How do you know your child is autistic?

Characteristics

Dr. Leo Kanner introduced the label early infantile autism in 1943.There is great diversity in the skills and behaviors of individuals diagnosed as autistic, and physicians will often arrive at different conclusions about the appropriate diagnosis. Much of this is due to the sensory system of an autistic which is quite different from the sensory system of other people, since certain stimulations can affect an autistic differently than a non-autistic, and the degree to which the sensory system is affected varies wildly from one autistic person to another.

Nevertheless, professionals within pediatric care and development often look for early indicators of autism in order to initiate treatment as early as possible. However, some people do not believe in treatment for autism, either because they do not believe autism is a disorder or because they believe treatment can do more harm than good.


Social development

Typically, developing infants are social beings—early in life they do such things as gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and will avoid eye contact, seemingly indifferent to other people.

Autistic children often appear to prefer being alone rather than in the company of others and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they seldom seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although autistic children are attached to their parents, their expression of this attachment is unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Autistic children lack "theory of mind", the ability to see things from another person's perspective, a behavior cited as exclusive to higher primates such as adult gorillas, adult chimpanzees, adult bonobos and children above the age of five. Typical 5-year-olds understand that other people have different knowledge, feelings, and intentions, interpretations based upon social cues (e.g., gestures, facial expressions). An individual with autism lacks these interpretation skills, an inability that leaves them unable to predict or understand other people's actions. The social alienation of autistic and Asperger's people is so intense from childhood that many of them have imaginary friends as companionship. However, having an imaginary friend is not necessarily a sign of autism and also occurs in non-autistic children.

Although not universal, it is common for autistic people to have difficulty regulating their behavior. This can take the form of crying or verbal outbursts that may seem out of proportion to the situation. Individuals with autism generally prefer consistent routines and environments; they may react negatively to change. It is not uncommon for individuals to exhibit aggression, increased levels of self-stimulatory behavior, self-injury or extensive withdrawal in overwhelming situations.


Sensory system

A key indicator to clinicians making a proper assessment for autism would include looking for symptoms much like those found in sensory integration dysfunction. Children will exhibit problems coping with the normal sensory input. Indicators of this disorder include oversensitivity or underreactivity to touch, movement, sights, or sounds; physical clumsiness or carelessness; poor body awareness; a tendency to be easily distracted; impulsive physical or verbal behaviour; an activity level that is unusually high or low; the inability to unwind or calm oneself; difficulty learning new movements; difficulty in making transitions from one situation to another; social and/or emotional problems; delays in speech, language or motor skills; specific learning difficulties/delays in academic achievement.

One common example is an autistic's hearing. The autistic may have trouble hearing certain people while other people are louder than usual. Or the autistic may be unable to filter out sounds in certain situations, such as in a large crowd of people (see cocktail party effect). However, this is perhaps the part of the autism that tends to vary the most from person to person, so these examples may not apply to every autistic.


Communication difficulties

By age 3, typical 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 or she hears his or her name, points when he or she wants a toy, and when offered something distasteful, makes it clear that the answer is "no." Speech development in autism takes a different developmental path than in non-autistic children. Some autistics remain mute throughout their lives, while being fully literate and able to communicate in other ways—images, sign language, and typing are far more natural to them. Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that autistics are unintelligent or unaware. Once given appropriate accommodations, many will happily converse for hours, and can often be found in online chat rooms, discussion boards or websites and even using communication devices at autism-community social events such as Autreat.

Those who do speak often use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat the same phrase over and over. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many autistics have a strong tonal sense, and can often understand spoken language better if it is sung to them.

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to interact with other autistics, they comfortably do so in "parallel monologue"—taking turns expressing views and information. Just as non-autistics have trouble understanding autistic body languages, vocal tones, or phraseology, autistics similarly have trouble with such things in non-autistics. In particular, autistic language abilities tend to be highly literal; non-autistics often inappropriately attribute hidden meaning to what autistics say or expect the autistic to sense such unstated meaning in their own words.

The body language of autistics can be difficult for non-autistics to understand. Facial expressions, movements, and gestures may be easily understood by some other autistics, but do not match those used by non-autistics. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the non-autistic's auditory system often cannot sense the fluctuations. What seems to non-autistic people like a high-pitched, sing-song, or flat, robot-like voice is common in autistic children. Some autistic children with relatively good language skills speak like little adults, rather than communicating at their current age level, which is one of the things that can lead to problems with their peers.

Since non-autistics are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let others know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for non-autistic people to learn to communicate with them, autistics do whatever they can to get through to them. Communication difficulties may contribute to autistic people becoming socially anxious or depressed.


Repetitive behaviors

Although autistics usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or wiggling their toes, others suddenly freeze in position. As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing. Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules or lighthouses. Often they show great interest in numbers, symbols or science topics.