism and Early Intervention | Blue Sails"
description: "Early signs of autism, what M-CHAT-R/F screening can tell you, how an autism evaluation works, and how early intervention works in Maryland for young children."
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# Autism and early intervention: early signs, screening and next steps

A plain-language guide for parents who have noticed something about their child’s communication, play or development. Learn what early signs can look like, what screening and evaluation involve, and how early support works in Maryland.

Key takeaways

- You do not need to be certain before asking. Bring specific observations to your child’s pediatrician or another qualified provider.

- Screening tools such as the M-CHAT-R/F show whether a full evaluation may help. They do not diagnose autism.

- A diagnosis comes from a developmental evaluation that combines history, observation and caregiver input.

- In Maryland, children under 3 can be referred to the Infants and Toddlers Program, and children 3 and older to their school system’s Child Find office.

[Explore the early-intervention autism program](https://bluesailscounseling.com/services/autism-services/early-intervention-program/)[Explore autism services](https://bluesailscounseling.com/services/autism-services/)

01 / Early signs

## Early signs of autism in toddlers

Autism affects how a child communicates, relates to other people and experiences the world. Signs often appear in the first two to three years and vary widely from child to child. Some children show differences early, while others develop skills and then seem to lose some of them.

Parents and caregivers often notice things such as limited response to their name by around 12 months, few gestures like pointing or waving, little shared attention such as showing a toy to an adult, delayed or unusual speech, repeated movements, strong attachment to routines, and strong reactions to sounds, textures or other sensory input. For how autism and ADHD can show up later in childhood and into adulthood, see our guide to [neurodivergence across the lifespan](https://bluesailscounseling.com/neurodivergence/).

One sign on its own does not mean a child is autistic. Many of these differences have other explanations, including hearing problems or a speech and language delay. A pattern of observations shared with a provider is more useful than any single checklist item.

| Area | What you may notice | What to consider |
| --- | --- | --- |
| Social communication | Limited eye contact, response to name, pointing or shared attention. | Note when and where you see it, and whether it is changing over time. |
| Play and interests | Lining up or repeating play in the same way, intense focus on parts of objects. | Strong interests are common in all children; look at flexibility and daily impact. |
| Language | Few words for age, repeating phrases, or using words in unusual ways. | A hearing check and speech and language assessment can be part of the picture. |
| Sensory responses | Strong reactions to noise, textures, lights or food, or seeking certain sensations. | Sensory differences occur in several profiles and do not establish a diagnosis alone. |
| Loss of skills | Stopping using words or social skills a child already had. | Any loss of skills at any age deserves prompt discussion with your child’s doctor. |

02 / Screening

## What autism screening (M-CHAT-R/F) can and cannot tell you

The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child visits, along with general developmental checks. A common tool is the M-CHAT-R/F, a parent questionnaire for toddlers about 16 to 30 months old, with a follow-up interview when needed.

The M-CHAT-R has 20 yes/no questions. Under the authors’ [scoring guide](https://www.mchatscreen.com/mchat-rf/scoring/), a total of 0–2 means lower likelihood; 3–7 calls for the follow-up interview, and the screen is positive if two or more items still show elevated likelihood; 8–20 is a positive screen without the follow-up. For a positive screen, the guide calls for referral to early intervention and a diagnostic evaluation at the same time. A positive screen does not confirm autism, and a lower result does not rule it out if you remain concerned. Keep sharing what you notice.

Helpful notes to bring include when you first noticed a concern, short examples from home and childcare, any changes in skills, hearing and vision history, and the questions you most want answered.

03 / Evaluation

## How an autism evaluation works

A diagnostic evaluation looks at development, communication, social interaction, play, behavior and sensory responses across settings. It usually combines a caregiver interview, developmental history, direct observation and records from childcare or other providers.

Structured observation tools such as the ADOS-2 can be part of an evaluation, but no single test makes the diagnosis. The evaluator applies DSM-5-TR criteria and also considers hearing, language, learning and other conditions that can look similar or occur alongside autism. The ADOS-2 has five modules, a Toddler Module and Modules 1 to 4, chosen mainly by a child’s age and spoken language, and its scores describe one structured session. An evaluation may also include a detailed caregiver interview, such as the ADI-R, and a measure of everyday adaptive skills, such as the Vineland-3.

If autism is diagnosed, the DSM-5-TR asks the evaluator to describe how much support a child currently needs, rated separately for social communication and for restricted, repetitive behaviors: Level 1 (“requiring support”), Level 2 (“requiring substantial support”) or Level 3 (“requiring very substantial support”). A level describes current support needs, not a child’s potential, and [levels of support may vary by setting and change over time](https://www.asha.org/practice-portal/clinical-topics/autism/).

Ask how results will be shared, what the report will include and what recommendations may follow. A good evaluation leaves you with a clearer picture of your child’s strengths and support needs, not only a label. For quick answers on ADOS-2 visits, school plans and coverage, see our [autism testing FAQs](https://bluesailscounseling.com/faq/#autism-testing-faq).

04 / Early intervention

## How early intervention works in Maryland

Early intervention means support that starts while a child is young, built around the child’s development and the family’s priorities. In many cases it can begin before a formal diagnosis. The [American Academy of Pediatrics](https://www.aap.org/en/patient-care/autism/) advises referring a child for intervention as soon as a developmental delay is identified, without waiting for an autism evaluation to take place, so evaluation and early intervention can move forward at the same time.

The Maryland Infants and Toddlers Program serves eligible children from birth to age 3 through a local program in each county, and a parent or provider can make the referral. For children 3 and older, the local school system’s Child Find office can evaluate eligibility for preschool special education services and an IEP.

A child under 3 may be eligible for the Infants and Toddlers Program with a 25% delay in one or more areas of development, atypical development or behavior that is likely to lead to a delay, or a diagnosed condition with a high probability of causing a delay. You can refer through the [statewide online referral site](https://referral.mditp.org/referral) or by calling 1-800-535-0182. Evaluations and services are free to families and need your consent, and the local program has 45 days from referral to complete the evaluation and, if your child is eligible, an Individualized Family Service Plan (IFSP).

If your child is in the program, transition planning with the school system begins at least 90 days before the third birthday ([34 CFR 303.209](https://www.ecfr.gov/current/title-34/section-303.209)). Infants and Toddlers eligibility does not carry over automatically: the school system completes its own evaluation with your consent, and if your child qualifies for preschool special education, an IEP should be in place by the third birthday.

Blue Sails offers an early-intervention autism program for children ages 2 to 6. Intake can talk through clinical fit, current availability and what your insurance requires.

- [Explore the early-intervention autism program](https://bluesailscounseling.com/services/autism-services/early-intervention-program/)

- [Explore autism services](https://bluesailscounseling.com/services/autism-services/)

- [Autism evaluations and diagnosis](https://bluesailscounseling.com/services/autism-services/evaluations-diagnosis/)

- [Care for toddlers and preschoolers](https://bluesailscounseling.com/clients/toddlers-preschoolers/)

- [Insurance and costs](https://bluesailscounseling.com/insurance-billing/)

Questions

## Frequently asked questions

What are the earliest signs of autism?

Early signs can include limited response to name, few gestures such as pointing, little shared attention, delayed speech, repeated movements and strong reactions to sensory input. Signs vary, and one sign alone does not mean a child is autistic. Share the pattern you notice with your child’s doctor.

At what age can autism be diagnosed?

Some signs can appear before 18 months, and by age 2 a diagnosis by an experienced professional can be reliable. Many children are identified later. If you are concerned at any age, you can ask for an evaluation rather than waiting.

Does a positive M-CHAT mean my child has autism?

No. The M-CHAT-R/F is a screening questionnaire. A higher result means a full evaluation is recommended. Only a developmental evaluation can determine whether a child is autistic.

Do we need a diagnosis to start early intervention?

Not always. The Maryland Infants and Toddlers Program bases eligibility on a child’s development, so a child under 3 may qualify without an autism diagnosis. Ask the local program or your child’s provider what applies to your family.

Who is the early-intervention autism program for?

Blue Sails’ early-intervention autism program is for children ages 2 to 6. Intake can talk through clinical fit, current availability and what your insurance requires before you enroll.

What does “Level 1” mean on an autism diagnosis?

Level 1 (“requiring support”) is the first of three DSM-5-TR support levels. The evaluator rates social communication and restricted, repetitive behaviors separately, so a child can have a different level in each area. A level describes current support needs, not intelligence or potential, and it can change as a child grows. Ask the evaluator what the level means for your child’s day-to-day support.

Can my child be evaluated in a language other than English?

You can ask for that. Federal special education rules require school evaluations to be given in the child’s native language or other mode of communication, unless that is clearly not feasible ([34 CFR 300.304](https://sites.ed.gov/idea/regs/b/d/300.304)), and early intervention evaluations follow a similar rule. For a private evaluation, ask in advance whether a bilingual clinician or a trained interpreter is available.

## Talk with our team about your child’s development

Tell us what you have noticed. Intake can explain the early-intervention autism program, clinical fit and insurance requirements. We accept TRICARE.

[Request an appointment](https://bluesailscounseling.com/client-intake/)[Call (410) 231-0488](tel:+14102310488)

If you are in crisis, call 911, go to the nearest ER, or call or text 988.