Child and Adolescent Psychiatry Consulting

Possible Indicators of Autism Spectrum Disorders

The following are possible indicators of autism spectrum disorders, according to the Public Health Training Network Webcast, Autism Among Us

• 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.

Children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction:

• 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.
• As they become toddlers, they may not seek comfort or respond to parents’ displays of anger or affection the way other children do.

Children with ASD are attached to their parents, but they may not respond interactively the way a normally developing child does, and may not enjoy cuddling, or playing, with their parents.  Some parents may doubt their child’s attachment.

Children with ASD also are slower in learning to interpret what others are thinking and feeling, and unable to predict or understand the actions of others:

• Facial expressions, gestures, body language, subtle social cues, are missed.
• The  can be egocentric, and have difficulty seeing things from another person’s viewpoint.
• Most 5-year-olds understand that other people have different information, feelings, and goals than they have.

Children with ASD may have trouble regulating their emotions.

• They may cry, or have verbal outbursts that seem immature or inappropriate
• They may be disruptive and even may be physically aggressive at times
• They may lose control when they are confused or overwhelmed by the environment around them, and this can result in self-harming behaviors as well as aggrssion toward people around them.

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.”

Children with ASD may never speak, or may start out cooing and babbling, but then stop. Still others may have language delay, so that they don’t start speaking until well into their elementary years.

Children with ASD who do speak may use “idiosyncratic” (unusual) language, such as:

• speaking in single word
• having trouble combining words into sentences that make sense
• repeating sentences over and over again
• repeating what they hear others saying, which is called echolalia
• some may have trouble with tone of their voice, so that they are monotone, or speak with a high-pitched voice, or in a sing-song way that makes what they are saying difficult to follow.

Some ASD children may have only slight language delays, or may even have expansive vocabularies, yet cannot sustain a conversation:

• they may speak without give-and-take, and without an awareness that the person they are talking to has lost interest.
• often they may talk on and on about a topic of interest to themselves, without any interest in having others comment,  and without providing others with the opportunity to do so.
• they may take figurative  phrases literally, such as believing someone’s heart is really “broken” when they hear the term “broken-hearted.”  They may have trouble understanding humor.
• some of these kids may speak in an “overly mature” way so that they do not fit in with their peers well, and they may relate better to adults.
• they do not understand body language, facial expression, or tone of voice

Children with ASD will often have facial expressions, movements and gestures that do not match what they are saying, and often their tone of voice is different from the way that they feel.

These communication difficulties make it difficult for persons with ASD to ask for what they need. They may simply scream or grab what they want, until they are taught ways to express themselves. As people with ASD grow up, they may become aware of their differences, and that it is difficult to make themselves be understood. This can lead to feelings of anxiety and or depression.

Repetitive Behaviors

Children with ASD often have odd or repetitive behaviors that make them appear different than other children.

• They may walk on their toes, or flap their arms, or sniff things more than other children their age.
• They may play with their toys differently than others, so that they prefer to sort and organize their toys instead of engaging in imaginative play. They may become upset if their toys are moved out of the organized way that they’ve intended. They may prefer to take objects apart rather than play with them.
• Ritual and routine may be very important, such as driving to and from school the same way each time, and having to have a fixed schedule. A slight change in routine can lead to confusion and overwhelm, which can lead to frustration, and emotional outbursts. For example, children with ASD may have significant difficulties on a day that a substitute teacher is in their classroom.
• As older children and adults, they may have a limited range of interest, with an intense focus on a topic, and may know many, many details about their interest, which they enjoy sharing with those around them, in a sort monologue. Often their interests are related to things mechanical or scientific, such as trains, dinosaurs, or plants.