Signs of autism in young people
When considering whether or not a child in your class is autistic, it is important that you take note of and record patterns over time in different areas of the child’s life, both at school and at home. All the potential signs in isolation can occur in children who are not autistic, it is only when enough of the signs occur together and over time that autism becomes a distinct possibility. It is important that you are in regular contact with the child’s parents because they may be able to add pieces of information that in conjunction with your observations help to form a complete picture of the child’s development. Some children with autism, particularly girls, will not necessarily exhibit enough signs of autism at school because they may camouflage or hide some of their traits in order to blend into the background, or because they exhibit a more passive presentation of autism. For example, intense and repetitive interests may be present but you might not necessarily be aware of them in the school context, which is why checking in with parents is so important.
Remember that autism comes in many shapes and sizes and that all autistic children are different and will not struggle in all the potential areas all of the time. Autism is developmental, and this means that we change over time and in different settings. For example, we might struggle to make eye contact in some settings but not in others. Anxiety and the amount of sensory overload can all affect how the child presents. It is common for children to bottle up anxiety over the school day and release it at home because they feel safer at home and able to express their feelings more freely. The autism academic Luke Beardon sums all of this up in the golden equation, which is autism plus environment equals outcome.
I will now guide you through some of the potential signs of autism that may be present in the children you support. It is important to bear in mind the key autism criteria as they are written in the diagnostic manuals. The criteria are broken down into two main areas: social communication and social interaction, and repetitive and restrictive behaviour, which includes sensory differences and intense, highly focused interests.
I will draw upon some personal examples of these signs as they were mentioned in my Educational Psychology report, which drew upon an assessment I had at school when I was 9 and 10 years old. I was not diagnosed autistic until I was 21, but most of the key signs were present in the report, which was later used as just one piece of evidence for my autism diagnosis.
Starting with social communication and interaction. There will usually be a pattern of social isolation that will be evident from early childhood. As mentioned in a previous slide, 75% of children who are later diagnosed autistic were observed as having social difficulties from the age of 5 if not earlier. As soon as I started reception class, the teacher noticed that I was not interacting with my peer group. The teacher intervened by getting two older girls to play with me at break times. As is common for many autistic children, I found it easier to play with children who were either much older or much younger than me. As my Educational Psychology report stated, ‘’there were some interaction difficulties, particularly with her peer group, preferring to play with much younger children’’. It is important to bear in mind that the child might not be consistently on their own all of the time, and may well try and interact with other children, but it is the quality of the interaction that is different, and the child will often experience social rejection because of their inappropriate social responses. Look out for any children in your class who do not appear to have made any consistent friendships, particularly peer group friends. Conversely, the child might have just one friendship that they cling to obsessively, being unable to share the friend, resulting in regular conflict and the breakdown of the friendship.
The child might be very sensitive to rejection and not be able to understand why their friend wants to play with other children. For example, when I started secondary school, I made a friend on my first day, but could not share this friend with other children, and had no understanding of personal space, which meant that I followed her everywhere. The friend tried to introduce me to her other friends, but this made me feel anxious and very threatened. One day I saw my friend walking off arm in arm with another girl and I burst into tears. A teacher asked me what was wrong but I could not communicate my feelings and so the issue was not investigated. Problems communicating feelings and telling teachers what is troubling the child, can contribute to a delayed autism diagnosis, which is why it is so important that you play detective and don’t wait for the child to come to you.
Another sign can include misinterpreting conversations. A personal example of miscommunication occurred shortly after I started school. The class was told that there would soon be a fire alarm practice. I took the conversation literally and when the alarm went off, I believed that the school was burning down in flames and was no longer a safe place. The experience temporarily traumatised me, and I refused to enter the school building. Eventually, the teacher found out what was wrong, and explained what was happening in a way that I could understand. Other potential autism signs can include taking offense easily, not being able to differentiate when they are being teased versus being bullied, and telling you they are fine even if they are really struggling. And as mentioned in my psychology report, the child might take a long time to decode instructions.
The next key area is restrictive and repetitive behaviour. Some autistic children will exhibit stimming, also known as self -stimulatory behaviour, which can include behaviours such as rocking, constantly fidgeting, and not being able to sit still. However, not all autistic children will stim in an obvious manner, and some autistic children, particularly girls and those with a more passive presentation, will hide any stims when at school but might stim at home. For example, I did not stim in an obvious manner at school, but at home I regularly walked on my tip toes. Tip toe walking is very common in autistic children, so ask the child’s parents if any such behaviour is present at home, even if it is not obvious at school.
A reliance on strict routines and needing to do things in a particular order is very common in autism, but again, this may or may not be obvious at school. Some children will react in an explosive way to changes in schedule, but other children will appear not to react at all, hiding their anxiety and upset, which will only be released once they get home and feel safe enough to release their feelings. I never had meltdowns at school, and thrived on the routine and structure that school gave me. My parents brought me up in a very structured way, and we always ate our meals together at the same time every day, so I knew what to expect. They did not know I was autistic at the time, but the way I was brought up, with clear boundaries and a strong sense of routine, meant that I had a generally happy childhood despite my struggles at school. However, I would explosively meltdown at home whenever there was a slight change to routine, and because my parents did not know I was autistic, this resulted in a great deal of family stress. Having a diagnosis would have helped them understand what was going on, reducing family stress and helping me to develop coping strategies.
The next sign is differences in sensory processing. The child might be very sensitive to noise, light, touch or smell. Certain self -stimulatory behaviours can also have a sensory function, for example the tip toe walking I mentioned earlier. When I am walking without shoes, I prefer to walk on tiptoes because the feeling of the ground against my bare feet can be unpleasant, giving me a tingly sensation. I also find it easier to balance when I am walking on my toes. Yet this issue for me is resolved when I wear thick shoes, and I can then walk in the typical manner, with my feet flat on the ground.
Some autistic children might be hypo or under sensitive to sensory input and need a lot of stimulation in order to regulate themselves. These children will often enjoy heavy impact sport, PE and loud, boisterous activities. It is also common for children to be both hyper or hypo sensitive at the same time or in different contexts. For example, when I was a child, I loved running really fast, and could be very energetic and boisterous during break times at primary school, which often annoyed other children. However, I was very easily overwhelmed during PE and games, and difficulties with PE and group sports was highlighted in my Educational Psychology report as a cause for concern. The report said that my responses were very slow, and that I did not know which way to face or where I was on the court. The report also noted that I had severe spatial awareness difficulties.
The next common sign is highly focused interests or hobbies. As with many of the signs already mentioned, teachers may not necessarily be aware of the presence of highly focused interests at school. The stereotype of autism is that of a boy obsessed with trains, dinosaurs, computers or an eccentric hobby, who will talk at length in a monologue about his special interest. However, many children with autism will not be so obvious in their presentation, and their interests might be more mainstream. For example, when I was a child, my intense, all consuming interest was food and what children had to eat in their lunchbox. I memorised the contents of every child’s lunch box in my class, and would then relate this information to my parents in great detail. However, this extra piece in the jigsaw of autism signs was not noticed at school because I did not talk about my interests at school, but combined with the signs that teachers observed and that were flagged in my report, my intense interest in food would have completed the picture. As a teenager I became incredibly obsessed with the actress Kate Winslet and babies, both of which are fairly common interests for teenage girls, but it was the intensity and level of preoccupation that set my interests apart. Although I kept these interests hidden at school, I thought about nothing else, and at home I would talk about nothing other than Winslet and babies. I even followed people with babies down the high street while taking detailed notes in my baby spotting diary, and I would meltdown whenever I could not access my interests.
Intense interests and hyper focus can sometimes result in talents in very particular areas of development. However, it is common in autism for there to be a spiky or split profile, which means that the child can be both talented and extremely delayed at the same time, even in the same area. For example, I learned how to read before I started school, and I was both hyperverbal and hyperlexic, which means that verbally I had a high IQ and I excelled at word recognition and recall. But alongside this peak in development, I really struggled to understand what I was reading. My reading age was 5 years ahead of my chronological age, but comprehension was almost 2 years below my chronological age, and this was flagged as a cause for concern in my report age 9.
There are other common signs that in conjunction with the key signs from the autism criteria already referred to, can provide vital information about the child’s development. Most autistic children will experience some degree of anxiety, and co-existing mental health problems are common. In my case, literal thinking and not understanding conversations contributed to the development of OCD, which began around the age of 7 and got particularly bad as a teenager, when I would avoid anyone with the slightest signs of a cold. At this age my life became incredibly limited, and I stopped travelling and going out. My educational psychology report mentioned my excessive hand washing, concerns around getting dirty, and that I seemed to lack confidence at times. Combined with the other signs, this should have been a potential autism red flag, but back in the 90s there was not as much autism awareness as there is today, and so I did not get the support I so badly needed.
Some children may exhibit low mood and refuse to go to school, but this is not the case for all autistic children. In my case, I generally loved attending primary school, particularly in the final years when we learnt about the human body and the ancient Greeks, areas of intense special interest. I was a happy child but also a very anxious child in need of support.
As already mentioned, meltdowns are common when there is a change of routine or sensory overload, but not all autistic children meltdown. Some autistic children instead shutdown, which means that they may look lost and in a world of their own, day dreamy and vacant. Shutdowns can be misinterpreted as wilful disobedience or laziness, but it’s important to bear in mind that a child in shutdown is not choosing not to engage, instead they can’t engage. The shutdown is a response to too much information, overwhelm and fatigue.
A sign that is often overlooked in autism is executive functioning. Executive functioning involves the ability to plan, organise and prioritise tasks. It can also affect time keeping, meaning that assignments might be handed in late. Poor executive functioning can mean that the child appears very disorganised. For example, my school report states that my ‘’organisational skills are very poor indeed’’ and that I put everything in one place. Executive functioning can mean that the child is slow to get dressed for PE because of difficulties completing each step in the process, and problems with transitions. This difficulty was flagged as a cause for concern in my development at nursery school.
Do check in with parents to find out what is going on at home. Often the parents will take on the role of personal secretary, tidying the child’s school bag and keeping their files in order. At secondary school I had to go to the learning support unit each week where my bag and planner would be checked. Over time it appeared that my organisational skills were improving but what was actually happening was that my mum was sorting my school bag and planner for me every evening. Without my mum’s support, I would have struggled even more.
The child might also appear confused and ask a lot of clarifying questions, and might need a lot of reassurance. Conversely, they might struggle in silence and not put their hand up when they need help.
Motor difficulties and clumsiness are also common in autism, even if the child does not also qualify for a diagnosis of dyspraxia. I particularly struggled with fine motor skills, which made artwork difficult, and the occupational therapist found a borderline degree of motor skill impairment. It took me a long time to learn how to tie my shoelaces, and I struggled to coordinate my limbs during swimming.
Problems with directionality were also noted in my report, making it hard for me to initially find my way around secondary school, which made me very anxious.
Poor working memory is common, making it hard for the child to remember the steps in a process. This can result in co-existing conditions such as dyscalculia in my own case. Despite the stereotype, some autistic children, instead of excelling at maths, really struggle because of difficulties with working memory.
To conclude, the main points to take away from this presentation are that it’s important to take into account the full picture of a child’s development over time, not to get side-tracked by the presence or absence of isolated traits, but instead to focus on patterns via detailed observation and conversation with the child’s parents.