Children and adults with ASD have difficulties that are usually grouped into three areas.
1. Verbal and non-verbal communication
Communication skills vary depending on the intellectual and social development of the individual child or adult. Some people with ASD have little, if any, speech and others appear to have normal speech. However, those that do have speech often find it difficult to communicate effectively.
For example, a person with ASD may say seemingly odd and inappropriate things, repeat verbal statements made by another person (called ‘echolalia’), talk about one specific topic for long periods of time with little awareness that others have lost interest, or say things that are not relevant to the current conversation. The unusual communication style of those with ASD can sometimes lead to children and adults with ASD being the victims of bullying.
In addition, those with ASD may find it difficult to keep eye contact with others and understand non-verbal communication such as facial expressions and hand gestures including pointing.
2. Social awareness and interaction
Children and adults with ASD often have difficulty following social rules, which may make them appear unfriendly. For example, they tend to avoid looking at the person talking and do not appear to be listening. When interacting with others, those with ASD may not follow what are perceived as common social behaviours. For example, they may touch and even lick others, or make blunt and impolite comments.
3. Activities and interests
Children with ASD often have a deal of difficulty playing imaginative games or engage in imaginative play (e.g., playing make believe). Instead, they may use toys and other objects in unusual ways (e.g., lining up objects, spinning and flicking objects). They can become intensely focused with an item such as a piece of string or a pencil and carry it around constantly, and may collect objects (e.g., stones, sticks, batteries). Both children and adults with ASD may also be more sensitive to touch and the taste or texture of some foods. Examples of this include rejecting a family member trying to give them a cuddle or insisting that all labels are cut off their clothes because the touch of them on their skin is unbearable. Some people with ASD may also act as if they are insensitive to pain or changes in temperature so they may put their hand directly into a flame. They also dislike change and being in new situations. They may also show unusual behaviour such as acting as if other people don’t exist, or doing things that cause them injury. Examples include repetitive hand-flapping, spinning, rocking, walking on their toes and biting themselves.
The severity of difficulties in these three areas varies across individuals. For example, one person with ASD may have difficulties such as a fixation with certain topics of conversation and difficulty understanding facial expressions or gestures. In comparison, a another person may have no verbal language, engage in self-injuring behaviour such as repeatedly banging his or her head against the wall, and need constant support in everyday activities such as dressing and preparing a meal.
People with ASD are also more likely to develop mental health difficulties. Both children and adults with ASD often experience stress and anxiety caused by their difficulty in dealing with change and unpredictable situations. They are also at risk of developing depression, especially in late adolescence and early adulthood. Because people with ASD often have difficulty understanding and communicating their own feelings (including anxiety or distress), these problems might not be picked up.
Children and adults with ASD may also experience sleep problems. Children in particular may have difficulty going to sleep, continue to be active through the night, wake frequently and sleep much less than expected for their age.