Limited eye contact as an early sign of autism in young children.

Eye contact and early signs: what to look for in a newborn to toddler

If you’re brushing up on pediatrics, you’ll notice certain behaviors show up early and repeat themselves. One of the most telling clues about autism spectrum disorder (ASD) in infancy and toddler years is how a child uses (or doesn’t use) eye contact. In many learning guides and EAQ-style questions, this is the go-to early sign to remember. Here’s the thing: limited eye contact isn’t just a small quirk. It often points to bigger social-communication differences that can shape a child's development.

The quick answer, in plain terms

Question: What is an early sign of autism spectrum disorder?

A. Limited eye contact

B. Excessive talking

C. Strong attachment to toys

D. Delayed walking

Answer: Limited eye contact.

Why this matters is bigger than any single moment in a clinic or classroom. Eye contact is the social handshake of early childhood. It’s how infants and toddlers start joint attention, share interest, and connect with caregivers. When that handshake is weaker or less frequent, it can signal challenges in social interaction that are core to ASD. Early identification matters because it opens doors to timely support, therapies, and strategies that can support language, social engagement, and overall development.

What’s special about eye contact as an early sign

Let me explain what makes limited eye contact stand out.

• Social communication is the foundation. In the first year, babies use eye contact to signal interest, share joy, and initiate back-and-forth exchanges. When eye contact is limited, those early social exchanges can be harder to establish.

• It’s not a single test, but a pattern. A child might sometimes look at faces but avoid sustained eye contact. A pattern of reduced eye contact across play, feeding, and routine care can be a red flag that prompts further evaluation.

• It’s not a diagnosis on its own. A lot of kids with limited eye contact don’t have ASD, and some with ASD may still make eye contact in certain moments. That’s why clinicians use a combination of observations, parent reports, and screening tools to build a fuller picture.

Now, what about the other options in that question? They can appear in kids for lots of reasons, but they aren’t classic early signs of ASD in the same way.

Excessive talking (B)

If a child talks a lot for their age, that’s not a typical early sign of autism. In fact, language development can vary a lot. Some kids with ASD may have strong verbal abilities, while others may have significant delays. “Excessive talking” can reflect other developmental or learning paths and isn’t a reliable early marker of ASD by itself. It’s more important to look at how communication is used across social exchanges—eye contact, shared attention, and responding to others.

Strong attachment to toys (C)

Many toddlers show a strong interest in certain toys or objects. This can be perfectly normal and even healthy play. For some kids with ASD, play may become repetitive or focused, but simply loving a favorite toy isn’t an automatic sign of ASD. The key distinction is whether the attachment interferes with social interaction, flexible play, and the ability to engage with people in ordinary ways.

Delayed walking (D)

Milestones vary widely. Some kids walk a little later than peers, and that’s often not a sign of ASD. While motor delays can co-occur with autism, delayed walking alone is not a specific early indicator. Pediatric teams look at a broader development profile—speech, social interaction, play, and repetitive behaviors—alongside motor milestones.

How clinicians approach early signs in practice

When a clinician spots limited eye contact or other concerns, what actually happens?

• Developmental surveillance and screening. Pediatricians routinely monitor development during visits. They use parent questionnaires and brief checks to spot red flags early. One common resource is a screening questionnaire that parents fill out before or during visits. It helps flag children who should be brought in for a more thorough evaluation.

• Formal screening tools. If concerns arise, a more detailed screening tool may be used. It isn’t a diagnosis, but it helps identify kids who need a comprehensive assessment. These tools combine caregiver reports, clinician observation, and, when appropriate, hearing and vision checks to rule out other causes.

• Comprehensive evaluation. If screening suggests ASD may be present, a multidisciplinary team analyzes development across domains: social communication, play, behavior, and language. They may include psychologists, speech-language pathologists, and developmental pediatricians. The goal is to confirm ASD status and plan targeted supports.

What to watch for and when to seek help

Parents and caregivers are often the first to notice something feels off. Here are practical red flags to discuss with a clinician:

• Consistently limited or absent eye contact, especially in interactive moments with caregivers.

• A lack of joint attention—when a child doesn’t look back to a caregiver after a shared moment (like pointing at a toy and then looking to the caregiver for confirmation).

• Delayed or atypical responses to name or familiar voices, particularly after 6 months.

• Limited social smiles or reduced sharing of emotions with caregivers.

• Repetitive behaviors or very narrow interests that interfere with play or learning.

• Any regression in skills, such as losing previously acquired language or social behaviors.

If you notice these patterns, don’t panic. Early consultation is about gathering information and supporting development, not judging a child’s future. The pediatrician can guide families toward the right next steps, whether that’s screening tools, early intervention services, or additional assessments.

What families can do at home to support social development

The home is where many early interactions happen, and small, daily habits can make a difference. Some practical ideas:

• Narrate play and daily routines. Describe what you see and do: “We’re stacking blocks now. Your turn to stack!” This exposure helps a child learn joint attention and turn-taking.

• Encourage eye contact in natural moments. Brief, gentle prompts like, “Look at me,” paired with a warm smile, can reinforce eye contact without pressure.

• Use toys and activities that invite shared attention. Silly hats, bubble games, picture books with clear images—these can become moments of social exchange.

• Be responsive. If a child looks at you after a gesture or vocalize, acknowledge the cue promptly. This helps build a confident, reciprocal interaction pattern.

• Check hearing and vision. Sometimes what looks like social disengagement is a simple sensory issue. A quick check can rule out hearing loss or vision problems that affect communication.

Myth-busting and common misconceptions

ASD can feel mysterious, but there are myths worth debunking:

• Myth: ASD is caused by parenting style. Not true. ASD is a neurodevelopmental condition with a complex mix of genetic and neurological factors. Parenting skills influence how well a child learns and adapts, but they don’t cause ASD.

• Myth: All kids with ASD have the same signs. Not at all. ASD exists on a spectrum, so signs vary widely. Some kids may have strong language; others may not.

• Myth: Eye contact alone can diagnose ASD. Eye contact is part of the bigger picture. Clinicians look at a constellation of behaviors and developmental milestones.

Putting it all together: what this means for students and future clinicians

If you’re studying pediatrics, you’ll see that early social engagement is a thread that runs through many child development topics. Limited eye contact is a particularly important sign because it sits at the intersection of social interaction and communication. It’s not the only marker, and it doesn’t tell the whole story by itself, but recognizing its significance helps you know when to ask the right questions and seek a fuller evaluation.

In the classroom, you’ll likely encounter scenarios where a child shows this pattern along with other subtle concerns. How you think through these scenarios matters:

• Start with observation. Note consistency—does the pattern hold across settings, times, and people?

• Consider the broader developmental picture. Language, play, imitation, social reciprocity—all of these pieces matter.

• Use screening as a guide, not a verdict. Screening tools help identify who needs a deeper look, but only a full assessment can determine ASD.

• Keep families engaged and informed. Clear, compassionate communication helps families feel supported rather than overwhelmed.

A few practical takeaways for your future practice

• Remember the core idea: limited eye contact is a meaningful early sign tied to social-communication challenges in ASD.

• Don’t rely on one sign alone. Combine observations, parent reports, and screening results to get the full view.

• Early action matters. When concerns arise, timely referral for screening and evaluation can unlock access to therapies that support social development and communication.

• Embrace a person-first approach. Each child is unique, and ASD is only one aspect of their story.

Closing thoughts: the bigger picture

Autism is a spectrum, and early signs are a compass, not a map. Limited eye contact helps us know where to look, but it doesn’t define a child’s potential. The moment we combine careful observation with supportive, evidence-based steps, we set the stage for growth, connection, and meaningful learning.

If you’re shaping your understanding of pediatrics, keep this idea in mind: social engagement is the passport to so much of early development. Eye contact opens doors—both in the clinic and at home. By recognizing that cue and pairing it with thoughtful assessment and family-centered care, you’re helping children reach their full potential, one shared glance at a time.