Autism in school-aged children

Spotting the signs of autism in school-aged children 

Younger children who have developmental delays are often diagnosed before the school years. However, children with typical language skills and average to above average intelligence may have more subtle symptoms and do relatively well until they’re exposed to the greater social demands of preschool or primary school. 

In fact, prior to starting school, some children may be assumed to be gifted and talented because of their special interests and precocious vocabulary.  It’s only when we start comparing their behaviour to that of typical children of the same age that their social challenges become apparent. 

There are autism screening tools for older children, including the Social Communication Questionnaire, the Childhood Autism Spectrum Test (CAST) and the Australian Scale for Asperger’s syndrome.  These tools are different from the early childhood screening tools, focusing more on social/conversational problems and fixated interests, and are suitable for use from the age of four years.  Again, none in perfect and no screening test should be used alone to rule in or rule out autism. 

One such tool is the Autism Spectrum Quotient: Children’s Version (AQ-10), designed for children aged 4 and above who do not have intellectual disability. This is available in adolescent and adult versions as well at www.autismresearchcentre.com.

Several autism guidelines, including diagnostic guidelines developed in Australia, now include information on the signs of autism in primary school-aged children. This information, summarised below, have been developed primarily for teachers and health professionals but is also useful for parents to see. 

Signs of autism in primary school children (aged 5 to 11 years of age) 

Spoken language may be unusual in several ways:

• Talking very little 
• Talking too much
• Monotonous tone of voice
• Repetitive language, with frequent use of certain phrases 
• Tendency to talk freely only about specific topics
• Talking ‘at’ others rather than in a two-way conversation

Responding to others

• Not appearing to notice and respond to others’ facial expressions and body language
• Sometimes not responding to their name being called (assuming adequate hearing)
• Difficulty with ‘small talk’
• Taking things literally and misunderstanding sarcasm or metaphor
• Responding to others in a way that seems rude or inappropriate

Interacting with others

• Reduced social interest in others, including children of their own age 
• If interested in others, may approach them inappropriately, seeming to be aggressive or disruptive
• Reduced awareness of socially expected behaviour, for example criticising their teacher and refusing to co-operate in class activities
• Difficulties sharing in the social play of others
• Not enjoying situations that most children do, such as school trips 
• Seemingly being unaware other’s personal space/ intolerant of people entering their personal space.

Eye contact, pointing and other gestures

• Reduced or poorly integrated use of gestures, facial expressions and eye contact when communicating with others (assuming adequate vision)
• Reduced pointing or showing objects to share interest

Play

• Reduced variety and flexibility in imaginative play

Restricted interests and/or rigid and repetitive behaviours

• Repetitive movements, such as hand flapping, spinning and finger flicking
• Repetitive play that object-focussed, not people-focussed
• Over-focused or unusual interests
• Insisting on following their own agenda
• Rigid expectations that other children should adhere to rules of play
• Strong preference for familiar routines and things being ‘just right’
• Difficulty coping with change or unstructured situations, such as the teacher being away.
• An over- or under-reaction to sensory stimuli, such as textures, sounds, smells, taste

Other

• Extreme emotional reactivity that appears excessive for the circumstances
• Unusual profile of skills and challenges (for example, poor social or motor coordination skills, while general knowledge, reading or vocabulary skills are well above chronological/mental age).
• Social and emotional development that lags other areas of development; naïve and overly trusting, less independent than peers.

If some of these features remind you of your child, please investigate further. Talk to your GP, or to their school about getting an autism assessment for your child. 

Note, however, that not all children will display all these signs. You may only recognise a few in your child. This is especially true if your child is a girl — girls often have better language skills and fewer repetitive behaviours than boys, as well as being more adept at hiding their social challenges.   

Many of the signs listed in the summary above are subtle and could easily be misinterpreted as ‘bad behaviour’. The last thing we want is for our child to be labelled ‘difficult’ or a troublemaker early in their school life when the behaviours they’re displaying are simply a function of their different neurological wiring. 

An official diagnosis should lead them to receiving more help and understanding at school. To not only survive but hopefully thrive in their important school years. 

Rose’s Story

When Rose was three years old preschool brought us in to talk how she was going. How she would retreat in group activities like circle time. She was overly cautious and wouldn’t do things like climbing frames or obstacle courses. She had very rigid thinking and would say that girls do this and boys do that. 

She also had this singsong voice, like baby talk, but more so than I would ever say is normal. And at school, they never heard her speak normally though she could do when with me. She was really struggling with reading and with writing. So, all that kind of stuff that led us to wonder if she had dyslexia. I took her to go see a developmental psychologist and they did an IQ test. 

She just struggled socially with friends. Even now at eight years old, she has not bonded with any children. She’ll say, ‘I just went to the library today and played by myself because I felt like I didn’t want to be around people today.’ She can’t read social cues easily.

Anxiety was also a problem for her and when she was diagnosed she also got the diagnosis of generalised anxiety. 

She said, ‘the classroom is too loud. I can’t think.’ There were only 16 kids in the in the class so it wasn’t a loud environment for a school, and she was struggling. We still were a bit like, you know, we don’t know what’s going on. 

I then sought help from my son’s OT, and she asked me, ‘Have you ever considered that Rose might be autistic?’ 

And I was like, ‘Excuse me?’  This was before we knew Thomas was autistic.  

And I said no and was in big denial about it. Everything I’d ever read about autism was very male specific and I said, ‘My daughter doesn’t line things up and roll things you know like play with wheels, or she’s not obsessed.’

The we talked about Rose’s emotions. She feels them more intensely than I could ever imagine. She feels these highs very high. And then the lows are very low.

She said, ‘Just trust me, just go and get her seen by a pediatrician.’ 

So, I went saw the pediatrician and she did the assessment on Rose. And she did come back as level one (ASD) but still autistic. And in some areas, she’s more like a level two, especially with the way that she deals with emotions.

Annie is mum to Thomas, five (level two ASD) and daughter, Rose, eight who also has a diagnosis of ASD. 

What to do first here in the Central West 

First of all, it is unfortunately the case that here in the Central West there is a shortage of paediatricians and psychologists. Accessing government-funded supports usually involves a very long wait, and even private professionals can take a long time to see.

So, the first things parents need to do is access online support and information. Start with:

Autism: What Next?

https://www.autismwhatnext.com.au/

This website has been designed to support families as they navigate concerns about their child’s development, through assessment and diagnosis and into the early years. There is a lot of information there, with videos and graphics. It is well worth spending a good amount of time here.

The Australian Autism Handbook, Edition 4. (I am a co-author of this book.)

This is a comprehensive guide to autism, with all the science you need plus many family stories. It gives you the facts, plus plenty of emotional support.

You can buy the book at all good bookshops, including Amazon. Buy it direct from the author and pay no shipping fees here: https://seanasmith.com/australian-autism-handbook/

Meanwhile, contact your GP to find out about your local  paediatricians and psychologists and get your name down. Many will have long waiting lists. I always advise asking to be put on their cancellation list as these do often happen. 

If your child does end up with a diagnosis of autism spectrum disorder, you might well find yourself feeling relieved and you understand your child better. You will be in very good company, many families have trod this path before and can offer support and guidance. 

This article is an edited and adapted extract from the Australian Autism Handbook, Edition 4. Co-author Seana Smith lives in Orange.