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What does autism really look like?

October 11, 2019 by Kimberly Drake

1 in 59. According to the CDC, that’s the current number of children with a diagnosis of autism spectrum disorder (ASD). This developmental disorder is the great mystery of human existence, with scientists scrambling to find the root cause for prevention and treatment. 

While all this scrambling for answers continues, parents of young children are scrambling a bit themselves, often wondering if the behavior they see in their child is a sign of ASD. Books and websites may list the symptoms, but it can be a significant challenge to decipher if a particular behavior is indeed worth a discussion with a health care provider. How do you know if it’s autism? What does autism really look like in a young child?



Social detachment

Children with autism may not seek out others to play with, or their play parallels the other children in a room. Parallel play looks like normal play on the surface, but when you observe closely, you will see the child with autism playing next to another child, but not engaging with what their playmate is doing. There is no, “hey, look what my toy can do” or other such interaction. 

Playing “make-believe” isn’t seen as well, and the autistic child will use toys in ways they are not intended, such as lining toy cars up in orderly rows instead of driving them. One of the earliest indications of social detachment is a lack of response when you call their name, which is why one of the first things pediatricians often do when autism is suspected is order a hearing test.



Differences in emotional expression

Although those with autism have a full range of emotions, they often express them differently. An autistic child may laugh when someone gets hurt, or at a funeral when everyone else is obviously sad. Their facial expressions might not match their internal feelings, and they may fail to recognize the emotions behind other’s facial expressions. This attribute often comes across as rudeness. 

In other cases, a lack of emotional response might also show itself when a parent leaves the room. While a neurotypical child may cry and call out for the parent, a child with ASD is unaffected by the parent’s absence. Additionally, some children on the spectrum will avoid physical contact with others and become rigid when hugged.



Communication difficulties

One of the most noticeable symptoms of autism is difficulty with or complete lack of verbal communication. Their speech may be delayed, or in some cases, as with the former Asperger’s label, it may be advanced beyond their age, almost collegiate. Their tone of speech might sound robotic or sing-song like, and in a lot of cases, the child with ASD will also avoid eye contact. 

Often, what appears as appropriate speech is actually something experts call echolalia. For example, the child may answer the question, “do you want juice” with “juice,” but when the question is immediately rephrased to, “do you want milk” the child responds with “milk.” They are merely repeating the last word heard. 

Also, repetitive sounds, words and phrases are common and often used during periods of stress or anxiety. Hand gestures are lacking or look awkward in a child on the spectrum as well, and idioms are taken literally, such as when someone says, “hold your horses,” the child will respond with, “I don’t have any horses.”



Behaviors

With communication difficulties and sensory challenges comes behavioral issues, as behavior is communication. A youngster with ASD may display seemingly unusual or repetitive actions, may flap their hands repeatedly, rock back and forth, or look at objects in an odd “side stare” manner. They may become fascinated by everyday items like a piece of lint or string and remain “stuck” on one object, activity or interest. 

Also, children with ASD will gravitate to an activity that is not “typical” for their age, such as opening and closing garage doors, or become enthralled in TV shows that are not age-appropriate, such as a teenager watching Sesame Street or a kindergartener watching PhD-level science programming. 

Those with ASD might also insist on specific routines or rituals and become agitated, angry or frustrated when these routines are disrupted without ample notice. They may show aggression and self-injurious behavior, have intense reactions to sounds, smells, textures, colors or tastes and display unusual eating habits, often only eating a few specific foods.

According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), because these symptoms occur at varying degrees, doctors categorize autism by levels 1, 2 or 3. Those mildly affected by autism are considered level 1, and their social, sensory and communication difficulties require some support. Individuals in the level 2 category need more assistance than those with a level 1 diagnosis, and those considered level 3 have communication and sensory challenges that require more intensive one-on-one support.

Not all children who display these indicators of autism have the disorder. In fact, each one of us can probably pick out one or two symptoms that fit our own behavior patterns. However, because the window of opportunity for successful intervention is small, when a child shows some of these signs, or you as a parent just know something isn’t right, it can’t hurt to take the child in to be screened. With autism, the sooner you know, the sooner you can begin the interventions they need.

Kimberly Drake can be reached at [email protected]

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