| Impairments in social communication and interaction |
- Abnormal language development, including muteness
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- If present, spoken language may be atypical; for example:
- Unusual prosody of speech (rate, rhythm, tone, volume)
- Persistent echolalia
- Referring to self by name or as "you," "he," or "she"
- Non-speech-like vocalizations
- Tendency to speak freely only about specific topics of interest
- Talking at others rather than having a back-and-forth conversation
- Unusual vocabulary for age or social group
- Responses to others may seem rude or inappropriate
- Difficulty understanding others' intentions (eg, takes things literally, misunderstands metaphors or sarcasm)
- Unable to adapt style of communication to social situations (eg, overly formal or inappropriately familiar)
- Reduced and poorly integrated gestures, facial expressions, body orientation, and eye contact
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- Limited use of language for communication
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- Reduced, absent, or atypical nonverbal communication (eye contact, gestures, facial expression)
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- Poor response to name (despite normal hearing)
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- Little or no response to others' gestures or facial expressions
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- Reduced interest in people, including children their own age
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- Apparent preference for aloneness
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- Difficulty making and maintaining peer friendships (may find it to be easier with younger children or adults)
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- Reduced or lack of enjoyment of situations that most other children enjoy (eg, birthday parties)
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- Difficulty joining in play of other children (eg, makes no effort to join in or uses wrong approach [eg, aggressive, disruptive])
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- Difficulty interacting in unstructured social situations (eg, school recess)
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- Poor understanding or following of social conventions (eg, greetings, farewell behaviors, taking turns, classroom behavior, awareness of personal space)
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- Easily overwhelmed by social or other types of stimulation, for example:
- Extreme reactions to invasion of personal space
- Resistance to being hurried
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- Reduced or absent response to others' feelings
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- Extremes of emotional reactivity that are excessive for circumstances
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- Abnormal interactions with adults (no interaction or too intense)
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| Restricted, repetitive behaviors, interests, and activities |
- Lack of flexible, cooperative, imaginative play or creativity, for example:
- Rigid expectation that other children adhere to rules of play
- Strong adherence to rules of fairness (may lead to arguments)
- Repeatedly reenacting scenes from videos or cartoons
- Preference for highly specific, narrow interests or hobbies (eg, collecting, listing, numbering)
- Difficulty with imagination (eg, in writing, for future planning)
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- Preoccupation with restricted patterns of interest that are abnormal in intensity or focus and interfere with activities of daily life
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- Strong preference for familiar routines
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- Inability to cope with change or situations that lack structure (may lead to distress [eg, anxiety, aggression])
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- Aberrant response to sensory stimuli (over- or under-sensitive), for example:
- Excessively touching people or objects
- Preferring to be in the dark
- Deliberately smelling objects
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