• A Simple Request

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    Dr. Smith descirbes the many components that must be coordinate to carry out a simple request, including eye contact, communicative speech and gesture. Given that eeach of these skills may be challenging for a child with autism, many children with autism may chose to act for themselves, before they think or attempt to request help from others.

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  • Lack of Spontaneous Production of Language

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    Dr. Smith compares a typical child's frequent use of speech with his mother to the notable silence of two children on the spectrum. Whereas the typically developing child in this clip vocalizes either to express his needs or as part of a social interchange, the children on the spectrum in this clip rarely direct sounds of any kind toward their mother, though she frequently speaks to them and attempts to engage them.

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  • Lack of Expressive Language

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    Christian K., a child with autism, does not understand how to communicate his wants to others. He lacks both the language and the nonverbal skills, such as making eye contact, pointing or gesturing, to tell his mother that he wants more candy. Further, he does not seek out his mother, an example of the social disconnection central to autism. Even when his mother realizes what Christian wants and prompts him to request the candy by saying or signing "more," he struggles to do so.

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  • Lack of Expressive Language

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    Ryan, who is four and a half years old, has autism. One of the warning signs is lack of expressive language or the ability to speak. In this clip, Ryan mumbles gibberish to himself rather than using language. The symptoms of autism are clear in both his lack of language and his tendency to be "in his own world," mumbling and laughing to himself rather than engaging with the other people in his home.

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  • Playing with a Balloon

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    Ryan, who is four and a half years old, has autism. Here, he insists on playing with a balloon only with his mother and has a tantrum when the evaluator, Connor Puleo, attempts to play with him. There are many warning signs shown here for autism. In particular are the many examples of echolalia where Ryan repeats his mother's questions rather than answering them. Other warning signs include Ryan's clear delays in language, lack of eye contact, lack of gestures or pointing to communicate his wants and possibly insistence on sameness.

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  • Pretend Play at Speech Therapy

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    In this video the speech therapist is playing house with Leighdionne. She uses the pretend game to not only teach and encourage her to speak certain words, but also to engage in and understand appropriate pretend play.

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  • Gabriel Plays The Guitar and Sings

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    Gabriel shows off his relatively strong skills and interest in music. Children with autism are often described as having variable skills, in that they may have strong skills in one area, such as music, but also show large deficits in other areas of development.

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  • Nathan Can't Express Himself

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    Nathan wants books from a drawer, but lacks the verbal and nonverbal communication to ask for help. He does not look for his mother until she calls his name, and he does not ask for help or gesture in any way to communicate his needs.

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  • Christian Communicates

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    Some chidlren with autism have significant language delays, such that they may use no or only a few words meaningfully and spontaneously. At 5 years old, Christian speaks only a few words, which include "mama," "Keekin" (Christian),"Titi"(his brother) and "mu" (music).

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  • Sal's Regression

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    Some children with autism may demonstrate typical behavior initially but fail to develop further or even lose skills they had previously mastered. Sal, a young child with autism, regressed from an energetic baby, who would captivate audiences at parties with his bubbly personality, to a distant child who would wander away with a flat affect. In less than a year after his birth, Sal became increasingly unresponsive to both languange and his name, demonstrating less vocalization and interest in communicating with his family/peers. Sal's parents' useful home videos and distinct memories provide a powerful recount of his rapid transformation to a child on the spectrum.

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  • Some Interest in Peek a Boo

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    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)

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    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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  • Restrictive Behavior (Sal Wants Rocky)

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    Children with autism may become fixated on specific desires, so much so that it will restrict their ability to do anything else. Sal's desire to "see rocky" is so intense that it distracts him from doing anything else, such as completing a puzzle with his father.

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  • Nathan Likes Toy Bunny; Signs for More; Joint Attention

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    Latha Soorya, PhD, uses Nathan's interest in a toy rabbit to assess his nonverbal communication skills. Though Nathan uses several positive nonverbal communication skills when he gives the rabbit to Dr. Soorya and signs for more, he rarely coordinates eye contact or vocalization with these requests. His language delay is also clear in that he cannot generate language even when very motivated to request the bunny. Additionally, he appears to become fixated on the bunny, crying when Dr. Soorya puts it away. Nathan's poor coordination of nonverbal cues, lack of expressive language and fixated interest on the bunny are all suggestive of an autism spectrum disorder.

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  • Difficulty Climbing Steps

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    Many children with autism experience gross motor delays or delays in their ability to move about and coordinate their movements. We see how Nathan struggles and resists walking up stairs.

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  • Risk Alert Expressive Language

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    Dr. Deborah Fein explains the forms of expressive communication that children use and how the lack of these communicative efforts may indicate a child is at risk.

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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

Social Emotional Reciprocity

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.

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).

Routines, Sameness, Rituals

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).

Sensitivity to Sensory Input

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).

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