Recognising Autism Spectrum Disorder (ASD)

What is ASD?

Autism spectrum disorder (ASD) is a developmental disorder that results in lifelong challenges with social interactions, communication and behavior. It is a “spectrum” because severity of symptoms ranges from mild to severe across the spectrum.

Symptoms of ASD are usually detected between 2 and 3 years of age, although they may be present earlier. In some countries, ASD is routinely screened at specific scheduled well child check visits with the doctor, using specific validated screening tools. The goal is for children with ASD to be identified early and be plugged into services such as early intervention programmes as early as possible. Sometimes, however, symptoms are not obvious until the child is in school and the child is noted by teachers to have problems.

What are the symptoms of ASD?

Two core symptoms of ASD consist of:

(1) problems with social interaction and communication
(2) restricted and repetitive behavior, activities, and/or interests.

Difficulty with or lack of interaction is a hallmark of ASD. Younger children may prefer playing alone. They may play alongside others, but not with them. Older children may become more keen in socializing, but have difficulty comprehending social cues or the needs of others. They may have trouble understanding others’ feelings. As for social cues, they may have difficulty using and interpreting nonverbal behaviors such as eye contact and body language. They may not point at objects to show interest, and they may not look at an object when someone else points it out to them. This arises from an abnormality in the ability to jointly share attention and interests with another. Some children with ASD have repetitive body movements for e.g. hand flapping or body rocking, and these commonly begin in preschool years.

Insistence on sameness is another characteristic. It may occur as part of daily routine, such as the need to eat particular foods in a specific order or to dress in a particular order. Changes in routine can cause the child to be upset or have a meltdown. Younger children may be preoccupied with specific sensory experiences, such as spinning objects, lights, or sniffing or licking non-food objects. Older children may be preoccupied with certain things such as dinosaurs, certain cartoon characters, or trains.

Children with ASD may perceive sounds, tastes, or touch differently for e.g. they may be overtly sensitive to certain fabric hence refuse to wear certain clothing. They may refuse to eat foods with certain tastes or textures, or eat only foods with certain tastes and textures. The restricted diet could lead to problems such as constipation.

Other features of ASD:

Some children with ASD may have special skills, despite significant difficulties in other areas. Hyperlexia, the ability to read far above one’s expected reading level, is one example.

In this situation however, the child may not understand what is being read or the purpose of reading. The severity and quality of language problems is widely variable. Unlike children with hearing impairment, children with ASD do not try to compensate by using alternate means of communication, like gesturing. They may not consistently respond to their name, and may not understand simple directions. When they speak, their language may consist of repetitive phrases or words spoken by others (echolalia). Others may speak but have difficulty starting or sustaining a conversation, or their language may be meaningful only to those familiar with their communication style, such as their own family.

When to seek help:

If you notice that your child has one or more of symptoms suggestive of ASD, you should talk your Doctor, who should then screen your child for ASD with a validated screening tool. If your Doctor’s screening is concerned it may be ASD, your child should be referred for comprehensive evaluation. Early diagnosis and management can modify some behaviors and improve socialization. Your child should also be referred for a hearing test, if not already done. Even if your child is not eventually diagnosed with ASD, early assessment and intervention services such as speech therapy can help address some concerns such as delayed language development.

Dr Lilian Wong is a Singapore and USA trained paediatric doctor. She is based at IMC Katong and has a special interest in autism and paediatric mental health.  

If you would like an appointment please call: 6342 4440 



References: UpToDate@2017. Autism spectrum disorder, Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential, Diagnoses Mark D. Simms and Xing Ming Jin. Pediatrics in Review 2015;36;355, Developmental Milestones. Rebecca J. Scharf, Graham J. Scharf and Annemarie Stroustrup. Pediatrics in Review 2016;37;25

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