Early signs of autism in Singapore: a parent’s guide (0–3)

A doctor told us she looked fine

When our daughter was two, we already had our quiet worries — she often didn’t turn to her name, and she rarely held eye contact. That year, a relative visited us — a doctor with more than twenty years of practice. He looked at her and told us what any parent would be glad to hear: she looks fine, she looks healthy, and it’s too early to say whether it’s autism.

He meant well, and by every ordinary measure he was right: look at her photos and videos from those years and you’ll see a cute little girl and nothing more. We were reassured. We waited. She was about three and a half before she finally saw a paediatrician.

Here’s what we’d want you to take from that — and it isn’t “don’t trust doctors”. It’s that a warm visit, even from an experienced doctor, is not a developmental assessment. The early signs of autism can be invisible across a living room and still be there in the everyday pattern only you can see: the name that goes unanswered, the point that never comes. If the people around you are reassuring but your gut keeps snagging on the same small things, you can accept the comfort and still book the appointment. Doing both is not distrust. It’s how it’s supposed to work.

What autism is (and isn’t)

Autism — the medical term is autism spectrum disorder, or ASD — is a difference in how the brain develops that shapes how a person experiences the world, communicates, and relates to others. It’s lifelong, and it’s not an illness: there is nothing to cure, and an autistic person cannot become non-autistic. What there is, is understanding and support — and the earlier those start, the better they fit.

Nobody fully knows what causes autism, though it can run in families. One thing is settled and worth saying plainly to every parent reading this at 2am: autism is not caused by parenting style. Nothing you did, or didn’t do, made your child autistic.

“Spectrum” is the most misunderstood word in the term. It doesn’t mean a line from “mildly autistic” to “severely autistic” — the National Autistic Society is explicit that this old picture isn’t right. It means every autistic person has their own combination of characteristics: different strengths, different challenges, different support needs. Two autistic children can look nothing alike — which is exactly why the signs below are patterns to notice, not boxes to tick.

The signs, age by age

Every toddler does some of these things sometimes. What matters is several signs, showing up often, and persisting — a pattern, not a moment. Ages are approximate; children develop at different paces.

Around 12 months

Most children this age respond socially: they turn to their name, look where you point, wave, reach up to be carried, and use eye contact freely. Worth noting if your child often does little of this — especially not turning to their name while clearly reacting to other sounds.

Around 15–18 months

This is when sharing attention normally blooms. The signs clinicians watch: leading you by the hand instead of pointing, pointing only to get things — never just to show you something interesting — few or no single words, and little early pretend play.

Around 2–3 years

Little interest in other children; play that leans repetitive (lining things up, the same segment on repeat) rather than pretend; speech that’s late, limited, or unusual in tone; repetitive movements like rocking, spinning, or hand-flapping; big reactions to small changes and strong sensory responses — to sounds, textures, lights, or foods.

That’s the shape. The full checklist — sign by sign, with the everyday examples — is in our checklist by age. Print it, tick what you recognise, and it becomes exactly what a doctor needs from you.

The signs that hide

Some children show autism quietly — girls especially. The NHS notes autistic girls may copy how other children behave and play, stay quiet in situations they find difficult, appear to cope socially, and show fewer repetitive behaviours than autistic boys. From the outside, that can look like shyness. Or like nothing at all.

The famously “easy” baby belongs here too — content alone, undemanding, absorbed in their own world. Sometimes that’s temperament. Sometimes it’s a child who isn’t seeking social connection the way most infants do. Quiet isn’t a red flag by itself; it’s just not automatic reassurance either.

What it might be instead

A pattern from the lists above doesn’t automatically mean autism — and knowing the look-alikes helps you ask better questions.

• Hearing. A child who doesn’t respond to their name may simply not hear well — it was our own first guess. A hearing check is often the sensible first step, and it’s worth doing even when, like ours, the child clearly lights up at her favourite songs.
• Speech delay alone. Plenty of late talkers catch up. What distinguishes autism is the social thread — gestures, shared attention, response to name — not just word count.
• ADHD. The two conditions can look remarkably similar in a young child — not sitting still, not responding, big feelings — and a child can be both: studies put the overlap at roughly a third to a half of autistic children and adolescents also meeting ADHD criteria. We’ve written a full guide to telling ADHD and autism apart.
• Temperament and pace. Children genuinely differ. That’s why the answer to “several boxes ticked” is never a conclusion at home — it’s a proper look by someone qualified.

Some autistic children also show a distinct profile around demands and autonomy — if every ordinary request lands like a threat, our PDA guide may ring true.

The road in Singapore, end to end

Here’s the whole route, so nothing about it is a mystery:

1. Start with your GP, polyclinic, or paediatrician. KKH’s own advice for concerned parents is exactly this. Describe concrete moments, not labels: “she doesn’t turn to her name; she pulls me by the hand instead of pointing” gives a doctor far more than “I think it might be autism”.
2. Ask about a developmental referral. For preschool-age children that means KKH’s Department of Child Development or NUH’s Child Development Unit — or a private developmental paediatrician if you’d rather trade cost for speed.
3. Know the one fact that removes most of the agonising: you don’t need a diagnosis to start getting help. Early-intervention support through EIPIC requires a paediatrician’s assessment that your child is at risk of a developmental condition — not a formal diagnosis. Seeing the doctor early isn’t jumping the gun; it’s what opens doors, whichever way the assessment goes.

Public-route waits are real, and the hospitals don’t publish official figures — plan for months rather than weeks, and use that time (next section). The full step-by-step — referrals, what the assessment involves, costs, waits — is in our guide to getting an autism diagnosis in Singapore. If you’re at the very beginning and unsure what order to do anything in, Start Here lays it out.

While you wait: what actually helps at 0–3

None of this requires a diagnosis, a therapist, or a single dollar:

• Keep talking, playing, responding. Child-development researchers call it “serve and return”: when a baby babbles, gestures, or cries and you respond — with eye contact, words, a hug — that back-and-forth builds the brain connections communication and social skills grow from. You’re already doing it; keep going, even on days it feels one-sided.
• Write down concrete moments. A dated note — “15 Aug: called her name six times at dinner, no turn; turned instantly to the song” — is worth more to an assessor than a month of worry.
• Don’t pause life for the waitlist. Playgrounds, songs, books, mess. Your child needs a parent, not a co-therapist — and the waiting months count for more when they’re still full of ordinary joy.