Autism Spectrum Disorder: Main features in children
Autism Spectrum Disorder (ASD) is a developmental disability that affects speech, social skills, learning and behaviour. The term ‘developmental disability’ means that it results from a problem occurring when the brain was developing in the early years. Typically, persons with developmental disabilities show features in the first six years of life, but these features often continue into adulthood. The term ‘spectrum’ means that some persons will have very severe features and some persons will have very mild features.
It is important for the public to be aware of the features of ASD. Public awareness assists in early identification of children with ASD and better awareness of the behaviour of adults who may have ASD. Early identification is necessary for early intervention and treatment of children to occur. Early intervention is known to improve developmental and behavioural outcomes for children with ASD.
There are four main features that parents or other relatives, caregivers and teachers may identify. Today’s focus is primarily on children and adolescents.
1. Speech development:
Speech delay is the most common symptom that Jamaican parents notice. Jamaican parents of children with ASD usually become concerned when their children are not speaking as expected about the age of two years. While some children may be delayed in their speech development, others may not speak at all, and still others may start speaking and then suddenly stop or their speech may regress to an earlier stage of development.
Some children with milder forms of ASD may be delayed in their speech but catch up by about three years. Many children also have unusual speech; their words may not be very clear, or they may repeat most or all of the words they hear. Some children may speak in a high-pitched squeaky voice or in a low-pitched voice; some may speak too loudly or too softly and others may speak without the usual variation in the tone of speech that we use to share expressions. Other children seem to speak about the same topic most of the time.
Special speech presentations that are typical of Jamaican children are speaking with an accent, often British or American, or speaking Standard Jamaican English all the time and not speaking Jamaican patois. As a result, parents are often asked if their children were born in America or ‘come from foreign’ .
2. Socialising with others:
Children, especially young children, typically socialise and play with other children easily. Children with ASD find it difficult to socialise. So, at preschool, instead of playing with their classmates, children with ASD may choose to play by themselves. They may also become attached to a single teacher and prefer to stay with the teacher rather than with other children. Some severely affected children may not interact well with their parents or their brothers and sisters at home. They may not run to greet their parents when they return home after a day’s work or may not play with their siblings. One aspect of socialising with others, which occurs within the first months of life, is making eye contact. Children with ASD find it difficult to make eye contact; some may make eye contact only with their family members, others may make brief eye contact with others, but have difficulty sustaining contact during a conversation, and others make no eye contact at all.
Children with ASD find it difficult to understand typical social and non-verbal cues, such as gestures and facial expressions. Young children may not understand pointing or an outstretched hand to receive items. Older children may persistently try to be a part of cliques whose members are trying to exclude them, may not understand the concept of personal space or may make socially inappropriate comments (e.g., “Why are you so fat?”). Adolescents may not understand the concept of friendship. They may have very few friends, no friends at all, or may consider their best friend to be someone they have not seen since preschool.
A less common feature of impaired socialisation with others is excessive friendliness, such as hugging of strangers.
3. Repetitive behaviour and resistance to change:
Children with ASD enjoy the same behaviour repeatedly. Repetitive behaviour may take a variety of forms, including spinning objects, spinning themselves, watching water running from taps, running in the same space, jumping, tearing pieces of paper to be, watching the same movie or cartoons, telling the same story at a particular point in a journey, and having the same meal for breakfast every day. There may be repetitive hand flapping when they are excited or upset.
Change makes children with ASD anxious and irritable, and they therefore resist change. Children may become upset by change of furniture in the home, and may scream on returning home as a result; they may also become upset if a new route is taken to a familiar place. They may have only certain brands or colours of food. Resistance to change can also be manifest as a sense of order. Children with ASD may stack items, put items in lines, always close open doors, or may become upset if a piece of a puzzle is missing.
4. Hypersensitivity to the senses:
Children with ASD are keenly aware of all the senses. Hypersensitivity to sound may manifest as crying or upset at hearing typical domestic sounds, such as use of a blender or mixer, loud motorbikes or music and singing at church. Some children cover their ears when they cry.
Hypersensitivity to touch is manifest by rubbing surfaces and body parts of other persons, or playing in liquids. Children with hypersensitivity to taste/texture may have difficulty transitioning to solid foods or taking a variety of different foods; getting children to eat can be quite a challenge for parents of children with ASD. They may also put a variety of objects to their lips or mouth. Children with hypersensitivity to smell may smell every object given to them, every food before eating, and may smell people. Children with ASD may visually stimulate themselves by waving items or their hands in front of their eyes, or by looking at objects from unusual angles and visually inspecting objects.
It is important to remember that every child does not have all the features, and that some features may be mild and others severe in the same child.
Professor Maureen Samms-Vaughan is a consultant developmental and behavioural paediatrician at The University Hospital of the West Indies and Professor of Child Health, Child Development and Behaviour, University West Indies. Send feedback to email@example.com.