Four Behaviors That May Be Red Flags for Autism

Some Behaviors Can Signal Developmental Problems

 These days, it seems as if any little quirk could be labeled a "sign of autism."  A child prefers to play alone, he must be autistic. She won't look people in the eye or she's slow to talk, and she's labeled autistic.

Of course, none of these behaviors by themselves are really signs of autism, though they may indicate anything from difficulty with vision or hearing to sensory processing disorder to simple shyness. On the other hand, certain behaviors (or combinations of behaviors) tend to be more suggestive of autism and may indicate that an evaluation would be a good idea.

1

Rocking, Twirling, Pacing

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Everyone, autistic or not, has stims (self-stimulatory behaviors). Some people bite their nails, others tap their finger. Some children suck their thumbs. Stims help us to relieve anxiety so that we can focus on the situation in front of us.

Most of us select stims that are culturally acceptable (nail biting rather than rocking back and forth, for example). There is no good reason why nail-biting should be more or less acceptable than rocking, but by imitating those around us we learn which actions are culturally acceptable.

People with autism, however, rarely look around to see what others are doing before doing what feels right to them. In addition, for many reasons, autistic children may be more anxious than their typical peers. Thus, the usual hair twirling and nail-biting are less common among people with autism.  Instead, certain specific stims, including toe walking, rocking, hand-flapping, twirling, and constant pacing, seem to be more common among people with autism than they are among the general population. In addition, such stims are likely to occur more often​ and can get in the way of children's' ability to participate in typical activities.

2

Lack of "Joint Attention"

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Joint attention is the process of paying attention to something with another person, thus sharing the experience. For example, you show your child how you're blowing bubbles, and he pops them. You introduce your daughter to a friend's dog, and she watches and then pats the dog as you did. You read to your little one, and he grabs the book, turns the pages, says well-remembered words with you. 

Children with autism are often unable to engage in joint attention or may have a very short joint attention span. At the same time, many children with autism can focus for hours on a solitary preferred activity such as playing a video game or lining up objects.

A child who is literally unaware that you are trying to get his attention, or who seems unable to see or hear what you see or hear, may have an issue with seeing or hearing. But if those issues have been checked and the issue continues, it's worth considering an evaluation with a developmental pediatrician or similar practitioner.

3

Extreme Need for Sameness

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Everyone has habits and routines, and some people really prefer to have a routinized life. Children, in general, are creatures of habit and enjoy hearing the same stories, watching the same movies, and repeating the same movies again and again.

Children with autism, however, often take sameness to an extreme. They may, for example, refuse to try any new food, new clothing, new TV show, or new bedtime story. They may even react with panic or a meltdown when a routine is changed. They may become extremely anxious when asked to wear a coat in winter, or nicer clothing for a special event. At school, transitions between classes can be very stressful, and changes in daily routine can be overwhelming.

While the need for sameness is not a sign of autism in itself, children with autism tend to want and rely on routine far more than typical children (and more, even, than most children with social anxiety that is NOT autism).

4

Repeating the Same Words, Ideas, or Actions

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Line Up Cars. Getty

Children do enjoy playing the same games over and over again, but with typical children, each game is a little different. New playmates or settings lead to novel ideas and interactions. Children with autism, however, tend to perseverate (get stuck) on the same thoughts, actions, or words—down to every last detail. 

For example, a child with autism might open and close a door in the same way, over and over again, ask the same question, in the same tone, 50 times (even when she knows the answer), or describe the same movie plot in the same words, in the same tone, multiple times. Perseveration of this sort is not absolutely unique to autism, but in combination with other "red flags" it is a good sign that evaluation would be appropriate.

What to Do if You See Behavioral Red Flags

If you're concerned about your child's behavior and this article has confirmed your worries, now is a good time to take action. Even if your general pediatrician has not raised any concerns, it's probably a good idea to see an autism evaluation through an autism clinic, children's hospital, or local developmental pediatrician. Even if your child is not autistic, there's a good chance that you've observed behaviors that suggest some sort of challenging developmental difference. In most cases, the earlier such a challenge is discovered the easier it is to remediate.

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