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Lack of Appropriate Facial Expression
It can be difficult for children on the spectrum to both express and interpret emotions. Therapy sessions often focus on teaching children on the spectrum facial expressions and descriptive gestures, though even imitating these social cues can prove challenging for them. Commentary by Dr. Christopher Smith
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Twins Playing with Mom
Dr. Smith narrates a video comparison of twins during a routine play session with mom. One twin, Nathan, is on the autism spectrum, while the other, Benjamin, is typically developing. Compared to Benjamin's enjoyment and easy engagement in the session, Nathan's enjoyment in the interaction is dubious, characterized by minimal sustained eye contact, smiling or social reciprocity.
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Emotional Tone
One early warning sign of an autism spectrum disorder is the lack of natural, varied facial expressions. Leighdionne, a young girl with ASD, shows almost no change in her expression across settings and activities; rather, her face remains flat and unidimensional, making it difficult for an observer to determine her feelings.
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Playing with Toys: Emotional Tone
Children at risk for autism may show minimal interest in toys or struggle to play with them in an appropriate manner. In this clip, Sajid requires constant prompting and guidance from his therapist to play appropriately with a variety of toys. Further, he frequently shows absent or odd facial expressions. While manipulating the toys he vacilates between a blank expression and inexplicable laughter, neither of which appear tied to his play.
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The Duck Song
The following clip shows how some children with autism lack the ability to appropriately respond to the emotions of others. In contrast to his classmates who comfort their teacher who is pretending to cry after reading a story, Christian remains seated. He does not exhibit concern or attempt to comfort his teacher; rather, he is nonresponsive to her emotion.
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Teaching Lucas Emotions
Though Lucas seems more interested in this picture book, he does not look back at his therapist Georgia as many typically developing children might. He does not seem to be interested in her reactions to the book or in sharing his enjoyment. Further, Lucas shows great difficulty in imitating and understanding the emotions Georgia demonstrates for him. He repeats "I'm angry." and smiles.
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Gabriel Hugs Mom
Gabriel hugs his mother, but does not seem to be expressing genuine affection. He focuses on what he wants and needs, in this case TV, looks away from his mother, and does not seem to reciprocate (his hug is a bit stiff and limited). When he is told he cannot watch TV, he quickly moves on.
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Some Interest in Peek a Boo
Connor Puleo, a child evaluator, tries to play Peek a Boo with Ethan using a white towel. Although the child shows some concern for the blanket, his attentiveness is temporary. For a majority of the game, Ethan's expression remains flat and he even seems distressed at times. Further, Ethan never asks for the game to continue or attempts to continue it himself.
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Some Interest in Bubbles (Signs for More)
When encouraged by his mother, Raquel, Ethan becomes interested in the bubbles the evaluator, Connor, is blowing. Ethan makes an effort to pop the bubbles with his finger and even signs to request more. However, his requests are infrequent, delayed and often not well coordinated. He often does not look at the examiner and requires the support of his mother to stay engaged in the interaction, despite his interest in the bubbles.
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Risk Alert Emotional Tone / Affection
Dr. Deborah Fein compares the emotional tone of typically developing children with those of children showing early signs of autism. The emotional tone of many children on the autism spectrum can be characterized by a flat affect or lacking facial expressions and the absence of apparent enjoyment in one's surroundings and activities.
Social Communication and Social Interaction
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Non-verbal Communicative Behaviors
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Flattened affect (lack of facial expressions)10
- Inability to follow a point1
- Lack of attention to voice4
- Lack of expressive language17
- Lack of eye contact16
- Lack of gesturing1
- Lack of pointing to request2
- Lack of pointing to show1
- Lack of receptive language2
- Lack of response to name11
- Unusual Point1
Understanding & Maintaining Relationships
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Restricted and Repetitive Patterns of Behavior
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
Stereotyped Motor Movements and Speech
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
Preoccupations -Interests or Objects
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).