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"But They Make Eye Contact": Why Friendly Toddlers Are Often Missed for Autism

One of the most persistent myths in early childhood development is that autistic children are always anti-social, aloof, or unable to make eye contact. When a professional dismisses a parent's concerns with phrases like "They are too friendly" or "They pointed at a toy, so it’s not autism," it can leave families in a dangerous limbo—knowing something is different but being denied the diagnosis needed to access support.

If you have been told your toddler cannot be autistic because they are social, here is the reality of the "Social Butterfly" profile and how to move forward when a doctor says "wait and see."

1. The "Too Friendly" Myth

Autism is a spectrum, and social motivation varies wildly.

  • Active-But-Odd: Many neurodivergent toddlers are desperate to interact but lack the "how-to" manual. They may hug strangers, get too close to faces, or engage in "performative" play (mimicking what they have been shown) rather than spontaneous imaginative play.

  • Fleeting Eye Contact: Many autistic children can make eye contact, especially with trusted adults or when requesting items. The clinical marker is not "zero eye contact"; it is unusual or inconsistent eye contact that doesn't coordinate well with gestures and speech.

2. Medical Diagnosis vs. Educational Identification

This is the most important distinction for parents to understand.

  • Medical Diagnosis: This comes from a doctor (psychiatrist, neurologist, developmental pediatrician). It is used for insurance billing and medical therapies (like ABA or private Speech/OT).

     

     

  • Educational Classification: This comes from your local school district. You do not need a doctor’s permission or diagnosis to get this.

  • The Loophole: If a doctor dismisses you, you can bypass them entirely and go to your school district. If the district evaluates the child and finds delays in communication, social skills, or adaptive behavior, they can classify the child as a "Preschool Student with a Disability" and provide free therapy, regardless of what the doctor said.

3. The "ADHD" Red Herring

It is common for professionals to suggest ADHD instead of Autism in toddlers who are constantly moving or spinning.

 

 

  • The Overlap: Both conditions involve regulation issues. However, rigid behaviors (lining up toys), sensory extremes (screaming in baths), and communication delays are hallmarks of Autism, not just ADHD.

  • Why it matters: While ADHD can coexist, mislabeling a sensory-avoidant autistic child as simply "hyperactive" denies them the sensory integration therapy they desperately need.

4. What to Do Next

  • Trust Your Gut: You are the expert on your child. You see them 24 hours a day; the doctor saw them for 40 minutes.

  • Seek a Second Opinion: Look for a Developmental Pediatrician or a Neuropsychologist rather than a general psychiatrist. These specialists are better trained to spot "high-masking" or social presentations of autism.