Characteristics of Autism

Characteristics of Autism
In the type and intensity of their symptoms, no two people with autism are exactly alike. They may share common traits, but each individual is as distinct and unique as a fingerprint or snowflake. Given each individual's unique and often enigmatic array of symptoms, diagnosis and treatment may be challenging.

As there are presently no medical tests for identifying autism, the professional's diagnosis is based solely on observation of behaviors. In the United States, a behavioral checklist known as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, commonly referred to as "DSM-IV", is used widely as a diagnostic tool.

This article will explore the signs and symptoms of autism as defined by the DSM-IV, provide specific examples of characteristics of autism, and explain the criteria for a diagnosis of autism.

The American Psychiatric Association breaks down autism symptoms into three general categories. These categories include:
A. Impairment in social interaction (e.g., difficulty relating to others),
B. Impairments in communication (e.g., speech and language delays), and
C. Restricted repetitive and stereotyped patterns of behavior (e.g., constant unusual body movements or inappropriate use of objects).

The DSM-IV lists specific characteristics under each of these three categories. An individual is given a diagnosis of autism if they demonstrate a total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C) and the disability is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Category A - Impairment in Social Interaction

The first category the DSM-IV addresses is impairment in social interaction skills. These are the skills we use everyday, almost subconsciously, while interacting with others.

We use them to engage others in conversation, respond appropriately to questions or comments, and ultimately to establish and maintain relationships with friends,
co-workers, customers, etc. Most people understand the importance of eye contact and waiting for our turn to talk when holding a conversation. We sense when it is time to change the subject or end the conversation by reading other people's body language, facial expressions and tone of voice. Persons with autism show a marked lack of these skills.

Individuals with autism demonstrate several characteristics that affect social interaction skills. Below is a description of each characteristic associated with category "A" of the DSM-IV explained in further detail.

Characteristic #1. "Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

The use of sarcasm in conversation exemplifies the importance of being able to interpret tone of voice, facial expression and body language. For example, a co-worker says, "So nice of you to join us!" after you walk in late for a meeting. If you did not understand how to interpret her tone of voice and other nonverbal signals you might think she was just happy to see you. Nonverbal communication frequently conveys more accurate information than the words we use. Children with autism have significant difficulty understanding and using non-verbal forms of communication, such as facial expressions, body language, and tone of voice. Additionally, they may not understand or demonstrate the use of gestures, such as pointing and waving, and have difficulty maintaining eye contact while interacting with others.

Characteristic #2. "Failure to develop peer relationships appropriate to developmental level." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Because many children with autism do not find peer interactions intrinsically motivating, they must be taught systematically how to interact with their peers. For example, children with autism frequently are difficult to engage in play routines such as peek-a-boo, hide and seek, chase games, etc. and generally do not seek out their peers for attention or interaction.

Characteristic #3. "A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing or pointing out objects of interest)." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Many children with autism tend to initially view significant adults in their life as a means to meet their needs and fulfill their requests. For example, they might bring an empty cup to their mother to request more juice but are not likely to bring her the cup to show that their favorite cartoon character is depicted on the cup.

Characteristic #4. "Lack of social or emotional reciprocity." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Children with autism may see adults, not as opportune partners for social interaction, but rather as tools to help them get what they want, such as turning on the computer or reaching a videotape on the top shelf. It is also quite common for young children with autism to have more interest in objects than people. This intense interest in objects tends to lead to spending the majority of their free time engaged in solitary activities, thus decreasing their opportunities for social experiences.

Category B - Impairments in Communication

The second category addressed in the DSM-IV is impairment in communication skills. For the majority of children with autism, communication skills are severely delayed. While there are exceptions, the majority of preschool-age children with autism demonstrate little to no use of functional speech and must be taught to use alternative means of communication such as pictures, sign language, and speech generating devices.

Below is a more detailed look at the characteristics defined by the DSM-IV to be associated with Category B - Impairments in Communication.

Characteristic #1. "Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime)." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Children with autism lack the ability to use gestures to compensate for their lack of speech. Thus, many children with autism have little means of functional, appropriate communication. This leads to frustration and challenging behaviors, which are often used for communicative purposes.

Characteristic #2. "In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Children with autism who are functional, verbal communicators often have difficulty understanding higher language skills such as conversational skills. (Conversational skills include appropriately initiating and maintaining a conversation by answering and asking relevant and related questions). Individuals with autism may not understand how to appropriately request attention to initiate a conversation and may be unable to maintain conversations because they may not be able to answer and ask questions effectively or comment appropriately.

Characteristic #3. "Stereotyped and repetitive use of language or idiosyncratic language." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Some children with autism use atypical speech such as echolalia, which is parroting back words or phrase that they have heard. Echolalic individuals may repeat words or phrases immediately after they are heard or they may delay repetition for minutes, hours, days or even weeks. This can be confusing for parents because they hear their child imitating words and may believe their child can "talk." A child that only echoes words is not independently initiating communication to meet his needs; thus he is not a functional verbal communicator.

Characteristic #4. "Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Most children with autism lack age-appropriate play skills. They tend to be difficult to engage in play routines such as peek-a-boo, hide and seek, chase games, etc. These are examples of social play because the play routine is contingent upon an interaction with another person. Most children with autism must be taught to develop independent as well as social play skills.

Category C - Restricted repetitive and stereotyped patterns of behavior

The third category addressed in the DSM-IV is restricted repetitive and stereotyped patterns of behavior, interest, and activities. Children with autism are often overwhelmed by the world around them because their sensory systems are not able to correctly interpret incoming sensory stimuli; thus, they develop rituals or routines to try and organize and make sense of their world.

Below is a more detailed look at the characteristics defined by the DSM-IV to be associated with Category C - Restricted repetitive and stereotyped patterns of behavior.

Characteristic #1. "Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Many children with autism form obsessions around their favorite things. For example, a child may become obsessed with a particular movie, character or part of a movie and may refuse to watch new movies or constantly rewind one scene to watch it over and over again. These obsessions or restricted interests limit their ability to explore new or unfamiliar things.

Characteristic #2. "Apparently inflexible adherence to specific, nonfunctional routines or rituals." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Individuals with autism frequently experience difficulty when changes are made to their routine. For example, some children with autism become extremely upset if their parents drive a different route home from school. It is believed that many individuals with autism crave their routines because their world is an unpredictable, confusing place. The routine is comforting because it creates order in a world that is otherwise chaotic.

Characteristic #3. "Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Many individuals with autism display unusual movements such as rocking, hand flapping, jumping, etc., which are generally self-stimulatory in nature. It is believed that many of these repetitive movements are done to self-calm when they are upset and/or to self-regulate their sensory systems.

Characteristic #4. "Persistent preoccupation with parts of objects." (DSM-IV Diagnostic criteria for Autistic Disorder. 1994.)

Some children with autism become obsessed with objects or parts of objects in a generally self-stimulatory manner. For example, rather than appropriately play with a toy car by rolling it, a child with autism may prefer to watch the wheels spin while holding the car upside down.

Now that you are aware of the symptoms of autism, if you are concerned your child displays characteristics of autism you should consult with your pediatrician who can refer you to a pediatric neurologist specializing in autism.

A pediatric neurologist will determine a diagnosis of autism by carefully considering the points quoted above from the DSM-IV. The criteria for a diagnosis of autism stipulates that an individual must display a total of six (or more) of the numbered points from all three categories with at least two from the first category and one from each of the second and third categories.

Bare in mind, most individuals with autism display a variety of signs and symptoms; many exhibit changes in the type and severity of the characteristics they display over time.


American Psychiatric Association. (2000). Pervasive developmental disorders. In Diagnostic and statistical manual of mental disorders (Fourth edition---text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 69-70.

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