All children with ASD demonstrate deficits in 1)
social interaction, 2) verbal and nonverbal communication, and 3)
repetitive behaviors or interests. In addition, they will often have
unusual responses to sensory experiences, such as certain sounds or
the way objects look. Each of these symptoms runs the gamut from
mild to severe. They will present in each individual child
differently. For instance, a child may have little trouble learning
to read but exhibit extremely poor social interaction. Each child
will display communication, social, and behavioral patterns that are
individual but fit into the overall diagnosis of ASD.
Children with ASD do not follow the typical patterns
of child development. In some children, hints of future problems may
be apparent from birth. In most cases, the problems in communication
and social skills become more noticeable as the child lags further
behind other children the same age. Some other children start off
well enough. Oftentimes between 12 and 36 months old, the
differences in the way they react to people and other unusual
behaviors become apparent. Some parents report the change as being
sudden, and that their children start to reject people, act
strangely, and lose language and social skills they had previously
acquired. In other cases, there is a plateau, or leveling, of
progress so that the difference between the child with autism and
other children the same age becomes more noticeable.
Possible Indicators of Autism Spectrum
Disorders
Does not babble, point, or make meaningful gestures
by 1 year of age
Does not speak one word by 16 months
Does not combine two words by 2 years
Does not respond to name
Loses language or social skills
Some Other Indicators
Poor eye contact
Doesn't seem to know how to play with toys
Excessively lines up toys or other objects
Is attached to one particular toy or object
Doesn't smile
At times seems to be hearing impaired
Social Symptoms
From the start, typically developing infants are
social beings. Early in life, they gaze at people, turn toward
voices, grasp a finger, and even smile.
In contrast, most children with ASD seem to have tremendous
difficulty learning to engage in the give-and-take of everyday human
interaction. Even in the first few months of life, many do not
interact and they avoid eye contact. They seem indifferent to other
people, and often seem to prefer being alone. They may resist
attention or passively accept hugs and cuddling. Later, they seldom
seek comfort or respond to parents' displays of anger or affection
in a typical way. Research has suggested that although children with
ASD are attached to their parents, their expression of this
attachment is unusual and difficult to "read." To parents, it may
seem as if their child is not attached at all. Parents who looked
forward to the joys of cuddling, teaching, and playing with their
child may feel crushed by this lack of the expected and typical
attachment behavior.
Children with ASD also are slower in learning to interpret what
others are thinking and feeling. Subtle social cues—whether a smile,
a wink, or a grimace—may have little meaning. To a child who misses
these cues, "Come here" always means the same thing, whether the
speaker is smiling and extending her arms for a hug or frowning and
planting her fists on her hips. Without the ability to interpret
gestures and facial expressions, the social world may seem
bewildering. To compound the problem, people with ASD have
difficulty seeing things from another person's perspective. Most
5-year-olds understand that other people have different information,
feelings, and goals than they have. A person with ASD may lack such
understanding. This inability leaves them unable to predict or
understand other people's actions.
Although not universal, it is common for people with ASD also to
have difficulty regulating their emotions. This can take the form of
"immature" behavior such as crying in class or verbal outbursts that
seem inappropriate to those around them. The individual with ASD
might also be disruptive and physically aggressive at times, making
social relationships still more difficult. They have a tendency to
"lose control," particularly when they're in a strange or
overwhelming environment, or when angry and frustrated. They may at
times break things, attack others, or hurt themselves. In their
frustration, some bang their heads, pull their hair, or bite their
arms.
Communication Difficulties
By age 3, most children have passed predictable
milestones on the path to learning language; one of the earliest is
babbling. By the first birthday, a typical toddler says words, turns
when he hears his name, points when he wants a toy, and when offered
something distasteful, makes it clear that the answer is "no."
Some children diagnosed with ASD remain mute throughout their lives.
Some infants who later show signs of ASD coo and babble during the
first few months of life, but they soon stop. Others may be delayed,
developing language as late as age 5 to 9. Some children may learn
to use communication systems such as pictures or sign language.
Those who do speak often use language in unusual ways. They seem
unable to combine words into meaningful sentences. Some speak only
single words, while others repeat the same phrase over and over.
Some ASD children parrot what they hear, a condition called
echolalia. Although many children with no ASD go through a stage
where they repeat what they hear, it normally passes by the time
they are 3.
Some children only mildly affected may exhibit slight delays in
language, or even seem to have precocious language and unusually
large vocabularies, but have great difficulty in sustaining a
conversation. The "give and take" of normal conversation is hard for
them, although they often carry on a monologue on a favorite
subject, giving no one else an opportunity to comment. Another
difficulty is often the inability to understand body language, tone
of voice, or "phrases of speech." They might interpret a sarcastic
expression such as "Oh, that's just great" as meaning it really IS
great.
While it can be hard to understand what ASD children are saying,
their body language is also difficult to understand. Facial
expressions, movements, and gestures rarely match what they are
saying. Also, their tone of voice fails to reflect their feelings. A
high-pitched, sing-song, or flat, robot-like voice is common. Some
children with relatively good language skills speak like little
adults, failing to pick up on the "kid-speak" that is common in
their peers.
Without meaningful gestures or the language to ask for things,
people with ASD are at a loss to let others know what they need. As
a result, they may simply scream or grab what they want. Until they
are taught better ways to express their needs, ASD children do
whatever they can to get through to others. As people with ASD grow
up, they can become increasingly aware of their difficulties in
understanding others and in being understood. As a result they may
become anxious or depressed.
Repetitive Behaviors
Although children with ASD usually appear physically
normal and have good muscle control, odd repetitive motions may set
them off from other children. These behaviors might be extreme and
highly apparent or more subtle. Some children and older individuals
spend a lot of time repeatedly flapping their arms or walking on
their toes. Some suddenly freeze in position.
As children, they might spend hours lining up their cars and trains
in a certain way, rather than using them for pretend play. If
someone accidentally moves one of the toys, the child may be
tremendously upset. ASD children need, and demand, absolute
consistency in their environment. A slight change in any routine—in
mealtimes, dressing, taking a bath, going to school at a certain
time and by the same route—can be extremely disturbing. Perhaps
order and sameness lend some stability in a world of confusion.
Repetitive behavior sometimes takes the form of a persistent,
intense preoccupation. For example, the child might be obsessed with
learning all about vacuum cleaners, train schedules, or lighthouses.
Often there is great interest in numbers, symbols, or science
topics.
Recent studies have shown that there is
currently a worldwide autism epidemic. In fact, more than 1.5
million people are affected in the United States alone, with one in
every 250 children diagnosed.
It's true that early detection and early treatment are the two key
factors in improving prognosis -- but too often parents get bogged
down in denial or confusion about this still mysterious disorder,
and are unable or unwilling to take the necessary steps.
The Essential Guide to Autism contains advice and information that
will help you make the right treatment decisions for your child.
Today, many youngsters can be helped to attend school alongside
their peers. Some programs are demonstrating that with appropriate
support, many people with autism can be trained to do meaningful
work and participate fully in community life.
All of the materials on this site have been included for the purpose of
providing general information, and they should not be relied on as a
substitution for professional advice.
