What Autism Looks Like

Core Symptoms of Autism

Autism Spectrum Disorder (ASD) exhibits primarily through two key symptomatic areas: challenges with social communication and interaction, and restricted and repetitive behaviors.

The range of social communication and interaction challenges spans significantly between individuals. Some may face extreme difficulties in understanding social cues and conversing, including challenges with:

• Back-and-forth dialogue
• Interpreting subtle forms of communication like body language or facial expressions
• Sharing one’s own thoughts and emotions effectively

On a less severe end of the spectrum, some might only find nuanced social interactions challenging, such as understanding sarcasm or teasing.

Children with autism often show noticeable signs early on, such as delays in speech development or not using conversational gestures that typical children may use naturally. In school settings, these communication challenges can result in children not engaging in group activities, being seen as withdrawn or aloof, or not picking up playground norms and rules naturally like their neurotypical peers.

Restricted and repetitive behaviors also manifest uniquely per individual. Common behaviors include:

• Repeated movements such as rocking or hand-flapping
• Ritualistic behaviors like arranging objects precisely
• Strong resistance to changes in schedule or environment

Some individuals may exhibit intense interests in specific topics, pouring excessive amounts of time into learning about or discussing them, which can alienate peers who do not share the same level of interest or find the content overwhelming.

The intensity and specific type of these behaviors can significantly impact everyday functioning. In more severe cases, these behaviors can obscure other aspects of life, making social relationships and general daily tasks challenging. In contrast, those on the lower end may find that their routines provide them comfort and order, only appearing a bit rigid or peculiar to others.

Educational environments need particular attention since they play a pivotal role in an autistic child’s development. Specialized educational strategies, including consistent routines, clear communication about schedule changes well ahead of time, and direct teaching of social rules and expectations, are crucial to support autistic students who may find the unpredictable nature of the school day stressful.

Understanding and addressing the spectrum of behaviors and difficulties associated with autism can create supportive pathways for those impacted, easing daily challenges and enhancing their ability to engage more freely within society. Engaging intentionally with individuals on the spectrum means gaining a deeper appreciation of the nuances inherent in their experiences and adjusting societal frameworks to accommodate and embrace these differences.

Developmental Progression and Diagnosis

Typically, indications of autism become evident in the early developmental stages, with many children showing symptoms by the age of two. The signs generally manifest gradually and can include:

• Lack of responsiveness to their name
• Unusual interest in particular objects
• Limited use of gestures in communication
• Delayed language skills
• Peculiar playing behaviors where interaction with peers is scant or atypical

Diagnosis often comes later than these initial signs. In the United States, though autism can be reliably diagnosed as early as age two, the average age at which children receive a diagnosis is around four to five years old.¹ This delay can vary even more significantly globally due to variations in healthcare access, diagnostic practices, and awareness levels. The gap between the emergence of symptoms and diagnosis can be critical, as early identification enables the onset of intervention services that can profoundly impact a child’s developmental trajectory and quality of life.

The diagnostic process involves a comprehensive evaluation by professionals who specialize in developmental disorders. The evaluation includes developmental screenings, parental interviews, direct observation and interaction with the child, and utilization of standardized diagnostic tools.

One major challenge in the diagnosis of autism concerns its diverse presentation across individuals. Due to this variability, a child showing mild signs might not receive a diagnosis until they face significant challenges in more demanding environments like school, where social interactions and communication skills are constantly put to the test. For girls and women, diagnosis can be particularly challenging because they are often better at masking their symptoms, performing expected social and communication behaviors through mimicked actions, which can lead to underdiagnosis or a delayed diagnosis.²

In scenarios where autism is diagnosed later in life, individuals have often navigated life aware of their own differences but without a framework or support system catered to their specific needs. While a late diagnosis provides crucial self-awareness and access to support services, it also confronts the individual with a retrospective understanding of lifelong challenges that might have been managed more effectively with earlier support.

Research consistently supports that the sooner supports and therapies begin, the more significant the impact on outcomes in communication skills, intellectual development, and social behaviors.³ Such interventions focus on building developmental skills across various domains through specialized teaching strategies aimed at enhancing an individual’s ability to function independently and successfully in their natural environments.

Understanding the developmental progression, recognizing the early signs, and obtaining a timely diagnosis opens a critical window to implement effective educational programs and interventions that profoundly shape an autistic individual’s ability to manage life comfortably and successfully. While the challenges in diagnosing autism are evident given the intricacies and diversity of its manifestations, strides continue to be made toward fine-tuning diagnostic processes and advocacy for early intervention strategies, ensuring supportive and enriching environments for all individuals on the spectrum.

Sensory Sensitivities and Responses

Individuals with autism often experience sensory sensitivities, which profoundly influence their daily activities and interactions. Sensory sensitivity can vary widely; some may be over-reactive (hypersensitive) to sensory input, finding ordinary stimuli like lights, sounds, or touch overwhelming and sometimes painful. Conversely, others might be under-reactive (hyposensitive) and seek out intense sensory experiences to satisfy their need for stimulation.

For those who are hypersensitive, everyday environments that others might find normal can be challenging. Fluorescent lighting often used in classrooms and office buildings can seem excessively bright and distracting, causing discomfort or even headaches. Similarly, the hum of background noises can be disturbingly loud or distressing to individuals with autism. This over-reactivity can lead to stress, anxiety, and sometimes physical pain, severely affecting their focus and ability to function in various settings.

In social situations, these sensory challenges can also lead to perceived behavioral issues. A child with autism who covers their ears and screams during a school assembly might be trying to cope with what feels like an assault of unbearably loud sounds. These reactions can be misinterpreted as behavioral problems rather than legitimate responses to overwhelming sensory input.

On the other end of the spectrum, individuals who are hyposensitive to sensory stimuli might not react to things like temperatures or pain in expected ways. This under-reactivity can be dangerous at times, such as not feeling the extent of heat from a burn or the cold in freezing temperatures. Socially, these individuals may not pick up on subtle cues communicated through facial expressions or body language, which can lead to misunderstandings or awkwardness in interactions with others.

In both instances, understanding and adjustments are key to supporting autistic individuals in managing their sensory sensitivities. Educators and parents can create more accommodating environments by reducing exposure to potential overwhelming stimuli or incorporating scheduled breaks for those who may become easily overstimulated. For undersensitive individuals, therapies and activities designed to safely provide sensory inputs can be beneficial, aiding them in better managing their environments and interactions.

Incorporating sensory-friendly activities and environments into everyday routines can profoundly impact an autistic individual’s comfort and ability to engage with the world around them. Personalized adaptations such as using noise-cancelling headphones in loud environments, having access to a quiet space when overwhelmed, or using tactile toys and tools to engage more positively with their environment make daily life more manageable and enjoyable for individuals on the autism spectrum, promoting inclusivity and understanding in homes, schools, and public spaces.

Social Interaction and Communication Challenges

For many individuals with autism, the domain of social interaction presents a complex array of challenges. At the core of this difficulty are several facets of interaction that neurotypical individuals might take for granted, including:

• Making eye contact
• Understanding body language
• Initiating or sustaining conversations

Making eye contact, for example, is a form of non-verbal communication often expected in social settings. However, for autistic individuals, maintaining eye contact can be uncomfortable or immensely stress-inducing. It involves a significant amount of neural processing, which can be overwhelming or distracting for someone on the spectrum.⁴ This natural aversion to eye contact can often be misinterpreted by others as a lack of interest or attention, potentially hindering the formation of social connections.

Understanding body language poses another significant hurdle. The subtle dance of human body language—a shrug, a tilted head, a shuffled foot—can convey volumes about a person’s feelings or intentions. Yet these cues often get lost in translation for individuals with autism, who may struggle to interpret what’s unspoken. Simultaneously, their own body language might not align with conventional expectations, which can lead to misunderstandings or the perception of social awkwardness.

Initiating conversations is another area laden with challenges. The intricate social choreography involved in starting and maintaining a conversation can be daunting. Persons with autism may find it difficult to pick up on social cues that signify when it’s their turn to speak or when a topic is considered socially appropriate. The anxiety about breaching social norms can deter them from engagement, leading to isolation.

Many autistic children and adults may have difficulty understanding the reciprocal nature of conversations. Conversations are an exchange that involves reacting not just to the words, but to the rhythm, tone, and subtleties within an interaction. The flow of exchanging conversational turns may seem unpredictable, and those with autism may speak at length about a favorite subject without recognizing the cues from others to change the subject or allow for another’s input.

Given these intricacies, strategies such as role-playing or social stories are often used in therapeutic settings or special education programs. These tools aim to explicitly teach autistic individuals how to interpret and respond to social signals, manage the nuances of conversation, and recognize and use nonverbal cues effectively. Technology also plays a role in supporting communication through devices and apps designed to build and enhance conversational skills.

Above all, compassion and understanding from society play a pivotal role. By acknowledging the hurdles that autistic individuals face in traversing a world largely designed for neurotypical engagement, everyone can contribute to an environment of acceptance and empowerment. Through patient interactions and open, adaptive communication strategies, it becomes possible to bridge the gap between different ways of experiencing the world, paving the way for richer, more inclusive human connections.

Photo by jwwhitt on Unsplash

Enhancing the lives of individuals with autism relies on our collective empathy and understanding. By fostering environments that are sensitive to their needs, we empower them to navigate their surroundings more comfortably and successfully.

1. Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveill Summ. 2020;69(4):1-12.
2. Ratto AB, Kenworthy L, Yerys BE, et al. What about the girls? Sex-based differences in autistic traits and adaptive skills. J Autism Dev Disord. 2018;48(5):1698-1711.
3. Zwaigenbaum L, Bauman ML, Choueiri R, et al. Early intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. Pediatrics. 2015;136 Suppl 1:S60-S81.
4. Hadjikhani N, Åsberg Johnels J, Zürcher NR, et al. Look me in the eyes: Constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Sci Rep. 2017;7(1):3163.