By what age range do autism red flags such as lack of pretend play and poor joint attention typically appear?

• A. By 12-15 months
• B. By 18-24 months
• C. By 3-4 years
• D. Only after age 5

Answer: (B)

Autism red flags like lack of pretend play and poor joint attention typically become noticeable as children approach their second year. By about 18 to 24 months, toddlers are expected to engage in simple pretend play and to share attention with others during interactions. Joint attention—eye contact, pointing, and following a caregiver’s gaze to share interest—should be developing during this period, and pretend play should begin to appear as children imitate and role-play with others. When these skills are absent or markedly delayed by 18–24 months, it raises concern for autism and warrants formal screening and referral for evaluation. This is also the age range when routine autism screening is commonly emphasized, highlighting the importance of early identification for timely intervention.