Signs & Symptoms of Autism Spectrum Disorder (ASD)

What Is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) is the formal diagnostic term for a neurological condition that impacts on a person’s ability to interact with the social world. Autism affects individuals in unique ways, resulting in different behaviors and expressions than neurotypical people.

There is a large amount of variability in how individuals are impacted by autism symptoms, as these occur on a spectrum. Some autistic people function adequately in social situations, but may come off as “different.” Others may have very little ability to articulate themselves verbally and/or interact socially.

Because of this variation in symptoms, there is debate regarding what being autistic really means. There is the argument that autism is best described simply as a difference in how some interact socially, rather than an actual disorder. Seeing as social behaviors are primarily controlled through our brains, any alteration in social behaviors is called “neurodiversity.” Therefore, autism is often described as an example of neurodiversity, not a disorder.

Asperger’s Syndrome is a term used for what is often called “high-functioning” autism. This diagnosis has actually been controversial and has since been dropped as a legitimate diagnosis in the DSM-5.

Symptoms of Autism

Given that autism is a neurological condition, it can be displayed in various ways. However, autism symptoms manifestation can be categorized into two main groups: social-communication difficulties and behavioral patterns.

Autism symptoms are exhibited by a variety of behaviors that fall under two general categories. Discussing these groupings can be a little confusing, because there are three main types of symptoms required before someone is diagnosed as being autistic–behavioral patterns, social challenges, and communication difficulties. However, the social and communication challenges are often lumped together, resulting in only two main groups. When you socialize with someone, some form of communication is necessary. Thus, when a person has issues with communicating, this will be seen primarily in how they socialize.

When the DSM-4 was still in use, autism could be diagnosed if someone clearly exhibited the symptoms of two categories. But, there was uncertainty about the third. The updated and most recent diagnostic requirement for autism includes all three groups.

Social & Communication Challenges

Autistic individuals often struggle with certain communication and social skills that neurotypical people are expected to learn as they mature. They may also experience delayed speech and language development as young children.

Social and communication related symptoms of autism may include:

• Delayed speech: Autistic individuals may be slower in language and speech development. This can sometimes be due to a limited interest in socializing in general, as compared to neurotypical people.¹²
• Difficulty reading others’ emotions: Autistic people may have difficulties reading other people’s emotions. Seeing as emotions are internal and individualized, they can struggle to understand how someone is feeling if they themselves are not feeling the same way at the same time.³
• Lack of emotional expression: Autistic individuals may struggle with alexithymia or be delayed in recognizing how to share their emotions with others. Trouble expressing emotions would cause others to think that people who have autism are not feeling certain emotions (sad, happy, scared etc.).⁴
• Monotone voice: Autistic folks often speak in a monotone voice, even in situations where they should be emotionally affected. This symptom is an offshoot of delayed communication and difficulties reading others’ emotions.
• Flat affect: Showing a lack of emotional response in facial expressions or other body language, primarily in nonverbal ways, is known as flat affect, and serves as another characteristic symptom in autistic individuals.
• Anger outbursts and aggression: Autistic individuals often have problems handling emotions effectively.⁵
  This leads to certain behaviors when something upsets them and it is not clear how they should respond.
• Sensory problems:  Autism often comes with associated problems related to certain sensory experiences. This could involve issues with how certain foods taste or pieces of clothing feel.⁶ Sensory problems often fall under the category of social difficulties, because others may not readily understand why an autistic person refuses to interact with particular items, foods, etc.⁷

Behavioral Patterns

Autistic people lean towards a desire for sameness, oftentimes resulting in rigidity and a tendency to focus on one topic, statement, or object. This can be evident in a behavior referred to as “scripting” where the individual repeats favorite lines from television shows or movies.

Another example includes “stimming,” or self-stimulation. In these cases, a person engages in the same specific behavior repeatedly. It is important to note that neither one of these patterns are negative, but can actually be beneficial for the autistic individual.

Repetitive behaviors in autism may become more frequent and intense as the person experiences increased emotional distress.⁹ Being upset impacts areas of the brain that control these behaviors and increase their severity. Therefore, when experiencing particularly upsetting situations, these actions can become quite disruptive.¹⁰

Repetitive behaviors can cause a “snowballing effect” in that emotional upset and then dealing with others’ responses to the behaviors causes them to worsen. Sometimes, this may result in autistic burnout.

Behavior related symptoms of autism may include:

• Echolalia: Repeating sounds is one behavior seen in autism. Echolalia may become problematic if sounds are repeated without any inclination as to what they relate to.
• Special interests: Autistic individuals often get very focused on one specific interest or topic. They will often discuss it with others frequently or may become hyperfocused on it.
• Lack of engagement in child play: Autistic children often engage in “parallel play.” While being in the presence of other children, they may play on their own or focus on a different activity.
• Anxiousness: Autistic individuals may become extremely anxious due to obsessive thoughts about something going wrong (becoming sick) or not having enough time to work on their special interest
• Sensory overload:  Becoming hyperfocused on certain sensory experiences often lead to a specific type of anxiety called sensory overload.
• “Kid cop” behaviors: Autistic individuals may become so focused on rules and will see it as their job to enforce these rules.¹¹ They act almost like a police officer in terms of upholding “law and order.” This can become a problem for children in particular, as they may “ignore” one rule to avoid breaking another.
• Inattentiveness: An autistic person may become so focused on one object or one thought that they look like they actually are not focused on anything.

Signs of Autism

Signs and symptoms appear differently in each individual, and autism in women may vary from autism in men, making it challenging to diagnose autism. However, a diagnosis may be suspected because of problems or peculiarities in how the individual interacts with other people. It is important to remember that exhibiting only one or two signs of autism makes it much less certain a person might have autism than displaying five or six.

Signs of autism may appear at different stages of life, as symptoms present themselves differently in each stage of life. Still, these signs are not definitive. There are other conditions, or no particular condition at all, that could explain a person’s behavior.

Babies & Toddlers

Parents and caregivers look for signs that a child is developing in effective ways through how they interact and communicate with the world. When a child reaches three years old, there is an expectation that the child will recognize more consistently how to effectively use verbal and nonverbal language to interact and make their needs known. This may not be evident in autistic children.

Child experts have identified specific milestones to look for in determining whether children are “on track” in terms of these skills. If these milestones are not met when expected, it is not a definitive sign of anything in particular. However, an autism diagnosis may be a possibility if a child misses each of these milestones.

Signs of ASD in babies and toddlers might include:

• Not making eye contact with adults by six to eight weeks old
• Not babbling by four months old
• Not following moving objects with their eyes by three months old
• Not responding to parent’s smile by four months old
• Seeming overly fussy or difficult to soothe
• Showing no interest in interacting with others

Young Children

Signs of autism in younger children are usually more noticeable than those for babies and toddlers, because there are many more social interactions and settings involved at this stage. As children start to attend school and activities, parents and caregivers can monitor the child’s behaviors and communication skills.

Signs of ASD in young children may include:¹²

• Not responding to their name
• Avoiding eye contact
• Not smiling when smiled at
• Getting upset if they do not like a certain taste, smell or sound
• Repetitive movements, such as flapping their hands or rocking their body
• Not talking as much as other children
• Not engaging in pretend play
• Repeating the same phrases

Teens/Adolescents

Social relationships become infinitely more important for youths as they enter adolescence.  This allows much more opportunity to identify whether there may be delays or differences in social abilities that need to be addressed.

Teenagers also tend to adopt special interests, so it may be worth noting if they start to focus on ones that seem much different from their peers’. Developing uncommon social patterns is not always a problem, but may be worth monitoring if it causes the teenager to isolate more.

Signs of ASD in teenagers may include:¹³

• Mistaking social cues or body language
• Misinterpreting conversations
• Finding it easier to form friendships online
• Poor eye contact
• Expressing that they ‘don’t fit in’
• Inflexibility or rigidity of thought (‘black and white’ thinking)
• Experiencing sensory overload
• Being unable to cope with crowds
• Sensitive to touch
• Having difficulties with the planning and organization of their work, bag, or school day
• A desire to withdraw from the outside world

Adults

Childhood and adolescence can be a whirlwind of challenges and new experiences, so much so that a person may not have time to reflect on why certain problems are occurring. For example, a person may finally recognize their “preference” for routine as much more of a “need” for it as they enter adulthood. They may notice that this behavior limits their ability to function adequately without causing problems. For this reason, an adult who begins recognizing signs of autism may want to consider seeking an accurate diagnosis.

Signs of ASD in adults may include:¹⁴

• Difficulties in joining conversation
• Speaking in a flat, monotone voice
• Having trouble relating to other people’s thoughts or emotions
• Using repetitive language
• Difficulties reading someone’s body language and emotions
• Dominating conversations and providing excessive information on topics of interest
• Taking things literally
• Being blunt in their assessment of people and things
• Difficulties maintaining eye contact

When to Consult a Doctor

While one’s symptoms may not cause severe difficulties, they may cause a person to feel different from others. Having a discussion with a healthcare professional can be beneficial in these cases, even if it is just to help the person understand and accept these differences.

Of course, there are other situations where autism symptoms cause challenges that require support. Research suggests that the earlier a professional is involved when managing these, the greater likelihood that symptom severity can be reduced.

Developmental pediatricians, neurologists, and neuropsychologists are typically the best professionals to consult for diagnosis. There are no medications specifically for autism, but some psychiatric medications may be used for treating any associated conditions.

Support & Therapy for Autism Symptoms

Psychotherapy for autism provides a similar degree of benefit as it does for individuals with other conditions. For autistic folks, it is important to find a therapist who has expertise in autism and experience with applied behavior analysis, as this is the approach found most helpful for autism.

Support options for autism symptoms include:

• Play therapy: Play therapy helps address social challenges by giving a child opportunities to express themselves through play, rather than explaining things in words.  This approach also helps a therapist teach the child skills that are important when interacting with other people.
• Social skills training: Therapy with autistic individuals tends to work best when it is focused and structured.¹⁵
  For this reason, specific behavior approaches can teach and help the individual learn effective social skills. This approach may often look like a class where students are led through exercises to learn these specific skills.
• Family therapy: Family therapy can be particularly helpful for autistic individuals, as it can be a structured approach to addressing complex situations where difficulties occur because of multiple factors.¹⁶
• Functional analytic psychotherapy:  Applied behavior analysis approaches are primarily what makes up this approach to therapy. It is very useful in these cases, because the client’s relationship with the therapist is used to facilitate effective social skill training.¹⁷
• Cognitive-behavior psychotherapy: Autism can cause considerable distress as the person tries to find the most effective ways of navigating through complex social environments. Cognitive-behavior therapy for autism can be an effective approach for helping clients find ways of effectively handling these difficulties.¹⁸
• Dance therapy: This is another approach to psychotherapy that can be particularly helpful for autistic individuals because of its focus on nonverbal communication.¹⁹ Dance therapy focuses on using movement to help the person express what is bothering them and find more effective means of handling emotionally distressing situations.
• Parent training: Parent training can help parents learn how to handle certain stresses of raising an autistic child.²⁰Also consider listening to autism podcasts for additional perspectives about parenting children with autism from parents in similar situations.
• Music Therapy: Music therapy for autism can help individuals develop communication skills and fine-tune their motor skills. It can also help with emotion regulation.

Final Thoughts

Communication is an essential aspect of human interaction. While there is no reason to be ashamed of one’s differences from others, sometimes deficits in these areas can leave an autistic person feeling anxious or alone. However, seeking support for any challenges can be beneficial when needed. Family and loved ones can help autistic individuals locate resources as well. Autism is a part of one’s individuality, and autistic folks are just as likely to live happy and fulfilling lives as those with any other condition or life journey.