Signs and symptoms of possible autism in secondary school children (older than 11 years or equivalent mental age)
Social interaction and reciprocal communication behaviours
Spoken language
Spoken language may be unusual in several ways:
- very limited use
- monotonous tone
- repetitive speech, frequent use of stereotyped (learnt) phrases, content dominated by excessive information on topics of own interest
- talking 'at' others
- rather than sharing a two-way conversation responses to others can seem rude or inappropriate
Interacting with others
- Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
- Long-standing difficulties in reciprocal social communication and interaction: few close friends or reciprocal relationships
- Reduced or absent understanding of friendship; often an unsuccessful desire to have friends (although may find it easier with adults or younger children)
- Social isolation and apparent preference for aloneness
- Reduced or absent greeting and farewell behaviours
- Lack of awareness and understanding of socially expected behaviour
- Problems losing at games, turn-taking and understanding 'changing the rules'
- May appear unaware or uninterested in what other young people his or her age are interested in
- Unable to adapt style of communication to social situations, for example may be overly formal or inappropriately familiar.
- Subtle difficulties in understanding other's intentions; may take things literally and misunderstand sarcasm or metaphor
- Makes comments without awareness of social niceties or hierarchies
- Unusually negative response to the requests of others (demand avoidant behaviour)
Eye contact, pointing and other gestures
- Poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people's eyes when speaking) assuming adequate vision, and spoken language used in social communication
Ideas and imagination
- History of a lack of flexible social imaginative play and creativity, although scenes seen on visual media (for example, television) may be re-enacted
Unusual or restricted interests and/or rigid and repetitive behaviours
- Repetitive 'stereotypical' movements such as hand flapping, body rocking while standing, spinning, finger flicking
- Preference for highly specific interests or hobbies
- A strong adherence to rules or fairness that leads to argument
- Highly repetitive behaviours or rituals that negatively affect the young
- Highly repetitive behaviours or rituals that negatively affect the young person's daily activities
- Excessive emotional distress at what seems trivial to others, for example change in routine
- Dislike of change, which often leads to anxiety or other forms of distress including aggression
- Over or under reaction to sensory stimuli, for example textures, sounds, smells
- Excessive reaction to taste, smell, texture or appearance of food and/or extreme food fads.
Other factors that may support a concern about autism
- Unusual profile of skills and deficits (for example, social or motor coordination skills poorly developed, while particular areas of knowledge, reading or vocabulary skills are advanced for chronological or mental age)
- Social and emotional development more immature than other areas of development, excessive trusting (naivety), lack of common sense, less independent than peers
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