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Indicators of autism as provided in guidelines by Scottish Intercollegiate Guidelines Network (SIGN):


Warnings of possible ASD in school-age children

Warning signs

Communication impairments

  • abnormalities in language development including muteness
  • odd or inappropriate prosody
  • persistent echolalia
  • reference to self as ‘you’, ‘she’ or ‘he’ beyond three years
  • unusual vocabulary for child’s age/social group
  • limited use of language for communication and/or tendency to talk freely only about specific topics

Social impairments

  • inability to join in play of other children or inappropriate attempts at joint play (may manifest as aggressive or disruptive behaviour)
  • lack of awareness of classroom ‘norms’ (criticising teachers, overt unwillingness to co-operate in classroom activities, inability to appreciate or follow current trends)
  • easily overwhelmed by social and other stimulation
  • failure to relate normally to adults (too intense/no relationship)
  • showing extreme reactions to invasion of personal space and resistance to being hurried

Impairments of interests, activities and/or behaviours

  • lack of flexible cooperative imaginative play/creativity
  • difficulty in organising self in relation to unstructured space (eg hugging the perimeter of playgrounds, halls)
  • inability to cope with change or unstructured situations, even ones that other children enjoy (school trips, teachers being away etc)

Other factors

  • unusual profile of skills/deficits
  • any other evidence of odd behaviours including unusual responses to sensory stimuli

NB difficulties are likely to be more subtle in older individuals or those without learning disability.

Warning signs

General picture

  • long standing difficulties in social behaviours, communication and coping with change, which are more obvious at times of transition (eg change of school, leaving school)
  • significant discrepancy between academic ability and ‘social’ intelligence , most difficulties in unstructured social situations, eg in school or work breaks
  • socially ‘naïve’, lack common sense, not as independent as peers

Language, non-verbal skills and social communication

  • problems with communication, even if wide vocabulary and normal use of grammar. May be unduly quiet, may talk at others rather than hold a to and fro conversation, or may provide excessive information on topics of own interest
  • unable to adapt style of communication to social situations eg may sound like ‘a little professor’ (overly formal), or be inappropriately familiar
  • may have speech peculiarities including ‘flat’, unmodulated speech, repetitiveness, use of stereotyped phrases
  • may take things literally and fail to understand sarcasm or metaphor
  • unusual use and timing of non-verbal interaction (eg eye contact, gesture and facial expression)

Social problems

  • difficulty making and maintaining peer friendships, though may find it easier with adults or younger children
  • can appear unaware or uninterested in peer group ‘norms’, may alienate by behaviours which transgress ‘unwritten rules’
  • may lack awareness of personal space, or be intolerant of intrusions on own space

Rigidity in thinking and behaviour

  • preference for highly specific, narrow interests or hobbies, or may enjoy collecting, numbering or listing
  • strong preferences for familiar routines, may have repetitive behaviours or intrusive rituals
  • problems using imagination eg in writing, future planning
  • may have unusual reactions to sensory stimuli eg sounds, tastes, smell, touch, hot or cold.

* developed by the guideline group based on their knowledge of the evidence base and their clinical experience


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