Symptoms of Autism Spectrum Disorder (ASD) can vary from mild to severe, and varies from one child to another, but there are common symptoms affecting mainly social and communication skills as well as behaviors. A person might have average intelligence, have little interest in other people, use limited verbal language, experience intense self-stimulatory behaviors such as hand-flapping, under-react to pain and over-react to sounds, have very good gross motor skills with weaknesses in fine motor skills. These symptoms may vary extensively from person to person.
There is often nothing about how people with ASD look that sets them apart from other people, however they communicate, interact, behave and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some poeple with ASD need a lot of support and assistance in their daily lives while others may need less support.
Today, a diagnosis of ASD includes several developmental disorder conditions that used to be diagnosed separately. They include Autism, Asperger Syndrome, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Rett Syndrome and Childhood Disintegrative Disorder.
ASD symptoms appear in children before 36 months of age and last throughout a person's life although they may improve over time. Some children with ASD show signs of forthcoming problems within the first few months of their birth and others between the age of 24 to 36 months. Some children with ASD seem to dvelop normally until around the age of 18 to 24 months and then they cease to gain new skills or they lose the skills they already had. Studies have show that 33%-50% of parents with children who have ASD noticed a sign before their child's first birthday; and 80%-90% saw the signs by 24 months of age.
It is important to note that some people without ASD may also show any of the mentioned symptoms but for people with ASD, the impairments make life very challenging.
Possible symptoms that may be considered as "red flags" - A person with ASD might:
- Not respond to their name by 12 months of age.
- Not point at objects to show interest by 14 months of age (such as point at an airplane flying in the sky).
- Not play "pretend" games by 18 months of age (such as a girl prentending to feed a doll).
- 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 issues are one of the most common symptoms found in all types of ASD. The social difficulties children with ASD have are not limited to shyness. The issues they have cause serious and challenging problems in every day life. Examples of social issues related to ASD include:
- 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 own feelings.
Typical infants are very much interested and curious about the world and the people around them. By their first birthday, 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". Typical toddlers also show interest in social games like peek-a-boo and pat-a-cake whereas a toddler with ASD might have a hard time learnign to interact with other people.
Some children with ASD might not be interested in other people at all while 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, significantly more so than other children and thsi can make other children not want to play with them.
People with ASD might have problems showing or talking about their feelings as well as understanding other people's feelings. Many people with ASD are extremely sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors such as flapping arms over and over again are common among kids with ASD. Anxiety and depression also affect some people with ASD. All these symptoms can make other social problems even harder to manage.
Each person with ASD has different communication skills. Some children can speak well while others cannot speak at all or speak very little. About 40% of children with ASD do not talk at all and about 25%-30% of children speak some words between 12 to 18 months of age and then lose them while others might not speak until later years into childhood. Examples of communication issues related to ASD include:
- Delayed speech and language skills.
- Repeats words or phrases over and over (echolalia).
- Reverses pronouns (saying "you" instead of "I").
- Gives unrelated answers to questions.
- Does not point or respond to pointing.
- Uses few or no gestures (does not wave "goodbye").
- Talks in a flat, robot-like or sing-song voice.
- Does not pretend in play (such as a girl prentending 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 children with ASD say only one word at a time while others repeat the same words or phrases over and over again. 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 "Would you like some juice?" he or she might repeat "Would you like some juice?" instead of answering the question. Although many children without ASD go through a stage where they repeat what they hear, it normally fades away by the age of 3. Some children 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" and vice versa. Their voices might sound flat, robot-like or high-pitched. People with ASD might stand too close to the person with whom they are speaking 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
Examples of unusual interests and behaviors related to ASD include:
- Lines up toys or other objects.
- Plays with toys the same way every time.
- Likes parts of an object or toy (example: wheels).
- Is very organized.
- Gets upset from minor changes.
- Has obsessive interests.
- Has to follow certain routines.
- Flap 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 while playing with 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 "melt down" or tantrum especially if found in an unfamiliar 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, inlucding the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.
Hyperactivity (very active)
Impulsivity (acting without thinking)
Short attention span
Causing self injury
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, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an 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.