Signs and SymptomsAutism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. People with ASDs handle information in their brain differently than other people.
ASDs are "spectrum disorders." That means ASDs affect each person in different ways, and can range from very mild to severe. People with ASDs share some similar symptoms, such as problems with social interaction. But there are differences in when the symptoms start, how severe they are, and the exact nature of the symptoms.
Example of Range of Symptoms
Following the chart below - a person might have average intelligence, have little interest in other people, use limited verbal language, experience intense self-stimulatory behaviors such as hand-flapping, under-react to pain and over-react to sounds, have very good gross motor skills, and have weaknesses in fine motor skills. These syptoms may vary widely from person to person.
It is important to note that some people without an ASD might also have some of these symptoms. But for people with an ASD, the impairments make life very challenging.
Possible "Red Flags"A person with an ASD might:
- Not respond to their name by 12 months of age
- Not point at objects to show interest (point at an airplane flying over) by 14 months
- Not play "pretend" games (pretend to "feed" a doll) by 18 months
- Avoid eye contact and want to be alone
- Have trouble understanding other people's feelings or talking about their own feelings
- Have delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- Give unrelated answers to questions
- Get upset by minor changes
- Have obsessive interests
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to the way things sound, smell, taste, look, or feel
Social SkillsSocial issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social "difficulties" like shyness. The social issues they have cause serious problems in everyday life.
Examples of social issues related to ASDs:
- Does not respond to name by 12 months of age
- Avoids eye-contact
- Prefers to play alone
- Does not share interests with others
- Only interacts to achieve a desired goal
- Has flat or inappropriate facial expressions
- Does not understand personal space boundaries
- Avoids or resists physical contact
- Is not comforted by others during distress
- Has trouble understanding other people's feelings or talking about own feelings
Some people with an ASD might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an ASD have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.
People with an ASD might have problems with showing or talking about their feelings. They might also have trouble understanding other people's feelings. Many people with an ASD are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an ASD. Anxiety and depression also affect some people with an ASD. All of these symptoms can make other social problems even harder to manage.
CommunicationEach person with an ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with an ASD have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood.
Examples of communication issues related to ASDs:
- Delayed speech and language skills
- Repeats words or phrases over and over (echolalia)
- Reverses pronouns (e.g., says "me" instead of "I")
- Gives unrelated answers to questions
- Does not point or respond to pointing
- Uses few or no gestures (e.g., does not wave goodbye)
- Talks in a flat, robot-like, or sing-song voice
- Does not pretend in play (e.g., does not pretend to "feed" a doll)
- Does not understand jokes, sarcasm, or teasing
People with an ASD might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with an ASD might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an ASD might smile while saying something sad.
People with an ASD might say "I" when they mean "you," or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an ASD might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the "kid-speak" that is common with other children.
Unusual Interests and BehaviorsMany people with an ASD have unusual interest or behaviors.
Examples of unusual interests and behaviors related to ASDs:
- Lines up toys or other objects
- Plays with toys the same way every time
- Likes parts of objects (e.g., wheels)
- Is very organized
- Gets upset by minor changes
- Has obsessive interests
- Has to follow certain routines
- Flaps hands, rocks body, or spins self in circles
People with an ASD often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with an ASD. They might "lose control" and have a "melt down" or tantrum, especially if in a strange place.
Some people with an ASD also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.
Other SymptomsSome people with an ASD have other symptoms. These might include:
- Hyperactivity (very active)
- Impulsivity (acting without thinking)
- Short attention span
- Causing self injury
- Temper tantrums
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Lack of fear or more fear than expected
- Unusual reactions to the way things sound, smell, taste, look, or feel
People with an ASD might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.
DevelopmentChildren with an ASD develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an ASD might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a "b" makes.
Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life. To learn more about developmental milestones, visit "Learn the Signs. Act Early," a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible "red flags" for autism spectrum disorders.