Symptoms of Autism
Autism affects the way a child perceives the world and makes
communication and social interaction difficult. The child may also
have repetitive behaviors or intense interests. Symptoms, and their
severity, are different for each of the affected areas
including Communication, Social Interaction and Repetitive
Behaviors. A child may not have the same symptoms and may seem very
different from another child with the same diagnosis. It is
sometimes said that if you know one person with autism, you know
one person with autism.
The symptoms of autism typically last throughout a person's
lifetime. A mildly affected person might seem merely quirky and
lead a typical life. A severely affected person might be unable to
speak or care for himself. Early intervention can make
extraordinary differences in a child's development. How a child is
functioning now may be very different from how he or she will
function later on in life.
The following information - about the social symptoms,
communication disorders and repetitive behaviors associated with
autism - is taken from the National Institute of Mental Health
From the start, typically developing infants are social beings.
Early in life, they gaze at people, turn toward voices, grasp a
finger, and even smile.
By contrast, most children with autism seem to have tremendous
difficulty learning to engage in the give-and-take of everyday
human interactions. Even in the first year of life, many do not
interact and avoid eye contact in a normal way. They may seem
indifferent to other people, and prefer being alone. They may
resist attention or passively accept hugs and cuddling. Later, they
may fail to seek comfort or respond to parents' displays of anger
or affection in a typical way. Research has suggested that although
children with autism are attached to their parents, their
expression of this attachment is unusual and difficult to "read".
To parents, it may seem as if their child is not connected at all.
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.
Children with autism also are slower in learning to interpret
what others are thinking and feeling. Subtle social cues, such as a
smile, a wave, or a grimace, may have little meaning to a child
with autism. To a child who misses these cues, "Come here" may
always mean the same thing, whether the speaker is smiling and
extending her arms for a hug or frowning and planting her fists on
her hips. Without the ability to interpret gestures and facial
expressions, the social world may seem bewildering. To compound the
problem, people with autism have difficulty seeing things from
another person's perspective. Most five year olds understand that
other people have different thoughts, feelings and goals than they
have. A child with autism may lack such understanding. This
inability leaves them unable to predict or understand other
Although not universal, it is common for people with autism to
have difficulty regulating their emotions. This can take the form
of "immature" behavior such as crying in class or verbal outbursts
that seem inappropriate to those around them. Sometimes they may be
disruptive and physically aggressive, making social relationships
even more difficult. They have a tendency to "lose control",
particularly when they're in a strange or overwhelming environment,
or when angry or frustrated. At times, they may break things,
attack others or hurt themselves. In their frustration, some bang
their heads, pull their hair or bite their arms.
By age three, most 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 a word or two, turns
and looks when he hears his name, points when he wants a toy, and
when offered something distasteful, makes it clear that the answer
Some people with autism remain mute throughout their lives;
although the majority develops spoken language and all eventually
learn to communicate in some way. Some infants who later show signs
of autism "coo" and babble during the first few months of life, but
they stop. Others may be delayed, developing language as late as
age five to nine. Some children may learn to use communication
systems such as pictures or sign language.
Children with autism who do speak often use language in unusual
ways. They seem unable to combine words into meaningful sentences.
Some speak only single words, while others repeat the same phrase
over and over. They may repeat or "parrot" what they hear, a
condition called echolalia. Although many children with autism go
through a stage where they repeat what they hear, it normally
passes by the time they are three.
Some children with autism who are only mildly affected may
exhibit slight delays in language, or even seem to have precocious
language and unusually large vocabularies, but have great
difficulty in sustaining a conversation. The "give and take" of
normal conversations may be hard, although they may often carry on
a monologue on a favorite subject, giving others little opportunity
to comment. Another common difficulty is the inability to
understand body language, tone of voice, or "phrases of speech."
For example, someone with autism might interpret a sarcastic
expression such as "Oh, that's just great" as meaning it really is
While it can be challenging for others to understand what
children with autism are less able to say, their body language may
also be difficult to understand. Facial expressions, movements and
gestures may not match what they are saying. Also their tone of
voice may fail to reflect their feelings. They may use a
high-pitched, sing-song, or flat, robot-like voice. Some children
with relatively good language skills speak like little adults,
failing to pick up on the "kid-speak" that is common in their
peers. Without meaningful gestures or the language to ask for
things, people with autism are less able to let others know what
they need. As a result, they may simply scream or grab what they
want. Until they are taught better ways to express their needs,
children with autism do whatever they can to get through to others.
As they grow up, they can become increasingly aware of their
difficulties in understanding others and in being understood. As a
result, they are at greater risk of becoming anxious or
Although children with autism usually appear physically normal,
odd repetitive motions may set them apart from other children.
These behaviors might be extreme and highly apparent or more
subtle. Some children and older individuals repeatedly flap their
arms or walk on their toes. Some suddenly freeze in a position.
As children, individuals with autism might spend hours lining up
their cars and trains in a certain way, rather than using them for
pretend play. If someone moves one of the toys, the children may be
tremendously upset. Many children with autism need, and demand,
absolute consistency in their environment. A slight change in
routines, such as mealtimes, dressing, taking a bath, and going to
school at a certain time or by the same route, can be extremely
Repetitive behavior sometimes takes the form of a persistent,
intense preoccupation. These strong interests may be unusual
because of their content (e.g. Being interested in fans or toilets)
or because of the intensity of the interest (e.g. knowing much more
detailed information about Thomas the Tank Engine than peers). For
example, a child with autism might be obsessed with learning all
about vacuum cleaners, train schedules, or lighthouses. Often older
children with autism have a great interest in numbers/letters,
symbols, dates or science topics.
Physical and Medical Issues that May Accompany Autism
Seizure Disorder, also called Epilepsy, occurs in as many as 39%
of people with autism. It is more common in children who also have
cognitive deficits than those without. Some researchers have
suggested that it is more common when the child has shown a
regression or loss of skills.
There are different types and subtypes of seizures, and a child
with autism may experience more than one type. The easiest to
recognize are large "grand mal" (or tonic-clonic) seizures. Others
include "petit mal" (or absence) seizures and subclinical seizures,
which may only be apparent in an EEG (Electroencephalogram). It is
not clear whether subclinical seizures have effects on language,
cognition and behavior.
The seizures associated with autism usually start either early
in childhood or during adolescence, but may occur at any time. If
there is a concern that a child may be having seizures, a referral
to a neurologist is recommended. The neurologist may order tests
which may include an EEG, an MRI (Magnetic Resonance Imaging), CT
(Computed Axial Tomography) and a CBC (Complete Blood Count).
Children and adults with epilepsy are typically treated with
anticonvulsant or seizure medicines to reduce or eliminate
occurrence. If a child has epilepsy, it is important to work
closely with a neurologist to find the medicine that works the best
with the fewest side effects and to learn the best ways to ensure a
child's safety during a seizure.
A small number of children with autism may also have an
identifiable neurogenetic condition such as Fragile X Syndrome,
Angelman's Syndrome, a neurocutaneous disorder called Tuberous
Sclerosis, Chromosome 15 Duplication Syndrome or another
If a child has clinical features, such as a family history or
physical symptoms, that are characteristic of one of these
disorders, a pediatrician may order tests or may refer a family to
a developmental pediatrician, a geneticist and/or a child
neurologist for testing. The chance of having one of these
abnormalities is a little higher if the child also has cognitive
deficits or mental retardation. It is also higher if the child has
certain physical features that are characteristic of a given
While none of these conditions is curable, it is important to
know if a child has one of these syndromes because there may be
other medical issues that go along with some of them. Having a
known genetic cause for autism may also change your risk of having
another child with autism.
Many parents report gastrointestinal (GI) problems in their
children with autism. The exact number of children with both
gastrointestinal issues such as gastritis, chronic constipation,
colitis, celiac disease and esophagitis and autism is unknown.
Surveys have suggested that between 46 and 85% of children with
autism have problems such as chronic constipation or diarrhea.
One recent study identified a history of gastrointestinal
symptoms (such as abnormal pattern of bowl movements, frequent
constipation, frequent vomiting, and frequent abdominal pain) in
70% of the children with autism, compared with 42% of children with
other developmental disabilities and 28% of children without
If a child has symptoms such as chronic or recurrent abdominal
pain, vomiting, diarrhea, or constipation, a consult with a
gastroenterologist (preferably one that works with people with
autism) is recommended. Sometimes the child's physician may be able
to help find an appropriate specialist. Pain caused by GI issues is
sometimes recognized because of a change in a child's behavior,
such as an increase in self soothing, behaviors such as rocking or
outbursts of aggression or self-injury. Bear in mind that a child
may not have the language skills to communicate pain caused by GI
issues. Treating GI problems may result in improvement in a child's
A popular dietary intervention for GI issues includes the
elimination of dairy and gluten containing foods. As with any
treatment it is best to consult the child's physician to develop a
comprehensive plan. In February 2007, Autism Speaks initiated a
campaign to inform pediatricians about the diagnosis and treatment
of GI problems associated with autism. For additional information
that can be shared with a child's doctor, please click here.
Sleep problems are common in children and adolescents with
autism. Having a child with sleep problems can affect the whole
family. It can also have an impact on the ability of a child to
benefit from therapy. Sometimes sleep issues may be caused by
medical issues such as obstructive sleep apnea or gastroesophageal
reflux and addressing the medical issues may solve the problem. In
other cases, when there is no medical cause, sleep issues may be
managed with behavioral interventions including "sleep-hygiene"
measures such as limiting the amount of sleep during the day, and
establishing regular bedtime routines. There is some evidence of
abnormality of melatonin regulation in children with autism. While
melatonin may be effective for improving the ability of children
with autism to fall asleep, more study is needed. Melatonin or
sleep aids of any kind should not be given without first consulting
with the child's physician.
Sensory Integration Dysfunction
Many children with autism experience unusual responses to
sensory stimuli, or input. These responses are due to difficulty in
processing and integrating sensory information. Vision, hearing,
touch, smell, taste, the sense of movement (vestibular system) and
the sense of position (proprioception) can all be affected. This
means that while information is sensed normally, it may be
perceived much differently. Sometimes stimuli that seem "normal" to
others can be experienced as painful, unpleasant or confusing by
the child with Sensory Integration Dysfunction (SID), the clinical
term for this characteristic. (SID may also be called Sensory
Processing Disorder or Sensory IntegrationDisorder.)
SID can involve hypersensitivity, also known as sensory
defensiveness, or hyposensitivity. An example of hypersensitivity
would be the inability to tolerate wearing clothing, being touched,
or being in a room with normal lighting. Hyposensitivity might be
apparent in a child's increased tolerance of pain or a constant
need for sensory stimulation. Treatment for SID is usually
addressed with occupational therapy and/or sensory integration
Pica is an eating disorder involving eating things that are not
food. Children between 18 and 24 months old often eat non food
items, but this is typically a normal part of development. Some
children with autism and other developmental disabilities persist
beyond the developmentally typical time frame and continue to eat
items such as dirt, clay, chalk or paint chips. Children showing
signs of persistent mouthing of fingers or objects, including toys,
should be tested for elevated blood levels of lead, especially if
there is a known potential for environmental exposure to lead.
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