Autism Spectrum Disorders: Signs and Symptoms (Part 2)

Communication

Each person with autism spectrum disorder (ASD) has different communication skills. Some people can speak well. Others can't speak at all or only very little. About 40 percent of children with ASD do not talk at all. About 25 to30 percent of children with ASD have some words at 12 to 18 months of age and then lose them.¹ Others might speak, but not until later in childhood.

Examples of communication issues related to ASD include

• 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 different ways than most people their age and development level. They might not be able to put words into real sentences. Some say only one word at a time, while 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?" they 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 age three. 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, they 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 an 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. They 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.

Atypical Interests and Behaviors

Many people with ASD have interests or behaviors that differ from what is common among others their age. Examples of interests and behaviors related to ASD include

• 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 an 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 them. 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 they walk by in a building or might always want to watch a video from beginning to end, including the previews and 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
• Potential self-injury
• Temper tantrums
• Irregular eating and sleeping habits
• Atypical mood or emotional reactions
• Lack of fear or more fear than expected
• Atypical reactions to the way things sound, smell, taste, look, or feel

People with ASD might have atypical responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or underreact to pain or to a loud noise. They might have abnormal eating habits. For instance, some people limit their diet to only a few foods, while 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 atypical sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unexpected 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.

Development

Children with ASD develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with ASD might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a "b" makes.

Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. However, there are age-specific developmental milestones used to measure a child's social and emotional progress in the first few years of life. To learn more about developmental milestones, visit "Learn the Signs. Act Early," a campaign designed by the U.S. Centers for Disease Control and Prevention (CDC) and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible red flags for autism spectrum disorders: Link opens in a new windowhttps://www.cdc.gov/ncbddd/actearly/index.html.

Reference

1. Johnson, C.P. (2004). Early clinical characteristics of children with autism. In V.B. Gupta (Ed.), Autistic Spectrum Disorders in Children (pp. 85–123). New York: Marcel Dekker, Inc.