Table 1Signs and symptoms of possible autism in preschool children (or equivalent mental age)

See ‘Using tables 1–3’ on page 62.

Social interaction and reciprocal communication behaviours

Spoken language
  • Language delay (in babble or words, for example less than ten words by the age of 2 years)
  • Regression in or loss of use of speech
  • Spoken language (if present) may include unusual:
    • non-speech like vocalisations
    • odd or flat intonation
    • frequent repetition of set words and phrases (‘echolalia’)
    • reference to self by name or ‘you’ or ‘she/he’ beyond 3 years
  • Reduced and/or infrequent use of language for communication, for example use of single words although able to speak in sentences
Responding to others
  • Absent or delayed response to name being called, despite normal hearing
  • Reduced or absent responsive social smiling
  • Reduced or absent responsiveness to other people's facial expressions or feelings
  • Unusually negative response to the requests of others (demand avoidant behaviour)
  • Rejection of cuddles initiated by parent or carer, although may initiate cuddles themselves
Interacting with others
  • Reduced or absent awareness of personal space, or unusually intolerant of people entering their personal space
  • Reduced or absent social interest in others, including children of his/her own age – may reject others; if interested in others, may approach others inappropriately, seeming to be aggressive or disruptive
  • Reduced or absent imitation of others’ actions
  • Reduced or absent initiation of social play with others, plays alone
  • Reduced or absent enjoyment of situations that most children like, for example, birthday parties
  • Reduced or absent sharing of enjoyment
Eye contact, pointing and other gestures
  • Reduced or absent use of gestures and facial expressions to communicate (although may place adult’s hand on objects)
  • Reduced and poorly integrated gestures, facial expressions, body orientation, eye contact (looking at people’s eyes when speaking) and speech used in social communication
  • Reduced or absent social use of eye contact assuming adequate vision
  • Reduced or absent joint attention shown by lack of:
    • gaze switching
    • following a point (looking where the other person points to – may look at hand)
    • using pointing at or showing objects to share interest
Ideas and imagination
  • Reduced or absent imagination and variety of pretend play
Unusual or restricted interests and/or rigid and repetitive behaviours
  • Repetitive ‘stereotypical’ movements such as hand flapping, body rocking while standing, spinning, finger flicking
  • Repetitive or stereotyped play, for example opening and closing doors
  • Over-focused or unusual interests
  • Excessive insistence on following own agenda
  • Extremes of emotional reactivity to change or new situations, insistence on things being ‘the same’
  • Over or under reaction to sensory stimuli, for example textures, sounds, smells
  • Excessive reaction to taste, smell, texture or appearance of food or extreme food fads

From: 3, Recognition

Cover of Autism
Autism: Recognition, Referral and Diagnosis of Children and Young People on the Autism Spectrum.
NICE Clinical Guidelines, No. 128.
National Collaborating Centre for Women’s and Children’s Health (UK).
London: RCOG Press; 2011 Sep.
Copyright © 2011, National Collaborating Centre for Women’s and Children’s Health.

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