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Section 1
Symptoms of Autism Spectrum Disorder

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In this section, we will discuss four symptoms of Autism Spectrum Disorder.  These four symptoms are: 1. difficulties with social interactions, 2. impaired communication, 3. unusual or unusually rigid behaviors and interests, and 4. unusual responses to stimulation and environment.

Many people can have difficulties interacting socially or have obsessive interest in a certain subject. However, for clients with Autism Spectrum Disorder, difficulty interacting socially and obsessive interests in a specific subject can be symptoms. Do you have any clients who have extreme difficulty reading social cues or body language? Do these clients also have obsessions with certain, specific subjects? As you listen to this section, think of your client. Might it be beneficial for him or her to be tested for Autism Spectrum Disorder?

Ruth, age 59, had a grandson, Alex, age 5, who had been recently diagnosed with Autism Spectrum Disorder. Ruth stated, "My daughter told me that Alex was born with Autism Spectrum Disorder, but what is it? All I’ve read is that it is going to affect how he will interact socially." How might you have responded? I stated, "The four symptoms that characterize children with Autism Spectrum Disorder are significant difficulties with social interactions, impaired communication, unusual or unusually rigid behaviors and interests, and unusual responses to stimulation and environment."

4 Symptoms of Autism Spectrum Disorder

♦ Symptom #1 - Impaired Social Interaction
I felt for Ruth to be an effect grandparent with Alex, to help him build basic social skills, first of all she needed four basic pieces of information regarding Autism Spectrum Disorder.  You might consider playing this section for your client who is asking for basic information.

 I stated to Ruth, "First, let’s discuss impaired social interaction. Children with Autism Spectrum Disorder may not appear unusual until they reach the preschool years, during which, as you know, children broaden their social worlds, learn to socialize in a group, and make friends. Basically, at this stage, Alex is likely to have difficulty learning the nonverbal and subtle aspects of social interaction that most children might learn effortlessly. He may not recognize social cues or the meanings of other people’s facial expressions or body language." 

Ruth stated, "I see what you mean. Last Christmas, when Alex was 4, our family got together for dinner. I was all ready to greet my grandson with a hug, since I hadn’t seen him in a while, but he marched right past me, grabbed a handful of books from our bookshelf and sat in the bathroom, reading. Alex learned to read at age 3, you see…he’s always been very bright. Of course I was sad he didn’t want to hug me, but I thought he was just shy. He doesn’t talk very much"

♦ Symptom #2 - Impaired Communication
I replied, "That brings me to a second major trait of Autism Spectrum Disorder, impaired communication. Unlike children with autism, who often develop only limited language, children with Autism Spectrum Disorder frequently learn language skills early and well, as you experienced."  Ruth stated, "But what’s so unusual about that? A lot of bright children talk early, learn their letters early and pick up adult-sounding phrases from their parents…especially if they are only children, which Alex is."

I stated, "What makes children with Autism Spectrum Disorder different is how these skills are applied. They may find it difficult to learn how to make small talk, make turns in conversation and change the subject gracefully, all of which are skills that most people refine over time, of course. Often, these children have a hard time gauging the point of view of other people in conversation, which can make it even more difficult." 

Ruth stated, "Recently, when I saw Alex, he went on and on to me about Mars. He must’ve talked for fifteen minutes! He was going on about pictures the Viking 2 took and that is was a 4.5 billion-year-old planet…all at age 5!"  I stated, "In Alex’s difficulty with social interaction, he may have ignored your social cues, plunging ahead with this information about Mars. Many people with Autism Spectrum Disorder have a hard time remembering to think about the other person’s interest in a subject, though this skill can be learned."

♦ Symptom #3 - Repetition of Odd Patterns of Behavior or Interests
I continued to state, "That story about Mars brings me to a third characteristic of Autism Spectrum Disorder. In addition to impaired social interaction and impaired communication, let’s discuss repetitive or odd patterns of behavior or interests. Children with Autism Spectrum Disorder often demonstrate a preoccupation with a narrow interest or unusual topic. Generally, these interests result in huge collections of facts and memorized bits of information, but little generalized context." 

Ruth stated, "Again, how is that different from any other gifted child? A lot of children collect facts about Mars or dinosaurs or what have you."  I stated, "Of course. Children with Autism Spectrum Disorder, however, tend to have a very limited focus. It’s as though the individual facts themselves are gathered and treasured, instead of having an interest in a subject that broadens as more information is acquired. 

"For example, a child who collects baseball cards may obsessively memorize the statistics and uniform numbers, but also be interested in the game of baseball and the social aspects of trading cards. A child with Autism Spectrum Disorder, however, might not only memorize and recite endless statistics, but may zero in on seemingly less relevant details, such as the intricacies of each team’s uniform. The child might use this knowledge in an off-putting way rather than as a doorway into social experiences."

♦ Symptom #4 - Unusual Responses to Stimulation and Environment
Ruth stated, "Here’s another unusual thing about my grandson…he used to wake up in the middle of the night, scared of what his parents thought were nightmares.  He was screaming about earthquakes in the night!  It turned out that it was the vibrations from the washing machine spin cycle.  In his half-asleep state, Alex thought they were earthquake tremors. But that washing machine is all the way in the basement, and Alex’s room is on the second floor! Isn’t that crazy, that he could feel that teeny tiny vibration?" 

I stated, "That brings me to a fourth characteristic of Autism Spectrum Disorder, which is unusual responses to stimulation and environment.  It isn’t unusual for children with Autism Spectrum Disorder to have acute senses of smell, hearing, or taste. Ironically, sometimes the very acuity of the senses makes the child appear impaired; some children appear to be hearing-impaired because they become so focused on a subtle sound that they block out, and become unresponsive to, other sounds and voices. In some cases, the senses themselves may be normal, but the child’s emotional stimuli may be heightened. Has that ever occurred with Alex?" 

Ruth stated, "Well, he hates balloons. He’s deathly afraid of the sound of them popping. At one of his birthday parties, we had balloons, and when one of them popped, he threw a full-fledged temper tantrum."  I stated, "That’s common. Loud noises, bright lights or strong odors are often overwhelming sensory input to a child with Autism Spectrum Disorder. Actually hearing a balloon pop, in Alex’s world, may be excruciating to him." Ruth stated, "Oh!  I had no idea it could be affecting him that way! I wonder if my daughter knows that…is there anything else you think I should know?" 

I stated, "One other thing. As Alex gets older, he may become more aware of his isolation, and be prone to depression. As he becomes aware of that, he may also have difficulty communicating his emotional state. Alex may therefore move from anxiety to panic or a tantrum without giving the usual warning signs that other children might provide. It’s something you may want to watch out for."

In this section, we discussed Four Symptoms of Autism Spectrum Disorder.  These included difficulties with social interactions, impaired communication, unusual or unusually rigid behaviors and interests, and unusual responses to stimulation and environment.  Do you have a client that you feel might benefit from being tested for Autism Spectrum Disorder?  Might your client or his or her loved ones benefit from hearing this section?

In the next section, we will discuss Structuring Family Life.  This will include predictability, responsibility and flexibility. 

Powers, M. D., Psy.D., & Poland, J. (2002). Asperger Syndrome and Your Child: A Parent’s Guide. HarperCollins.
(AS is now ASD per DSM-5.)
Reviewed 2023

Peer-Reviewed Journal Article References:
Bos, D. J., Silverman, M. R., Ajodan, E. L., Martin, C., Silver, B. M., Brouwer, G. J., Di Martino, A., & Jones, R. M. (2019). Rigidity coincides with reduced cognitive control to affective cues in children with autism. Journal of Abnormal Psychology, 128(5), 431–441.

 Lovett, S., & Rehfeldt, R. A. (2014). An evaluation of multiple exemplar instruction to teach perspective-taking skills to adolescents with Autism Spectrum Disorder. Behavioral Development Bulletin, 19(2), 22–36.

Solomon, M., Iosif, A.-M., Krug, M. K., Nordahl, C. W., Adler, E., Mirandola, C., & Ghetti, S. (2019). Emotional false memory in autism spectrum disorder: More than spared. Journal of Abnormal Psychology, 128(4), 352–363.

Wood, J. J., Kuhfeld, M., Sturm, A., Cai, L., Wood, K. S., Cornejo Guevara, M. V., Galán, C. A., Johnson, A. R., Cho, A.-C., & Weisz, J. R. (2021). Personalized autism symptom assessment with the Youth Top Problems Scale: Observational and parent-report formats for clinical trials applications. Psychological Assessment. Advance online publication.

Wood, J. J., Sze Wood, K., Chuen Cho, A., Rosenau, K. A., Cornejo Guevara, M., Galán, C., Bazzano, A., Zeldin, A. S., & Hellemann, G. (2021). Modular cognitive behavioral therapy for autism-related symptoms in children: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 89(2), 110–125.

QUESTION 1
What are four symptoms of Autism Spectrum Disorder? To select and enter your answer go to Test.

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