Autism Assessment

There is extreme diversity in Autism symptoms, making them difficult to narrow down. Symptoms vary hugely from person to person. Symptoms can also be harder to spot in some people with autism due to ‘masking’, where autistic people learn to hide their symptoms in order to blend in. However, regardless of how signs manifest, they tend to fall into general categories: Behavioural, Social, Emotional, Sensory, and Developmental.

Behavioural Symptoms

1. Restricted Behaviours - These include routines and rituals, specific diets, and struggling with change.
   1. Routine Adherence - Autistic children often prefer things to stay the same, such as taking the same route somewhere, or getting ready for bed in the same order each night. Routines and rituals are often highly specific/strict, and are comforting to the child, even if they appear unusual to others. Children can become dysregulated if these routines are disrupted.
   2. Specific Diets - Restricted behaviour can be most apparent in a child’s diet. They may prefer to eat the same things every day, and/or refuse to eat more than a few foods or try new ones. Foods have a different texture, taste and colour,so some children may prefer processed foods, which stay the same, instead of fresh produce, which can vary a lot. This is not specific to all autistic children though, especially ‘sensory seeking’ children.
   3. Struggling With Change - Autistic children find it hard to adapt to change, and may appear ‘rigid’ or ‘stubborn’ because of this. If their routine is changed, especially if it is sudden, they may become distressed for the day or even longer. They may struggle with small transitions (class to class) or only bigger transitions, (moving house or school).
2. Specific Interests - These include atypical interests, 'special interests', and perceived disinterests.
   1. Atypical Interests - Autistic children’s interests can be the same as any other child’s, but also often appear atypical or even developmentally inappropriate. Their interests may seem mundane, (like transportation types down to the colours/models)
   2. 'Special' Interests - Interests are often highly specific, focused, or at times atypical. Some of these interests become so strong that they are referred to as ‘special interests’. Children can spend a lot of time researching, thinking about, or discussing their special interests. This can make others uncomfortable, but some children may not recognise this.
   3. Disinterest - Autistic children may sometimes appear disinterested in other’s interests, or others as a whole if they do not relate to their special interests, which can sometimes be upsetting.
3. Repetitive Behaviours - This includes ‘stimming’ and more specifically, echolalia.
   1. Repetitive Movements/'Stimming' - 'Stimming' is a repetitive movement pattern often used to help self-regulate or express emotions. Stimming can include rocking back and forth, repeating phrases, pacing, flapping hands, and more. During meltdowns, stimming can go from a healthy outlet to self-regulate or to a point where it may be damaging.
   2. Echolalia - Echolalia is the name given the repetition of names, words, or phrases, without apparent meaning. This may be the child’s way to structure a social response (for example, repeating a question asked to them before responding to it)
4. Play - This includes atypical play, imaginary play, and struggles with rules. It is very common for autistic children to struggle with traditional social playing.
   1. Atypical Play - Autistic children may play very differently to other children, or struggle to play the same way. They may focus on the self-regulatory or sensory aspects of play rather than the social ones, such as lining up toys instead of sharing them or using them in imaginative play. Children may play obsessively and avoid other kinds of play, especially group/social play, due to disinterest or anxiety. It is very common for autistic children to prefer ‘parallel play’, where children are physically together, but play independently.
   2. Imaginary Play - Imaginary play is an important part of development, and can vary widely in autistic children. ‘Pretend play’ may be rare or even nonexistent, or extremely common, depending on the child. It’s also common for children to have imaginary friends to play with instead of other children, or to ‘script’ socialising with. Imaginary play may often relate to special interests, such as an imaginary friend being a fictional character of a show they fixate on, or pretending to be involved in their interest, such as being a palaeontologist searching for dinosaur fossils in their garden
   3. Struggles With Rules - Autistic children may either not follow the rules of a game due to not understanding them and/or their purpose, or may fixate on the rules so deeply that they do not want any changes to the game, even when they may be necessary, like adding a new player. These struggles may lead to conflicts and exclusion.

Social Symptoms

1. Atypical Verbal Communication - This includes Tone, Speech, and Processing.
   1. Tone - Autistic children’s tone is often atypical and may seem socially inappropriate. Speech tone can be flat/monotonous, or highly expressive, sometimes even ‘sing-songy’ - at times one person may fluctuate between the two extremes. Tone may not align with the child’s mood/interest level, conversation tone or situational tone. Sometimes children can be mistaken to be rude, disinterested, sarcastic, moody, condescending, and/or disingenuous because of their tone.
   2. Speech - Autistic people communicate differently to non-autistic people. Autistic children may speak much more or much less than peers - possibly due to anxiety or not understanding conversational rules, struggle with the flow of conversation and pragmatic language use (often taking things very literally and missing jokes or the meaning of idioms), and struggle to explain thoughts, feelings and behaviours. Speech may also at times appear stilted, almost scripted, as the child may create mental frameworks to talk to others in an attempt to socialise or mask symptoms.
   3. Processing - Autistic children may take longer to process what has been said to them, or struggle to understand it and its meaning.
2. Atypical Nonverbal Communication - This includes Facial Expressions, Eye Contact, and Body Language.
   1. Facial Expressions - Autistic children’s facial expressions may seem subdued, even nonexistent, or be highly emotive, sometimes seeming exaggerated - like tone, this can fluctuate within an autistic child. Expressions often don’t entirely match emotions. This can confuse others, who misread these expressions as socially inappropriate - such as a flat, neutral expression when listening to a friend’s woes, or a severe expression when joking around. This can lead to miscommunications and social problems.
   2. Eye Contact - Autistic children often have atypical eye contact, either making very little to none, which may come off as impolite or disinterested, or making much more than their peers, which may be uncomfortable for recipients. Sometimes increased eye contact is due to masking, where autistic people make eye contact because they know it’s important to people, but don’t understand the rules or use of it. Eye contact may also vary in an autistic person depending on mood or familiarity with another person.
   3. Body Language - Autistic children’s body language, including gestures and body movements, may be atypical. Movements and gestures may be less frequent, or missing entirely and subdued, or exaggerated and highly expressive. They may be socially inappropriate, too, such as large, exaggerated gestures in a more neutral professional setting. Posture and other body language may seem abnormal to others, too, such as being slumped over or sitting unusually.
3. Lack Of Communication - This includes non-reciprocity, unresponsiveness, and passivity.
   1. Non-Reciprocity - Autistic people may fail to reciprocate social gestures from others as they may not realise they are meant to be reciprocated, or don’t know how to reciprocate them. This may be changed by masking, or alternatively, some autistic people are highly social and motivated, and may reciprocate, though this reciprocation may seem unusual to others.
   2. Unresponsiveness - Autistic children may respond slowly/infrequently, or not at all, to their name, greetings, facial expressions like smiling, or questions directed at them. They may not get involved in conversations, games, and pretend-play, and may seem to not acknowledge others or look at people, even when they are listening to them. They may then come off as rude or disinterested. These symptoms may be more apparent when children are tired or preoccupied, as they are less able to mask them.
   3. Passivity - Autistic children may be less proactive than others when initiating social interaction, such as conversation, sharing information or objects/toys, or playing/spending time together, especially with people they don’t know. Alternatively, making or highly social autistic children may initiate and socialise with others frequently, but this socialising may seem unusual or stilted, or overwhelming in large quantities.
4. Relationships/Socialising - This includes Empathy, Social Cues, and Social Struggles.
   1. Empathy - It’s a common misconception that autistic people cannot empathise with others. Autistic people often have high levels of affective empathy, the feelings we experience in response to other’s emotions, sometimes to the point of ‘hyperempathy’, but can struggle more with ‘cognitive empathy’, or ‘perspective taking’. Whilst they may easily understand how they would feel in a certain scenario and empathise based on this, they may struggle to understand how others may perceive and experience the same scenario differently based on their unique experiences or personality. They may hold strong, rigid opinions and black and white thinking.
   2. Social Cues - Autistic children struggle with the rules and nuances of social interaction that non-autistic people can pick up, often misunderstanding or entirely missing social cues, even when they seem obvious to others. This can lead to them coming off as rude, inconsiderate, weird, or selfish. However many autistic children, especially older ones, may be anxious to not miss social cues, and ther
   3. Social & Relationship Struggles - Unfortunately, autistic people often have social difficulties and are at greater risk of bullying and isolation. They struggle with the flow of conversation, understanding jokes, and reading others, which can lead to feelings of not belonging. They may also frequently get into conflict due to misunderstandings. Due to this, they may prefer to be alone, or be anxious about their relationships.

Emotional Symptoms

1. Emotional Regulation - This includes Emotional Regulation & Autism, and Emotional Dysregulation.
   1. Emotional Regulation & Autism - Autistic children can be much more sensitive and emotional than others, and some much less so - this can also present very differently: children can feel overwhelmingly large emotions but show very little of it, for example. Some autistic children may have Alexithymia, issues describing or recognising emotions, which can make emotional regulation much harder. Autistic children may stim or engage in 'special interests' to self-regulate, and their way of staying calm may look different to others’.
   2. Emotional Dysregulation - Autistic children can experience more emotional dysregulation than their peers. They can become dysregulated faster than others, leading to an outburst/meltdown or a shut-down, where the child seems unresponsive. This may be due to the increased stress of the sensory environment, distress from social difficulties and exclusion, or distress from feeling misunderstood. This can build up over time, leading to increased sensitivity, disengagement, and risk of mental health issues.
2. Masking - This includes what masking is, and the impact it can have on an individual.
   1. Masking - This is a learnt process to hide autistic symptoms to appear more ‘normal’ and blend in or avoid social backlash. This becomes more common as children grow older and become more self-aware, and may become second-nature when in social situations. This can be mistaken for an ‘improvement’ in symptoms, but it isn’t - the child is not learning healthy ways to manage symptoms, they are learning to suppress them out of anxiety. Masking has a host of short term and long term negative consequences.
   2. Impact of Masking - Masking uses up a lot of mental resources to micromanage individual behaviours to be more palatable to others, which ignores one’s own needs. This combination of ignored needs and extreme self-managing leads to exhaustion, burnout, and in the long term, mental health issues. It is very common for autistic children to appear happy and well-behaved in public, but then shut down or explosively dysregulated once home, or at the end of an outing if they cannot continue masking for a longer period of time. Masking impacts emotional wellbeing, productivity, and genuine connections with others, as most or all energy is used on maintaining a more ‘likeable’ persona. Masking also makes it harder to identify autism and support it.
3. Meltdowns - This includes Meltdowns/Shutdowns and the causes of them.
   1. Meltdowns/Shutdowns - Meltdowns/Shutdowns are the result of children finding negative feelings/experiences too overwhelming to process, and consequently being unable to function as normal. Meltdowns are typically externalised, and may involve yelling/screaming, crying, and physical behaviour against oneself or the environment/others. Shutdowns are typically more internal, often appearing as though the person is ‘somewhere else’ mentally. The child may withdraw, go quiet/nonverbal, or appear unresponsive. Sometimes, meltdowns and shutdowns can occur sequentially, such as a child who shuts down after releasing all their pent-up energy in a meltdown, or a child who is shutting down is accidentally pushed over the edge by well-meaning peers checking on them and ends up having a meltdown.
   2. Causes of Meltdowns - Many things can cause a meltdown/shutdown, and this could vary by the day. Autistic people experience the world very differently, and the world is often not designed with them in mind, making it harder to navigate. This can lead to social, informational, and sensory experiences becoming very overwhelming, where non-autistic people could manage them. These experiences can build up until the emotions and energy become impossible to manage, leading to a meltdown/shutdown. In some children, especially older ones, it’s also possible to feel shame over the overwhelming feelings, which unfortunately can make a meltdown/shutdown more likely or more severe.
4. Mental Health - This includes the link between autism and mental health, and comorbidities.
   1. Autism & Mental Health - Children with autism are at greater risk of developing mental health conditions, particularly as they grow older, becoming more self-aware and holding greater responsibilities. The world is often not accessible to or accepting of autistic children, who are at greater risk of bullying, exclusion, abuse, discrimination, and isolation by younger peers and adults alike. This can create feelings of significant psychological distress, which can evolve into longer-term physical or mental health problems. Autism can sometimes also be misdiagnosed as several mental health/learning conditions, or be comorbid with them.
   2. Comorbid Conditions - There are established links between autism and many mental health conditions, including depression, anxiety, OCD, schizophrenia, self-harm, phobias, OCPD and SPD. New research links autism to PTSD/C-PTSD and BPD, but this is less established.

Developmental Signs

1. Developmental Differences - This includes differences in language development, cognitive development, and motor development.
   1. Language Developmental Differences - It’s common for autistic children to have accelerated or delayed language development. Autistic children may not start to speak until much later than their peers, or may struggle with pragmatic language use for much longer than other children. Language development is often atypical or uneven, such as an advanced vocabulary but underdeveloped pragmatic language abilities. This can cause social difficulties for children, which in turn can cause the child to miss opportunities to learn, making language acquisition and development harder.
   2. Cognitive Developmental Differences - Autism is often marked by executive dysfunctioning and deficits in social cognition. Autistic children may struggle planning behaviours, paying attention, self-regulating, initiating tasks, and seeing from other people’s perspectives. This can create academic, behavioural and social difficulties for children. However, children with autism can show remarkable attention to detail and ability to retain information, particularly when it relates to one of their ‘special interests’.
   3. Motor Developmental Differences - Because it’s a global developmental condition, autism impacts motor development and skills. Atypical or delayed motor development is common, as well as a regression in motor skills. Autistic children often struggle more with balance, following directions, bodily awareness, dexterity, motor planning, and hand-eye coordination, making them appear clumsy or having unusual body movements. They may also be at greater risk of joint hypermobility or poor muscle tone, which contributes to motor impairments. However, autistic children may show greater ability in some motor domains, particularly if they relate to an interest, such as a child who loves art honing their fine motor skills through practice. Autism is also comorbid with Developmental Coordination Disorder (DCD, also known as dyspraxia).
2. Medical Issues - This includes gastrointestinal issues, epilepsy, and other medical issues.
   1. Gastrointestinal Issues - Children with autism are at a greater risk of problems such as diarrhoea, constipation, gas, and stomach upsets. It isn’t entirely known why this happens, as it’s a more recent discovery. Different explanations include unfortunate consequences of a less nutrient rich, restricted diet, a difference in gut microbiome, or anxiety, which is more common in autistic people.
   2. Epilepsy - There is a small overlap between epilepsy and autism. If a child already has epilepsy, it may be worth keeping an eye out for signs of autism.
   3. Other Medical Issues - Autism is comorbid with several mental and physical health problems. As well as the ones already listed, autistic people are more likely to have joint issues, sleeping issues (particularly insomnia), and may be more likely to have autoimmune disorders. Autism is also comorbid with ADHD, Dyspraxia/DCD, and Dyslexia.
3. Learning Differences - This includes learning differences and their impact.
   1. Learning Differences - Whilst autism isn’t a Specific Learning Difficulty (SpLD), it does impact cognition, which can make learning different. Autism is also comorbid with many SpLDs.
   2. Impact on Learning - Autistic children may struggle to listen to or engage with their teachers, understand instructions, pay attention to tasks, organise their learning to keep on top of work, and have difficulty focusing on information unrelated to their interests. Social, behavioural and sensory difficulties may also create unique learning differences and difficulties, such as a fluorescent classroom light distracting a child from working because it’s too bright when a non-autistic child wouldn’t notice it, or an autistic child struggling in group work tasks because of social difficulties and exclusion.
4. Executive Dysfunction - This includes executive function and dysfunction.
   1. Executive Functioning - This is our ability to regulate, manage, and control thoughts and behaviour. It impacts all aspects of daily functioning, including, but not limited to, planning and organisation, self-control and regulation, problem solving, and attention. Autistic people can excel at some aspects of executive functioning, such as remarkable attention to special interests, thinking outside the box for problem-solving, and/or organising schedules and routines.
   2. Executive Dysfunction - Many autistic children struggle with executive functioning, referred to as executive dysfunction, due to their symptoms. They may struggle to tidy a mess because they are overwhelmed by planning the steps to do so, find themselves forgetting their classroom tools often, struggle paying attention to a topic unrelated to their interests, and much more. This may also be influenced by external factors, for example, the child’s sensory and social environment - an overstimulated child may find emotional regulation particularly difficult.

Sensory Symptoms

1. Sensory Processing - This includes sensory processing issues, sensory profiles, and atypical diets.
   1. Sensory Processing Issues - Autistic children can appear to have much stronger or milder reactions to certain sensations than would be expected. This is because they process the sensory world very differently to others, and therefore can be hypersensitive (more sensitive) or hyposensitive (less sensitive) to different stimuli. A child can become overwhelmed by sensory experiences, through overstimulation (too much sensory input) or understimulation (too little sensory input), and may as a result experience a ‘sensory overload’ - distress due to unpleasant or overwhelming sensory experiences.
   2. Sensory Profiles - Many autistic children’s sensory responses can be described as ‘sensory seeking’, where they may be understimulated by their environment and seek out more stimulation, or ‘sensory avoiding’, where they are overstimulated by their environment and seek out less. The same child could also show both of these responses depending on the sensation or day. They may seek out extremely strong tasting food, avoid some textures, prefer unusual temperatures/light levels, dislike physical affection, and much more. Behaviour can sometimes appear unusual, but within the context of the child’s ‘sensory profile’, it starts to make more sense.
   3. Atypical Eating - Sensory differences tend to be most apparent in an autistic child’s diet. For example, it is common for ‘sensory avoiding’ children to eat primarily ‘bland’, ‘beige’, more processed foods, as the texture and flavour tends to be more predictable and manageable, whereas unprocessed foods such as fruit and vegetables can range widely in texture and flavour. On the other hand, ‘sensory seeking’ children may actively want foods with different textures and flavours, even ones neurotypical people may struggle with, such as very spicy or sour ones. Children can also show both sensory seeking and avoiding in their diets, such as a child who seeks out sour foods but won't touch fruit because of the texture. Some children have ‘safe foods’, which are foods they trust won’t be an unpleasant sensory experience for them.
2. Atypical Interoception - This includes interoception and autism, and the consequences of atypical interoception
   1. Interoception & Autism - Interoception is our ability to recognise and process internal states. They can be physical, such as hunger, thirst, toileting, pain, temperature and energy, or emotional, such as stress, anger, anxiety, joy, and sadness. Autistic children are often hyper or hypo sensitive to their internal state, and can fluctuate between these extremes.
   2. Consequences of Atypical Interoception - Autistic children may forget to attend to their physical needs until it is harmful, or may need to attend to them immediately, even if the feeling is only mild - this can also fluctuate within the child. They may also struggle to recognise their emotions or others, and overexert themselves past their limits until they are exhausted/burnt out. Children struggle to identify internal states, and therefore can’t attend to or communicate their needs, which can lead to dysregulation and dysfunction.
3. Atypical Exteroception - This includes exteroception and autism, and the consequences of atypical exteroception.
   1. Exteroception & Autism - Exteroception is our ability to recognise and process external sensory information, done mostly through external receptors in our skin. It’s involved in perceiving temperature, responding to pain, navigating, manoeuvring our bodies, and experiencing the five senses - essential for sensory processing. Autistic children may struggle with this, and may have difficulties with touch (gentle versus pressured, for example), dress inappropriately for the temperature - either due to poor perception of temperature or due to sensory issues with certain fabrics or clothing styles, or react atypically to pain.
   2. Consequences of Atypical Exteroception - Similarly with issues with interoception, issues with exteroception can make self-regulation much harder as children may be unable to recognise their own experiences and senses, and therefore be unable to address negative ones.
4. Atypical Vestibular Processing & Proprioception - This includes the vestibular system and autism, proprioception and autism, and the consequences.
   1. Vestibular System & Autism - The vestibular system regulates body control and balance. Autistic children who struggle with vestibular sensations may feel a sense of motion sickness without moving at all, causing distress, as they are unable to recognise or communicate what has made them feel poorly. They may be at risk of injury due to precarious physical activity done in an attempt to stimulate the urge to achieve specific balance when understimulated.
   2. Proprioception & Autism - Proprioception describes our ability to receive feedback from our body about where it is in relation to the rest of the environment, and how parts of the body are moving, regulating movement and pressure. Children with poor proprioception may struggle with invading personal space by misperceiving distance, being involved in accidents due to their clumsiness such as dropping things or breaking something by using too much pressure, accidentally disrupting others with sensory seeking such as jumping or stomping, or injuring themselves or others with biting and pinching.
   3. Consequences - Like interoception and exteroception, this can disrupt self-regulation, as the child is not fully aware of what is causing their distress and therefore cannot address their needs. This can lead to meltdowns, shutdowns and other behavioural, social and academic problems.

Autism is a phenomenally diverse condition. It can look differently in everyone, even in two identical twins raised in the same home. There is no one way it manifests itself, which can make it incredibly difficult to spot. No one can represent every facet of autistic life, but below are some fictional accounts of autism in different children based on real symptoms and experiences to help illustrate some of the many ways autism can manifest:

‘C’ is Six.

She struggles with language, but is able to use a communication booklet to communicate basic information, can understand language and simple instructions from others, and occasionally use the names of other children, teachers, and family members.

She almost never talks for social purposes. She struggles with a lot of daily tasks that other children don’t, such as toileting, hygiene, dressing, and finding her way, meaning she needs someone with her most of the time to help her. Her movements are often uncoordinated or delayed, and she is not as active and energetic as the other children, but often ‘stims’ by trying to balance on or hang/swing off of things, including rocking her chair, which has raised some safety concerns at school.

‘C’ is very picky with food, and will often get very upset if her food isn’t a specific texture. She also requires a routine for self-regulation, and can go into a meltdown if she feels her routine has been disrupted.

‘Z’ is Seventeen.

They have a very specific routine to get ready for the day or bed, and become inconsolable if this routine is not followed. They have an extreme aversion to unfamiliar textures, especially more ‘squidgy’ ones because they ‘feel wrong’. They are very unhappy at school, frequently reporting feeling ‘overwhelmed’ by the atmosphere, struggling to engage with their work, and feeling isolated from their peers, sometimes even getting into verbal altercations with others, if ‘Z’ feels their classmates have done something ‘immoral’, which has led to ‘Z’ losing or drifting from friends.

‘Z’ can lash out at themselves or others, especially when they feel particularly overwhelmed or lonely, at times leading to physical harm. However, at home, ‘Z’ is much more regulated, as long as their routines are followed. They do not like people touching them, even family members, particularly when they are already overwhelmed. The stress, tumultuous interpersonal relationships, emotional dysregulation, black-and-white thinking, aversion to activities or objects because they ‘feel wrong’ physically, and need for routine, has led to ‘Z’ being diagnosed with anxiety, OCD, and a possible emergent personality disorder, as autism was not considered by the clinician. These diagnoses have helped somewhat, but Z still often feels incapable, confused, and alone, as their autism has been missed, even by themself, and therefore never properly accommodated.

‘A’ is Ten.

He is polite, quiet, and exceptionally well-behaved at school, but at home, he is loud, chatty, and frequently explosively emotional, especially first thing after school.

He often settles down by dinner time, but he needs to eat or drink something very cold, change into comfortable pyjamas, and watch videos on Youtube or TikTok first, and still will be defiant when asked to do some chores, such as dishes or throwing food from dinner away. His mother is concerned about ‘A’s interests, as they centre around topics considered quite morbid for his age, and whilst ‘A’s peers describe him as ‘nice’, they also find him quite ‘weird’ because of their interests and way of talking, and some children have bullied ‘A’ for this, as well as their habit of rocking back and forth during floor time, but this was dealt with by the teacher and school counsellor. However, he is still quite isolated, having no close friends, but he doesn’t appear extremely bothered by this, except around his and other’s birthdays, where he feels quite lonely and left out. ‘A’ has to follow a somewhat restricted diet, as he easily gets an upset stomach.

Whilst ‘A’s teachers say he is a highly capable student, his exam results and grades are not reflective of this. He struggles to focus or comprehend instructions, and therefore plan what to do next, but feels too shy to ask for help, often sitting in class for a long period of time doing nothing, until a grownup or other student notices and offers assistance.

‘G’ is Two.

She hit all her language milestones as expected, and has an extensive vocabulary for her age. She is very gregarious, talking to anyone she comes across, only occasionally being shy with adults she hasn’t met before, and regularly talking to and playing with imaginary friends. However, she rarely makes eye contact or uses gestures when talking to others, including not pointing at items she wants or waving to say hello, and also rarely copies others’ behaviours, though she is noted as having a very expressive face for her age. She has some motor difficulties, having difficulty navigating places, even familiar ones, but she still greatly enjoys exploring places, and often finds random parts of a room or objects in it to smell, touch, hold, or taste. She also has a very diverse food palette for her age, particularly enjoying sour, spicy and pickled foods a lot where her siblings avoid them.

‘G’ is very physically affectionate, and really enjoys deep pressure ‘bear hugs’, especially when she’s upset. She has started reading, and is showing excellent progress for her age. She read a book about fish and other underwater animals and quickly became obsessed with it. She stopped showing interest in all other interests, and started watching programs to do with underwater life, fictional and real, collecting toys of underwater animals and fantasy creatures, and loves visiting the beach near her and other bodies of water, especially rockpools where she is able to see the animals. She rarely actually plays with her toys, she prefers to organise them by type, and gets very dysregulated and upset if someone interferes with them. This has led to some problems at her nursery, as she sometimes ‘monopolises’ the ocean toys and gets angry if other children want a turn. ‘G’ often does specific movements that make her ‘like a fish’ or will make specific ‘ocean sounds’, sometimes to the point it becomes disruptive.

During bathtime, ‘G’ spends hours in the water playing pretend and enjoying the water, and becomes upset if bathtime is cut prematurely. She has met another girl in the nursery who also likes underwater life, and they have become very close this way, but sometimes fight over their interest.

‘L’ is Seven.

He was nonverbal for most of his life and is now diagnosed with selective mutism. He has a few friends in school but he is not very close to any of them, often feeling like the ‘extra’ in the group, and has been bullied before. He sometimes repeats his friends’ jokes back to them to try and relate to them, but does this in a ‘deadpan’ tone and accidentally comes off as rude. ‘L’ has sometimes seemed inconsiderate or callous because he struggles to understand what’s going through someone’s mind and read them, so he doesn’t know how to act around them. However, when he is able to understand someone, such as seeing them cry from sadness, he is remarkably caring and helpful, even if in unconventional ways. He takes things very literally, struggling to understand phrases like ‘raining cats and dogs’, and if instructions are not given to him very explicitly, he will not be able to follow them. ‘L’ avoids going out when he can, as he finds the noises, smells, and lights of many places very upsetting. However, he does enjoy his garden, as it is quiet and secluded, and he can run around and play sports in it, which he greatly enjoys, as he often has to miss PE due to the social stress he feels during team sports.

He is very talented at sports, but his fine motor skills are an area of weakness for him, so his teachers have suggested that he use a laptop for writing. He is very messy, and struggles to clean up after himself because he cannot focus on it. His attention span is notably short, unless he is focusing on the sports he enjoys, at which point he can spend hours doing it to the point he neglects himself. His high energy and attention issues have led to teachers suggesting the possibility of ADHD as well as Autism.

He struggles a lot with change, notably holding on to pieces of stuffed toy when it was broken and took ‘keepsakes’ from his nursery when he left for primary school. He is not very expressive, and when he is upset or overwhelmed he tends to withdraw or go quiet instead of having a meltdown.

‘P’ is Sixteen.

He was bullied often in primary school, but has become fairly popular in secondary school, with a large group of friends. He is described as a ‘class clown’, and his friends enjoy his company, but he often feels as though people laugh more at him than with him, and he dislikes that he feels like he has to make jokes that are unkind to others to be able to fit in. He is also very self-conscious that his friends are getting into relationships but he is not. Even though he mostly enjoys himself when he’s with friends, he comes home exhausted and sometimes very withdrawn and snappy, even if he was only out for an hour or two. ‘P’ works at a restaurant to save up for university, but he doesn’t enjoy this.

He finds it difficult to communicate with customers, because he ‘doesn’t understand what they expect’ from him, and he is uncomfortable with clearing and washing utensils because he is afraid of random food touching him. ‘P’ is ‘obsessed’ with old TV shows, spending his free time watching and rewatching them, and researching trivia about them. He is very passionate about TV, and wants to study film at university to hopefully base a career on his passions. ‘P’ rarely fights with anyone, but when he does, he is very rigid in his views, and it’s difficult to talk him down when he’s upset with someone, in contrast to his funny, easy-going persona. He often rocks on his chair, even as an older child, and he has tipped over on it before, leading to occasional injuries.

‘F’ is Twelve.

She recently started secondary school, and has struggled with the big changes and new responsibilities. She often gets lost on her way to her new school, scaring her and making her late, which disrupts her routine and upsets her. She does not like her new school because it is ‘too loud, bright, and busy’, which she finds overwhelming and irritating. She often wears sunglasses and headphones in class because of this, which has gotten her in trouble before. She often rejects the school dinners, as she finds them off putting and they tend to upset her stomach, which has led to her mother starting to pack her her own specific snacks for lunchtimes.

‘F’ is described as ‘abrasive’ and ‘sometimes aggressive’, as she sometimes disregards the feelings of others, saying unkind things to classmates who interrupt her when she is overwhelmed by the school’s sensory environment, starting arguments with other students without an obvious reason, and frequently talking back to teachers if she feels they’re being ‘stupid’. Her tone is often quite flat or harsh, she tends to speak very loudly, and her facial expressions don’t always match what she’s saying, which sometimes confuses others.

‘F’ seems oblivious to her social impact, often inserting herself into social groups and not understanding why they treat her differently, which causes her to lash out and isolate herself. However, there are a couple girls in her class who seem to like ‘F’, and try to talk to her, but she is yet to consider them friends. She often spends her break times running or walking around instead of playing with others, and excels in PE in some areas, but struggles a lot playing team sports. She enjoys swimming the most because the water makes her feel calmer, and she likes going up and down the lanes, but she hates the process of getting changed before and after.

‘O’ is Fourteen.

They no longer attend school because she found it too stressful, and was frequently going to the bathroom during lessons to have a panic attack. She is now homeschooled, specifically focusing on art. They are still highly anxious, often getting very upset over any changes, even if they’re insignificant or good changes, and cannot socialise with other people, even answering the door. They have some online friends who they spend time with, that she met through sharing their art on the internet. It is very difficult for her parents to get them to engage with lessons other than art ones, which has led to some concerns about her academic progression.

She will sometimes engage with writing, to make up stories about characters they created. They draw these characters often with a variety of different mediums, even sometimes making real music or creating clothes that she thinks their characters would like. She often relates these characters to real situations or experiences, and their parents have tried using this to help her understand social situations better. ‘O’ can be very socially closed off and blunt, sometimes not looking at people when they’re talking, or not responding to her name, and often takes longer to process what was said to them and think of a response. ‘O’ has very strong reactions to things, such as accidentally hurting herself, the temperature changing, or the feeling of something on her skin. Because of this, they often avoid leaving the house. They feel ashamed of this and have low self esteem, and have been diagnosed with depression and social anxiety. However, since leaving school, she has shown an improvement in their symptoms, and appears more willing to try to leave the house on her terms.

Autism impacts every aspect of a child’s life, from early developmental milestones to their ability to regulate themselves and talk to others.

If you suspect your child has autism, you can start by observing and documenting specific behaviours, then share your concerns with your GP who can perform initial screenings to rule out any other causes and refer you to a specialist for a full neurodevelopmental assessment. Early intervention and diagnosis can make a significant difference. Educate yourself through trusted sources and seek support from professionals and parent networks to best support your child’s needs.