The warning signs change with age. Since children pass through numerous developmental stages and skill sets as they age it is important to look at warning signs in terms of the age of the child. The most common age ranges are infant to preschool, school age and young adult years. A previous blog entry focused on the first signs of autism. This entry will focus on the appearance of autism over a developmental continuum.
For infants under age 1 year they may have difficulty with self soothing and appear irritable and unable to regulate themselves. They also may be distant and not respond to being looked at, touched or hugged. For the preschool child there generally is a delay in language although in children who are eventually diagnosed with Aspergers Syndrome there is usually normal early language milestones. Language reciprocity is lacking in terms of joint attention (pointing or looking at an object to direct another person to look at it) and turn taking. Often gaze will be distant and it appears the child is looking through people and not looking at the face and eyes of the person they are interacting with. Shared pleasure is lacking as are the qualitative patterns of non-verbal communication. Gaze may be peculiar in the angles chosen to look at objects as well as the monitoring of gaze with certain objects being stared at for extended periods. Repetitive mannerisms including finger movements and hand flapping may be present as is a lack of interest in initiating social interaction with peers. Pretend play is lacking as is imitation and imagination. Finally, patterns of over reactivity or under reactivity to sensory stimuli or events are often present.
For the school age child patterns are often much more visible and evident. They continue to be rigid and inflexible in their interactions with others. When encountering new physical environment they seem uncomfortable and unsettled often standing at the periphery or against a wall.They have difficulty joining into play routines with others and are often frustrated when peers do not want to engage in an activity they way they want. They tend to be bossy and want to be in control. Their awareness to expected behavior for the classroom or playground makes them appear to be uncooperative and unwilling to listen to the directions of others and at the same time are often overwhelmed by social situations. They can become upset if their social space is breached or if they are hurried. Language issues include unusual vocabulary for age as well as frequently having strong or extensive interests or knowledge about specific topics. Speech musicality is absent and echolalia of word or topic is often present. Overall the use of language for social interaction and communication is limited.
For the young adult patterns may be very elusive and difficult to quantify for the high functioning individual without a learning disability. Issues with social behaviors and communication continue as do responses that appear naive or lacking of common sense. Although academic skills may be advanced for age there is a deficiency in social intelligence and the ability to perceive the intent, purpose and meaning of others. In conversations they may direct the discussion with little regard to what the other person is saying and they may show extensive knowledge about various topics. Speech quality may be unmodulated, repetitive and flat and certain phrases may be used repetitively. Understanding of metaphors, humor and sarcasm is often lacking as language is interpreted in a literal or concrete fashion. Body language and facial expression including eye contact and gestures are often inappropriate as is general social interaction and the ability to initiate and maintain friendships. Finally there is often an interest in keeping routines the same with a reliance on rituals and other repetitive behaviors while having a limited ability to utilize imagination and executive function skills for future planning.