Signs of Autism
Part One: Communication Characteristics
What is autism?
Autism spectrum disorder (ASD) is a developmental disorder consisting of particular behaviors in three categories:
- Social skills (also called pragmatics)
- Behavior (specifically restricted or repetitive behaviors, interests, or actions)
This article will focus on autism characteristics that fall under the category of communication. I will describe what neuro-typical is or what is considered a typically-developing child’s behavior. I will also compare this to the actions of autistic or neuro-diverse behavior.
What are the communication characteristics of autism?
Lack of pointing
- Typically developing children 12 months or older point with an extended index finger towards an item they are interested in or desire to obtain. The point is often combined with eye contact and a sound or word to request or comment.
- Autistic children often lack the skill of pointing with an extended index finger towards an item they are interested in or desire to obtain.
Example: Kiko is 23 months old. He sees his favorite train is out of reach on the table. He reaches for the item but does not point. His mother is standing next to him, and rather than looking at her and then pointing, Kiko continues to reach for the item and becomes increasingly frustrated. His mom asks, “do you need help?” but Kiko does not seem to notice his mother has asked him a question and continues to reach for the item.
Echoing words or phrases without meaning
- Typically-developing children between the ages of 9 and 12 months begin to use words meaningfully and independently – not just in repetition. While they do imitate words, they do this in response to being asked to imitate or as a way of learning a new word, but they soon learn to use the word independently on their own.
- Autistic children may repeat words or phrases rather than using them meaningfully.
Example: Dad says, “Johnny, what do you want to do?” but the child repeats, “Johnny, what do you want to do?” rather than answering the question.
The repeating of phrases is called echolalia. Learn more about this behavior in my blog about echolalia–
Memorized phrases used without meaning
- Typically developing children may enjoy or learn specific phrases, often from a movie or show they enjoy, but they use these phrases meaningfully and inappropriate contexts.
Example: Ben enjoys the movie Toy Story and has learned the phrase “there’s a snake in my boot.” Ben says this phrase to his mom to request to watch the movie. He also uses the phrase in pretend-play with a Toy Story action figure. Sometimes he even pretends there is a snake in his shoes and says this phrase as a way to make his mother laugh.
- Autistic children may memorize phrases, often from a movie or show, but use these phrases without an exact meaning and in contexts that don’t seem appropriate.
Example: Mimi has learned the phrase “there’s a snake in my boot” from the movie Toy Story. She says this phrase frequently and for no apparent reason. The times Mimi says, “there’s a snake in my boot” seems random and is not directed towards anyone in particular. It appears as if she is talking to herself.
This behavior is also called scripting, and a child may repeat the phrase many times in a short period, which would be called a stimming behavior.
Problems expressing their needs and wants
- Typically developing children associate spoken words with the physical item. They also will say the words while looking at the person they are talking to.
- Autistic children may have learned to physically say a word, but they cannot always use the word as expected to communicate with another person.
Example A: Mommy has heard Becky say the word “milk,” but it was random. Mommy shows Becky the milk bottle and asks Becky, “What is it?” but Becky does not respond.
Example B: Mommy has heard Becky say the word “Binky,” but only when repeating her. It’s time for bed, and Becky is looking for her binky. Mommy asks Becky, “what do you want?” but Becky does not seem to understand and does not answer.
Regression of skills
- Typically-developing children continue to improve skills as they develop and age. Skills or words are not typically lost or suddenly forgotten, although significant changes in the child’s life like a new baby being born or the child suffering from an illness is likely to result in a minor, temporary regression of skills. Parents should discuss these instances with their pediatrician.
- Autistic children may suddenly and unexpectedly show regression in skills and may or may not regain those skills without professional intervention. The most common period for regression among autistic children is near their first birthday.
Example: Luis is turning one year old in a few days. He previously used the words “Mama” and “Dada” appropriately to name and call for his parents. Suddenly and for no apparent reason, Luis is no longer using those words. His parents try to get him to say the words like he used to, but he has not said them for weeks.
Lack of responding to their name
- By 12 months, typically-developing children know and respond to their name being called by either looking in the direction of the person who called their name.
- Autistic children may not respond by looking towards a person when their name is called.
Example: Marco is 18 months old, and his dad has noticed that Marco does not respond when he calls out Marcos’s name to get his attention. Dad tries multiple times and even gets louder or waves to get his son’s attention, but Marco does not understand that the word “Marco” is referring to himself, and he needs to respond.
What are other communication characteristics of autism?
Lack of showing items of interest to people
- Typically-developing children between the ages of 15-18 months begin to show interesting items to other people. They will hold up the item to show an adult and make eye-contact, or they will go over to the adult and bring the item and make appropriate eye-contact in a way that makes the experience a “shared experience.” This behavior is often accompanied by a sound or a word to communicate their interest or gain the adult’s attention.
- Autistic children may not show or bring items of interest to an adult as a way of sharing the experience. Rather than involving another person or expressing their pleasure to the person, the child may prefer to interact with the item on their own.
Example: Raj is 20 months old, and his mother has noticed that he enjoys playing with cars but does not hold up the item to show his mother. He never brings items to her to gain her attention or brings her to items he enjoys. His mother tries to involve herself in his play, but it seems that either Raj doesn’t realize she is there or isn’t interested in her involvement.
Using an adult's hand as a tool
- Typically-developing children bring items to adults when needing help or wanting an adult to do something. They may pull an adult by the hand to get them to the item or location, but this is typically in combination with vocalizations or words and pointing, and appropriate eye contact.
- Example: Sarah is playing with a train set, and the train cars become disconnected. Her mother is sitting nearby. Sarah taps her mother to gain her attention, looks her in the eye then looks at the train set. Sarah picks up the broken train set and hands it to her mother, and then looks expectantly at her in hopes that she will help.
- Autistic children may take an adult’s hand and move it towards an item or move it to perform an action with an object. This behavior is often without eye-contact or vocalizing.
Example: Mariah is playing with a train set. The train cars have become disconnected, and she becomes frustrated. Her mother is sitting nearby. Without making eye contact or even looking in her mother’s direction, she takes her mother’s hand and uses it “as a tool” to reconnect the train cars. Her mother says, “let me help,” and tries to pick up the train set and fix it, but Mariah continues to hold onto her mother’s hand and move it in an attempt to fix the train using her mother’s hand.
Prosody refers to intonation, stress pattern, loudness variations, pausing, and rhythm. We express prosody mainly by varying pitch, loudness, and duration.
- Typically-developing children use natural patterns of prosody.
Example: Micah is 30 months old and has learned to use a few simple sentences. He wants a cookie and asks his mother, “Can I have a cookie?” in a way that sounds natural for his age, and has I made it a raised inflection at the end of the sentence to indicate he is asking a question.
- Autistic children may use unusual prosody, or in other words, the stress and intonation of their speech may sound “odd” to the listener. Unusual prosody for spoken language may be using a sing-songy or character voice that sounds unnatural.
Example: Nico is 30 months old and has learned to use a few simple sentences. However, the way he speaks sounds unusual for his age. His mother describes his way of talking as “robotic” and “unnatural.” She even says she is unsure if he asks a question because he doesn’t use the appropriate inflection when asking a question. When he says, “Can I have a cookie?” it sounds like he is making a statement rather than asking an actual question.
Lack of pretend play skills
- Typically developing children who are 18 months and older begin to use pretend-play.
Example: Rosalia is 24 months old, and she is playing with a set of cars. Her mother notices that Rosalia is now pretending a toy car is a cell phone, and she is babbling in the way of having an imaginary conversation with someone over the phone. Rosalia even holds the toy car up to her mom’s ear in the way of wanting her mom to pretend to talk on the phone as well.
- Autistic children may not use pretend play as would be expected for their age.
Example: Brad is 24 months old, and he is playing with a set of cars. His mother notices that he is only playing with the cars in one way, which is to roll the cars across the floor. She has never seen him do any pretend-play with the vehicles, so she decides to show him a few different ways to play pretend with the cars. She shows him how to pretend the car is a cell phone and talk into it. Next, she shows him how to pretend the cars are talking to each other. Lastly, she shows him how to pretend the cars are hungry and eat a pretend hamburger. Although she shows him these examples of play several times, he does not show any interest in this kind of play and continues to only play with the cars in one way. She has not seen him do any other instances of pretend play with other toy items either.
Common Questions about Autism
If you have insurance, a great place to start is with your pediatrician. Discuss your concerns with them and ask for a referral for a developmental evaluation from a pediatric psychologist and speech-language pathologist.
If you live in the United States and your child is under the age of three years old, contact your state Early Start program and ask for a developmental evaluation from their team of professionals. These services are state-funded and free of charge.
If you live in the United States and your child is under the age of three years old, contact your local school district and ask for a developmental evaluation by the school psychologist. These services are state-funded and free of charge.
Contacting a licensed professional in your area is the best way to get answers, but of course, this process takes time. I'm sure you are feeling worried and want to start something right away to help your child. That's why I've created the online course for parents called How to Teach a Toddler to Talk.
Yes! As a speech-language pathologist, I’ve helped scores of autistic children learn to communicate. Waitlists for evaluations can be quite long, and speech therapy is not as accessible during the covid-19 pandemic, so while you pursue in-person services, enroll in my online course for parents.
One of the critical skills that autistic children struggle with is communication, and that is what speech-language pathologists are best at treating! I specialized in this autism speech therapy during my master's program in Speech-Language Pathology and Audiology. In my DIY online course for parents, I share my step-by-step process for helping your child from home.
An estimated 60% of autistic people learn to talk in some manner through intervention. I'd love to share my expertise with you in my online program, How to Teach a Toddler to Talk! and give you tangible steps to start today with your child.
Check out Adrianna’s story. She’s a mother of a child with autism and she found help through my online course.
Disclaimer: This information is meant for general education and not to diagnose. Every child is different, and Autism Spectrum Disorder is a complex developmental disorder that can manifest differently in other people.
Note: I am electing to use identity-first language to describe the Autistic community in this blog because it is the preference of many Autistic people.