CORE SIGNS AND SYMPTOMS
Autism affects the way your child perceives the world and may make communication and social interaction difficult. ASD is characterized by social interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors.
However, symptoms and their severity vary widely across these three core areas. Taken together, they may result in relatively mild challenges for some people on the autism spectrum. For others, symptoms may be more severe, as when repetitive behaviors or lack of spoken language interfere with everyday life.
Typically developing infants are social by nature. They gaze at faces, turn toward voices, grasp a finger and even smile by 2 to 3 months of age.
By contrast, most children who are on the autism spectrum have difficulty engaging in the give-and-take of everyday human interactions. By 8 to 10 months of age, many infants who are eventually diagnosed with autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone.
To parents, it may seem as if their child is disconnected. They may not seek comfort or respond to family members’ displays of anger or affection in typical ways. Research suggests that children with autism are attached to their parents. However, the way they express this attachment may look different compared to non-autistic children.
Some social symptoms of autism might include:
Difficulty interpreting what others are thinking and feeling
Subtle social cues, such as a smile, a wave or a frown, may not convey meaning to an autistic person in the way that those without autism interpret them. For example, a child with autism may not know or indicate they understand your full meaning when you say “Come here!” with your arms extended out for a hug, or when you say it with a frown on your face. Without the ability to interpret gestures and facial expressions, the social world can seem bewildering.
Difficulty seeing things from another person's perspective
Most 5-year-old children understand that other people have thoughts, feelings and goals that may be different from their own. A person with autism may not show such understanding. This, in turn, can interfere with the ability to predict or understand another person’s actions.
Difficulty regulating emotions
Some autistic children experience challenging behaviors, such as outbursts or crying in contexts when they don’t seem warranted or make sense to others. It’s helpful to know that challenges in regulating emotions may be attempts to communicate when situations are overwhelming, unexpected or new. Some behaviors can become disruptive or physically aggressive in such overwhelming or frustrating situations. Self-injurious behavior, such as head banging, hair pulling or self-biting, may also occur.
Fortunately, autistic children can be taught how to socially interact, use gestures and recognize facial expressions.
Also, there are many strategies that can help a child with autism respond to frustrations and learn to communicate their needs, so they don’t have to express those feelings and needs through challenging or potentially unsafe behaviors.
Young children with autism tend to be delayed in babbling, speaking and learning to use gestures. Some infants who later develop autism coo and babble during the first few months of life before losing these communicative behaviors. Others experience significant language delays and don’t begin to speak until much later.
With therapy, however, most autistic people do learn to use spoken language, and all can learn to communicate in their own way. Many nonverbal or nearly nonverbal children and adults learn to use communication systems, such as pictures, sign language, electronic word processors or even speech-generating devices.
Some communication difficulties might include:
When language begins to develop, an autistic person may use speech in unusual ways. Some have difficulty combining words into meaningful sentences. They may speak only single words or repeat the same phrase over and over. Some repeat what they hear verbatim. This is called echolalia.
Expressive and receptive language
Many parents assume that a child who is unable to express language is also unable to understand the language of others. But this is not always the case. It is important to distinguish between expressive language and receptive language.
- Expressive language is how a person communicates their feelings, thoughts and needs. Children with difficulties in expressive language are often unable to express what they are thinking through language.
- Receptive language is how a person understands information. Children with difficulties in receptive language are often unable to understand what others are saying.
The fact that your child may seem unable to express themselves through language does not necessarily mean they are unable to comprehend the language of others. Be sure to talk to your doctor or look for signs that your child can interpret language, as this important distinction will affect the way you communicate with them.
Pragmatics are social rules for using language in a meaningful context or conversation. Examples include taking turns in conversation, changing the way a person talks to different listeners, and using eye contact and gestures when speaking or listening. Challenges in pragmatics are a common feature of spoken language difficulties in children with autism, including in children with no language delays and highly fluent speech. These challenges may become more apparent as your child gets older.
Some autistic children exhibit only slight delays in language. They might even develop advanced language with large vocabularies, yet they also may have difficulty sustaining a conversation. Some children and adults with autism may talk for a significant amount of time about a favorite subject, yet may not have the ability or tools they need to manage the “to and fro” of conversation. In other words, the ordinary “give and take” of conversation proves difficult. Some autistic children with superior language skills may sound like “little professors” or may not pick up on the “kid-speak” that’s common among their peers.
Another common difficulty is interpreting nonverbal communication, such as body language, tone of voice and facial expressions. For example, a person with autism might interpret a sarcastic, “Oh, that’s just great!” as meaning it really is great. Conversely, some autistic individuals may not use typical body language. Facial expressions, movements and gestures may not match what they are saying. Their tone of voice may not reflect their feelings. Some use a high-pitched sing-song or a flat, robot-like voice. This can make it difficult for others to know what they think, feel or need.
When attempts to communicate don’t work, it can lead to frustration for the person with autism and could escalate to a behavioral outburst, such as screaming or grabbing. Fortunately, there are proven methods for helping autistic children and adults learn more productive ways to express their needs. Learning and understanding what your child is trying to communicate in certain circumstances will also help with these behaviors. As an autistic person learns to communicate what they want, feel and think, and you learn to better understand their efforts to communicate, challenging behaviors often subside.
Unusual repetitive behaviors and a tendency to engage in a restricted range of activities are other core symptoms of autism. Common repetitive behaviors include: arranging and re-arranging objects, hand-flapping, rocking or wiggling fingers in front of the eyes.
These symptoms and others are often due to:
Need for sensory stimulation
Sometimes the repetitive behavior, such as staring at lights, fans or running water, is related to a need or desire for certain types of sensory stimulation. Under-responsiveness and over-responsiveness to sensory stimulation are another form of repetitive behavior. For example, many children with autism are very sensitive to loud noises or even to noises that don’t seem too loud (over-responsiveness). Or they may not respond as expected to pain when they fall or hurt themselves (under-responsiveness).
Restricted range of activities
Many autistic children play with toys in a restricted way. For example, some spend hours lining up toys in a specific way instead of using them for pretend play. Similarly, some adults can become preoccupied with having household or other objects in a fixed order or place. It may be upsetting to them when something disrupts the order. Many autistic children and adults need and demand consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to anxiety or outbursts.
Repetitive behaviors can also take the form of intense preoccupations or obsessions. These extreme interests might strike others as unusual, such as a fascination with fans, vacuum cleaners or toilets. Some autistic people have a strong depth of knowledge in specific topics. For example, a child or adult may know and share astonishingly detailed information about a favorite cartoon or the subject of astronomy. Older people with autism may develop interest in numbers, symbols, dates or science topics. For some, these interests can be viewed as a strength and used in different ways as the child ages, including in potential employment opportunities.
Executive functioning and theory of mind
People with autism may have difficulty processing large amounts of information and relating to others. Two core terms related to these challenges are executive functioning and theory of mind. Both of these issues can impact their behavior.
Executive functioning refers to a person's ability to process information.
Theory of mind refers to a person's ability to understand and identify the thoughts, feelings and intentions of others.
Difficulties in the area of executive functioning can manifest themselves in many different ways, such as:
- Challenges with complex thinking that requires holding more than one train of thought at the same time
- Difficulty seeing how minor details fit into a bigger picture
- Difficulty maintaining attention or organizing thoughts and actions
- Poor impulse control
- Inability to use skills related to self-regulation
- Difficulty inhibiting inappropriate responses
Temple Grandin once said, "I cannot hold one piece of information in my mind while I manipulate the next step in the sequence."
Theory of mind
People with autism can encounter difficulty recognizing and processing the feelings of others, which is sometimes referred to as “mind-blindness.” It can be difficult for them to understand that others may have different feelings from their own. In the book Asperger Syndrome and Difficult Moments by Brenda Smith Myles and Jack Southwick, the authors illustrate social deficits caused by theory of mind:
- Difficulty explaining one’s behaviors
- Difficulty understanding emotions
- Difficulty predicting the behavior or emotional state of others
- Problems understanding the perspectiveof others
- Problems inferring the intentions of others
- Lack of understanding that behavior impacts how others think and/or feel
- Problems with joint attention and other social conventions
- Problems differentiating fiction from fact
As a result of these challenges, autistic people may not realize if another person’s behaviors are intentional or unintentional. This often leads others to believe that the person with autism does not have empathy or understand them, which can create great difficulty in social situations.
Helping a person with autism learn to better understand feelings, as well as reasons for certain behaviors can improve these challenges.
Strengths and challenges
Created by Stephen Shore, Ed.D., Adephi University professor, Autism Speaks board member, self-advocate
It is important to note that this is a general list. For every strength and challenge, you will often find examples in people that prove the opposite. For example, clumsiness is a common challenge. However, some with autism have significant strengths in movement and balance, perhaps as a dancer.
- Attention to detail
- Often highly skilled in a particular area
- Deep study resulting in encyclopedic knowledge on areas of interest
- Tendency to be logical (helpful in decision-making where emotions may interfere)
- Less concern for what others may think of them (can be a strength and a challenge), also known as independent thinking. Often results in novel “big picture” insights due to different ways of looking at things, ideas, and concepts.
- Visual processing (thinking in pictures or video)
- Average to above average intelligence
- Often very verbal (propensity of giving detailed descriptions may be useful in providing directions to lost persons)
- Direct communication
- Nonjudgmental listening
- Grasping the “big” picture
- Uneven set of skills
- Difficulty developing motivation to study areas not of interest
- Difficulty perceiving emotional states of others
- Difficulty perceiving unwritten rules of social interaction, but can learn these rules through direct instruction and social narratives
- Difficulty processing in non-favorite modalities such as aural, kinesthetic, etc.
- Difficulty parsing out and summarizing important information for a conversation
- Sensory integration problems where input may register unevenly, distorted and difficultyin screening out background noise
- Generalization of skills and concepts
- Difficulty expressing empathy in ways that others expect or understand
- Difficulty with executive functioning resulting in challenges planning long-term tasks