Early Signs of Autism at Age 4: A Guide for Parents

Are you concerned that your 4 year old is showing signs of autism? Here are the signs of autism at age 4 for parents and teachers so they can be aware of a child who may be neurodivergent.

Signs of autism at four years old

Autism doesn’t present as differently at age four than it does at age two or age three, but you might notice more autistic traits due to child development.

Autistic children are more likely to develop insecure attachment styles if they’re the only autistic in the household, or surrounded by high-masking individuals, due to unmet needs. This is why it’s crucial to accept that autistic children will never be “normal” and learn how to meet their unique needs.

Language and communication skills

• Processes language at a slower rate than peers
• Seems to “think before speaking” (to clarify, this is not what is happening with autistic people)
• Lacks a social filter
• Repeats the same words or phrases other people, movies, songs or TV have said ) echolalia)
• Doesn’t wave, point or perform other gestures
• Talks with their hands a lot
• Speaks in an iambic format (patterns of words or tone, sing-songy, or with a particular rhythm)
• Monotone voice
• Tells literal jokes and has a unique sense of humor
• No sense of time
• Struggles with numbers, or excels at numbers
• Needs specific, visual instructions one at a time instead of all at once and cannot follow them otherwise
• Doesn’t answer questions per your expectations

Repetitive or restrictive behaviors

• Expresses self through repetitive motions, such as hand flapping or wringing, rocking back and forth, spinning, or pacing
• Dinosaur hands or flamingo pose (if you know, you know)
• Obsessed with organizing everything or patterns (this is known as aesthetic stimming, which is visual stimming)
• Needs particular routine to function, though it is not hugely dependent on time of day
• Prefers to discuss favorite topics or play with favorite toys, only
• Loves certain parts of toys or objects, like doll hair, car wheels, or velvet patch in sensory book
• Easily frustrated and/or overwhelmed

Social

• Doesn’t make eye contact
• Doesn’t respond to own name
• Plays differently from peers, such as sorting or lining up toys
• Engages in a pretend play that you’re not accustomed to (more imaginative or detailed)
• Prefers realistic play
• Doesn’t make up stories (lies, even if “pretend”)
• Prefers to interact with pets instead of people
• Prefers parallel play (playing in same vicinity, but separately)
• Doesn’t share or take turns
• Doesn’t like physical contact
• Is not easily soothed/comforted by non-autistic individuals
• Struggles to understand their feelings and bodily needs (alexithymia)
• Blank facial expressions
• No interest in upholding social expectations of neurotypical friend making

Other signs of autism at age 4

• Expressions of frustration (aggression, yelling, etc.)
• Self-harm (sign of sensory overload or general overwhelm)
• Hypersensitivity to smells, sounds, textures, tastes and/or sights
• Lack of fear (no sense of danger) or excessive fear
• Bed wetting
• Impulsivity
• Prefers certain foods
• Likes to eat certain foods even when not hungry (oral stimming)
• Little concept of personal space, or prefers a lot of personal space
• Delayed potty training

Autism is NOT an intellectual disability

Contrary to popular opinion and information in other articles on the internet, intellectual disability is not a sign of autism. Intellectual deficits are not, and have never been, part of the diagnostic criteria for autism.

Coupling these two disabilities with each other perpetuates stigma and prevents proper diagnoses being made, which prevents autistic people from receiving the support they need.

Rather, autism is a social/communication difference. Current discussions in the autistic community challenge associating autism with disorders, because “disorder” implies something is wrong and autism traits are mostly differences. If society was more accepting of neurodivergence, autistic individuals might struggle less.

Regardless of whether you classify autism as a disorder, the only similarity it has to intellectual disabilities is being a disability. Autism doesn’t affect one’s intellectual capabilities.

Your autistic child can have both diagnoses — autism and an intellectual disorder — but the two are not synonymous.

What is the diagnostic criteria for autism?

The diagnostic criteria for autism at age four is the same as it is at any age. Autistic traits will just present differently at age four than at age 12.

The diagnostic criteria is confusing, but these are the main factors in an autism diagnosis:

1. Persistent social and communication difficulties
2. Restrictive or repetitive behaviors or interests
3. Symptoms must be present in early childhood (but might fully manifest until overwhelm, hence why many autistic adults are not diagnosed until they’re in crisis)
4. Symptoms cause clinically significant impairment in social, occupational or other functional areas of life
5. Symptoms not better explained by intellectual disability or developmental delay; for both autism and intellectual disability diagnosis, social and communication traits must be exceptionally lower than developmental level

So you might think, “But all toddlers/kids do that!” If yours doesn’t do this repeatedly, on a regular basis, to the point that the criteria is met, then it is probably not autism.

However, autistic children do do these things repeatedly, and their autistic traits change over time. If you think your child might be autistic, please get the screened so they can learn how to understand themselves.

Autistic people should not be in crisis mode in order to receive or be considered for a diagnosis. This trauma can, and should, be avoided. An undiagnosed autistic child is still an autistic child.

Click here for a free PDF printable checklist of the 7 steps to take when your child needs residential treatment.