Autism Spectrum Disorders
While the exact symptoms of ASDs can be highly individual, varying considerably from one affected child to another, the primary symptoms tend to fall into three broad categories: communication challenges, problems with social interaction, and repetitive behaviors or interests. Some may also have sensitivity to sensory experiences such as loud sounds and the bustle of a large crowd. Each of these sets of difficulties can range from very mild to very severe in a particular child, and they can even be fluid over time in the same child.
“Some kids might look more like they have autism one day, Asperger’s another,” says James Coplan, M.D., owner of Neurodevelopmental Pediatrics of the Main Line in Rosemont, PA, and author of Making Sense of Autistic Spectrum Disorders. “The disorders can blur into each other.” Signs and symptoms of ASDs usually begin before a child turns 3, though some children with ASD appear to develop normally then regress, often between their first and second birthdays. At that point, they may become withdrawn, silent, and disinterested in interacting with others. They may stop developing new skills or they may lose the language and social skills they had already mastered.
When it comes to communication issues, ASD problems can relate to both verbal and nonverbal communication. Some children with severe autism may be mute for most if not all of their lives. For others, language may be delayed or they may not speak in the usual ways; they might struggle to combine words into meaningful sentences, speak only in single words, or repeat the same phrase over and over. Others may only be able to parrot what they hear others saying, a condition called echolalia. Meanwhile, others may have fairly normal language skills but may have difficulty maintaining a conversation. Children with Asperger’s syndrome, by contrast, may be super verbal. “They’re like little professors -- they’ll talk your ear off about whatever topic they’re interested in and they don’t understand that other people don’t share that interest,” Dr. Coplan says.
Problems With Social Interaction
On the social front, an infant with ASD may be unresponsive to people, may resist being held or cuddled by parents, or focus exclusively on one object while ignoring others for long periods of time. Children with ASD may avoid eye contact with other people and may not answer to their name. Because they don’t understand social cues like facial expressions or tone of voice, children with ASDs have trouble interpreting what others are thinking or feeling. They may lack empathy as well. In other words, they just don’t get the give-and-take of everyday social interactions.
Repetitive Movements or Interests
In addition, many children with ASD engage in repetitive movements such as flapping their arms or hands, walking on their toes, rocking their bodies, or spinning in circles. They may also develop self-injuring behaviors like head-banging. Sometimes they do this to self-soothe; other times, they do it to stimulate themselves (what’s often called “stimming”). “Stimming behaviors are most evident during the preschool years and usually become less prominent as the child gets older, although they may re-emerge from time to time when the child becomes very excited or upset,” says Dr. Coplan. Children with ASDs also often play in repetitive ways -- lining up their trains in a particular formation, for example -- or they become fascinated with small parts of objects or odd items (like rubber bands). Others have obsessive interests (in robots or space, for example) and talk about them incessantly (in the case of Asperger’s) even if their companion doesn’t share their preoccupation; as these children get older, they may develop an encyclopedic knowledge and be able to recite long lists of facts and figures about their passionate interest, which can make them seem highly intelligent. All of these attributes can be found individually in children without ASDs, but talk to your doctor if your child exhibits several or many of these behaviors.
Although it’s not one of the main diagnostic criteria, doctors also look out for unusual responses to sensory experiences; kids with ASDs may be hyper- or hypo-sensitive to the way things sound, look, smell, taste, or feel. (However, many kids have sensory sensitivities but don’t have an ASD.) They may be driven to meltdowns by the sensation of a shirt tag rubbing against their or they may be completely intolerant of mushy foods. They might freak out when a fire truck drives by with its siren blaring or have a four-alarm fit in a crowded, brightly lit department store. And they may become highly upset by minor changes to their environments or routines. Meanwhile, others seek more stimulation -- by continuously spinning in circles on the playground or being a serial hugger in preschool (not because they’re truly affectionate but because they crave the sensation of pressure against their bodies).