It’s impossible to say how you might feel when the suspicion starts to creep up that your son or daughter might have a disability. For some parents, it’s absolutely heartbreaking (even if they feel guilty for feeling that way). For others, it’s actually a relief. For many more it’s a mixture of the two, but however you feel about it, there’s no question that the step between suspecting autism and looking for a diagnosis is a big one.
What are the signs of autism?
Autism is a lifelong developmental disability which affects 1 in 100 people in the UK. It affects the way a person communicates and how they experience the world around them.
Some people challenge the idea of autism as a disability and see it as no more than a different way of viewing and experiencing the world.
Autism is described as a spectrum condition. This means that while people with autism, including Asperger’s Syndrome, share certain characteristics, they will be highly individual in their needs and preferences. Some people with autism are able to live relatively independent lives but others may face additional challenges, including learning disabilities, which affect them so profoundly that they need support in many areas.
There’s a saying popular among people with autism and their families: ‘If you’ve met one person with autism, you’ve met one person with autism.’ The condition affects everybody differently, and people with autism, just like people everywhere, have all sorts of individual personalities, tastes, outlooks and beliefs. Autism can impact on a great deal of someone’s life and experiences, but it’s never the whole story about them.
No one child is likely to display every symptom of autism exactly as the textbook says. However, there are some general areas to watch out for:
Challenges with speech
Speech development is one of the big areas when it comes to autism. Some common signs include:
- Being a ‘late developer’ with talking, either stalling or starting to lose speech skills at a time when other children’s speech is ‘exploding’.
- Learning little or no language at all. (Children like this are referred to as being ‘non-verbal’.)
- In some cases, it may be learning speech early with an impressively advanced vocabulary – but possibly being inflexible, pedantic or literal-minded with it, sometimes having difficulty understanding metaphors, turns of phrase or sarcasm.
- Echolalia. This is a term that describes a behavior common to many, though not all, children with autism: repeating particular sounds, words or phrases simply for the satisfaction of saying them over and over, with no reference to whether the phrase is relevant to what’s going on around them. Phrases children with autism choose for echolalia are often (though not always) picked up from recorded voices rather than ordinary conversation: repeating, for instance, a phrase from a favourite TV show or app, or an automated announcement from a bus, train, lift or other voice-over machine.
- Talking in pre-learned phrases rather than making up new sentences.
- An unusual intonation – either sounding very monotone, or else sounding sing-song because they exactly copy the tone in which they first heard the word.
- Not using common non-verbal ways of communicating, such as shaking the head or pointing.
- Difficulty catching the rhythm of conversation, either leaving big pauses, drifting off, speaking in monologues or interrupting.
It’s important to remember that these speech issues are just a small part of the bigger picture when it comes to autism. A child who is developing normally may also show these signs and so they aren’t necessarily a sign of autism.
Challenges with socialising
Children with autism often have difficulty with social interaction. They might not be indifferent to others, but the instinct for how to behave around people is generally challenging for them. Some examples:
- Limited eye contact. Doing less ‘gazing’ than most babies or small children, avoiding people’s eyes, sometimes making it hard to tell if they’re paying attention, or even if they’ve heard you at all. (It’s not unusual for children with autism to be suspected of hearing problems, when actually they can hear fine but aren’t reacting.)
- Not responding to efforts to engage them. Not turning when you call their name, wandering off while you’re speaking to them or trying to start a game.
- No apparent instinct for being cuddled – thrashing about in an embrace, not wrapping his or her legs around someone’s waist when balanced on a hip, not leaning back against the person holding them when sitting on a lap, and so on.
- Difficulty making friends. Not knowing how to join in games, or being uninterested in or sometimes frightened of other children. Alternatively, trying to make friends but not managing because their efforts seem ‘off’ to the other kids.
- Having problems with personal space - not being aware of other people’s, or getting upset if somebody enters theirs.
- Being solitary, preferring to play alone.
- Having trouble grasping basic forms of manners, like saying ‘hello’ and ‘goodbye’.
- Difficulty grasping the idea of taking turns.
- Restricted play skills. Children with autism will often play in what’s called a ‘rigid and repetitive’ way with toys. This doesn’t mean they stiffen up like robots but it does mean that they use the toys in a limited way and show no interest in doing anything else with them. Those limits are often imaginative, for instance, opening and closing the door on a doll’s house over and over rather than playing with the dolls inside it. They may also frequently re-enact TV shows and films they’ve seen or a previous interaction with someone.
Autism often brings with it some difficulties with sensory processing. Certain sensations are either experienced as if they’ve been turned way up or way down, either overwhelming (perhaps enjoyably, perhaps not) or barely noticeable, and children can do unusual things to compensate. For instance:
- ‘Stimming’. This is short for ‘self-stimulatory behaviour’, and it means engaging in repetitive behaviours for comfort or relaxation. A child stimming might rock, flap their hands, push their face right up against a fan to watch the blades spin, snap their fingers, or otherwise enjoy doing the same thing over and over.
- Not liking to be physically close to others.
- Having unusual preferences about touching – for instance, being comforted by hard squeezes but agitated by gentle contact.
- Being highly stimulated by certain visual experiences. Children with autism are often drawn to spinning objects like fans and wheels, to bright or flashing lights, or to certain colours,
- Finding certain noises unbearable.
- Having easily irritated skin – for instance, finding all clothing abrasive and wanting to go around naked, or being tormented by clothes that aren’t washed in the right detergent.
- Being unusually resistant to certain kinds of discomfort – for instance, having a high pain threshold, or not seeming to notice when it’s cold.
- Seeking out strong sensations to do with balance, such as jumping, turning in circles or walking on tiptoe. (This is often an attempt to compensate for impaired proprioception.)
- Delayed motor skills – being late to sit up, crawl, walk or develop hand-eye coordination.
- Being unusually clumsy, having difficulty working out exactly where the limits of his or her body are.
- Adamantly resisting eating certain kinds of food – not just ‘picky eating’, but ruling out all foods of a certain texture or colour, or having a very limited list of food they’ll eat and refusing everything else no matter how hungry.
- Having problems with sleep. Children with autism often find it nearly impossible to relax; add that to the fact that they struggle to understand conventions (like, say, going to bed at night even if you don’t feel like it), and broken nights are not uncommon.
- Being late to develop ‘toileting’ skills – i.e. getting out of nappies and learning to use the toilet. Children with autism often don’t show the usual signs of being ready to potty-train, such as indicating that they need to go or telling parents they need a nappy change. Add to this the fact that toilet training means a change in routine – something children with autism often fear – and many children with autism stay in nappies for years after their neurotypical peers.
There’s a stereotype that people with autism are hyper-logical, which often leads people to assume that they’re unemotional. This is pretty far from the truth. When it comes to emotions, children with autism can be volatile. They’re children, after all, and autism can be pretty stressful: children under stress get emotional. Some common issues include:
- Being anxious. Children with autism generally suffer a high ‘baseline’ level of anxiety, though they aren’t always able to communicate this. Anxious feelings can also escalate very quickly if something triggers them.
- Being ritualistic: certain things have to be done the exact same way each time or there’s trouble. (Often this is at least partly about creating a sense of safe predictability in an otherwise unpredictable world, and hence can be an attempt to manage anxiety.)
- Being obsessive – having certain interests that nearly dominate their lives. If the child can talk, they can talk about one of their interests for hours, and may not notice of the listener isn’t interested.
- Being very uncomfortable with or uninterested in anything unfamiliar.
- Having particular difficulty regulating their emotions, being easily upset or overwhelmed.
- Tuning people out if they feel uncomfortable, overwhelmed or shy. A child with autism confronted with a situation that makes them nervous may retreat into their most repetitive forms of play as a way of managing stress that they don’t know how else to deal with.
- Being reckless. Children with autism can often have difficulties imagining things, which means they have difficulty predicting what will happen next. When you can’t predict things, you can’t anticipate danger, so a child with autism might rush into the road because he or she simply didn’t consider the fact that a car might be coming.
Of course, your child won’t exactly fit the template; nobody does. But if enough of this is sounding familiar, it’s probably time to look into a diagnosis. Think of it this way: if your child does have autism, diagnosing it sooner is better for all of you, and if they don’t, then you might as well lay your worries to rest.
Research suggests that the earlier a child starts getting interventions to teach them skills and support for things like sensory discomfort, the better a chance they’ll have of making progress. Our brains are at their most flexible when we’re very young, and the sooner we start learning techniques, the more naturally and confidently we can use them when we’re older. The rule of thumb when it comes to interventions is the sooner the better, but it’s never too late.
If you suspect that your child may have autism, the first step is to seek a diagnosis. This may seem like a daunting prospect, and there’s a temptation to ‘give them time’ to see if they catch up, but it really is a good idea to consult a paediatrician as soon as you can. The earlier you know, the sooner you can access support, which can make life easier for you and the future brighter for your son or daughter. Knowing what you’re dealing with isn’t the end of the road, it’s the start of the journey – and at least it gets you pointed in the right direction.