Each autistic child presents very differently and has their own unique areas of strength and difference. That said, I will outline the criteria for autism, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; American Psychiatric Association, 2022), and provide examples of some common ways that autistic children may present across various age groups. The descriptions that I provide are by no means exhaustive, but rather are meant to be a guide to help families understand how a child may present across the various criteria required for an autism diagnosis. Individuals with autism have differences in the following areas, either currently or in their history:

 

Social Communication and Interaction (all 3 criteria must be present)

 

• Social-emotional reciprocity – this refers to how well a child initiates social interactions with others, how they respond when others initiate interactions with them, and their ability to maintain back and forth interactions (e.g., play and/or conversation). For young children, they may show reduced or limited attempts to initiate social interactions with others, may not consistently respond to the social initiations of others, may make social bids to others only when making requests or trying to participate in motivating activities, and may have difficulty engaging in back and forth play. For older and/or verbally fluent children, the child may not initiate interactions with others as frequently as expected, may not respond in socially expected ways to the play and/or conversational invites of others (e.g., may not respond or provide responses that seem stilted; may change the subject back to their own areas of interest, etc.), and may have difficulty maintaining back and forth conversation.
   

• Nonverbal communication skills – this refers to how well a child uses eye contact, gestures, and facial expressions for communicative purposes. Children with autism may have difficulty making eye contact and/or utilizing eye contact to modulate social interactions (e.g., may not look at the individual to “check in” periodically during conversation). They may not use gestures (i.e., using their hands to “talk” and describe things) to assist with communication, or their gestures may have an unexpected quality (e.g., repetitive, exaggerated, etc.). For children who have delayed speech, they may not use gestures to compensate for language delays in order to help adults understand what they want or need. Some children with autism may not show a range of facial expressions to communicate emotion; their facial expressions may appear more neutral, and it may be hard to guess how they are feeling based on their facial expression.
   

• Maintaining and understanding relationships – this refers to a child’s ability to make and keep friends, their ability to share in play with others, and their overall understanding of various types of social relationships. Children with autism may have difficulty initiating and responding to peer interactions, as well as maintaining friendships over time. They may show a preference for playing more independently and/or may struggle to engage in interactive and imaginative play with their peers. For older children, they may have difficulty understanding various types of social relationships (e.g., friendship, marriage, etc.), may have difficulty reading social cues (e.g., picking up on when others are no longer interested in what is being talked about, difficulty maintaining personal space, etc.), and may struggle to utilize a social filter (e.g., difficulty modulating their behavior based on the setting, unintentionally making comments about others that could hurt their feelings without understanding why that comment may be upsetting to someone).

 

 

Restricted, Repetitive Patterns of Behavior (at least 2 of the following behaviors are present)

 

• Repetitive or unexpected movement, speech, or use of objects – autistic children may engage in repetitive/unexpected movements, such as hand flapping, rocking, spinning in circles, pacing back and forth, etc. They may also demonstrate speech pattern differences, such as engaging in repetitive vocalizations or sounds, scripting/reciting lines from videos or television shows, repeating others’ spoken language (i.e., echolalia), and/or using language that sounds formal or advanced for their age. Repetitive/unexpected use of objects may also be present, such as lining up toys, sorting toys by color or shape, playing with parts of toys rather than the whole toy (e.g., spinning the wheels of toy vehicles), etc.  
   

• Preference for sameness or routine – children with autism may have difficulty when there are unexpected events or changes to their typical routine. They may also have difficulty when they have to transition from one activity to the next. Further, they may be focused on the rules at times and may try to correct or enforce the rules on others.
   

• Focused or unexpected interests – autistic children may show strong interests in certain toys, items, or topics. They may want to spend the majority of their time playing with these specific toys or talking about their preferred topics, and it may be difficult to direct their attention to different toys or topics. They may also show strong interest in certain videos, movies, or television shows; they may want to re-watch certain shows or episodes, or may rewind videos to re-watch certain parts.
   

• Sensory processing differences – children with autism may demonstrate sensory aversions and/or sensory seeking behaviors. Sensory aversions may include sensitivity to loud sounds, certain lights or smells, food textures, clothing fabrics or tags in clothing, and/or grooming activities (e.g., teeth brushing, nail clipping, ear cleanings, having hair washed or brushed, etc.). Sensory seeking behaviors may include mouthing or chewing on objects, visually inspecting items (e.g., looking very closely at objects, may look at objects from different angles), seeking certain sounds, rubbing/feeling certain textures (e.g., soft blankets, other people’s skin, etc.) or seeking tactile input (e.g., crashing into objects, seeking deep pressure/squeezes), and/or sniffing objects that are not meant to be sniffed (e.g., smelling fingers or other objects).
   

 

Reference:
American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). 

https://doi.org/10.1176/appi.books.9780890425787