Signs & Symptoms

Autism may present itself through different signs and symptoms in various individuals.

Some symptoms are common among autistic individuals whereas others are unique and may be overlooked as a sign of autism. Some of the autism signs include attachment to specific things or topics, preference to play alone, or repetition of phrases and noises (echolalia). Young children can start to show signs of autism in early childhood, which may continue over time. Autism in girls may show differently, whereas some others only get diagnosed in their adolescent years or adulthood.

What is echolalia

Echolalia is the involuntary, non-contextual repetition of something someone else has said. There are two kinds of echolalia – immediate and delayed.

Immediate echolalia occurs straightaway. For example, an autistic individual repeats an instruction immediately after hearing it while not necessarily obeying it.

Delayed echolalia occurs at a later point in time. For example, an autistic individual may suddenly repeat something a few hours, days, or perhaps weeks after the word/phrase was heard.

Here is a simple example to help understand this symptom:

Think of that game The Broken Telephone, where a message gets passed along, whispered from person to person, and gets distorted along the way. Echolalia can be like that, with the brain receiving a message but not fully understanding it, so it gets “distorted” and repeated back in a different way.

General Symptoms

Autism in Children

Autism in Girls

General Symptoms

In a more general sense, the symptoms of autism can be but are not limited to, the following criteria based on The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is one of the key resources used by professionals in diagnosing individuals with autism. These criteria may be present at any age and require a screening for confirmation.

Please consult a healthcare professional to decide the next step for your child or yourself

General Symptoms

Symptoms	Source
Problems with social cues and responses.	Unusual way of socialising Poor conversational skills Limited sharing of interests and emotions.
Problems with nonverbal communication.	Difficulty with eye contact Challenges in using and interpreting body language Unusual speech patterns Peculiar facial expressions or reactions in certain situations.
Problems with social awareness and understanding relationships.	Difficulty adjusting behaviour to fit social situations Trouble initiating or maintaining friendships Lack of interest in others.
Abnormal speech, movements, and play.	Use of overly formal language Repeating songs or dialogues excessively Engaging in repetitive behaviours like teeth grinding or social grimacing Repeatedly opening and closing doors.
Preoccupations with objects or topics	Strong attachment to unusual objects Excessive perfectionism Focusing intensely on minor or irrelevant parts of objects.
Rituals and resistance to change.	Following strict routines Engaging in repetitive verbal or nonverbal behaviours. Strong resistance to changes in routine or thinking.
Unusual sensory behaviours	Fixation on textures or sensations. Odd responses to sensory input. Unusual ways of exploring sensory aspects of objects.

Symptoms	Source
Problems with social cues and responses.	Unusual way of socialising Poor conversational skills Limited sharing of interests and emotions.
Problems with nonverbal communication.	Difficulty with eye contact Challenges in using and interpreting body language Unusual speech patterns Peculiar facial expressions or reactions in certain situations.
Problems with social awareness and understanding relationships.	Difficulty adjusting behaviour to fit social situations Trouble initiating or maintaining friendships Lack of interest in others.
Abnormal speech, movements, and play.	Use of overly formal language Repeating songs or dialogues excessively Engaging in repetitive behaviours like teeth grinding or social grimacing Repeatedly opening and closing doors.
Preoccupations with objects or topics	Strong attachment to unusual objects Excessive perfectionism Focusing intensely on minor or irrelevant parts of objects.
Rituals and resistance to change.	Following strict routines Engaging in repetitive verbal or nonverbal behaviours. Strong resistance to changes in routine or thinking.
Unusual sensory behaviours	Fixation on textures or sensations. Odd responses to sensory input. Unusual ways of exploring sensory aspects of objects.

Determining Signs as Symptoms of Autism

If you suspect that these signs are indicative of autism, it is recommended you make an appointment for an assessment with a medical practitioner. Remember, seeing one or two signs alone might not mean an individual is autistic.

Understanding more about autism and the different behaviours and traits that come with it is important. This helps in getting a correct diagnosis and finding the right support and therapies.

For more information on the assessment and diagnostic process of autism, see the next section: Assessment and Diagnosis

Autism in Children

Parents may begin to notice the signs, or “red flags”, of autism in children from as early as 6 months up to 3 years of age, especially at developmental milestones, such as:

No babbling, pointing or other gestures by 12 months of age.
No meaningful words by 18 months of age.
No spontaneous (non-echoed) two-word phrases by 24 months.

Here are some of the signs and symptoms of autism to look out for in your child

6 to 11 months

Aspect of Development	Red Flags
Language	Delayed/no babbling at all at 10 months.
Social & Behaviour	Poor/reduced eye contact. No/limited gestures by 10 months. Does not usually try to get attention by 9 months. Does not respond to name when called by 10 months. Rarely smiles when approached by parent(s)/caregiver(s).
Play & Level of Understanding	No interest in playing. Does not notice if interesting objects/toys are taken away, by 9 months.
Movement & Hand Skills	May have delays in rolling over, sitting, and crawling (but not always).

1 year to 18 months

Aspect of Development	Red Flags
Language	Delayed/no babbling at all at 10 months.
Social & Behaviour	Poor/reduced eye contact. No/limited gestures by 10 months. Does not usually try to get attention by 9 months. Does not respond to name when called by 10 months. Rarely smiles when approached by parent(s)/caregiver(s).
Play & Level of Understanding	No interest in playing. Does not notice if interesting objects/toys are taken away, by 9 months.
Movement & Hand Skills	May have delays in rolling over, sitting, and crawling (but not always).

2 to 3 years

Aspect of Development	Red Flags
Language	No words with meaning/ only single words. Stock phrases. Jargon. Many made-up words. Echolalia. Not able to understand simple instructions that involve two steps.
Social & Behaviour	Difficulty with simple self-care. No concern for others. In his/her “own world”. Poor response to social initiations. Only initiates contact to meet needs. Does not immediately respond to his/her name. Disinterest in others. Poor imitation Does not show affection/ dislikes hugs. Poor eye contact. Limited gestures. Rarely points. Does not look where you point. Repetitive movement (Stereotypies)
Play & Level of Understanding	Does not play with toys in a normal imaginative way. Only solitary or parallel play. No symbolic play. No associative play.
Movement & Hand Skills	May or may not be delayed.

5 years and above

Aspect of Development	Red Flags
Language	Monotonous tone Excessive information on topics of own interest Talking ‘at’ others instead of a two-way conversation Responses to others may seem rude or inappropriate.
Social & Behaviour	Lack of response to other people’s facial expressions/feelings Lack of response to own name being called, despite normal hearing Difficulties in understanding other’s intentions; may take things literally and misunderstand figures of speech Unusually negative response to requests of others. Lack of awareness towards personal space, or unusually intolerant of people entering their personal space Excessive insistence on following own agenda Dislike of change (may lead to anxiety or other forms of distress) Extremes of emotional reactivity that are excessive for the circumstances.
Play & Level of Understanding	Inability to share in social play or ideas of others Solitary play Lack of flexible imaginative play or creativity, although scenes seen on visual media may be re-enacted High expectation that other children should adhere to rules of play Repetitive play and oriented towards objects rather than people Over or under reaction to sensory stimuli (textures, sounds, smells) Excessive reaction to taste, smell, texture or appearance of food or extreme food fads. Lack of enjoyment of situations that most children like.
Movement & Hand Skills	Repetitive “stereotypical” movements (hand flapping, body rocking while standing, spinning, finger licking) Lack of, and poorly integrated gestures, facial expressions and body orientation and eye contact Absence of joint attention (lack of gaze switching in conversations, following a point (looking at the person’s hand rather than the object pointed to), using pointing at or showing objects to share interest.)

Summarised from: “AUTISM IN SHORT: A Handbook For Parents” by Dr. Subhashini Jayanath.

6 to 11 months

Aspect of Development	Red Flags
Language	Delayed/no babbling at all at 10 months.
Social & Behaviour	Poor/reduced eye contact. No/limited gestures by 10 months. Does not usually try to get attention by 9 months. Does not respond to name when called by 10 months. Rarely smiles when approached by parent(s)/caregiver(s).
Play & Level of Understanding	No interest in playing. Does not notice if interesting objects/toys are taken away, by 9 months.
Movement & Hand Skills	May have delays in rolling over, sitting, and crawling (but not always).

1 year to 18 months

Aspect of Development	Red Flags
Language	Delayed/no babbling at all at 10 months.
Social & Behaviour	Poor/reduced eye contact. No/limited gestures by 10 months. Does not usually try to get attention by 9 months. Does not respond to name when called by 10 months. Rarely smiles when approached by parent(s)/caregiver(s).
Play & Level of Understanding	No interest in playing. Does not notice if interesting objects/toys are taken away, by 9 months.
Movement & Hand Skills	May have delays in rolling over, sitting, and crawling (but not always).

2 to 3 years

Aspect of Development	Red Flags
Language	No words with meaning/ only single words. Stock phrases. Jargon. Many made-up words. Echolalia. Not able to understand simple instructions that involve two steps.
Social & Behaviour	Difficulty with simple self-care. No concern for others. In his/her “own world”. Poor response to social initiations. Only initiates contact to meet needs. Does not immediately respond to his/her name. Disinterest in others. Poor imitation Does not show affection/ dislikes hugs. Poor eye contact. Limited gestures. Rarely points. Does not look where you point. Repetitive movement (Stereotypies)
Play & Level of Understanding	Does not play with toys in a normal imaginative way. Only solitary or parallel play. No symbolic play. No associative play.
Movement & Hand Skills	May or may not be delayed.

5 years and above

Aspect of Development	Red Flags
Language	Monotonous tone Excessive information on topics of own interest Talking ‘at’ others instead of a two-way conversation Responses to others may seem rude or inappropriate.
Social & Behaviour	Lack of response to other people’s facial expressions/feelings Lack of response to own name being called, despite normal hearing Difficulties in understanding other’s intentions; may take things literally and misunderstand figures of speech Unusually negative response to requests of others. Lack of awareness towards personal space, or unusually intolerant of people entering their personal space Excessive insistence on following own agenda Dislike of change (may lead to anxiety or other forms of distress) Extremes of emotional reactivity that are excessive for the circumstances.
Play & Level of Understanding	Inability to share in social play or ideas of others Solitary play Lack of flexible imaginative play or creativity, although scenes seen on visual media may be re-enacted High expectation that other children should adhere to rules of play Repetitive play and oriented towards objects rather than people Over or under reaction to sensory stimuli (textures, sounds, smells) Excessive reaction to taste, smell, texture or appearance of food or extreme food fads. Lack of enjoyment of situations that most children like.
Movement & Hand Skills	Repetitive “stereotypical” movements (hand flapping, body rocking while standing, spinning, finger licking) Lack of, and poorly integrated gestures, facial expressions and body orientation and eye contact Absence of joint attention (lack of gaze switching in conversations, following a point (looking at the person’s hand rather than the object pointed to), using pointing at or showing objects to share interest.)

Summarised from: “AUTISM IN SHORT: A Handbook For Parents” by Dr. Subhashini Jayanath.

Autism in Girls

As mentioned before, every autistic person experiences autism differently. This can be due to many factors, and gender is one of them. Autism may present differently in girls compared to boys.

Autistic girls often struggle with stereotypes and societal expectations. Their meltdowns are seen as emotional, and their neatness can hide signs of autism. Interests like animals or reading are seen as normal, and not linked to autism. They may repeat activities like reading or doing homework perfectly, which can cause anxiety in stressful situations.

These girls feel anxious about hiding their true feelings to fit in, doing well at school but facing challenges at home. They value friendships but find group situations hard, sometimes feeling left out or bullied. They learn social rules by watching others and might express their uniqueness with piercings or dyed hair.

Puberty also makes emotional struggles worse and periods can be tough due to sensory sensitivities. Managing periods can be costly and challenging and is something that should be considered in supporting those affected.

Girls may show signs of autism in different aspects such as the following:

Symptoms	Source
Friendships	Have intense friendships Uncomfortable with conflict Prefer to play on their own.
School	Finds changes between classrooms difficult Finds school assemblies difficult due to proximity of many people Has an ability to spot patterns and/or consider a subject without bias.
Anxiety	Prone to extended absence from school Has an eating disorder Has anxiety manifesting in physical symptoms (i.e: stomachaches.)
Emotional	Pretends to be a cat (or any other animal) Values soft toys/plushies longer than peers Seems emotionally and socially younger than their friends.
Sensory	Has a strong sensory reactions to clothes, touch, noise or smell Has poor interoception (identifying physical sensations in the body which can be linked to identifying emotions) Avoids baths and showers, hair brushing, tooth brushing for sensory reasons.
Social	Self-identifies as ‘Emo’ or ‘Geek’, or other archetypes. Intense interests in common topics for their peers (pop culture, TV shows, etc.) Tendency to people please and give answers they think people want to hear.
Autistic Inertia	Difficulty with organisations Finds it difficult to build a plan without breaking it down into smaller segments. Finds it difficult to be interrupted when in deep focus.
Others	Enjoys collections, and the act of collecting. Has trouble with directions. Restricted eating choices

Source: “Autism, Girls & Keeping It All Inside” by Autistic Girls Network (AGN)

Symptoms	Source
Friendships	Have intense friendships Uncomfortable with conflict Prefer to play on their own.
School	Finds changes between classrooms difficult Finds school assemblies difficult due to proximity of many people Has an ability to spot patterns and/or consider a subject without bias.
Anxiety	Prone to extended absence from school Has an eating disorder Has anxiety manifesting in physical symptoms (i.e: stomachaches.)
Emotional	Pretends to be a cat (or any other animal) Values soft toys/plushies longer than peers Seems emotionally and socially younger than their friends.
Sensory	Has a strong sensory reactions to clothes, touch, noise or smell Has poor interoception (identifying physical sensations in the body which can be linked to identifying emotions) Avoids baths and showers, hair brushing, tooth brushing for sensory reasons.
Social	Self-identifies as ‘Emo’ or ‘Geek’, or other archetypes. Intense interests in common topics for their peers (pop culture, TV shows, etc.) Tendency to people please and give answers they think people want to hear.
Autistic Inertia	Difficulty with organisations Finds it difficult to build a plan without breaking it down into smaller segments. Finds it difficult to be interrupted when in deep focus.
Others	Enjoys collections, and the act of collecting. Has trouble with directions. Restricted eating choices

Source: “Autism, Girls & Keeping It All Inside” by Autistic Girls Network (AGN)

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Assessment & Diagnosis

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