Autism: Symptoms (page 2)

— Centers for Disease Control and Prevention
Updated on Jan 30, 2012


Each person with an ASD has different communication skills. Some people may have relatively good verbal skills, with only a slight language delay with impaired social skills. Others may be not speak at all or have limited ability or interest in communicating and interacting with others. About 40% of children with ASDs do not talk at all. Another 25%–30% of children with autism have some words at 12 to 18 months of age and then lose them.[1] Others may speak, but not until later in childhood.

People with ASDs who do speak may use language in unusual ways. They may not be able to combine words into meaningful sentences. Some people with ASDs speak only single words, while others repeat the same phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with an ASD, "Do you want some juice?" he or she might repeat "Do you want some juice?" instead of answering your question. Although many children without ASDs go through a stage where they repeat what they hear, it normally passes by age 3. Some people with ASDs can speak well but may have a hard time listening to what other people say.

People with ASDs may have a hard time using and understanding gestures, body language, or tone of voice. For example, people with ASDs might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with ASDs might smile while saying something sad. They might say "I" when they mean "you," or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with ASDs might stand too close to the people they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with relatively good language skills speak like little adults, failing to pick up on the “kid-speak” that is common in their peers.

Repeated Behaviors and Routines

Unusual behaviors such as repetitive motions may make social interactions difficult.

Repetitive motions are actions repeated over and over again. They can involve part of the body or the entire body or even an object or toy. For instance, people with ASDs may spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car in front of their eyes. These types of activities are known as self-stimulation or “stimming.”

People with ASDs often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting or frustrating to people with ASDs. They may “lose control” and have a “melt down” or tantrum, especially if they’re in a strange place.

Also, some people with ASDs develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by in a building or may always want to watch a video in its entirety—from the previews at the beginning through the credits at the end. Not being allowed to do these types of routines may cause severe frustration and tantrums. .

Additional Disabilities and Conditions

Children with an ASD may also have one of several other developmental disabilities such as mental retardation/intellectual impairment, epilepsy, fragile X syndrome, or tuberous sclerosis.  A study published by CDC in 2003 found that 62% of the children who had an ASD had at least one additional disability or epilepsy (glossary). Of those children, 68% had mental retardation/intellectual impairment, 8% had epilepsy, 5% had cerebral palsy, 1% had vision impairment, and 1% had hearing loss. Other studies show that 5% to 38% of adults with ASDs have epilepsy.[2] And some people with ASDs may have mental disorders such as depression and anxiety. Although these additional conditions may not be key to the ASD diagnosis, they do add challenges for the person with ASD and his or her family.  

Associated Features

People with ASDs might have a range of other behaviors associated with the disorder. These include hyperactivity, short attention span, impulsivity, aggressiveness, self-injury, and temper tantrums. They may have unusual responses to touch, smell, sound, and other sensory input. For example, they may over- or under-react to pain or to a loud noise. They may have abnormal eating habits. For instance, some people with ASDs limit their diet to only a few foods, and others may eat nonfood items like dirt or rocks (this is called pica). They may also have odd sleeping habits. People with ASDs may seem to have abnormal moods or emotional reactions. They may laugh or cry at unusual times or show no emotional response at times you would expect one. They may not be afraid of dangerous things, and they could be fearful of harmless objects. People with ASDs may also have gastrointestinal issues such as chronic constipation or diarrhea. 

It is important to remember that children with ASDs can get sick or injured just like children without ASDs. Regular medical and dental exams should be part of a child’s intervention plan. Often it is hard to tell if a child’s behavior is related to the ASD or is caused by a separate health problem. For instance, head banging could be a symptom of an ASD, or it could be a sign that the child is having headaches. In those cases, a careful physical exam is important.

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