Autism is a neurodevelopmental condition in which affected individuals have difficulties interacting with others on a social level, behave in unusual, repetitive or stereotypical ways and are often intensely focused on a narrow range of topics or objects.

When should I worry about possible signs of Autism? Here are a few signs that would warrant further assessment. Please remember that not all people with autism show the same features. It is best to discuss concerns with a health worker or paediatrician familiar with the topic.

1. Avoiding eye contact

Children (and adults) with autism have difficulties with social communication. One of the ways in which we communicate are through looking at others and using body language and gestures when we interact. Lack of eye contact can be a very early sign suggestive of possible autism. Children with autism can avoid eye contact for a variety of reasons such as simply not being interested in other people, regarding the other person as just another object or because they struggle integrating eye contact with speech. People with autism often find eye contact very uncomfortable and I have seen many children with autism who would actively avoid eye contact during consultations.

2. Not interested in playing back and forth games

Children with autism struggle interacting with others in an interactive or reciprocal way. These difficulties are often noticed at a young age. Babies often do not smile or babble in an interactive way or are not interested in back and forth games, such as peek-a-boo. As a child gets older, they start interacting more during play and would do activities together. Children with autism can appear as if they are oblivious to other children. When trying to interact they often struggle negotiating the social rules of play, would often play near other children rather than with them and would lack imagination in their play.

3. Not sharing enjoyment with others

Shared enjoyment refers to the child’s desire to interact with others just for the sake of connecting. Children do this through bringing objects of interest to their parents or pointing towards things. Children with autism often do not bring things to the parents and do not point towards objects to get someone’s attention (look at the cat/truck/ train.) Children with autism also struggles understanding that others want to share with them and would struggle follow another person’s pointed finger or eye gaze towards and object.

4. Lack of interest in playing with others

Many children with autism lack social motivation and awareness. That means that they are often not interested or struggle understanding social rules and are less motivated to follow the rules just for the sake of being socially accepted. Children with autism would thus often struggle to make friends and would often, but not always, play on their own or play alongside other children.

5. Not responding to their name

Parents of children with autism often wonder initially whether their children can hear as they often don’t respond to their name and appears as if they are ignoring their parent. The reason for this behaviour is due to difficulties paying attention and understanding language. Any child with language delay should have a hearing test to rule out hearing loss as a reason for this behaviour.

6. Repetitive actions or movements – stereotypical behaviour

Common stereotypical movements are hand flapping, rocking or spinning. Children can also play with objects in a stereotypical way, such as lining up or grouping toys or being fascinated with part of a toy only such as the wheels on a car. Some typically developed children can also do this but the frequency and intensity are less than in children with autism. Children with autism also frequently talk in unusual ways, such as repeating words or phrases after other people or having a flat or unusual intonation to their voice.

7. Intense interests in certain objects, topics or part of toys

Many people with autism have intense interests in certain topics often from a young age. The interests in these topics are typically more intense and longer lasting than similar aged peers such as an obsession with dinosaurs or certain cartoon characters. Sometimes children with autism would become very attached to certain toys or unusual objects such as bottle tops or stones.

8. Sensory

Children with autism often struggle processing sensory information. Some kids are extremely fussy eaters and would only eat food that are a certain colour or texture. They could be very particular about the texture of clothing items, have difficulties tolerating seams or tags on clothing. Many kids with autism would feel overwhelmed in noisy environments which can lead to meltdowns.

9. Non-functional routines

Children with autism often function better within predictable routines and feel anxious when the unexpected happen. Examples of non-functional routines include having to use the same cup, plate and cutlery, sitting in a certain ‘spot’ or travelling the same way to school every day. Changes in these routines could often lead to meltdowns.

10. Meltdowns

Meltdowns are different from tantrums. A tantrum is an anger or frustration outburst and will normally settle when the child gets what they want whereas a meltdown happens when a child feels overwhelmed by a situation. Meltdowns can often be extreme and prolonged in children with autistic spectrum disorder and occur at an older age than expected.