Understanding Autism

Written By Sarah Masters

What is Autism? 

“Autism” or “Autism Spectrum Disorder” (ASD) is a developmental delay caused by differences in the brain. Children with ASD often have difficulty with social communication and interaction, and restricted or repetitive behaviors or interests. Children with ASD may also have different ways of learning, moving, or paying attention (CDC, 2022). 

There are three core deficits within Autism that I want us to further dive into: 1. Impaired communication 2. Impaired reciprocal social interaction 3. Restricted, repetitive, and stereotyped patterns of behavior or interests. 

What does Impaired Communication look like? 

Children with ASD often have difficulty understanding what is being spoken to them, as well as difficulty expressively communicating their wants and needs to others. A fancy word for understanding what others are saying to you is Auditory Comprehension. Children with ASD often have delays in auditory comprehension skills or “receptive language”. A child may have difficulty following commands with and without the use of gestural cues. For example, “Put your blanket in the bag”. A child may have difficulty understanding the vocabulary within that command, therefore they demonstrate difficulty executing the task. 

Another important language skill is expressive communication. Some children with Autism may be non-verbal or have very limited expressive communication skills. Some children with ASD who are verbal, produce repetitive or rigid language. Often these children will say things that have no meaning or are not related to the present activity. For example, a child may sing the ABCs when the alphabet is not present or count up to 10 when numbers are not present, or script dialogue from their favorite TV show when that show is not currently playing. 

A child may also repeat what has just been said–this is called echolalia. Immediate echolalia is the repetition of speech immediately after the utterance. For example, a caregiver might say “What color is this?” and the child will repeat “What color is this?” instead of answering the question. Delayed echolalia is the repetition of verbal messages that were previously heard and which are repeated after a time delay of a few minutes, hours, days, weeks, months, or years (Vicker, 1999). For example, a child may say “meeska mooska, Mickey Mouse!” often within a session when the activity is not relevant to Mickey Mouse. 

Some children with ASD may have narrow interests and exceptional abilities. A child may be able to have an impression monologue of an interest of theirs (dinosaurs, titanic, weather, etc), but otherwise have difficulty having a conversation with a communication partner related to that topic of interest. Other children may have exceptional skills in math, art, and/or musical talents. According to the National Institute of Deafness and Other Communication Disorders, “approximately 10% of children with Autism have “savant” skills, or extremely high abilities in specific areas such as memorization, calendar calculations, music or math” (NIDCD, 2020). 

Children with ASD often have poor use of nonverbal communication skills. They often avoid eye contact and have difficulty using gestures to convey their wants/needs. With the inability to use gestures and nonverbal means of communication, children may become increasingly frustrated because they are not able to communicate their thoughts, feelings, wants, and needs. Therefore, we may see increased temper tantrums and meltdowns. 

Impaired Reciprocal Social Communication?

Another hallmark characteristic of Autism Spectrum Disorder is impaired reciprocal social communication. Children with ASD often have difficulty in normal back-and-forth conversations with others. Some children demonstrate difficulty responding to or initiating social interactions. Many children are mistakenly thought to have a hearing impairment because they do not respond to the speech of others or respond to their own names (NIDCD, 2020). 

“We often see children with ASD demonstrate difficulty developing, maintaining and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to the absence of interest in peers” (UNC Autism Research Center, 2022). 

Examples of social communication and social interaction characteristics related to ASD can include: 

  • A literal interpretation of others’ words

  • Difficulty establishing and maintaining relationships

  • Tendency to speak bluntly without regard for the impact of words on others

  • Inappropriate facial expressions, gestures, or eye contact

  • Limited imaginative or pretend play

  • Limited ability to initiate, respond to, or maintain a conversation

  • Abnormal voice inflection and cadence

  • Overgeneralization of social behavior across all contexts and environments

  • Difficulty understanding or taking on others’ perspective

Restricted, Repetitive, and Stereotyped Patterns of Behavior Or Interests: 

Another hallmark characteristic of ASD is the presence of restricted and repetitive interests. “Individuals may engage in stereotyped and repetitive motor movements (e.g., hand flapping or lining up of items) or speech (echolalia)” (Leon, 2013). Repetitive behaviors can vary across each individual. Some children repeat words over and over, while others may pace or rock back and forth. Some examples of stereotyped behaviors include, but are not limited to spinning objects, strict adherence to order, predictable routines, and delayed or immediate echolalia. Restricted and repetitive behaviors are not “wrong” in nature. Many individuals with Autism engage in these behaviors because it can be calming. These behaviors can vary from mild to severe and can have an impact on an individual’s engagement with their environment and others around them. 

You may also come across is “self-stimulatory behaviors” or “stimming”. This is a term used often to describe restricted and repetitive patterns of behavior. Stimming behaviors for children on the Autism spectrum can include full-body movements like spinning, pacing, and/or rocking back and forth. These behaviors are providing sensory input to the vestibular system, which allows for balance and orientation of the body (Children’s Hospital of Philadelphia, 2020). Stimming behaviors do not have to affect the entire body. You may see behaviors that affect one or more senses. For example, “visual stimming”, where you may see squinting, staring at rotating objects, and looking at objects very close to one’s face or out of their periphery. You may also hear “vocal stimming”, which includes squealing or making other repetitive vocalizations. Many individuals on the Autism Spectrum have shared that they stim in order to adapt to new environments. Self-stimulatory behaviors can be calming, help reduce internal anxieties, and be pleasing to the individual (Wang, 2022). 

Characteristics of Autism:

Source: AutismKey.com

  • Repetitive behaviors 

  • Unresponsive to commands or questions (“in their own world”)

  • Delayed speech and language (non-verbal, especially by age 3)

  • Lack of imitation of others or imaginative play 

  • Indifferent to the feelings of others 

  • Sensitivity to light and sound (covers ears to certain sounds)

  • Self-stimulatory behaviors (rocking, hand flapping, spinning)

  • Echolalia 

  • Unusual emotional responses

  • Frequent temper tantrums/meltdowns 

  • Responds adversely to physical affection, hugs, kisses, etc

  • Shows no interest in making friends 

  • Does not initiate conversation 

  • Very limited diet (picky eating) 

  • Frequently walks on tiptoes as a toddler 

  • Socially withdrawn or socially awkward 

  • Shows little expressive language 

  • Clumsiness (falls or trips often) 

  • Improper use of pronouns, statements, and questions

  • Unusual tone of the rhythm of speech 

  • Self-injurious behavior (head banging, hitting oneself, scratching/biting self)

  • Frequently makes irrelevant remarks 

  • Difficulty with abstract language and concepts 

  • Preoccupied with one or only a few narrow interests 

  • Need for sameness 

  • Severe tantrums when routines are disrupted 

  • Attachment to unusual objects such as car parts, leaves, etc 

  • Fascination with spinning objects or spinning one’s self 

  • Very good at rote memory such as repeating lists or facts 

Understanding Autism
Sarah Masters

My name is Sarah and I have recently joined the team at Wilson Pediatrics. I am a speech language pathologist, and I am passionate about working with young children on their speech and language skills. I love seeing children make progress in their skills and build their confidence. This profession is so rewarding. I earned my Master’s of Science Degree in Speech Language Pathology, studying Communication Sciences and Disorders at the University of Kentucky. I am a Lexington native, I love UK basketball, being outdoors, reading, and playing with my kitten, Boots.

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