Could My Child Have Autism?

No individual symptom is a sign of autism, and no two children with autism have identical symptoms. There are no medical tests that can determine whether a child is autistic, and there are no hard and fast rules for how autism should be diagnosed. In fact, in some cases, it can be tough for even a professional to diagnose an autism spectrum disorder. But if your child has several of the following symptoms—and they can't be attributed to any other disorder—it might be a good idea to consider an autism screening or evaluation. 

Children with autism spectrum disorders almost always have challenges with speech and language, but unless the challenges are obvious (a five-year-old with no spoken language, for example), they can be hard to spot. That's because children with autism may use plenty of words, and may even use more words than their typical peers. Here are some tips for determining if you child is having difficulties with verbal communication; it's important to note that these difficulties are not, in themselves, signs of autism:

• They use few or no spoken words by age two, nor do they use gestures, gibberish, or other means to communicate their needs or thoughts.
• They use only words they are repeating from television, movies, or other people, especially if they are not using the words to communicate meaning (e.g., repeating a random phrase from a favorite TV show).
• They are not hard of hearing but don't respond when their name is called.
• Lack of eye contact, even when eye contact is requested.
• Never initiating interactions or conversations with others.
• They do not go through the usual babbling or gibberish stages of speech.
• They develop spoken language at the usual time, but use words oddly, have an unusually flat voice, or misunderstand the intended meaning of words.

Children with autism interact in unusual ways with objects, toys, and potential playmates. They are most likely to prefer their own company than the company of other children or to demand that playmates interact with them in certain predictable ways. Here are some forms of play that are common among children with autism:

• Lining up objects or toys rather than using them in pretend or interactive play;
• Interacting in the same way with the same objects (toys, doors, containers, etc.) over and over again;
• Enacting the same scenes (often from TV) over and over again in exactly the same way;
• Engaging in "parallel play" (two children playing near one another but not interacting) long past the point when such play is developmentally typical;
• Ignoring or responding angrily to attempts to join them in their play or make changes to their play schemes;
• Having difficulty with age-appropriate forms of play such as rule-based games, pretend play, organized sports, or other activities that require social communication.

Unusual Physical Reactions and Behaviors

People with autism often have unusual physical behaviors that set them apart from their peers. While none of these behaviors is, in itself, a sign of autism, all of them can be part of the autism "package." For example, autistic children may:

• Rock, flap, or otherwise "stim," often as a way to calm themselves;
• Over- or under-respond to sensory input, including pain;
• Are unusually picky eaters and may refuse foods with particular textures or strong flavors;
• Have an unusual gait that may include toe walking or awkward movements;
• Respond in age-inappropriate ways to unexpected changes in routine (angry melt-downs or extreme anxiety as a result of apparently minor changes);
• Exhibit age-inappropriate behaviors or interests or have difficulty with developing age-appropriate abilities in toileting, dressing, etc.

While the criteria for autism spectrum disorder do not include physical or mental symptoms or illness, such issues are unusually common among children with autism. 

• Sleep problems are common among people with autism. Many autistic children have trouble falling or staying asleep, and adults on the spectrum often have similar issues.
• Many children with autism have mild or more significant delays in gross and ​fine motor skills; for example, they may have difficulty with manipulating silverware, using scissors, climbing, jumping, etc.
• Seizure disorders are more common among children with autism.
• Gastrointestinal (GI) problems such as constipation, diarrhea, and/or vomiting are more common among children with autism.
• Autistic people of all ages are more prone than their typical peers to social anxiety, generalized anxiety, ADHD, depression, OCD, and other developmental disorders and mental illness.

Again, none of these symptoms, individually, are signs of autism but combined with other symptoms, they may raise enough concerns to warrant an evaluation.

Quite a few people with autism have unusual symptoms that may not cause problems in themselves but which do suggest a different developmental path. A few such symptoms include:

• Hyperlexia: a very precocious ability to decode written language without the accompanying ability to understand the meaning of the text;
• Synesthesia: unique responses to sound, color, letters, or numbers (for example, some people with synesthesia "see" sounds, "hear" colors, or otherwise experience unique responses to sensory input;
• Savant syndrome: Autistic savants, who represent a small percentage of the autistic population, may have amazing abilities to memorize information, do complex calculations, play piano, and so forth—much like the character of Raymond in the movie "Rain Man." 

If you've read through this checklist and find that your child seems to exhibit some of these symptoms, now is the right time to seek an autism evaluation. Start by contacting your pediatrician and asking for a referral to a clinic, developmental pediatrician, or another specialist. If your pediatrician can't help, consider contacting your school district for suggestions.

You may choose to seek an evaluation before your pediatrician suggests it, and that choice is perfectly appropriate. The reality is that parents are often the first to notice their child's differences and delays. After all, your pediatrician only sees your child once a year, or when he's sick, so she may not have a chance to see what you notice every day.

There really is no downside to seeking an evaluation. While you may discover that your child is not autistic, chances are you've discovered some issues that can and should be addressed while your child is young. And if your child is autistic, now is a great time to start providing therapies that can give your child the tools she needs to be successful.