Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication, social interaction, and the presence of restricted, repetitive patterns of behavior, interests, or activities.
Recent estimates from 2020 indicate that approximately 1 in 36 children are diagnosed as autistic. Although autism is often diagnosed in childhood, some people may receive a diagnosis in adulthood.
While the specific cause of autism is unknown, it is thought that a complex interplay of genetic and environmental factors can contribute to its development.
Autism is present from birth and is lifelong. Autistic individuals may display a range of traits that vary on a spectrum, and these may also vary throughout life.
While many people who are not autistic can relate to some of the traits associated with autism, there are certain criteria that have to be met to be officially diagnosed as autistic.
It is essential to recognize that autism is a natural variation in human neurodiversity, and while it may present challenges, it also comes with unique strengths and perspectives.
Below will be a discussion of some of the main signs of autism and examples of how this may look.
Please keep in mind that this is not an exhaustive list and should not be used as a diagnostic tool. Talk to a health professional if you think you may be autistic and want to seek an official diagnosis.
Social communication and interaction
According to the DSM-5 criteria, autistic individuals have differences in 3 areas of social communication and interaction:
1. Social-emotional reciprocity
Examples:
- Struggle with back-and-forth conversation
- May seem blunt or rude without meaning to
- Dislike for small talk
- Struggle to show empathy for others despite feeling empathetic
- Withdrawn in social situations
- Find it hard to share emotions with others
- Struggle with vague language or ‘reading between the lines’
2. Nonverbal communication differences
Examples:
- Differences in eye contact (either not liking it or excessive use)
- Differences in facial expressions (either lack of or using expressions not typical for the situation)
- Difficulty understanding non-verbal speech
- Struggle with understanding social cues
3. Relationship differences
Examples:
- Difficulties making friends or forming relationships
- Difficulty maintaining friendships
- May prefer to be alone
- May want friendships but struggle due to other autistic traits
Repetitive behaviors
According to the DSM-5 autistic individuals must also experience at least 2 of the 4 types of restricted, repetitive behaviors outlined below:
1. Repetitive movements
Self-stimulating behaviors (also known as stimming) can be used to provide a pleasing sensory experience for autistic individuals as well as to help them regulate their emotions or cope with an overwhelming situation.
Examples of stimming can include:
- Hand flapping
- Hair twirling
- Repeating specific words or phrases (echolalia)
- Watching the movement of an object
- Repeated blinking
- Looking at a visually pleasing color or something shiny (e.g., the way someone’s hair shines)
- Listening to a certain sound or song repeatedly
- Humming
- Smelling (e.g., having a favorite spice to open and smell)
- Biting or chewing
2. Preference for sameness or routines
Examples:
- Preferring a structured day
- Becoming upset if plans change suddenly
- Having a favorite mug or utensil and only wanting to use them
- Feeling stressed when things are uncertain
- Needing clarity
- Eating the same or similar food every day
- Setting strict rules (e.g., I must study for 2 hours every day, I must go to the gym every 3 days)
3. Fixated interests
Examples:
- Having intense special interests (e.g., in history, transportation, books, celebrities, a video game, politics)
- Spend much free time invested in special interests
- Collecting objects or information related to the special interest
- Feeling happy and relaxed when engaging in a special interest
- Feeling sad or frustrated when not engaging in the special interest
- Wanting to speak about special interests to others
4. Sensory differences
Autistic individuals may have hyper or hyposensitivity to sensory input. This can vary from person to person, with some seeking out sensory stimuli while others actively avoiding the same stimuli.
Some examples of sensory differences include:
- Dislike fluorescent lights
- Easily startled by loud noises
- Indifferent to pain
- Disliking hot weather
- Disliking certain food textures
- Disliking tight or scratchy clothes
- Strong aversion to certain smells
Many autistic individuals may have a strong response to certain sensory stimuli and may even report feeling pain or discomfort.
Is masking a sign of autism?
Masking (or camouflaging) is a strategy that some individuals use to hide or suppress their autistic traits in order to fit in with societal norms and expectations. Masking can be used by any autistic person but appears to be more common in females, adults, and people of color.
Many people might read the list of traits associated with autism and think that it does not apply to them because they might frequently use appropriate facial expressions or make eye contact for instance.
However, on further investigation, they may realize that they are forcing facial expressions and eye contact even when it feels uncomfortable and unnatural to them because they do not want to be negatively perceived. This is an instance of masking.
For example, you are meeting a friend for coffee who has just told you she has unfortunately lost her job. While you may genuinely feel bad for her, it does not feel natural to express this. However, you do not want your friend to think you don’t care, so you adjust your facial expression to one of concern (frown and brows furrowed), and you tell her that you are so sorry that this happened.
Other examples of masking autism can involve suppressing stimming, especially when in public, holding back on talking about special interests, pretending to be fine when plans go wrong, following a social script to cope with social situations, or pretending to understand a vague request.
Masking is mentally and emotionally exhausting, often leading to burnout and fatigue. The pressure to conform to neurotypical norms and the constant effort to mask one’s true self can also have detrimental effects on mental health.
It is, therefore, important to take into account masking behaviors when addressing the traits of autism, and it should be considered during the diagnostic process.
Autism in adults
There is often a misconception that autism is something that can only impact children. However, autistic children grow up to be autistic adults.
The signs of autism noted above can apply to both children and adults in varying ways.
The challenges associated with autism, such as difficulties in social communication, restricted interests, and sensory sensitivities, continue to impact individuals throughout their lives.
As awareness and understanding of autism have grown, more adults are being diagnosed as autistic, highlighting the importance of recognizing and supporting autistic individuals across the lifespan.
In many cases, autistic adults may have learned compensatory methods to cope with living in a world that is not always neurodiverse-friendly. Likewise, many autistic adults have learned what they do and do not like and have been able to live a life for themselves that is authentic to who they are.
References
Bölte, S., Girdler, S., & Marschik, P. B. (2019). The contribution of environmental exposure to the etiology of autism spectrum disorder. Cellular and Molecular Life Sciences, 76, 1275-1297. https://doi.org/10.1007/s00018-018-2988-4
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of autism and developmental disorders, 49(5), 1899-1911. https://doi.org/10.1007/s10803-018-03878-x
Maenner, M. J. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020. MMWR. Surveillance Summaries, 72.
Mandy, W. (2019). Social camouflaging in autism: Is it time to lose the mask?. Autism, 23(8), 1879-1881. https://doi.org/10.1177/136236131987855
Skuse, D., Greaves-Lord, K., Rodrigues da Cunha, G., & Baird, G. (2024). Autism spectrum disorder. In G. M. Reed, P. L. -J. Ritchie, A. Maercker, & T. J. Rebello (Eds.), A psychological approach to diagnosis: Using the ICD-11 as a framework (pp. 61–77). American Psychological Association. https://doi.org/10.1037/0000392-004
Thomas, R. P., Coulter, K. L., & Fein, D. A. (2023). Autism spectrum disorder. In G. G. Brown, T. Z. King, K. Y. Haaland, & B. Crosson (Eds.), APA handbook of neuropsychology: Neurobehavioral disorders and conditions: Accepted science and open questions (pp. 707–724). American Psychological Association. https://doi.org/10.1037/0000307-033
Further information
- What is autism?: National Autistic Society
- Early Warning Signs Of Autism: Centers for Disease Control and Prevention (CDC)
- Autism: NHS Inform
- Signs of autism in adults: NHS
