Problems with communication and social interaction

ASD can involve a range of issues with communication, many of which appear before age 5.

Here’s a what this might look like over time:

  • From birth: trouble maintaining eye contact

  • By 9 months: not responding to their name; not displaying facial expressions reflective of their emotions (like surprise or anger)

  • By 12 months: not engaging in basic interactive games; not calling a parent a special name, like “mama” or “dada”; using few or no gestures, like waving

  • By 15 months: not sharing their interests with others (by showing someone a favorite toy, for example)

  • By 18 months: not pointing or looking where others point; not pointing to show you something

  • By 24 months: not noticing when others appear sad or hurt; not saying more than one of two words

  • By 36 months: not noticing other children or joining them in play

  • By 48 months: not engaging in “pretend play,” like like pretending to be a doctor or treacher

  • By 60 months of age: not singing, acting, or dancing

Additionally, autistic children might have trouble expressing their feelings or understanding those of others starting at 36 months.

As they age, they might have difficulty talking or very limited speaking skills. Other autistic children might develop language skills at an uneven pace. If a particular topic interests them, for example, they might develop a very strong vocabulary for talking about that one topic, but they might have difficulty communicating about other things.

As autistic children begin talking, they might also talk in an unusual tone ranging from high-pitched and “sing-songy” to robotic or flat.

They might also show signs of hyperlexia, which involves reading beyond what’s expected of their age. Children on the autism spectrum might learn to read earlier than their neurotypical peers, sometimes as early as age 2. But they tend not to comprehend what they’re reading.

While hyperlexia does not always accompany autism, a 2017 review suggests anywhere from 6% to 20% of autistic children demonstrate early signs of hyperlexia, depending on how narrowly hyperlexia is defined.

As they interact with others, autistic children might have difficulty sharing their emotions and interests with others or find it hard to maintain back-and-forth conversations. Nonverbal communication, like maintaining eye contact or body language, might also remain difficult.

These challenges with communication can persist throughout adulthood.

Autism

ASD describes a group of neurodevelopmental conditions that become evident during early childhood. Certain genetic and environmental factors can contribute to its development. Autism spectrum disorder (ASD), or autism, is a broad term used to describe a group of neurodevelopmental conditions. Differences in communication and social interaction characterize these conditions. People with ASD often demonstrate restricted and repetitive interests or patterns of behavior.

What are the symptoms of autism?

Symptoms of ASD typically become clearly evident during early childhood, between ages 12 and 24 months. However, symptoms may also appear earlier or later.

Early symptoms may include a marked delay in language or social development.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), used by clinicians to diagnose various psychiatric disorders, divides symptoms of ASD into two categories:

  • problems with communication and social interaction

  • restricted or repetitive patterns of behavior or activities

Autism spectrum disorder (ASD) is a neurological and developmental condition that primarily affects the brain's development and function, leading to differences in how individuals perceive and socialize with others. While often described in terms of social and behavioral characteristics, autism can also significantly affect various physical systems and functions throughout the body

Restricted or repetitive patterns of behavior or activities

In addition to the communication and social issues mentioned above, autism includes symptoms related to body movements and behaviors.

These can include:

  • repetitive movements, like rocking, flapping their arms, spinning, or running back and forth

  • lining objects, like toys, up in strict order and getting upset when that order is disturbed

  • attachment to strict routines, like those around bedtime or getting to school

  • repeating words or phrases they hear someone say over and over again

  • getting upset over minor changes

  • focusing intently on parts of objects, like the wheel of a toy truck or the hair of a doll

  • unusual reactions to sensory input, like sounds, smells, and tastes

  • obsessive interests

  • exceptional abilities, like musical talent or memory capabilities

Other characteristics

Some autistic people might experience additional symptoms, including:

  • delayed movement, language, or cognitive skills

  • seizures

  • gastrointestinal symptoms, like constipation or diarrhea

  • excessive worry or stress

  • unusual levels of fear (either higher or lower than expected)

  • hyperactive, inattentive, or impulsive behaviors

  • unexpected emotional reactions

  • unusual eating habits or preferences

  • unusual sleep patterns

  • self-stimulating behaviors, known as “stimming“

What are the different types of autism?

The DSM-5-TR currently recognizes five ASD subtypes or specifiers:

  • with or without accompanying intellectual impairment

  • with or without accompanying language impairment

  • associated with a known medical or genetic condition or environmental factor

  • associated with another neurodevelopmental, mental, or behavioral disorder

  • with catatonia

Someone can receive a diagnosis of one or more specifiers.

Before the DSM-5-TR, autistic people may have received a diagnosis of:

It’s important to note that a person who received one of these earlier diagnoses has not lost their diagnosis and will not need to be reevaluated.