Children to be referred typically exhibit difficulty with more than one of the following:

• playing "pretend" games (such as pretending to "feed" a doll).

• pointing at objects to show interest (such as pointing at an airplane flying over).

• looking at objects when another person points at them.

• relating to others or not having an interest in other people at all (child may show an interest in people, but doesn’t seem to know how to talk, play, or relate to them).

• understanding other people's feelings or talking about their own feelings being held or cuddled (child might cuddle only when they want to).

• expressing their needs using typical words or motions.

• adapting when routines change.

Children may also

• show a loss of skills they once had (i.e., may have stopped saying words were once using).

• avoid eye contact or prefer to be alone.

• appear unaware when other people talk to them, but respond to other sounds.

• repeat, or “echo” words or phrases said to them, or repeat words or phrases in place of normal language (echolalia).

• react in unusual ways to the way things smell, taste, look, feel, or sound.