Signs of Autism

Possible “Red Flags”

A person with ASD might:

• Not respond to their name by 12 months of age
• Not point at objects to show interest (the point at an airplane flying over) by 14 months
• Not play “pretend” games (pretend to “feed” a doll) by 18 months
• Avoid eye contact and want to be alone
• Have trouble understanding other people’s feelings or talking about their own feelings
• Have delayed speech and language skills
• Repeat words or phrases over and over (echolalia)
• Give unrelated answers to questions
• Get upset by minor changes
• Have obsessive interests
• Flap their hands, rock their body, or spin in circles
• Have unusual reactions to the way things sound, smell, taste, look, or feel

Social Skills

Social issues are one of the most common symptoms in all types of ASD. People with ASD do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to ASD:

• Does not respond to name by 12 months of age
• Avoids eye-contact
• Prefers to play alone
• Does not share interests with others
• Only interacts to achieve a desired goal
• Has flat or inappropriate facial expressions
• Does not understand personal space boundaries
• Avoids or resists physical contact
• Is not comforted by others during distress
• Has trouble understanding other people’s feelings or talking about their own feelings

Typical infants are very interested in the world and the people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye-bye”. Typical toddlers also show interest in social games like peek-a-boo and pat-a-cake. But a young child with ASD might have a very hard time learning to interact with other people.

Some people with ASD might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with ASD have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.

People with ASD might have problems with showing or talking about their feelings. They might also have trouble understanding other people’s feelings. Many people with ASD are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with ASD. Anxiety and depression also affect some people with ASD. All of these symptoms can make other social problems even harder to manage.

Communication

Each person with ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them. Others might speak, but not until later in childhood.

Examples of communication issues related to ASD:

• Delayed speech and language skills
• Repeats words or phrases over and over (echolalia)
• Reverses pronouns (e.g., says “you” instead of “I”)
• Gives unrelated answers to questions
• Does not point or respond to pointing
• Uses few or no gestures (e.g., does not wave goodbye)
• Talks in a flat, robot-like, or sing-song voice
• Does not pretend in play (e.g., does not pretend to “feed” a doll)
• Does not understand jokes, sarcasm, or teasing

People with ASD who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with ASD say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with ASD, “Do you want some juice?” he or she might repeat “Do you want some juice?” instead of answering your question. Although many children without ASD go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with ASD can speak well but might have a hard time listening to what other people say.

People with ASD might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with ASD might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with ASD might smile while saying something sad.

People with ASD might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with ASD might stand too close to the person they are talking to or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.

Unusual Interests and Behaviors

Many people with ASD have unusual interests or behaviors.

Examples of unusual interests and behaviors related to ASD:

• Lines up toys or other objects
• Plays with toys the same way every time
• Likes parts of objects (e.g., wheels)
• Is very organized
• Gets upset by minor changes
• Has obsessive interests
• Has to follow certain routines
• Flaps hands, rocks body, or spins self in circles

Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with ASD might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”

People with ASD often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with ASD. They might “lose control” and have a “meltdown” or tantrum, especially if in a strange place.

Some people with ASD also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.

Other Symptoms

Some people with ASD have other symptoms. These might include:

• Hyperactivity (very active)
• Impulsivity (acting without thinking)
• Short attention span
• Aggression
• Causing self-injury
• Temper tantrums
• Unusual eating and sleeping habits
• Unusual mood or emotional reactions
• Lack of fear or more fear than expected
• Unusual reactions to the way things sound, smell, taste, look, or feel

People with ASD might have unusual responses to touch, smell, sounds, sights, tastes, and feel. For example, they might over- or under-react to pain or to loud noises. They might have abnormal eating habits. For instance, some people with ASD limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.

People with ASD might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.

Excerpts from the CDC website: http://www.cdc.org