Autism Information Center
As the name "autism spectrum disorders" suggests, ASDs cover a
wide range of behaviors and abilities. People who have an ASD,
like all people, are very different in how they act and what they
can do. No two people with ASDs will have the same symptoms.
People with ASDs have serious impairments with social, emotional,
and communication skills. They might repeat certain behaviors again
and again and might have trouble changing their daily routine. Many
people with ASDs also have different ways of learning, paying
attention, or reacting to things. ASDs begin before the age of 3 and
last throughout a person's life. It is important to note that some
people without ASDs might also have some of these symptoms. But for
people with ASDs, the impairment is bad enough to make life very
Social impairments are one of the main problems in all of the autism
spectrum disorders (ASDs). People with ASDs do not have merely
social “difficulties” like shyness. The social impairments they have
are bad enough to cause serious problems in everyday life. These
social problems are often combined with the other areas of deficit,
such as communication skills and unusual behaviors and interests.
For instance, the inability to have a back-and-forth conversation is
both a social and a communication problem.
Typical infants are very interested in the world
and people around them. By the first birthday, a typical toddler
tries to imitate words, uses simple gestures such as waving “bye
bye,” grasps fingers, and smiles at people. But the young child with
autism may have a very hard time learning to interact with other
people. One way very young children interact with others is by
imitating actions—for instance, clapping when mom claps. Children
with ASDs may not do this, and they may not show interest in social
games like peek-a-boo or pat-a-cake. Although the ability to play
pat-a-cake is not an important life skill, the ability to imitate
is. We learn all the time by watching others and by doing what they
do—especially in new situations and in the use of language.
People with ASDs might not interact with others
the way most people do. They might not be interested in other people
at all. Some might want friends but have social problems that make
those relationships difficult. They might not make eye contact and
might just want to be alone. Many children with ASDs have a very
hard time learning to take turns and share—much more so than other
children. This can make other children unwilling to play with them.
People with ASDs may have problems with
expression, so they might have trouble understanding other people's
feelings or talking about their own feelings. Many people with ASDs
are very sensitive to being touched and might not want to be held or
cuddled. Self-stimulatory behaviors, common among people with ASDs, may seem odd to others or
make them uncomfortable, causing them to shy away from a person with
Social issues such as trouble interacting with
peers, saying whatever comes to mind even if it’s inappropriate,
difficulty adapting to change, and even poor grooming habits can
sometimes make it hard for adults with ASDs to get and/or keep a
job at their intellectual level. Anxiety and depression, which
affect some people with ASDs, can make existing social impairments
even harder to manage.
Social skills that many people learn by watching
others may need to be taught directly to people with ASDs. When
deciding what to teach, remember the social value of learning
independent living skills such as toilet training and other basic
grooming skills (bathing, tooth brushing, dressing appropriately,
etc.). Click here to learn more about autism treatment.
Because children and adolescents with ASDs are
“different,” and because they are often very literal and sometimes
naïve and overly trusting, they are often the target of bullies and
might be easily taken advantage of. It is very important to teach
all children from a very young age to be tolerant and accepting of
differences. It is also important to teach children and adolescents
with ASDs about personal safety and tell them to go to a parent,
teacher, or other trusted adult if they need help.
There are many strategies and curriculum
supplements for teaching children and adolescents with and without
ASDs about bullying and other personal safety issues. These can be
found by visiting a local bookstore, searching an online book
seller, or by contacting a publishing company that specializes in
disability-specific and/or education publications. Teachers and
health care professionals are often good resources for this type of
information as well.
For more examples of the social issues related
to ASDs, click here.
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Each person with an ASD has different communication skills. Some
people may have relatively good verbal skills, with only a slight
language delay with impaired social skills. Others may be not speak
at all or have limited ability or interest in communicating and
interacting with others. About 40% of children with ASDs do not talk
at all. Another 25%–30% of children with autism have some words at
12 to 18 months of age and then lose them.
Others may speak, but not until later in childhood.
People with ASDs who do speak may use language
in unusual ways. They may not be able to combine words into
meaningful sentences. Some people with ASDs speak only single words,
while others repeat the same phrases over and over. Some children
repeat what others say, a condition called echolalia. The repeated
words might be said right away or at a later time. For example, if
you ask someone with an ASD, "Do you want some juice?" he or she
might repeat "Do you want some juice?" instead of answering your
question. Although many children without ASDs go through a stage
where they repeat what they hear, it normally passes by age 3. Some
people with ASDs can speak well but may have a hard time listening
to what other people say.
People with ASDs may have a hard time using and
understanding gestures, body language, or tone of voice. For
example, people with ASDs 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 ASDs might smile
while saying something sad. They might say "I" when they mean "you,"
or vice versa. Their voices might sound flat, robot-like, or
high-pitched. People with ASDs might stand too close to the people
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 relatively good language skills speak like little
adults, failing to pick up on the “kid-speak” that is common in
For more examples of the communication issues
related to ASDs, click
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Behaviors and Routines
Unusual behaviors such as repetitive motions may
make social interactions difficult.
Repetitive motions are actions repeated over and
over again. They can involve part of the body or the entire body or
even an object or toy. For instance, people with ASDs may spend a
lot of time repeatedly flapping their arms or rocking from side to
side. They might repeatedly turn a light on and off or spin the
wheels of a toy car in front of their eyes. These types of
activities are known as self-stimulation or “stimming.”
People with ASDs 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 or frustrating to people with ASDs.
They may “lose control” and have a “melt down” or tantrum,
especially if they’re in a strange place.
Also, some people with ASDs develop routines
that might seem unusual or unnecessary. For example, a person might
try to look in every window he or she walks by in a building or may
always want to watch a video in its entirety—from the previews at
the beginning through the credits at the end. Not being allowed to
do these types of routines may cause severe frustration and
For more examples of repetitive behaviors and
routines related to ASDs, click
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Disabilities and Conditions
Children with an ASD may also have one of
several other developmental disabilities such as
mental retardation/intellectual impairment, epilepsy,
fragile X syndrome, or
tuberous sclerosis. A
study published by CDC in 2003 found that 62% of the children who had an ASD had at least
one additional disability or epilepsy (glossary). Of those children,
68% had mental retardation/intellectual impairment, 8% had
epilepsy, 5% had
cerebral palsy, 1% had
vision impairment, and 1% had
hearing loss. Other studies show that
5% to 38% of adults with ASDs have epilepsy.
And some people with ASDs may have mental disorders such as
depression and anxiety. Although these additional conditions may not
be key to the ASD diagnosis, they do add challenges for the person
with ASD and his or her family.
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People with ASDs might have a range of other behaviors
associated with the disorder. These include hyperactivity, short
attention span, impulsivity, aggressiveness, self-injury, and temper
tantrums. They may have unusual responses to touch, smell, sound,
and other sensory input. For example, they may over- or under-react
to pain or to a loud noise. They may have abnormal eating habits.
For instance, some people with ASDs limit their diet to only a few
foods, and others may eat nonfood items like dirt or rocks (this is
called pica). They may also have odd sleeping habits. People with
ASDs may seem to have abnormal moods or emotional reactions. They
may laugh or cry at unusual times or show no emotional response at
times you would expect one. They may not be afraid of dangerous
things, and they could be fearful of harmless objects. People with
ASDs may also have gastrointestinal issues such as chronic
constipation or diarrhea.
It is important to remember that children with
ASDs can get sick or injured just like children without ASDs.
Regular medical and dental exams should be part of a child’s
intervention plan. Often it is hard to tell if a child’s behavior is
related to the ASD or is caused by a separate health problem. For
instance, head banging could be a symptom of an ASD, or it could be
a sign that the child is having headaches. In those cases, a careful
physical exam is important.
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Pattern of Development
Some children with ASDs show hints of future
problems within the first few months of life. In others, symptoms
may not show up until 24 months or later. Studies have shown that
one third to half of parents of children with ASDs noticed a problem
before their child’s first birthday, and nearly 80%–90% saw problems
by 24 months. Some children with ASDs seem to develop normally until
18–24 months of age and then they stop gaining new language and
social skills, or they lose the skills they had.
Children with ASDs develop at different rates in
different areas of growth. They may have delays in language, social,
and learning skills, while their motor skills 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
ASDs 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.
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Possible Red Flags for
Autism Spectrum Disorders
Children and adults with an autism spectrum disorder might:
Not play "pretend" games (pretend to "feed" a
Not point at objects to show interest (point at
an airplane flying over)
Not look at objects when another person points
Have trouble relating to others or not have an
interest in other people at all
Avoid eye contact and want to be alone
Have trouble understanding other people's
feelings or talking about their own feelings
Prefer not to be held or cuddled or might
cuddle only when they want to
Appear to be unaware when other people talk to
them but respond to other sounds
Be very interested in people, but not know how
to talk to, play with, or relate to them
Repeat or echo words or phrases said to them,
or repeat words or phrases in place of normal language
Have trouble expressing their needs using
typical words or motions
Repeat actions over and over again
Have trouble adapting to changes in routine
Have unusual reactions to the way things smell,
taste, look, feel, or sound
Lose skills they once had (for instance, stop
saying words they were once using)
Talk to your child’s doctor or nurse if your child loses
skills at any age.
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What can I do if I think my child has
If you or your doctor thinks there could be a problem, ask for a
referral to see a developmental pediatrician or other specialist.
You can also call your local early intervention agency (for children
under 3) or public school (for children 3 and older). To find out
who to speak to in your area, check with the
National Dissemination Center for Children with Disabilities.
Today, the main research-based
treatment for ASDs is intensive structured teaching of skills,
often called behavioral intervention. It is very important to
start this intervention as early as possible to help your child
reach his or her full potential. Acting early can make a real
difference! To find out more about treatment and therapy, click here.
Even if your child has not been diagnosed with an ASD, he or
she may be eligible for early intervention services. The
Individuals with Disabilities Education Act (IDEA)
children under the age of 3 who are at risk of having serious
developmental delays may be eligible for services. These services
are provided through an early intervention system in your state.
Through this system, you can ask for an evaluation. To learn more
about early intervention,
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Disclaimer: We have provided a link to
these sites because they have information that may be of interest to you. CDC does not necessarily endorse the views or information presented on
these sites. Furthermore, CDC does not endorse any commercial products or information that may be presented or advertised on these sites.
 Johnson, C.P. Early Clinical
Characteristics of Children with Autism. In: Gupta, V.B. ed:
Autistic Spectrum Disorders in Children. New York: Marcel
Dekker, Inc., 2004:85-123.
 Tuchman,R., and Rapin, I. Epilepsy in
autism. Lancet Neurology 2002; 1(6):352-358.
November 01, 2007
Content source: National Center on Birth Defects and Developmental