How do you know if someone has ASD?

Autism is a hidden disability; that is you cannot tell from looking who has autism and who does not.

Autism can be defined as a lifelong developmental disability that affects how a person communicates with and relates to other people. It also affects how they make sense of the world around them.

Autism Spectrum Disorder is a spectrum condition, which means that while all people with autism share certain difficulties, their condition will affect them in different ways. You will never meet two people with autism who are the same. As the saying goes “If you have met one child with autism, then you have met one child with autism”.

The exact cause of autism is still unknown. There are theories of a genetic link, but it is likely to be multifunctional and have some environmental influences. Autism is a lifelong neurodevelopmental disorder and is characterised by a “triad of impairments”.

How does ASD affect people?


Social Communication

  • People with autism have difficulties with both verbal and non-verbal language. Many have a very literal understanding of language, and think people always mean exactly what they say. They can find it difficult to use or understand:
  • Facial expressions or tone of voice
  • Jokes and sarcasm
  • Common phrases and sayings e.g. “its raining cats and dogs”. People mean that it is raining heavily, but a person with autism may take this literally and be on the lookout for cats and dogs!
  • Body language
  • Some people with autism may not speak, or have fairly limited speech. They will usually understand what other people say to them, but prefer to use alternative means of communication themselves, such as sign language, makaton or visual symbols such as PECS (Picture Exchange Communication System).
  • Others will have good language skills, but they may still find it hard to understand the give-and-take nature of conversation, perhaps repeating what the other person has just said (known as echolalia) or talking at length about their own interests. Some people may repeat what they have heard on TV and use it out of context.
  • It helps if other people speak in a clear, consistent way and give people with autism time to process what has been said to them.

Social Interaction

  • People with autism often have difficulty recognising or understanding other people’s emotions and feelings, and expressing their own, which can make it more difficult for them to fit in socially. They may:
  • Not understand the unwritten social rules which most of us pick up without thinking; they may stand too close to another person for example, may touch others without consent or start an inappropriate topic of conversation.
  • Appear to be insensitive because they have not recognised how someone else is feeling
  • Prefer to spend time alone rather than seek out the company of other people
  • Not seek comfort from others including family members
  • Appear to behave “strangely” or inappropriately, as it is not always easy for them to express feelings, emotions or needs.
  • People with autism may seem very “inward”, in fact the word autism derives from “auto” meaning self. Most people with autism are very happy to be alone and not seek attention from others including family members. However, a lot of children with autism crave social attention, but do not have the skills to be able to communicate with others.
  • Difficulties with social interaction can mean that people with autism find it hard to form friendships: some may want to interact with others and make friends, but may be unsure how to go about this.

Social Imagination (Imaginative Thought)

  • Imaginative thought allows us to understand and predict other people’s behaviour, make sense of abstract ideas, and to imagine situations outside of our immediate daily routine. Difficulties with social imagination mean that people with autism find it hard to:
  • Understand and interpret other people’s thoughts, feelings and actions
  • Predict what will happen next or could happen next. Imagining the future is extremely difficult
  • Understand the concept of danger, for example, that running onto a busy road poses a threat to them
  • Engage in imaginative play and activities, they may prefer more rigid play with no changes. Some people with autism may enjoy some imaginative play but may prefer to act out the same scenes over and over again
  • Prepare for change and plan for the future
  • Cope in new or unfamiliar situations
  • Difficulties with social imagination should not be confused with a lack of imagination. Many people with autism are very creative and may be, for example, accomplished artists, musicians or writers.

How common is ASD?

  • Prevalence is rising. Current figures are at approximately 1% of the population. It is unknown whether this rise in figures is due to better and earlier diagnosis or if autism is actually on the rise. Autism affects males far more than females, with a ratio of 4:1.

How does ASD usually present?

  • Over 50% of parents have cause for concern by 12-18 months of age. Speech delay is a common first concern. Other common concerns and traits include:
  • Lack of, or inconsistent use of eye contact
  • Lack of social smile, imitation or response to name
  • Lack of interest in others
  • Lack of emotional expression
  • Few directed vocalistations
  • Absence of joint attention skills (pointing to “show”, follow a point, monitoring other’s gaze, and referencing objects or events)
  • Few requesting behaviours
  • Few social gestures (such as waving, clapping, nodding and shaking head)
  • Pretend play is reduced in many children
  • Regression (Losing skills that have previously been acquired) is seen in approx. 25% of children with ASD. The skills may be in language, play or social skills.
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