Communication

As with other symptoms, communication skills vary among people with ASD. Some may speak very well, others very little or not at all. According to research, about 40% of children with ASD do not speak at all. About 25%–30% of children with ASD will have some words at 12 to 18 months of age and then lose them. Others have delayed language development and do not speak until later in childhood. Most children with ASD display some level of difficulty with communication. Symptoms may include:

  • Delayed development of speech and language skills
  • Flat, robotic speaking voice, or a high-pitched or singsong voice
  • Repeating the same word or phrase over and over, or repeating back what others say (echolalia)
  • Difficulty adjusting communication to appropriately match the context or the needs of the listener. Examples:
    • ​Using the same speaking voice or volume in both indoor and outdoor settings
    • Speaking to adults and children in the same way
    • ​Using overly formal language
    • ​Not adopting "kid speak" that is commonly used by other children
  • Difficulty following the rules of conversation or storytelling. Examples:
    • Inability to stay on topic when talking or answering questions
    • Continuing to talk about their own interests regardless of the listener's response
    • Making factual comments that are inappropriate to the context
    • Providing unrelated or inappropriate answers when asked questions
    • Not taking turns in a conversation 
  • Asking repetitive questions
  • Unable to "read between the lines" in conversation. Examples:
    • Difficulty understanding things that are not stated explicitly (i.e. making inferences)
    • Not recognizing sarcasm, joking, or humor
    • Not understanding idiomatic speech or metaphors
    • ​Difficulty using context to appropriately interpret language with multiple meanings
    • Taking everything literally
  • ​​Difficulty using correct pronouns (such as saying “you” instead of “I")
  • Struggling with listening to what others are saying

Sources:

Centers for Disease Control & Prevention (link)
Diagnostic & Statistical Manual (DSM-5)
Autism Speaks (link)
Autism Research Institute (link)​

Common Symptoms of Autism

Behaviors & Interests

Children with ASD also display restricted, repetitive patterns of behavior, interests, or activities. People with ASD may engage in stereotypes or repetitive motor movements, use of objects, or speech. They often thrive on establishing routines and ritualized behavior that are unusual or unnecessary. Even small variations to their normal routine or pattern can be very distressing, leading to "meltdowns" or tantrums, especially in unfamiliar or strange places. Additionally, children with ASD often develop highly restricted and fixated interests that are abnormal in intensity or focus. Many also display hyper-reactivity or hypo-reactivity to sensory stimuli (light, sound, touch, taste, smell) or have unusual interests in sensory aspects of the environment. Symptoms in this category may include:

  • Echolalia and/or idiosyncratic speech
  • Lining up toys or other objects, or flipping objects over
  • Limited imaginative play. Examples:
    • Always playing with a toy in the same way
    • ​Only playing with part of a toy (such as spinning the wheels of a car)
    • ​Not participating in "make believe" play or imitating the behavior of others
  • Establishing specific routines or rituals (and getting upset when a routine is changed, even slightly)
  • Extreme sensitivity to touch, light, pressure, and/or sound (sensory sensitivities)
  • Fussy or overly restrictive eating habits
  • Developing obsessive interests or fixation on unusual topics or objects
  • Impulsive behavior
  • Constant movement or "hyper" behavior, which may include engaging in "self-stimulatory" behaviors. Examples:
    • Rocking body back-and-forth or side-to-side
    • Flapping hands or arms repeatedly
    • Repetitive blinking (excessive)
    • Moving fingers in front of eyes
    • Placing objects or body parts in mouth, excessive chewing
    • Smelling objects or sniffing people
    • Rubbing or scratching their own skin with their hands or objects
  • Unusual difficulty with transitions or changes in their routines or environment

Other Symptoms
Other common symptoms in children with ASD include:

  • Aggressive behavior, both with self and others
  • Self-injuring behaviors
  • Abnormal eating habits. Examples:
    • Limiting their diet to only a few foods
    • Eating nonfood items like dirt or rocks (this is called pica)
    • ​Highly sensitive to texture and smell
  • Unusual sleeping habits or difficulty with sleeping
  • Limited attention span​
  • Unusual mood or emotional reactions. Examples:
    • Laughing or crying at unusual or inappropriate times
    • Not showing an emotional response when one is usually expected
    • Anxiety, depression, or aggression
  • Lack of fear or more fear than expected (not being afraid of dangerous things and/or being afraid of harmless events or objects)
  • Clumsiness or lack of coordination
  • Motor difficulties, such as walking on tip-toes
  • GI problems, including constipation or diarrhea

​Social Skills

Social issues are one of the most common symptoms for all forms of ASD. Children on the spectrum may begin showing social symptoms as early as 8 to 10 months old. Infants are typically very interested in the world and people around them. By 12 months of age, a "typical" toddler will interact with others: making eye contact, copying words and actions, and using simple gestures like pointing, clapping, and waving "bye bye". Toddlers also typically show interest in social games and interactions, such as peek-a-boo and pat-a-cake. In contrast, young children on the spectrum may have a very difficult time learning to interact with other people and engage in social behavior. These social difficulties are more severe than simple shyness, and they cause serious disruptions to the child's daily life. Symptoms may include:

  • Not responding to own name by 12 months of age
  • Difficulty understanding and using social/non-verbal behavior. Examples:
    • Avoiding eye-contact
    • Displaying flat or inappropriate facial expressions
    • Not responding to or using social gestures like smiling, waving, or pointing
  • Displaying little or no desire to communicate with others. Examples:
    • Only communicating to meet personal needs rather than social engagement
    • Not initiating or participating in social interactions or conversations with others
    • Preferring to play alone
  • Difficulty understanding personal space or boundaries. Examples:
    • Standing too close to people
    • Inappropriate physical contact with others
  • Avoiding or resisting physical contact
  • Unaware of the how to adjust interactions to match different groups of people (i.e. family, friends, staff, strangers, etc.)
  • Not wanting to be comforted by others when upset
  • Trouble understanding emotions. Examples:
    • Displaying little awareness of other people's feelings
    • Inability to talk about their own feelings