In 2017, I began writing a book about the Autism Spectrum. The book was intended to support professionals to understand, recognise and support individuals on the spectrum. The book was accepted for publication; however, due to other work commitments, I was not able to meet their deadlines and the book ended up on the back shelf so to speak. I do eventually hope to have the time to finish the book; however, I include here a chapter that I feel people reading this site may find interesting.
In this chapter, I take a somewhat medical model view since when it comes to identification, this is often the most efficient model to take. I would, however, encourage readers to consider my comments on the main page of this site.
Another thing to note is that I use the term ASD rather than ASC within this page. In my more recent work I have adopted the term ASC as I feel the word "condition" though still somewhat derogatory, is much more positive than "disorder."
Developmental Differences: Essential information for early identification.
The early identification of Autism is probably one of the most pivotal factors in long term outcomes for individuals on the spectrum. The earlier it is identified the sooner children and families can begin to understand their behaviour and put in place measures to support. With the diagnostic pathway taking three years or more, identifying the signs early is even more important. This page aims to offer reflections drawn from my own experience-both personal and professional- to help educational professionals and parents to spot the signs and get children on the pathway for diagnosis at the earliest possible opportunity.
Key diagnostic criteria for the Autism Spectrum are:
Social differences
May not keep eye contact or makes little or no eye contact
Shows no or less response to a parent's smile or other facial expressions
May not look at objects or events a parent is looking at or pointing to
May not point to objects or events to get a parent to look at them
Less likely to bring objects of personal interest to show to a parent
Many not have appropriate facial expressions
Has difficulty perceiving what others might be thinking or feeling by looking at their facial expressions
Less likely to show concern (empathy) for others
Has difficulty making and keeping friends
Communication differences
Less likely to point at things to indicate needs or share things with others
Says no single words by 15 months or 2-word phrases by 24 months
Repeats exactly what others say without understanding the meaning (often called parroting or echoing)
May not respond to name being called but does respond to other sounds (like a car horn or a cat's meow)
May refers to self as "you" and others as "I" and may mix up pronouns
May show no or less interest in communicating
Less likely to start or continue a conversation
Less likely to use toys or other objects to represent people or real life in pretend play
May have a good rote memory, especially for numbers, letters, songs, TV jingles, or a specific topic
May lose language or other social milestones, usually between the ages of 15 and 24 months (often called regression)
Behavioral differences
Rocks, spins, sways, twirls fingers, walks on toes for a long time, or flaps hands (called "stereotypic behavior" or stereotypies)
Likes routines, order, and rituals; has difficulty with change or transition from one activity to another
May be obsessed with a few or unusual activities, doing them repeatedly during the day
Plays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck)
May not cry if in pain or seem to have any fear
May be very sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
May have unusual use of vision or gaze—looks at objects from unusual angles
(adapted from APA (2013). Diagnostic and statistical manual of mental disorders (5th ed.) )
However, the extent to which these can be identified very much depends on where the child is on the spectrum. When considering more severe cases of autism spectrum disorder (ASD), children are often diagnosed much earlier. Significant differences in speech development, lack of engagement with the world around them and poor motor development are so significant that they become clearly noticeable in the pre-school years. Characteristics are sometimes misinterpreted in early childhood as sensory difficulties such as deafness but as the child develops, generally clinicians are able to identify the condition relatively early. When it comes to higher functioning children on the scale, however, identification and diagnosis can be much more difficult. Whilst many children on the higher end of the spectrum do exhibit many of the aforementioned traits, they do so to a lesser extent so they are rarely identified. Indeed, most children with high functioning autism and Asperger’s syndrome are not identified until they are of school age and even in these cases, unless teachers or other professionals working with them have an awareness of the features of ASD and are able to identify these, the children’s barriers may go unnoticed. Early identification of ASD is essential as, whilst there is no way to remove the behavioural differences associated with the spectrum, strategies can be developed to prevent these differences from becoming barriers.
I was diagnosed at the age of 11. The reason I was diagnosed was because at this age, I had a break down. When I moved to secondary school, I could not cope with the constant changes in routine, the noise, the complex social groups and I closed myself down and almost completely shut myself off from society. This was positive in the sense that it led to my ASD being recognised, but early intervention in primary school would have improved my early educational experience significantly. For this reason I am including this page exploring signs of high functioning autism in the early years of development through to middle childhood. Teachers within early years and primary education have a vital role to play here as by noticing the signs and giving children strategies and interventions early, they have the opportunity to significantly improve the educational experiences of those with ASD and indeed their outcomes for the future.
Identification of children with Asperger’s syndrome and high functioning autism in early years and primary settings can be quite difficult. Poor eye contact and delayed speech development are signs which practitioners look for, but often the fact that higher functioning children do not necessarily exhibit these signs means that other key indicators are missed. When considering whether or not a child may have ASD, it is important to focus on the key features of the spectrum: difficulties in social interaction, fixated thinking and a desire for routine, differences in sensory perception and difficulties in coordination and posture. Within the early years and primary aged children, these manifest in several key ways.
Play development
Those of you reading this with early years training will know that play development is often described in five stages.
Age
Type of Pl
0-2 years
Solitary
Plays alone, and later begins playing with adults
Limited interaction with other children.
2-2 ½ years
Spectator
Observes and notices other children when they play around them but does not actively play with them.
Imitates others.
Likes repetitive play
2 ½ - 3 years
Parallel
Plays alongside other children but not with them.
Continues to imitate others during play.
3 -4 years
Associate
Starts to interact with others with some fleeting cooperation in play.
Beginning to develop friendships and preferences for playing with some but not all children.
Play becomes more symbolic.
4-6+ years
Co-operative
Enjoys playing in small groups.
Likes to play with others, usually of the same gender. .
Capable of playing cooperative play and enjoys using rules.
This above is included here as an indication that play development tends to follow a developmental trajectory. I am by no means suggesting that these stages exclusively represent the play development of all children. Indeed, the area of play development is a complex topic which is beyond the scope of this book. These stages are however useful when drawing comparisons and identifying potential early signs of ASD.
Within pre-school and nursery settings, most children should be in the associate stage of play development moving into the Co-operative stage. They are not fully co-operative and may be still developing an ability to incorporate rules and complex co-operation within their play, but they do enjoy forming friendships with certain children and are able to play with some level of cooperation. Children with ASD however tend to be more concurrent with the parallel stage of development. Usually, young children with high functioning ASD will be more than happy playing alongside other children-provided there are no hypersensitivity issues which will be discussed later-but will often play alone. Their play is often very repetitive. Indeed, I remember when I was at nursery that I would play with the same activity every day. The only time I would deviate from this was when I was forced to by one of the teachers and trust me I was not happy when this happened.
One of the key features of early play development for children with ASD is its ritualistic/ repetitive nature. The common cliché of children lining up blocks as being a sign of ASD actually has some validity, though the ritualistic and repetitive play behaviours can vary widely between individuals. Examples of play that I have observed include building things with Lego that follow set colour or symmetrical patterns; playing with water but having a set pattern through which the water flows e.g. pouring the water through a set sequence of containers; playing with things that create repetitive movements- my old favourite was fiddling with a piece of string; having one specific toy e.g. a car and playing with it day after day in the same way, the list is endless. But repetition and ritual are key early signs of ASD in early play development. Recognising these early signs in play development can help early identification.
In typical development, as children grow older, one of the core features of play development is the development of symbolic or pretend play. Piaget (1962) outlined the cognitive steps that children go through as they move between exploring an object to using it within symbolic play. Children start by exploring objects independently e.g. shaking a rattle and understanding that it makes a noise. As they grow older, they begin to use objects symbolically beginning to participate in solitary pretend play e.g. a toddler picking up a phone and pretending they are talking with someone. By the time they reach school age, they begin to move on to pretending with others. As children’s ability to represent things symbolically develops, they begin to participate in complex imaginative play often creating imaginary worlds and exploring them with their peers. This involves a form of imaginative play whereby the imaginary world is co-constructed between the children involved i.e. the children create the imaginary world together.
Observation one outlines a typical play situation between Tom and Andrew. Tom and Andrew are both six year old boys. Their cognitive and social development is within the norm for their age and they are both achieving their developmental milestones at the expected rate.
Observation one Tom and Andrew-a game of dragons Tom runs up to Andrew with a stick and asks if he wants to play pirates. Tom declines saying that they played pirates yesterday. The two discuss different games for a while and eventually decide to play dragons. Both boys start running around the playground. Tom throws himself onto the floor. He looks up. Waiting for Andrew to react. He exclaims that the dragon has got him and he is going to be eaten. Andrew runs over to Tom, waves his Sword around in the air and helps him up. Andrew urgently asserts that they need to get to the top of the mountain before the dragons come again. Tom agrees and the two boys run off to the other side of the playground. They both pretend to climb the mountain. Andrew shouts that he has got to the top. Tom disagrees saying the he got to the top first. The two argue briefly but then agree that they both got to the top at the same time. Tom states that he has found the magic spear, Andrew adds that he has found a shield. They both then agree that they are ready to kill the dragon. At this point the bell rings and both children line up to go back into school discussing how they are going to continue the game at lunchtime.
(Taken from Wheeler, 2009)
Observation one clearly shows that the two children are co-constructing their play. They are creating the game collaboratively, responding to each other’s behaviour and agreeing the development of the game together. Their interactions are by no means perfect and they do argue but their interaction is reciprocal and both children are actively involved in the creation of the game.
The development of symbolic play for children with ASD, however, is very different to this. These differences are important for teachers to understand. One of the biggest misconceptions that is held by many teachers is that children with ASD do not engage in imaginative play. After all, the triad of impairments specifies difficulties in social imagination as being one of the core features of the condition. The key word here however is ‘social’. Children with ASD can often create imaginary worlds and can participate in extremely complex imaginative play. The difference however is that their play is not co-constructed. Children with ASD will happily participate in imaginative play and will often allow other children to play alongside them. A key feature of this, however, is that the play is parallel in nature. The children may seemingly be playing together but on closer examination it is clear that the play is not being co-constructed, rather the child with ASD is creating the imaginary world completely independently and the other child is just along for the ride. As long as the other child is willing to participate in the imaginary world created by the child with ASD, there are no problems, if however, they try to interject or change the game in any way, difficulties arise.
Observation two outlines a play situation between Harry and Mathew. Mathew is a seven year old boy diagnosed with Asperger’s syndrome (now ASD), Harry is a five year old boy. He is not diagnosed with ASD but loves to play with Mathew as he enjoys the imaginary journeys that Mathew takes him on. The two children often play together and Harry always allows Mathew to lead the game.
Observation two Harry and Mathew.
It is just before playtime and Mathew is staring intently at the clock watching the second hand tick by. The bell rings. He leaps out of his seat and runs towards the door. The teacher stops him stating that she wants him to have a good play time today: he must not hit people, he must share with the other children and he must come in sensibly when the bell goes. Mathew, staring out of the window at the playground, nods and runs towards the door. As he runs out onto the playground, he heads straight for the ship. Harry sees him and starts running behind him. The two children climb onto the ship. Mathew exclaims that there is treasure under the sea and they must dive down to get it. He throws himself off the ship, knocking another child out of the way as he does. He then runs straight into the middle of the playground and grabs a stone. He holds it up into the air stating that he has claimed the treasure. Harry runs up to him to see. Mathew states there is no time he needs to get back to the ship. He runs back towards the ship, knocking into several children as he does. Again Harry follows behind him picking up a stone on his way. Harry shouts that he has found treasure as well. Mathew ignores him and climbs onto the ship. He exclaims that he needs to get back to land before pirates attack the ship. Harry pretends to start the engine to which Mathew states no don’t be stupid it’s a sailing ship. He runs to the centre of the ship knocking Harry out of the way and starts to pretend to pull a piece of rope towards him. Harry starts to cry, Mathew does not notice this and carries on with the game. A teacher approaches the children and tells Mathew he needs to get off the ship because he is not playing nicely. Mathew responds by telling her that she is interfering with an important mission. She demands that he gets off the ship. He becomes angry and starts shouting stating that she is ruining everything. She leads him over to the bench and makes him sit down. After a few minutes, his attention is diverted by a nest of ants underneath the bench. He spends the rest of playtime intently watching the ants whispering to himself as he does.
(Taken from Wheeler, 2009)
At first glance, when observing these two children, it may seem like Mathew is participating in co-operative symbolic play- a normal developmental behaviour for his age. On closer examination, however, it is clear that Mathew is in fact not playing with Harry, he is playing beside him. He is more than happy for Harry to run around with him but Mathew is creating the game independently. This is a core sign of symbolic play development in young children with ASD and indeed is prevalent right through their development.
As children with ASD grow older, they will often be able to learn social rules and play games according to a set of rules that they understand. But if these rules are changed or influenced in any way, they find it difficult to cope. When I was a child for example, I used to love playing many games. I used to start off watching the other children, learning the rules and then when I was confident that I understood the rules, I would join in. The trouble was the second anyone deviated from these rules or the second the other children changed the game in anyway, I could not cope. This is important for teachers to be aware of as many children with ASD are very intelligent and often hide their difficulties by memorising the rules of a game or social situation before they try to join in. This is particularly common in girls and is one of the reasons why identifying ASD in girls in so much more difficult. The key feature of their behaviour is that they can learn the rules but when the game deviates from these rules they find it difficult to cope and will often become distressed, unable to mediate the situation.
It is important for teachers to be very aware of these features of play development as sometimes children with ASD find friends, often younger, who will happily run around with them playing their games. This can be mistaken for normal social play but actually it is often parallel in nature and the construction of the play is independent rather than social. Often children with ASD can play games with groups of children- following seemingly complex rules. When these rules are broken or changed however, they find it difficult to function. Identifying patterns within these children’s behaviour in relation to the way in which they respond to such changes can help identify their difficulties and indeed allow them to be supported.
It should be stated that often, particularly during times of high stress, children with ASD will prefer solitude. They will be perfectly content concentrating on their special interest for however long they wish, completely ignoring the other children around them. This is a common behaviour and is often one of the first warning signs of ASD but it is very important that teachers understand that this is not the only feature of play development. Indeed, particularly at the high functioning end of the spectrum, signs are much more subtle, requiring teachers to look more closely at the features of the play that the children are participating in.
Summary
Early play development for children with ASD is often very repetitive in nature. They enjoy playing with the same things over and over again, they will avoid playing with other children and play is often parallel in nature.
Children do often develop an ability to play symbolically but this is not reciprocal. Children will play alongside another child by they will create the imaginary play independently, the other child is merely along for the ride.
Many high functioning children with ASD will participate in games with groups of children and can develop an ability to follow rules. This ability is however based on observation and these children are unable to cope with sudden changes to the rules.
Solitary play is common, but must not be confused as the only sign of ASD.
Language development
This is an area that often causes some confusion for practitioners as a central feature of classical autism is a significant speech delay. Indeed, Kanner describes mutism or a kind of language that is seemingly not intended for interpersonal communication as a common feature for children with classical autism (Kanner, 1943). The developmental trajectory that language development can take for some children with ASD however is very different. After all, a key feature of Asperger’s syndrome is the development of very adult like language perhaps giving the illusion of enhanced language development.
When considering normal language development a child speaks their first words at around 9-12 months, although from around 6 months they may make “babbling” sounds such as dadada, which parents often mistake for first words. The development of children’s expressive language takes off in the third year of life where Davis (1999) states that they learn approximately 50 words a month. They begin to engage in simple dialogue and they begin to use language within simple symbolic play. They develop receptive language, an ability to listen to short stories and follow commands of up to three steps. Pragmatic language-the kind of language that is used in social interactions- also begins to develop. Around the age of 4 children begin to understand that they need to wait until they have someone’s attention before they speak and they begin to develop an understanding that they should talk differently to peers, teachers, younger children etc. (Leventhal-Belfer and Coe, 2004)
In cases where children have more severe autism (classical autism) children’s language development is significantly delayed. They may not speak their first words until much later and sometimes children never develop fluent speech. When it comes to children on the higher functioning end of the autism spectrum (particularly Asperger’s syndrome), however, early speech development may follow a very similar trajectory to the norm, with children meeting their mile stones at the correct age. The nature of their language development however has clear differences. Development of expressive and receptive language tends to follow the normal developmental trajectory, however, children with ASD tend to have difficulties in pragmatic language resulting in difficulties in interacting with peers. They may not understand that they need to wait to gain someone’s attention before speaking and they often have difficulty in understanding that they should talk differently to different people e.g. peers, teachers etc. Often children with high functioning ASD speak in a very formal way in all contexts. They develop very adult like and precise speech at a very early age and this is often misinterpreted as good language development whereas actually it is indicative of an inability to adapt language to different contexts.
As children with typical development grow older, they usually develop an understanding of more metaphorical language. They begin to understand and use idioms or sayings within their everyday language. Children with ASD however find this area of development difficult. Their interpretation of language tends to be very literal, meaning that they often find it difficult to understand idioms. Many teachers have had the experience of telling an autistic child to pull their socks up resulting in a rather literal response. One thing to bear in mind here however is that higher functioning children on the spectrum are often intelligent and once they have encountered an idiom and have had its meaning explained to them, they will often interpret it correctly and may even try to use it within their own language. It is important therefore not to mistake a child’s understanding of a select number of idioms as normal development.
Non-verbal communication is another area of language development which is often different for children with ASD. Whilst even at pre-school age, most children are able to interpret non-verbal communication and body language, children with ASD struggle with this and indeed an inability to read non-verbal cues often follows them throughout their development. A typical response will be for a teacher to hold up their hand to indicate for the child to stop talking and a child with ASD to continue talking with no understanding that they are supposed to stop. I remember when I was about seven years old talking to people who would actually turn their back on me and walk away. I would just follow them continuing to speak, since I had no idea that their behaviour actually indicated that they did not want to talk to me.
Children with ASD do have an ability to learn to interpret some key non-verbal cues (something that we will explore further later in the book) and often through observation children are able to learn a select number of behaviours which again gives the perception that they understand non-verbal communication. This is however an area that children with ASD do find difficult and a failure to understand simple non-verbal cues can indicate that a child is on the spectrum.
Summary
Whilst many children with autism have significant delays in speech development, many higher functioning children may reach their milestones at the expected rate.
Often expressive and receptive language development for children with high functioning ASD is normal. Difficulties are in pragmatic language-language used in social interaction.
Children with ASD often have difficulties understanding idioms.
Children with ASD commonly have difficulties in the interpretation of non-verbal communication.
Social development and collaboration
Social development, particularly in terms of collaboration and group work, is perhaps the area of development that is most noticeably different for children with ASD within a school context. The trouble is, as with so many aspects of the syndrome, this aspect of development can vary so widely for different children depending on where they are on the spectrum. Some children will completely avoid social interaction. They will play alone, seek to work alone in class and make no attempt to socialize unless they are encouraged by adults. Indeed, even when they are encouraged to participate in group work, they will undertake parallel interactions, working alongside rather than with their group. Others however, try to engage in social interactions and try to collaborate, but have clear difficulties in doing so.
Primary aged children will often have difficulties in working as a group whether they have ASD or not. The difficulties associated with children with ASD however are very precise. One of the main things that underpins this is their language development. As I have previously stated, children with ASD have difficulty in using pragmatic language. They therefore will commonly speak in an expressive way, stating what they think and what should happen but do not do so in a way that allows others to contribute. This can lead to one of two things happening. It can either lead to the person with ASD doing everything themselves and the other children in the group just observing or it can lead to the other children not allowing the child with ASD to lead, leading to the child either becoming disruptive, or the child isolating themselves from the group, often working alongside the other children in the group but doing so in their own way without interaction.
Reciprocity of interactions in one of the key areas that children with ASD struggle with. Often children with ASD will have a set way of approaching a task and will find it difficult to approach it in any other way. The problem is children with ASD have difficulties in mediating conflicts and expressing their opinions within group situations. Whereas children commonly have different ways of doing things and may even argue over what is the best way to approach a task, children with ASD will find it difficult to express themselves in an appropriate way in these situations. They will not try to explain or justify themselves in such situations. They will simply view themselves as being right and any alternative way of approaching the task will be seen as incorrect. This often leads to them becoming frustrated and disruptive in social situations and unfortunately, as I have seen many times, often other children will not want to work with them. These signs are very apparent particularly within early primary aged children and teachers should watch carefully to understand why children are becoming disruptive in group tasks rather than reacting without understanding.
One of the worst thing a teacher can do is punish children for not participating in group tasks effectively. When I was at school, I was constantly in trouble for not working nicely with my group. The difficulty was that this was not something I could help. I did not understand how to express myself appropriately within the group and when the other children worked in a way that I disagreed with, I responded with frustration and anger. In my mind, these children were doing it wrong and I became angry that they were not listening to me as I was telling them how to do it correctly. Identifying children’s difficulties in this area early is important as there are a range of strategies that can help children mediate these situations which will be explored later.
Cognitive development.
As has been previously stated children with classical autism have significant delays in cognitive development which makes their difficulties far easier to identify. Higher functioning children- particularly those who would formally have been diagnosed with Asperger’s syndrome- however often have average to above average intelligence. On intelligence tests they commonly score well and often children with high functioning ASD will be of the higher range of ability in the class, something that makes the identification of their difficulties particularly difficult. Their cognitive development is however underpinned by certain characteristics. For one thing, they often have a keen memory for facts and figures. They can often memorise huge numbers of facts within a certain subject but may have difficulty in applying this to other areas. Indeed ‘special interests’ are very common to children with ASD.
It is common for children with high functioning ASD to have extreme differences in ability from subject to subject. A child may for example be gifted in areas such as science or numeracy but may be of low ability in literacy. This is partly due to the fixated nature of the cognitive processing of children with ASD. Whereas it is common for most people to develop a shallow understanding of a range of subject areas, the nature of the high functioning autistic mind is to focus on a selection of key areas and develop a deep rich understanding in these areas. This results in children developing very uneven ability across the different areas of the curriculum. In relation to literacy development, it should be noted that difficulties in literacy are common to many children with ASD as often such children also have dyslexic traits.
Theory of mind is perhaps the area of cognitive development that shows the most significant difference for children with high functioning ASD. Theory of mind is the ability to understand the thoughts and feelings of others (Frith, Morton and Leslie, 1991). Frith (1991) identified that children with ASD were unable to ‘mind read’. That is, they had difficulty in attributing meaning to the actions of others and understanding the thoughts and feelings of other people-particularly the fact that such people can have thoughts or feelings different to their own. The term mindblindness has been used to describe this phenomenon. Around the age of four children begin to develop theory of mind. They begin to understand that different people have thoughts and feelings different to their own and accept these. Leventhal-Belfer and Coe (2004) describe this in terms of ice cream stating that a child of typical development will accept that another child may prefer a different flavour ice cream provided they do not need to eat it. A child with ASD, however, will have difficulty in accepting the fact that a friend may prefer a different flavour ice cream to them and may express this as being ‘stupid’.
Difficulties in theory of mind can manifest in many ways such as not being able to recognise sarcasm or white lies and not being able to understand the reasons for someone else’s behaviour. Unfortunately, this can commonly cause lots of arguments in the classroom and understanding children’s difficulties in this area can enable teachers to identify the cognitive developmental differences that could identify children as potentially having ASD, despite their seemingly normal cognitive development in other areas.
Summary
Classical Autism is underpinned by significant delays in cognitive development.
Higher function children often have normal to above average cognitive development but this is characterised by fixated thinking and deep understanding of specific topics rather than a broad understanding of many.
Children with ASD commonly have ‘mindblindness’ difficulties in interpreting the thoughts and feelings of others.
Physical and sensory development.
In terms of appearance children with ASD have no clear physical differences than other children. Indeed, Wing (1976) describes them as having a very normal and often attractive appearance. Having said that, there are often clear physical developmental signs of ASD in the form of development of motor co-ordination and differences in sensory processing (Ghlers and Gillberg, 1993; Tantam, 1991 and Attwood, 1998).
Motor clumsiness is something that is prevalent in 50-90% of children diagnosed with Asperger’s syndrome-with its prevalence in the new ASD classification likely to be similar (Attwood, 1998). It is therefore important that educational practitioners are aware that motor clumsiness, though not restricted solely to ASD, can be an indicative factor and thus could help early identification.
In very early development, one of the first developmental signs of motor clumsiness in children with ASD is a slight delay in learning to walk. Indeed, you will note that in the case study of Fritz V outlined in the last chapter, Fritz learnt to talk before he was able to walk. Generally, children with the former diagnosis of Asperger’s Syndrome learn to walk up to three months later than expected (Manjiviona and prior, 1995). In home visits to new parents who have children starting in nurseries or foundation stage units, a knowledge of when children achieved key developmental milestones, not only aids early assessment of children’s development but can also help to identify possible developmental difficulties that the children face, including ASD.
For children in early primary school the signs of motor clumsiness are likely to become more apparent. They are likely to be uncoordinated when running and struggle to learn skills such as catching a ball. I remember when teaching a year three class (7-8 year olds) I came across a Ben, child who was diagnosed with High Functioning Autism. We were learning jumping sequences in relation to a gymnastics unit of work. The first stage of the learning was seemingly simple, jump from two feet and land on two feet. For most children in the class it was easily attainable within a few practices. For Ben, however, it took nearly the whole lesson of practice before he was able to do it confidently and even then it was clear he needed intense concentration to achieve it. This is just one small example and indeed motor clumsiness will be clear in a variety of ways particularly in physical education lessons. It is important to look out for such signs as possible indicators of ASD, as well as a number of other difficulties.
Children with ASD can have difficulties in the development of both their gross and fine motor skills and this can manifest its self in a range of ways in the classroom. One of the clearest signs of the poor motor development associated with high functioning ASD is handwriting. Children will often be quite intelligent and able to articulate their ideas in a very formal and indeed often scientific way, however, when it comes to recording these ideas they may find it far more difficult. Their handwriting is often scruffy and when they do try to write neatly, their pace is often very slow. This can be indicative of a range of specific learning difficulties, however, it is important to bear in mind that difficulties in relation to fine motor skills are a common feature for some children with ASD and if these manifest in conjunction with any of the features described previously, practitioners should see it a possible indicator.
In addition to the difficulties in motor clumsiness and fine motor skills that children experience, seemingly involuntary repetitive movements are also common to many children on the spectrum. This can involve things such as arm flapping or jumping up and down persistently. These signs are often seen when the child is particularly excited or anxious. This can also be an example of the ritualistic behaviour associated with ASD such as pacing or rocking and can be a method that children use to cope during anxious situations.
In addition to the aforementioned physical signs, extreme differences in the way in which they perceive sensory stimuli is a common feature of ASD. This often manifests its self even in the most highly functioning children on the scale and can be a key indicator for early diagnosis. The problem is that this manifests in two key ways which are basically extreme opposites of each other. Children can either be hypersensitive-have high level of perception of sensory stimuli, or they can be hyposensitive- have a very low level of perception of sensory stimuli. In high functioning children, it is my experience that hypersensitivity is the most common. Children will be highly sensitive to sounds, smells and touch which often result in them being unable to cope in situations with excessive noise. They may place their hands over their ears, or trying to get away from the situation, hiding in the corner or under the table.
Children who have hypersensitivity to touch may have extreme difficulties in wearing things made out of certain materials. This may be obvious during school plays or museum visits where they are encouraged to wear different cloths. It may seem that these children are being naughty, or rebellious but actually the physical discomfort that they feel when they wear certain cloths is a very real thing.
Parents evenings are also a time when children’s hypersensitivity to touch can be identified. I have often had conversations where parents have reported the impossible task of getting their child ready for school in the morning. This can be due to a range of factors but in children with ASD- or who may potentially have ASD- one of the common reasons that parents have such trouble getting them ready for school can be that they cannot bear the feel of the school uniform.
When I was a child, I would have extreme battles with my mother if she made me wear certain things. A shirt that I had worn several times before, may be over dried or become coarse after it had been washed a few times and I simply could not bear to wear it. It was not until I was older and able to articulate my discomfort to my mother that we began to overcome this difficulty. Indeed to this day, I can only wear clothes that are made of pure cotton and have been washed with softener and ironed immediately after they are dried.
Hyposensitivity is essentially the opposite of hypersensitivity. Children may be unaware of how much force they are using in a situation. This can manifest its self in many ways including children being very heavy handed, perhaps hurting other children when in fact their intention was just to touch or tap them. They may have difficulties in knowing how much force to use when writing and may break pencils or other classroom equipment completely unintentionally.
Difficulties in sensory perception also manifest in relation to spatial awareness. Children often have difficulties in perceiving their bodies in relation to other objects. This can result in them running into other children in the playground or needing to be very close to a wall or object in order to gain sensory stability. Such behaviours can also be indicative of ASD in young children.
Summary.
Motor clumsiness is something which though not exclusive to ASD is present in 50-90% of cases.
Difficulties in fine motor skill development is common, causing difficulties with handwriting, using scissors etc.
Hyper and hypo sensitivity are common features of ASD and often in higher functioning children, their reactions to sensory stimuli can be among the clearest initial indicators of their ASD.
To refer or not to refer.
The fact that a child exhibits any of the features of ASD outlined in this chapter by no means indicates that they definitely have ASD. The diagnosis of ASD is extremely complex and in current practice in the United Kingdom, involves referral to a multiagency team including psychologists, child psychiatrists and speech therapists. It is only by triangulation of data from all of these sources that a diagnosis can be made and even then, it is very common for children to have traits of ASD but to not have enough positive indicators to be diagnosed.
I would like to stress a key point. If you have concerns, take action. If you believe that a child may show signs of ASD, at the very least refer them to the person responsible for leading special educational needs with in your institution. They will then gather evidence through observation and refer them to external agencies if needed.
I have come across far too many cases where teachers have noticed some ASD behaviours in a child and dismissed them because they had high attainment or because they made good eye contact. The result of this is that these children have not had the early intervention and support that they need to help prevent their differences from becoming barriers and in some very unfortunate cases, they go into adulthood without ever having this support.
Written by Marc Wheeler (2017)