Dr. Smith describes how a child on the spectrum fails to give his mother a warm, flexible and spontaneous greeting. Similarly, Dr. Smith also describes the child's limited attempt to direct his mother's attention. Though he points out an object of interest, he does not look back to his parents to ensure that they see it and share his enthusiam.
Lack of joint attention is another possible warning sign for autism. Christian K. (2 years 9 months old with autism) is being read to by his father from a children's book. Christian K. shows very little interest in the book. He turns the pages before his father has finished reading and never points or makes eye contact with his father.
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.
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.
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.
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 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).
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).