Ted Hutman, Ph.D. is Assistant Clinical Professor in Psychiatry at the David Geffen School of Medicine at UCLA and a licensed clinical psychologist practicing in Santa Monica, CA.
What is autism?
Autism expresses itself through a spectrum of symptoms. Autism spectrum disorder (ASD) appears in infancy and early childhood, causing delays in many basic areas of development, such as learning to talk, play, and interact with others.
The signs and symptoms of autism vary widely, as do its effects. Some children with autism have only mild impairments, while others have more obstacles to overcome. However, every child on the autism spectrum has problems, at least to some degree, in the following three areas:
- Communicating verbally and non-verbally.
- Relating to others and the world around them.
- Thinking and behaving flexibly.
There are different opinions among doctors, parents, and experts about what causes autism and how best to treat it. There is one fact, however, that everyone agrees on: early and intensive intervention helps. For children at risk and children who show early signs, it can make all the difference. But no matter your child’s age, don’t lose hope. Treatment can reduce the disorder’s effects and help your child thrive in life.
What is high-functioning autism?
Although it’s not an official diagnosis or medical term, “high-functioning” implies that someone with autism has the intellectual ability to navigate society without assistance. It was often used to describe people with Asperger's syndrome, which was initially categorized as a separate and milder disorder than autism. A child diagnosed with Asperger's, for example, might not experience the same speech delay as a child diagnosed with autism. However, while Asperger’s is now officially incorporated into the broader autism spectrum, you might sometimes still hear the term used.
[Read: Autism Spectrum Disorders]
In a 2019 study, researchers argued that the term “high-functioning” could be both harmful and misleading. It puts heavy emphasis on IQ and doesn't account for all the potential strengths and weaknesses an autistic individual may possess. And just because someone has an average or high IQ, it doesn't mean they can adapt or function well in other ways.
One baby's story
Melanie is a healthy one-year old, but her parents are worried about her development because she's not doing many things that her older brother did at her age, like playing peek-a-boo and mimicking expressions and gestures.
Melanie's mom and dad try to engage her with toys, songs, and games, but nothing they do gets her interest, let alone a laugh or a smile. In fact, she rarely makes eye contact. And although her hearing has been checked and is normal, she doesn't babble, make other baby noises, or respond when her parents call her name. Melanie needs to be checked out by a child development specialist right away.
How parents can spot the warning signs
As a parent, you're in the best position to spot the earliest warning signs of autism. You know your child better than anyone and observe behaviors and quirks that a pediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your child's pediatrician can be a valuable partner, but don't discount the importance of your own observations and experience. The key is to educate yourself so you know what's typical and what's not.
Monitor your child's development. Autism involves a variety of developmental delays, so keeping a close eye on when—or if—your child is hitting the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays don't automatically point to autism, they may indicate a heightened risk.
Take action if you're concerned. Every child develops at a different pace, so you don't need to panic if your child is a little late to talk or walk. When it comes to healthy development, there's a wide range of “typical.” But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child's doctor immediately. Don't wait.
Don't accept a wait-and-see approach. Many concerned parents are told, “Don't worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply “grow out of” their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.
Trust your instincts. Ideally, your child's doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it's telling you something is wrong, and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.
Regression of any kind is a serious autism warning sign
Some children with autism spectrum disorder start to develop communication skills and then regress, usually between 12 and 24 months. For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or a child may stop playing social games he or she used to enjoy such as peek-a-boo, patty cake, or waving “bye-bye.” Any loss of speech, babbling, gestures, or social skills should be taken very seriously, as regression is a major red flag for autism.
Signs and symptoms of autism in babies and toddlers
If autism is caught in infancy, treatment can take full advantage of the young brain's remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.
[Read: Autism Treatments, Therapies, and Interventions]
The earliest signs of autism involve the absence of typical behaviors—not the presence of atypical ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.
Some autistic infants don't respond to cuddling, reach out to be picked up, or look at their mothers when being fed.
Your baby or toddler doesn't:
- Make eye contact, such as looking at you when being fed or smiling when being smiled at.
- Respond to their name, or to the sound of a familiar voice.
- Follow objects visually or follow your gesture when you point things out.
- Point or wave goodbye, or use other gestures to communicate.
- Make noises to get your attention.
- Initiate or respond to cuddling or reach out to be picked up.
- Imitate your movements and facial expressions.
- Play with other people or share interest and enjoyment.
- Notice or care if you hurt yourself or experience discomfort.
Developmental red flags
The following delays warrant an immediate evaluation by your child's pediatrician:
By 6 months: No big smiles or other warm, joyful expressions.
By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
By 12 months: Lack of response to name.
By 12 months: No babbling or “baby talk.”
By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving.
By 16 months: No spoken words.
By 24 months: No meaningful two-word phrases that don't involve imitating or repeating.
Signs and symptoms in older children
As children get older, the red flags for autism become more diverse. There are many warning signs and symptoms, but they typically revolve around impaired social skills, speech and language difficulties, non-verbal communication difficulties, and inflexible behavior.
Signs of social difficulties
- Appears disinterested or unaware of other people or what's going on around them.
- Doesn't know how to connect with others, play, or make friends.
- Prefers not to be touched, held, or cuddled.
- Doesn't play “pretend” games, engage in group games, imitate others, or use toys in creative ways.
- Has trouble understanding feelings or talking about them.
- Doesn't seem to hear when others talk to them.
- Doesn't share interests or achievements with others (drawings, toys).
Basic social interaction can be difficult for children with autism spectrum disorder. Many kids on the autism spectrum seem to prefer to live in their own world, aloof and detached from others.
Signs of speech and language difficulties
- Speaks in an atypical tone of voice, or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question).
- Repeats the same words or phrases over and over, often without communicative intent.
- Responds to a question by repeating it, rather than answering it.
- Uses language incorrectly (grammatical errors, wrong words) or refers to him or herself in the third person.
- Has difficulty communicating needs or desires.
- Doesn't understand simple directions, statements, or questions.
- Takes what is said too literally (misses undertones of humor, irony, and sarcasm).
Children with autism spectrum disorder have difficulty with speech and language. Often, they start talking late.
Signs of nonverbal communication difficulties
- Avoids eye contact.
- Uses facial expressions that don't match what they are saying
- Doesn't pick up on other people's facial expressions, tone of voice, and gestures.
- Makes very few gestures (such as pointing). May come across as cold or “robot-like.”
- Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises. Can also be unresponsive to people entering/leaving, as well as efforts by others to attract the child's attention.
- Atypical posture, clumsiness, or eccentric ways of moving (e.g., walking exclusively on tiptoe).
Children with autism spectrum disorder have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.
Signs of inflexibility
- Follows a rigid routine (e.g., insists on taking a specific route to school).
- Has difficulty adapting to any changes in schedule or environment (e.g., throws a tantrum if the furniture is rearranged or bedtime is at a different time than usual).
- Unusual attachments to toys or strange objects such as keys, light switches, or rubber bands. Obsessively lines things up or arranges them in a certain order.
- Preoccupation with a narrow topic of interest, often involving numbers or symbols (e.g., memorizing and reciting facts about maps, train schedules, or sports statistics).
- Spends long periods watching moving objects such as a ceiling fan, or focusing on one specific part of an object such as the wheels of a toy car.
- Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behavior, or “stimming”). Some researchers and clinicians believe that these behaviors may soothe children with autism more than stimulate them.
Children with autism spectrum disorder are often restricted, inflexible, and even obsessive in their behaviors, activities, and interests.
Common restricted and repetitive behaviors
- Hand flapping
- Rocking back and forth
- Spinning in a circle
- Finger flicking
- Head banging
- Staring at lights
- Moving fingers in front of the eyes
- Snapping fingers
- Tapping ears
- Lining up toys
- Spinning objects
- Wheel Spinning
- Watching moving objects
- Flicking light switches on and off
- Repeating words or noises
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Causes of autism
Until recently, most scientists believed that autism is caused mostly by genetic factors. But groundbreaking new research indicates that environmental factors may also be important in the development of autism.
Babies may be born with a genetic vulnerability to autism that is then triggered by something in the external environment, either while he or she is still in the womb or sometime after birth.
It's important to note that the environment, in this context, means anything outside the body. It's not limited to things like pollution or toxins in the atmosphere. In fact, one of the most important environments appears to be the prenatal environment.
Prenatal factors that may contribute to autism
Taking antidepressants during pregnancy, especially in the first 3 months.
Nutritional deficiencies early in pregnancy, particularly not getting enough folic acid.
The age of the mother and father.
Complications at or shortly after birth, including very low birth weight and neonatal anemia
Maternal infections during pregnancy.
Exposure to chemical pollutants, such as metals and pesticides, while pregnant.
More research on these prenatal risk factors is needed, but if you're pregnant or trying to conceive, it can't hurt to take steps now to reduce your baby's risk of autism.
Reducing the risk of autism: Tips for expectant mothers
Take a multivitamin. Taking 400 micrograms of folic acid daily helps prevent birth defects such as spina bifida. It's not clear whether this will also help reduce risk of autism, but taking the vitamins can't hurt.
Ask about SSRIs. Women who are taking an SSRI (or who develop depression during pregnancy) should talk with a clinician about all the risks and benefits of these drugs. Untreated depression in a mother can also affect her child's well-being later on, so this is not a simple decision to make.
Practice prenatal care. Eating nutritious food, trying to avoid infections, and seeing a clinician for regular check-ups can increase the chances of giving birth to a healthy child.
Source: Harvard Health Publications
Autism and vaccines
While you can't control the genes your child inherits, or shield him or her from every environmental danger, there is one very important thing you can do to protect the health of your child: make sure he or she is vaccinated on schedule.
Despite a lot of controversy on the topic, scientific research does not support the theory that vaccines or their ingredients cause autism. Five major epidemiologic studies conducted in the U.S., UK, Sweden, and Denmark, found that children who received vaccines did not have higher rates of autism. Additionally, a major safety review by the Institute of Medicine failed to find any evidence supporting the connection. Other organizations that have concluded that vaccines are not associated with autism include the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), the American Academy of Pediatrics, and the World Health Organization (WHO).
|Myths and facts about childhood vaccinations|
|Myth: Vaccines aren't necessary.|
Fact: Vaccines protect your child from many serious and potentially deadly diseases, including measles, meningitis, polio, tetanus, diphtheria, and whooping cough. These diseases are uncommon today because vaccines are doing their job. But the bacteria and viruses that cause these diseases still exist and can be passed on to children who aren't immunized.
|Myth: Vaccines cause autism.|
Fact: Despite extensive research and safety studies, scientists and doctors have not found a link between childhood vaccinations and autism or other developmental problems. Children who are not vaccinated do not have lower rates of autism spectrum disorders.
|Myth: Vaccines are given too early.|
Fact: Early vaccination protects your child from serious diseases that are most likely to occur—and most dangerous—in babies. Waiting to immunize your baby puts him or her at risk. The recommended vaccination schedule is designed to work best with children's immune systems at specific ages. A different schedule may not offer the same protection.
|Myth: Too many vaccines are given at once.|
Fact: You may have heard theories that the recommended vaccine schedule overloads young children's immune systems and may even cause autism. But research shows that spacing out vaccinations doesn't improve children's health or lower their risk of autism, and as noted above, actually puts them at risk for potentially fatal diseases.
What to do if you're worried
If your child is developmentally delayed, or if you've observed other red flags for autism, schedule an appointment with your pediatrician right away. In fact, it's a good idea to have your child screened by a doctor even if he or she is hitting the developmental milestones on schedule. The American Academy of Pediatrics recommends that all children receive routine developmental screenings, as well as specific screenings for autism at 9, 18, and 30 months of age.
Schedule an autism screening. A number of specialized screening tools have been developed to identify children at risk for autism. Most of these screening tools are quick and straightforward, consisting of yes-or-no questions or a checklist of symptoms. Your pediatrician should also get your feedback regarding your child's behavior.
[Read: Helping Your Child with Autism Thrive]
See a developmental specialist. If your pediatrician detects possible signs of autism during the screening, your child should be referred to a specialist for a comprehensive diagnostic evaluation. Screening tools can't be used to make a diagnosis, which is why further assessment is needed. A specialist can conduct a number of tests to determine whether or not your child has autism. Although many clinicians will not diagnose a child with autism before 30 months of age, they will be able to use screening techniques to determine when a cluster of symptoms associated with autism is present.
Seek early intervention services. The diagnostic process for autism is tricky and can sometimes take a while. But you can take advantage of treatment as soon as you suspect your child has developmental delays. Ask your doctor to refer you to early intervention services. Early intervention is a federally funded program for infants and toddlers with disabilities. Children who demonstrate several early warning signs may have developmental delays. They will benefit from early intervention whether or not they meet the full criteria for an autism spectrum disorder. In other words, there is more risk involved in the wait-and-see approach than in receiving early intervention.
Ted Hutman, Ph.D. is Assistant Clinical Professor in Psychiatry at the David Geffen School of Medicine at UCLA and a licensed clinical psychologist practicing in Santa Monica, CA.
Hotlines and support
- In the U.S.
Call theAutism SocietyNational Helpline at 1-800-328-8476.
Call the Early Intervention helpdesk in Perth at 1800 778 581 orGet support for your childfrom NDIS.
Call theAutism CanadaFamily Support Representative at 1-800-983-1795.
- New Zealand
Find helplines and support in your area atAutism New Zealand.
Last updated or reviewed on February 27, 2023
Speak to your GP or health visitor
Make an appointment with your GP (or health visitor in the case of young children). Take along a list of behaviours and characteristics that make you think your child might be autistic. It could be useful to keep a behaviour diary leading up to any appointments after the referral.
In-Home Supportive Services (IHSS)
Parents who have been deemed caregivers are granted a specific number of paid hours every month so your child can remain safely in his own home, as it is considered an alternative to out-of-home care such as board and care facilities. IHSS pays up to around $3,000 per month.
We have online mental health quizzes for many conditions including ADHD, autism, anxiety, depression, PTSD, and more. Each one should take no longer than five minutes.What are the red flags for autism in a 2 year old? ›
What are the early warning signs for autism spectrum disorder? The early warning signs for an ASD include concerns about a child's social skills, communication, and restricted or repetitive patterns of behaviors, interests, activities, and emotional regulation.At what age is autism usually detected? ›
ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults.Can a child have mild autism? ›
A child could have mild symptoms of autism, but parents and guardians should still take proactive steps to seek a diagnosis. When a child has autism spectrum disorder (ASD), caregivers can work with professionals to develop appropriate strategies in response.Do parents of autistic kids get money? ›
Yes, there are many forms of financial aid and benefits available to parents of children with autism from sources such as the Social Security Administration, Medicaid, insurance, grants, and educational support.Is it hard to get SSI for a child with autism? ›
Financial limitations are the top reason why children with autism are denied SSI benefits. All parents with a child with autism that is under the age of 18 must meet the relevant financial requirements to access monthly benefits.Can a parent be paid to be a caregiver to an autistic child? ›
In some cases, parents may be able to receive compensation for providing care to their autistic child through certain programs. However, this is not a universal option and depends on the specific program and state regulations.Is ADHD a part of autism? ›
ADHD is not on the autism spectrum, but they have some of the same symptoms. And having one of these conditions increases the chances of having the other. Experts have changed the way they think about how autism and ADHD are related.
Inheritance. ASD has a tendency to run in families, but the inheritance pattern is usually unknown. People with gene changes associated with ASD generally inherit an increased risk of developing the condition, rather than the condition itself.Is autism a disability? ›
Autism is a neurological developmental disability with an estimated prevalence of one to two percent of the American and worldwide population. The diversity of the disability means that each person's individual experience of autism and needs for supports and services can vary widely.What are the false signs of autism? ›
Conditions That Can Be Mistaken for Autism. These include: Speech delays, hearing problems, or other developmental delays: Developmental delays are when your child doesn't do things doctors expect kids their age to be able to do. These can include language, speech, or hearing problems.What odd things do autistic children do? ›
Stimming might include: hand and finger mannerisms – for example, finger-flicking and hand-flapping. unusual body movements – for example, rocking back and forth while sitting or standing. posturing – for example, holding hands or fingers out at an angle or arching the back while sitting.What looks like autism but is not? ›
There are other brain disorders that mimic autism symptoms, like ADHD and anxiety disorders, including selective mutism. Autism can be misdiagnosed as another disorder with some shared symptoms.Which parent carries autism gene? ›
Since autism is less prevalent in females, autism was always thought to be passed down from the mother. However, research suggests that autism genes are usually inherited from the father.Why is autism more common in boys? ›
Certain genetic variants are linked to a higher chance of a child being somewhere on the spectrum. Also, it takes fewer variants to predispose a boy to developing autism than it does a girl.Why is autism increasing? ›
The CDC says more children are being diagnosed with autism than ever before. The rates may reflect growing awareness of autism spectrum disorder and a focus on getting more children into treatment. Other factors including air pollution, low birth weight, and stress may also be behind the increase in diagnoses.What does level 1 autism look like? ›
Defining the Traits and Behaviors of Level 1 Autism
Difficulty switching between activities. Problems with executive functioning which hinder independence. Atypical response to others in social situations. Difficulty initiating social interactions and maintaining reciprocity in social interaction.
Some developmental health professionals refer to PDD-NOS as “subthreshold autism." In other words, it's the diagnosis they use for someone who has some but not all characteristics of autism or who has relatively mild symptoms.
Untreated autism causes changes in brain function that make it more difficult for the person to control impulsive behavior or think rationally about their actions before they act on them. This can lead to situations where ASD adults are unable to live alone and take care of themselves without assistance.Does autism count as a disability on taxes? ›
Is Autism Considered a Disability for Tax Purposes? The short answer is “yes,” the Earned Income Tax Credit (EITC) does cover children with autism as a disability, but the process is a bit more complex than merely claiming the EITC on your tax return.Do autistic children love their parents? ›
Autistic children love their parents
You may have to learn to see how your child expresses affection and not take it personally if your child doesn't show affection in the way that typical children do.
The maximum SSI benefit amount for a child with autism in 2021 is $794 per month. However, the actual benefit amount a child receives may be less than this if their income or resources exceed the limits set by the SSA.What benefits does an autistic child get? ›
Supplemental Security Income, or SSI, is a monthly government payment through Social Security which is designed to support people who are aged (65 and older), blind, or disabled. Individuals with autism may be eligible to receive SSI to help support them financially.How do I get the $16728 Social Security bonus? ›
To acquire the full amount, you need to maximize your working life and begin collecting your check until age 70. Another way to maximize your check is by asking for a raise every two or three years. Moving companies throughout your career is another way to prove your worth, and generate more money.What states have the best benefits for autism? ›
Colorado, New York, Maryland, and Connecticut typically rank high as the states providing the most benefits to autistic people in all age groups.Can you get money for being autistic? ›
Conditions like autism are recognized by the Social Security Administration (SSA) as potentially disabling and may be able to qualify you or your child for Social Security Disability (SSD) benefits through one of both of the SSA's disability programs.What are the benefits of high functioning autism? ›
Higher intelligence: Many people with HFA are really smart and have a great memory along with a strong vocabulary and ability to think visually. This helps them to think outside the box and be creative problem solvers. Honest and accepting: They'll be honest and tell you the truth. Those with HFA see through pretense.Can you do a home test for autism? ›
A good place to start might be to do a self-assessment. There is a questionnaire called the AQ10 test which you can download and complete to give a general indication of whether someone might have Autism. There are 2 versions available, one for adults & one for children (AQ10 for children).
Children with ADHD often have difficulty paying attention to the same thing for too long, and they may get distracted easily. Autistic children may have a limited scope of interest. They may seem to obsess over things that they enjoy and have difficulty focusing on things that they have no interest in.How do you test a 3 year old for autism? ›
There is no blood or imaging test that can be used to diagnose ASD. Instead, doctors diagnose children with autism by observing their behavior and monitoring their development. During an exam, your doctor will ask you questions about your child's behavior to see whether they meet standard developmental milestones.How do I know if my 3 year old has autism? ›
What are the symptoms of autism in a 3-year-old? Particular changes or challenges in a 3-year-old can sometimes indicate autism. Possible signs of autism include always playing alone, not speaking, and unusual body movements, among others. Autism spectrum disorder (ASD) affects approximately 1 in 59 children .What is mild autism? ›
Mild autism is level 1 autism spectrum disorder. It means a person does not have severe symptoms and needs a lower level of support than someone else with autism. People with mild autism still have a hard time communicating and interacting with others.Is there currently no medical test to diagnose autism? ›
Early diagnosis can make a huge difference in the lives of children with autism spectrum disorder (ASD) and their families. But it's not always easy to make an ASD diagnosis. There's no lab test for it, so doctors rely on observing the behaviors of very young children and listening to the concerns of their parents.Do autistic children behave differently at home? ›
It's quite common for autistic children who do not appear to have any behavioural difficulties at school to behave differently at home. Tony Attwood refers to this as the Jekyll and Hyde character (Attwood, 1998). In section, we look at some of the reasons behind this behaviour, and offer tips to parents and carers.How do I know if my son is slightly autistic? ›
Autism in young children
avoiding eye contact. not smiling when you smile at them. getting very upset if they do not like a certain taste, smell or sound. repetitive movements, such as flapping their hands, flicking their fingers or rocking their body.
Sometimes, environmental factors can cause sensitivity to a child diagnosed with autism, such as light and sounds that can be very distracting and uncomfortable. These can cause the child to become temporarily hyperactive or disruptive.What is a stubborn behavior of autism? ›
It's common for autistic children to behave in challenging ways or ways that are difficult to manage. For example, autistic children and teenagers might: refuse or ignore requests. behave in socially inappropriate ways, like taking their clothes off in public.Can a child show signs of autism and not be autistic? ›
Children can be misdiagnosed as having Autism Spectrum Disorder (ASD) and not actually be autistic. It is concerning enough for a parent to be told their child is on the Autism Spectrum, but for a child to be misdiagnosed as having autism can cause unnecessary stress and worry for the family.
Having a family health history of ASD makes you more likely to have a child with ASD, or to have ASD yourself. If you have a child with ASD, you are more likely to have another child with ASD, especially if you have a daughter with ASD or more than one child with ASD.What is the biggest symptom of autism? ›
- finding it hard to understand what others are thinking or feeling.
- getting very anxious about social situations.
- finding it hard to make friends or preferring to be on your own.
- seeming blunt, rude or not interested in others without meaning to.
- finding it hard to say how you feel.
About stimming and autism
Stimming might include: hand and finger mannerisms – for example, finger-flicking and hand-flapping. unusual body movements – for example, rocking back and forth while sitting or standing. posturing – for example, holding hands or fingers out at an angle or arching the back while sitting.
- By 6 months: No big smiles or other warm, joyful expressions.
- By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
- By 12 months: Lack of response to name.
- By 12 months: No babbling or “baby talk.”