signs and symptoms of possible autism in primary school children (aged 5 to 11 years or equivalent mental age)

Last edited 02/2018

Signs and symptoms of possible autism in primary school children (aged 5 to 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

Responding to others

  • Reduced or absent response to other people's facial expression or feelings
  • Reduced or delayed response to name being called, despite normal hearing
  • Subtle difficulties in understanding other's intentions; may take things literally and misunderstand sarcasm or metaphor
  • Unusually negative response to the requests of others (demand avoidant behaviour)

Interacting with others

  • Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
  • Reduced or absent social interest in people, including children of his/her own age - may reject others; if interested in others, may approach others inappropriately, seeming to be aggressive or disruptive
  • Reduced or absent greeting and farewell behaviours
  • Reduced or absent awareness of socially expected behaviour
  • Reduced or absent ability to share in the social play or ideas of others, plays alone. Unable to adapt style of communication to social situations, for example may be overly formal or inappropriately familiar
  • Reduced or absent enjoyment of situations that most children like.

Eye contact, pointing and other gestures

  • Reduced and poorly integrated gestures, facial expressions and body orientation, eye contact (looking at people's eyes when speaking) and speech used in social communication
  • Reduced or absent social use of eye contact, assuming adequate vision
  • Reduced or absent joint attention shown by lack of:
    • gaze switching
    • following a point (looking where the other person points to - may look at hand)
    • using pointing at or showing objects to share interest

Ideas and imagination

  • Reduced or absent flexible imaginative play or creativity, although scenes seen on visual media (for example, television) may be re-enacted
  • Makes comments without awareness of social niceties or hierarchies

Unusual or restricted interests and/or rigid and repetitive behaviours

  • Repetitive 'stereotypical' movements such as hand flapping, body rocking while standing, spinning, finger flicking
  • Play repetitive and oriented towards objects rather than people
  • Over-focused or unusual interests
  • Rigid expectation that other children should adhere to rules of play
  • Excessive insistence on following own agenda
  • Extremes of emotional reactivity that are excessive for the circumstances
  • Strong preferences for familiar routines and things being 'just right'
  • 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

Other factors that may support a concern about autism

  • Unusual profile of skills or 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