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High Pitched Screams
Dr. Smith explains that seemingly purposeless screaming can be a form of sensory stimulation for children on the spectrum.
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Playing with Toy Cars
Dr. Smith advises that odd or repetitive use of toys, a symptom of autism, can be difficult to detect as many typically devleoping children will engage in such activities briefly or as part of more functional play. Autism related, odd or nonfunctional sctions can be distinguished from these more typical behaviors by their highly repetitive, prolonged quality, their preoccupation of the child's attention and time, and their relation to sensory interests.
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Examples of Sensory Stimulation
Dr. Smith explains that not all children with autism (but many) engage in an array of unsual behaviors related to sensory interests, including oral, auditory, visual and tactile fixations. Making repetitive finger movements in front of the eyes is a classic symptom of autism that also likely has a sensory component.
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Odd or Inappropriate Intonation in Autism
Dr. Smith describes the differences in the intonation, rate or volume of speech found in some children with autism spectrum disorders.
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Gagging: A Sensory Stimulation
Dr. Smith explains that gagging is another type of sensory stimulation that can be included in the repetitive and restrictive behavior domain of the DSM criteria for autism.
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Stimming on the Wheels of a Toy Car
Unusual sensory interests can be expressed in a young child with autism through a strong, unusual interest in movement or repeated actions, such as the spinning wheels of a toy bus or car. The following clip demonstrates how such interests prevent Sajid, a young boy with autism, from playing with his toys appropriately.
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Sensory Seeking Behavior: Running in Circles
Sensory seeking behavior can be a warning sign for autism. While listening to music, Christian K., a child with autism, displays a repetitive, physical behavior, running around a chair in circles, that is potentially related to his sensory interests and needs. Particularly, the repetitive routine, and seemingly rigid nature of this behavior suggests that it may have a sensory component as opposed to being a typical celebratory dance.
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Sensory Seeking Behavior: Flipping Pages of a Book
Children with autism will sometimes do things to get sensory input. Rather than looking through and sharing a picture book with his father, a typical behavior for toddlers, Christian K. (2 years 9 months) quickly flips through the pages of a children's book while vocalizing to himself, a behavior likely related to his sensory interest in the sight of the flipping pages and images, rather than a true interest or understanding of the story.
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Mom Tries to Teach Lucas Play Skills
Lucas's mother tries unsuccessfully to engage Lucas in a game of legos. Lucas does not show an interest in this age appropriate toy or the prospect of interacting with his mother; rather, he disengages from her, focusing instead on some stray coins, staring at the wheels of a truck and eventually wandering off. Both Lucas' repetition of the word "coins" and his fixation on the truck wheels may reflect an intense sensory interest.
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Nathan Looking At Book Sideways
Flipping the pages of books, much like looking at train wheels or falling snow, provides Nathan with visual sensory stimulation, what his mother refers to as "stimming." Nathan is more interested in flipping the pages of books from an unusual, sideways angle than actually looking at the pictures they contain. Because sensory interests prompt such seemingly purposeless and odd behaviors, this risk alert is sometimes easier to spot.
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Nathan Hits Himself in the Head
Children on the autism spectrum may often engage in repetitive behaviors, the purpose of which is unclear to others. Here, Nathan, a child on the spectrum, repeatedly touches his head and hair, though it is unclear why.
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Sensory Seeking
Sensory seeking behaviors, that is behaviors related to seeking tactile, oral or visual sensations, are a common symptom in autism. Throughout his therapy session, Christian is distracted by sensory seeking behaviors, most notably, brushing his skin with his fingers and grinding his teeth.
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Wells: Then and Now: Repetitive Motor Behaviors
Repetitive motor behaviors can be a warning sign for autism. Wells liked moving his toy cars back and forth and looking at them at an angle to the exclusion of other more productive play activites. Wells' dad explains how Wells has shown vast improvements since therapy. Examples of Wells are shown at ages 2 years 8 months, and 3 years 5 months.
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Sensory Seeking Behavior
Sensory seeking behavior is a possible sign of autism. In this observation, though it appears that Ryan may simply be playing with a toy computer, his tendency to peer at the computer from different angles and swing his hand back and forth in front of the screen suggests that he may also be seeking out visual stimulation.
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Sibling Interaction
Dr. Smith discusses how difficult it is for a child on the spectrum to engage in and sustain appropriate, cooperative play with others and why sometimes they may resort to aggressive behavior.
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Spinning and Stimming
One early warning sign of autism is repetitive motor movements. Here we see Nathan spin his body around over and over while making repetitive, high pitched sounds. This unusual spinning behavior is clearly different than a simple spinning game. Rather, the purpose of Nathan's spinning is unclear and has a notable repetitive, stereotyped quality to it, consistent with an autism spectrum disorder.
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Risk Alerts Restricted and Sensory Interests
Dr. Deborah Fein discusses and explains restricted and repetitive behaviors and interests (RRBIs), one of the three domains that comprises an autism diagnosis. RRBIs encompass the risk alerts which are classified by the unusual behaviors performed repetitively or for sensory stimulation, including: Restricted and Sensory Interests and Motor Stereotypies.
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).