So broad brush strokes aside, what does ASD really look like? The Australian Psychological Society2 suggests the challenges experienced by those ‘on the spectrum’ fall into three key areas:
- verbal and non-verbalcommunication
- social awareness andinteraction
- behaviours, activities and
1. Verbal and non-verbal communication
Communication skills vary widely between those with ASD. In terms of verbal communication skills some will show significant disadvantage while others may be highly competent. Those with apparently ‘normal’ speech may also find it difficult to communicate effectively within the pragmatics, or “social use” of language.
They may say unusual or socially inappropriate things, repeat words or phrases they have heard from others or the television (echolalia), or focus on a specific topic for extended periods. Non-verbal communication skills will reflect similar variability. Some may struggle to make or maintain eye- contact. Additionally, some may have difficulty understanding non-verbal communication such as facial expressions and gestures.
2. Social awareness andinteraction
Children with ASD often struggle with social awareness and the nuances of ‘typical’ social interaction. They might experience difficulty understanding or recognising the emotional state of those around them or display an apparent lack, or excess, of empathy. Those with ASD or ASD like characteristics may also struggle to control their impulses and engage in what would normally be considered socially inappropriate behaviours, such as touching, ‘invading’ personal space, licking, biting or hitting.
3. Behaviours, activities andinterests
Children with ASD may face challenges in the way they engage with their environment and may present with behaviours, activities and interests that may be considered unusual or atypical.
Children with ASD or ASD like characteristics may struggle to engage in play in a typical way.They may not understand imaginative play, play with toys in unusual ways, or they may fixate on specific items or toys. Specific routines or patterns may be very important to those with ASD, and change or transitions to new environments and activities may be challenging.
Unusual, restrictive or repetitive behaviours are also common in those with ASD. This may include sensitivities to specific sensory inputs, such as touch, sound or texture, and associated sensory seeking or avoidance behaviours. Those with ASD may also engage in repetitive actions such as hand-flapping, spinning, rocking, and walking on tip-toes.
While all of these challenges are common for those with ASD, it is important to remember that as an ASD the severity of the difficulty will vary greatly. Some children will have high intelligence, while others will present with an intellectual disability. Some will experience severe social and communication difficulties that impact on everyday life and work, while others will work as public speakers and communicate very effectively. It is critical to recognise that those children with a spectrum disorder are, like everyone else, people with individual strengths and weaknesses, likes and dislikes, hopes and wishes. They simply engage in the world in different and often more complex ways.
It is vital to be aware that ASD looks different in different people. This is particularly relevant between genders. Recent research shows that characteristics of females often vary considerably from those of males. Girls with ASD or ASD like characteristics are likely to demonstrate increased social imitation skills, a desire to interact with others, increased imagination and linguistic abilities, and different interests, such as those that focus on animals or people.
Children with ASD often experience other developmental issues and health problems. Studies in the USA indicate that children with ASD often have comorbidities including eczema, allergies, asthma, ear and respiratory infections, gastrointestinal problems, migraines, sleep disorders, and seizures. In terms of mental health, 50% of children with ASD present with intellectual disability and 70% with emotional and/or behavioural disorders such as anxiety, depression, attention problems, aggression or hyperactivity.
As a developmental disorder, symptoms of ASD manifest in early childhood. Research suggests that indicators can be observed in children from 12 months with a range of symptoms emerging by 2 years of age, with 50% of parents reporting the emergence of symptoms within the first year.
Following examples are widely accepted early signs where further monitoring may be required:
- difficulties with, or lack of, eye contact during interaction or play
- little or no imitation of others’ actions during interaction and play;
- lack of,or minimal use of, pointing to objects/events to show things to other people.
- reduced use of non-verbal gestures, such as waving or shaking/nodding head
- rarely showing objects to other people to share interest
- absent, or delayed ability to engage in, pretend play