Frequently Asked Questions about Autism

Symptoms/behaviors of ASDs can range from mild to severe, and may seem to appear gradually or suddenly. Atypical development may be observed from birth, or more commonly, become noticeable during the 12- to 36-month period. Symptoms include:

• Social Deficits - Children with autism have difficulty in social interactions. They may avoid eye contact and interactions with people and resist or passively accept attention. They are often unable to read social cues or exhibit emotional reciprocity. Thus, they are unable to predict or understand other peoples’ behavior. They may also have difficulty controlling emotion, may be disruptive or aggressive at times, or may lose control, especially when frustrated or presented with a new situation or environment. Head-banging, hair-pulling and arm-biting may occur.

• Communication Difficulties - Communication skills are affected in children with autism, but difficulties vary. Some children may have good basic language skills, but exhibit difficulty initiating or sustaining conversations, such as not giving others the opportunity to respond. Others may experience delays or regression in language development; still others remain mute or may use language in unusual ways, such as repeating a phrase, or parroting what they hear (echolalia). Body language is also often hard to read in children with autism. Facial expressions, tone of voice and gestures often do not match verbal content and emotions. They have difficulty expressing what they want or need. They may also appear deaf, not responding to their names or attempts at conversation.  

• Repetitive Behaviors - Patterns of behavior, interests and activities may be restricted, repetitive or stereotyped. For example, a child may spend long periods of time arranging specific toys in a particular manner, rather than playing with the toys. Intense preoccupation with certain topics, such as obsessively studying maps, may also be seen. Odd repetitive motions, either extreme or subtle, such as arm-flapping, freezing, rocking back and forth or walking on their toes may also occur. Often, people with autism demand consistency in their environment. A minor change in routine may be tremendously upsetting.

• Sensory Difficulties - In children with autism, the brain seems unable to balance the senses appropriately. Many autistic children are highly attuned or even painfully sensitive to certain sounds, textures, tastes or smells. Some seem oblivious to cold or pain, but react hysterically to things that wouldn't bother other children. In some people, the senses are even scrambled. For example, touching a certain texture may induce a gagging response.

• Unusual Abilities - In rare cases, some children with ASDs display remarkable abilities, such as drawing detailed, realistic pictures at a young age or playing an instrument without training. Some can memorize difficult lists of items, such as statistics or names (this is called islets of intelligence or savant skills).

Asperger's Syndrome is the second most common ASD and is a milder form of autism. Children with Asperger’s Syndrome exhibit higher language development than children with autism and often have normal intellectual ability combined with a disinterest in social communication. Children with Asperger’s may not initiate or sustain a conversation and do not compensate for their limited language by using nonverbal means of communication, thus limiting their peer relationships. Similar to autism, children with Asperger’s do not share enjoyment or interests with others.

Rett syndrome is a genetic disorder almost exclusively found in females. After early normal development, autistic symptoms begin to develop between 6 and 18 months, which typically include shunning social contact, talking cessation, unique motor behaviors, and a regression in skills. A single gene mutation has been identified as a cause of Rett syndrome, a finding that may enable researchers to develop improved diagnostics, earlier interventions and better treatments for the condition.

To date, no biological diagnostic tests exist that detect autism. But scientists are hopeful that advanced imaging techniques and differences in blood levels of proteins in autistic versus normal children may have implications for diagnosis. Already, improved diagnostic procedures have allowed clinicians to diagnose children at a younger age.

Formal diagnosis involves parental input and structured and systematic screening instruments, such as the Modified Checklist for Autism in Toddlers (M-CHAT) and the Autism Behavioral Checklist (ABC) for older children. The Childhood Autism Rating Scale (CARS) and the Autism Diagnostic Inventory-Revised (ADI-R) are used, as well. These tools measure the prevalence of symptoms. Symptoms may be present from birth, or may occur after months of normal development. However, no two children with these disorders behave the same way. Children as young as 18 months may be diagnosed, but have different clinical features than an older child with autism.

Between 18 months and 36 months, symptoms may include:  

• Limited pretend play
• Lack of pointing to demonstrate interest
• Reduced gaze following
• Less frequent demonstration of repetitive, stereotypic behaviors
• In children with autism between 2 years and 3 years of age, the following features may be observed:  
• Communication difficulties
• Socialization deficits with caregivers
• Perceptual sensitivity
• Other difficult behaviors