Diagnostic features

Abnormal or impaired development is evident before the age of three years in at least one of the following three areas:

• development of selective social attachments or of reciprocal social interaction
• receptive or expressive language, as used in social communication
• functional or symbolic play.

Difficulties are sometimes apparent from birth, or may follow a year or two of apparently normal development. Asperger syndrome might not be recognized until after a child starts school.

Social difficulties:

• These will depend on the age of the child, his/her developmental level and the severity of the disorder.
• Children with autism have difficulties in interacting reciprocally with others; they may ignore other people or be relatively insensitive to their needs, thoughts or feelings.
• Their use of non-verbal communication (eye contact, facial expression, body posture and gestures) in social situations is limited and they find it difficult to share enjoyment with others. Often their best social interactions are with adults, and they usually show difficulties in interacting with same-age peers and in forming friendships.
• The social difficulties of children with Asperger syndrome are similar but often more subtle: they may miss the unspoken rules of social interaction and fail to ‘read’ social situations.
  
  

Communication difficulties:

• Nearly all affected children are delayed in their acquisition of language (with some never acquiring useful speech) and usually there is little attempt to communicate using other means (gesture or mime).
• Young children may show little interest in the speech of others.
• Early language may consist of immediate repetitions of what is heard and spontaneous communication may be stereotyped or unusual.
• About 30% of children with autism present with a loss/plateauing of language and/or other skills, most commonly in the second year of life.
• Children with Asperger syndrome lack any clinically significant general delay in language or cognitive development. They may be early talkers but their language may be formal or somewhat stereotyped and, like children with autism, they show conversational difficulties.
• Make believe and social play are usually deficient.
  
  

Behaviour difficulties:

• Children with autism or Asperger syndrome show a tendency to routinized behaviour, resistance to change and sometimes have unusually intense interests. Some may insist on specific non-functional routines or rituals and be upset by minor environmental changes. Others might be unduly preoccupied with objects, activities or intellectual interests, which are sometimes unusual in quality, for example part objects or non-functional elements of play materials (eg wheels or wrappings).
• Interrupting these activities and interests can lead to distress.
• They may show stereotyped and repetitive motor mannerisms, for example hand or finger flapping or twisting, or whole body movements.
• Behaviours that are not specific to autism, such as tantrums or self-injury, can often be particularly problematic when children are young.
  Boys are affected three to four times more commonly than girls.
  

Last edited: 20/1/2004

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