This document is a non-working example of a set of exploratory questions to help identify autistic traits and co-occurring conditions in children of primary school age.
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Human communication is the process by which people exchange mutually-understood information and influence one another. It is made possible through the use of language, the diverse system of sounds, gestures, or symbols acquired through learning.
The different types of language are
- spoken language, the verbal way of sharing information with others which uses the voice to produce sound patterns and tones, which are the variances in the sound used to express emotion.
- written language, a nonverbal way of sharing information with others using
- a visual sequence of symbols to represent spoken language as marks on a medium such as paper or a screen
- a non-visual touch system of communication for people who are blind, in which blocks of raised dots represent letters of the alphabet, numbers, punctuation marks and special characters.
- sign language, a visual but nonverbal way of communication for people who are deaf, nonspeaking or nonverbal, in which information is shared using hand gestures, facial expressions, and body language.
Compared to a typical child of similar age how would you describe your child's ability to understand and comprehend the language they hear or read?
Human speech can be described as the use of the voice to create sounds that communicate thoughts as spoken words from within a language in such a way as to convey meaningful messages.
Speech is a complex set of skills that combines
- articulation, which is the ability to produce singleton sounds accurately using the tongue, lips, jaw, teeth, palate, and vocal folds as required
- phonology, which is the organising of the patterns of single and groups of speech sounds in the brain and then being able to say them
- intelligibility, which is how understandable the speech is when the speaker delivers it to an everyday user of the same language.
The essence of a person's speaking involves
- accent, which is the distinctive way a speaker has of pronouncing a language
- pitch, which is how high or low the speaker's voice sounds
- volume, which is how loud or quiet the speaker's sound is
- duration, which is how long the speaker holds the sound for.
Although each child will develop their speech and language skills at their own rate, there are typical communication milestones
- by twelve months a baby being able to react to certain words, follow simple commands, and copy some sounds
- by eighteen months the child starting to use language in a more recognisable way and understand some simple words and instructions
- from two to three years' old, the child being able to say more than a few basic words and put those words together in an order that makes simple sentences
- from three to four years' old, the child's speech being easily understood by their close family and familiar caregivers
- from four to five years' old, the child's speech being easily understood by people with whom they do not have regular contact
- from five to six years' old, the child being able to follow multi-step instructions and the meaning of other people's conversations
- from six to seven years' old, the child being able to share ideas and listen for a sustained period of time to other people's conversations.
Compared to a typical child of similar age how would you describe your child's ability to express their thoughts in spoken words in a way that an everyday user of the same language could comfortably understand?
The combined skills associated with the ability to communicate with other people in an appropriate way are the foundation of comfortable social interaction. This includes what we say, how we say it, our facial expressions and body language, and how appropriate our interactions are in a given situation.
Pragmatic language has three major skills associated with it
- knowing what to say, such as
- greetings and goodbyes
- informing of intent to act
- stating intent to act
- making requests
- demanding action
- avoiding repetition or irrelevant information.
- knowing how to say something, such as
- adjusting style of speech to correctly suit the situation or person
- adjusting content to correctly suit the situation or person
- conversational skills
- using humour.
- knowing when to say something, such as
- taking turns when in conversation and using appropriate strategies for gaining attention and interrupting
- asking for clarification or help, or offering help appropriately
- staying on topic and not skipping between random or loosely associated conversational strands
- making relevant contributions to a topic
- introducing and maintaining new topics rather than focusing on one.
Non-verbal pragmatic skills that are vital for successful social communication include
- the use and understanding of appropriate situational body language, such as
- facial expressions
- eye contact
- gestures.
- maintaining body distance and personal space
- waiting and turn taking.
Pragmatic skills can be poorly developed or absent in autistic children and can lead to the child unintentionally causing offense when none was meant by being seen as rude, defiant, disrespectful, or insubordinate.Compared to a typical child of similar age how would you describe your child's ability to adapt their combined use of language and style of speaking to correctly suit the social context?
Autistic children will often think, listen, speak, read and write literally and logically. They may interpret words and phrases exactly as spoken, without realising that the expressions convey a hidden meaning that differs from their literal translation.
Examples include- difficulty recognising sarcasm, a form of verbal irony that involves saying something contrary to what is actually meant, often with a mocking or humorous intent, to convey a hidden meaning
- difficulty recognising and interpreting idioms, metaphors and similes.Idioms are phrases or expressions that have a non-literal meaning, such as
- “Make up your mind”
- “Crying your eyes out”
Metaphors are figures of speech that directly refer to one thing by mentioning another, such as - “Your head is in the clouds”
- “You are my sunshine”
Similes are figures of speech that directly compare two things, such as- “You are as innocent as a lamb”
- “You are as busy as a bee”
Cognitive ability can be impaired in autistic children and cause them to respond too literally, examples beingYou say to your child “pull your socks up”, meaning to make an effort to improve their performance or behaviour, but- if wearing socks, they pull them up as requested
- if not wearing socks, they become confused or distressed.
You say to your child “Hello, how has your day been?”- they understand all of the words
- the order the words are presented in makes sense
- however, the question is non-specific in its request and requires a summing up all of the related and unrelated events that have happened throughout that day in a single answer
- the autistic mind is unable to process the request resulting in distress and heightened anxiety.
You say to your child “What did you think you were doing!?”- the question seems to make sense so they answer literally with “I was running for the bus”
- they are then punished for bad behaviour, but also admonished for being disrepectful
- they do not understand why they have incurred someone's anger for being honest
- the result is distress, confusion, and a possible snap onset of depression.
Compared to a typical child of similar age how would you describe your child's ability to recognise non-literal language, successfully interpret its true meaning, and respond in a way that was not oversimplified?
Conversation can be defined as a talk between two or more people in which thoughts, feelings, and ideas are expressed, information is exchanged, or questions are asked and answered.
When autistic and non-autistic people come together, confusion surrounding each others differing needs, expectations and styles of conversation can cause a communication breakdown on both sides.An autistic child might- prefer conversation to be direct and provide all relevant information clearly and in as few words as possible, avoiding things they might find difficult to recognise such as hints, implied meanings and assumptions
- prefer conversation to be fact-focused, avoiding things they might not understand the need for such as small-talk or speculation and gossip
- show a preference for “info dumping”, where they monopolise conversations for extended periods to relay excessive amounts of information on topics of special interest to them
- communicate with another person in a style that could be described as talking “at” them
- need additional time to interpret the meaning behind everything being said, so try to avoid faster-paced conversations or group social settings
- only be able to relax enought to involve themselves in conversation when in environments that do not overwhelm their senses.
Compared to a typical child of similar age how would you describe your child's ability to engage in free-thinking conversation about a broadening range of subjects?
Autistic children may often ask a large number of literal questions, those being direct questions that require straightforward and readily understood answers and have no complex purpose or hidden agenda.
Persistant questions, such as- asking “why” excessively but in an innocent way
- that is not meant to be disrespectful
- that is not a passive-aggressive challenge to the other person's authority.
- questions that focus on specific topics of particular interest to them
- questions about what is happening around them
- questions about what is going to happen soon
- questions about when something is going to happen
- questions about the answers they receive to their questions.
Repetitive questions, where the child seems to become stuck in a thought loop and asks the same question over and over again, and the process can include- repeatedly asking the same question in exactly the same way
- asking the question in a different way but still making the same basic enquiry, so actually still asking exactly the same question
- interrupting conversations to ask the question
- becoming overly frustrated if the answer given to the question is different to the previous one.
How would you describe your child's ability to engage in conversation that was not dominated by them asking persistant or repetitive questions?
Talking in monotone describes speaking in a flat and unvarying way that sounds repetitive and disinterested from the speaker and dull and uninteresting to the listener.
Key features include- the speaker's voice having very little or no noticeable changes in tone, speed, and volume
- the speaker's voice lacking emphasis with no rising or falling pitch
- the speaker's voice remaining consistently flat and emotionless
- the speaker using incorrect or no pauses.
Normal flow of speech should be clear and fluent with the speaker conveying meaning without significant effort. It should be easily understood by a listener who speaks the same language and should not contain noticeable errors in articulation or language structure.The speaker should be able to- produce sounds accurately
- use appropriate vocabulary, the learnt collection of words used by the speaker to help convey ideas, emotions, and information
- use appropriate grammar, the set of rules that govern how words or groups of words and sentences should be arranged together
- have varied intonation, the way the pitch of the speaker's voice rises or falls when speaking and helps to express emotion, add emphasis, and organise speech into units that are easier to understand
- speak at a pace and volume that are comfortable for other people to experience.
Compared to a typical child of similar age how would you describe your child's ability to inject natural rhythm and flow into their speech by using variations in pitch, tone, volume, speed, and pauses to emphasise certain words or ideas and convey meaning?
Echolalia, also known as parrot talk, is the unrequested repetition of vocalisations made by another person.
The speech repetition can be directed towards a particular person or non-person directed.There are two major types- immediate echolalia, where the repetition of speech occurs immediately after the original utterance
- delayed echolalia, when the repetition of speech occurs sometime after the original utterance.
The features of speech repetition can be- unmitigated, where the repetition of speech is an exact mimic of the original utterance
- mitigated, when the repetition of speech is altered.
The purpose for the repetition can be- communicative, known as functional or interactive echolalia, where the repetition has an apparent meaningful or communicative purpose, such as the child using a phrase memorised from an advert that says “the best whataburger anywhere” to indicate that they are hungry
- semi-communicative, where the repetition lacks any clear communicative purpose but may be linked to self-soothing, with the child repeating memorised words and phrases that are abstract to the situation.
How would you describe your child's level of impairement from using spoken language that simply involved repeating other people's choices of words and tone?
Dysfluent speech patterns are any of a variety of breaks, irregularities, or nonsensical word variations that occur within the flow of otherwise fluent speech.
Stuttering or stammering, which is when the child knows exactly what they want to say but struggles physically to get the words out, and examples include- repeating sounds, for example “a-a-a-ction”
- repeating syllables, for example “ju-ju-ju-jump”
- prolonging sounds, for example “ssssscamper”
- becoming blocked on a sound, during which it will take time for the word to come out, for example “a - - - live”.
Cluttering, which is when the child is unsure what they want to say and speaks at a rate that is too fast for them to cope with or for the listener to comfortably understand, and symptoms include- excessive repetition of whole words or phrases
- excessive revision of ideas, such as “I would like to - I was thinking about going to the park”
- a lot of hesitations such as “um”, “erm”, “hmm”, “uh”, “huh”
- overuse of filler words such as “like”, “so”, “well”
- excessively joining sounds in words together without breaks, such as “it sounds like this” becoming “tsoundslikethi”
- excessively deleting sounds or syllables, such as “computer” becoming “puter”
- pauses in places where you would not expect the speech to break grammatically.
Atypical dysfluencies, for example- repetition at the ends of words, such as “buzzzzz”
- extending sounds at the ends of words, such as “buzz-uzz”
- the repetition being split and another thought sandwiched within it, such as “I want to pl - that is a nice dog - ay in the park”
- inserting a sound in the middle of a word, such as “dog” becoming “dog-og-og”.
How would you describe your child's ability to talk in a way that was unimpaired by any aspect of dysfluent speech?
Children with autism may want to interact with others, but often lack the social skills to engage appropriately.
Social and emotional learning can be defined as the interrelated combination of- self-awareness, which defines your ability to understand your emotions, thoughts, and values and their influence on your behaviour
- self-management, which defines your ability to manage your emotions, thoughts, and behaviours effectively
- social awareness, which defines your ability to understand the perspectives of other people and show empathy for them, regardless of their background or status
- relationship skills, which defines your ability to establish and maintain positive and supportive relationships
- responsible decision-making, which defines your ability to make well-informed and constructive choices about your behaviour and social interactions.
Other children may respond negatively to an autistic child's differences and subject them to- manipulation
- humiliation and ridicule
- threats and intimidation
- physical and social bullying.
When looking specifically at your child's social and emotional personal development, particular areas of focus are- whether they lack common sense, regardless of their level of intelligence
- whether they are extremely naive and have an overly simplified view of life
- whether they lack experience and have an overly uncomplicated view of life
- whether they are overly trusting and see people as honest and kind, even if those people might not be
- whether they are less independent than could reasonably be expected from their age group.
Compared to a typical child of similar age how would describe your child's level of social and emotional maturity?
Autistic individuals may have challenges with understanding and using nonverbal cues during social communication. As a result, they may suffer from below average and poorly integrated facial expressions and body language compared to what is seen as typical behaviour.
Examples of unconventional facial expressions during social interaction can include- reduced emotionally-driven facial expressiveness, except for smiles and frowns which can have similar intensity and size to neurotypical individuals
- difficulty understanding the meaning of facial expressions during social communication, in particular those not directly linked to smiles or frowns
- a reduced liklehood of showing unconscious social connectivity by mimicking the facial expressions of people with whom they share social interaction
- odd or ambiguous facial expressions that can be difficult to interpret.
Examples of unconventional body language during social interaction can include- reduced or non-existant eye contact
- gaze patterns
- reduced use of gestures and a lack of understanding about how gestures can be used to enhance verbal communication or express feelings
- unusual mannerisms such as hand flapping, rocking or swaying
- awkward physical closeness whereby they stand too close to other people in conversation and make them uncomfortable.
Compared to a typical child of similar age how would you describe your child's overall ability to use integrated facial expressions and body language when involved in social interaction?
Social hierarchy can be thought of as the structured ranking of individuals based on social status, the position or rank assigned to a person in relation to the other people around them.
The ability to know and understand the concept of social hierarchy is something children are expected to learn as they grow into their environment and experience social interaction.Autistic children can struggle with a basic understanding of hierarchical rules and see everyone as equal. This can cause particular problems in institutions that are clearly defined by hierarchy, such as schools.
How would you describe your child's ability to correctly identify and respond to any difference between their social status and that of the people they meet within the layered ranking of accepted social hierarchy?
Children with autism can have difficulty understanding the concepts of both physical space and personal boundaries. They can unwittingly approach another person then behave around them in a way that could be misinterpreted as invasive, aggressive or upsetting.
Markers can include- a noticeably reduced awareness of being too close to another person
- touching other people in an unusual way
- walking in between two people who are talking
- being unaware that they are talking too loudly or making too much noise.
Compared to a typical child of similar age how would you describe your child's combined ability to respect and not invade other people's personal space?
Children with autism may struggle to understand abstract concepts or things they cannot see.
This can manifest itself as- difficulty adapting to fluid situations and understanding what is required of them
- understanding the world only from their own perspective with no concern for other people's viewpoints
- difficulty learning, applying, and being flexible to seemingly abstract rules, possibly leading to oppositional behaviour
- an inability to conceptualise time, so struggling to imagine why or how long they will have to wait.
Compared to a typical child of similar age how would you describe your child's ability to wait patiently or without pushing in?
Empathy describes the ability to relate to other people on a deeper emotional level and it forms a vital part of social connectedness.
Cognitive empathy requires intellect and a conscious effort to try to understand another person's emotions and guess reasonably accurately what they are thinking or feeling and why.Emotional empathy describes the ability to share another person's emotional experience and is sometimes described as “feeling what they feel”. It is typically founded on the person's individual experiences of similar emotions or situations, and examples include- being able to recognise then feel the same emotion as the other person
- feeling distress in response to the other person's pain
- feeling compassion towards the other person and a willingness to help them
- understanding when emotional empathy is the appropriate emotion or skill to use.
Compared to a typical child of similar age how capable would you say your child was of quickly interpreting another person's body language and facial expressions, connecting with them on an emotional level, then responding in an appropriate way?
Social interaction is a dynamic and unpredictable sequence of social actions between individuals or groups. It can be a particularly intense and overstimulating experience for an autistic child.
Social anhedonia describes a significant lack of interest in social contact coupled to an obviously reduced ability to derive pleasure from social situations.Symptoms include- social withdrawal or isolation
- reduced interest in social contact and interaction
- a reduced ability to derive pleasure from interpersonal experiences
- a lack of close friends and intimate relationships, and decreased quality of those relationships
- difficulty adjusting to social situations
- depressed mood.
Social fatigue can occur after having engaged in full social interaction. The feelings can range from mild fatigue through to exhaustion and last from a few hours to days after the event has finished.Causes can include- the strain of reading facial expressions and body language and trying to interpret the intentions behind certain interactions
- becoming overwhelmed by the sensory input of large crowds or loud noises
- emotional overload by taking on the emotions and feelings of those around them, multiplied by the number of people involved in the social situation
- having to employ masking behaviours for long periods of time.
Markers can include- an onset of tiredness or exhaustion shortly after a social activity
- wanting or needing time away from social situations to recharge after a social activity
- experiencing heightened post-activity anxiety and stress, such as
- headaches
- difficulty concentrating
- difficulty sleeping
- increased moodiness.
- post-activity meltdown
- post-activity onset of depression.
How would you describe your child's approach to allowing regular social interaction to form a normal part of their everyday life?
Autistic children may not understand the concept of ownership and sharing so can have difficulty advancing from solitary play to partnered or group play. They may also have difficulty coping if their rules of play are not strictly followed by the other participants in the activity.
A child with autism may occasionally be amenable to parallel play, whereby they can engage in a solitary activity whilst being in the same room as others.Given the choice they may prefer to engage in completely solitary activities that let them keep control and manage their feelings or avoid sensory overload and provide them with self-stimulation.
Compared to a typical child of similar age how would you rate your child for their willingness to engage in the social play and creative ideas of familiar adults and children within their own age group?
A child with autism may struggle to spontaneously create and participate in imaginative play, and symptoms can include- more repetitive or literal play patterns, such as repeatedly re-enacting scenes from the internet or TV
- play that is more oriented towards objects than to interacting other people
- difficulty engaging in pretend scenarios
- difficulty with tasks that require creative flexibility to generate new ideas within an existing concept.
Autistic children may develop intense passions or obsessions with specific topics or activities, often surpassing what is considered typical or expected, and examples might include- repeatedly watching scenes from the internet or TV
- listening to or playing music in a repetitive way
- fascination with trains, specific animals, dinosaurs, or cartoon characters
- becoming overly attached to objects (or parts of objects) such as toys, dolls or figurines, socks or shoes
- collecting items such as bottle tops, stones, postcards, postcodes or numbers.
Conversely, autistic children can excel creatively with originial thought to produce ideas that are new and unique, and examples can include- deep imaginative play, possibly including long periods alone or talking to themselves, whilst creating stories with great detail and characters, sometimes with strange combinations of objects as body parts for specific purposes
- visualising connections between everyday objects that are abstract to reality or creating drawings that reveal extraordinary artistic interpretations of shape and the relationship between objects
- building novel structures out of toy blocks that have not existed before
- heightened visual perception, vivid imagination, and enthusiastic use of digital technology to lift ideas out of their mind's eye and into “reality”.
Autistic children may also have the ability to remember detailed information for long periods of time. This can lead to superior performance in subjects that require memorisation, such as music, history, mathematics or the sciences.
Compared to a typical child of similar age how would you rate your child's creativity?
A child's ability to respond to their name is foundational in the evolution of complex communication skills and in learning to understand simple verbal instructions, such as those linked to recalling them from a dangerous situation.
An autistic child may not respond to their name being called, and reasons can include- being unable to because they do not understand what is expected of them, in particular within the give-and-take of even the most simple of social interactions
- refusing to because they do not value social interactions so lack motivation to respond
- a demand avoidance reaction in response to experience of their name being called in association with punishment for behaviour or failure.
How would you describe your child's ability to respond appropriately when their name was called?
An autistic child may seem to avoid eye contact altogether or make fake eye contact, such as looking just above the other person's eyes or having a downcast gaze.
Any child might avoid eye contact for reasons such as- feeling a general sense of social anxiety or shyness
- being fearful of or harbouring a dislike of the person who is attempting to make eye contact with them
- being hard-of-hearing or deaf so unaware that they should look at someone
- coming from a culture where direct eye contact is seen as a sign of disrespect.
For an autistic child there can be significant additional complications, examples being- finding eye contact an intense and overwhelming sensory experience, possibly leading to increased anxiety, stress and pain
- the confusion caused by trying to focus on spoken language and another person's eyes at the same time
- the distracting nature of processing verbal information when also concentrating on making eye contact
- a reduced or absent understanding of the social significance of eye contact.
How would you describe your child's willingness to make and maintain direct eye contact with another person when involved in social situations?
Joint attention is the coordinated act of two people concentrating on the same thing at the same time.
Examples include- when you point at something with a finger, whether your child reasons to look where you point or simply looks at your hand
- when you turn your attention to something with your eyes, whether your child reasons to look where you look or simply looks at your face.
How would you describe your child's ability to pay attention to the same thing as the person they are interacting with at the same time?
Autistic children can struggle with cognitive inflexibility and find change or transition particularly challenging, especially if it is sudden or unplanned. They can be triggered to very high levels of anxiety and stress or shows of aggression if confronted with variation to their routines.
Markers can include- becoming distressed by changes to their environment, such as
- the absence of familiar people
- the presence of new people
- a change to the furniture layout in a room.
- having rigid preferences about things, such as
- only eating foods
- only wearing clothes
- only being willing to use particular types of objects or branded products.
- a heightened need for routine around daily activities, potentially to the point of demanding an exact sequence of events that is followed with precise attention to the tiniest detail, for example
- a strict order to how they get dressed
- a need to travel via a specific route when going to familiar places
- a very particular sequence of events in the lead up to bedtime.
- struggling with transitions, such as stopping play when it is time to do something else or moving between schools or classes
- engaging in rituals to reduce anxiety and increase feelings of control, for example
- having to get out or use their favourite objects at particular times
- repeatedly arranging their favourite objects in a particular way
- repeatedly asking the same questions and expecting specific answers.
In sensory-intensive environments the effort of trying to cope with the multiple aspects of change can trigger bolting or a meltdown, or contribute to multi-sensory overload or autistic burnout.How would you describe the frequency and scale of any heightened emotional reactions by your child in response to changes to their familiar routines, rituals, or surroundings?
In sensory-intensive social environments the effort involved in trying to camouflage themselves can contribute to autistic burnout.
This question explores whether your child tries to avoid drawing attention to themself if they become involved with a group of people through the concealment by social camouflaging.Example avoidant behaviours include- not joining in with conversations
- avoiding asking questions
- avoiding talking about themselves
- keeping to the outer edge of the group
- sticking to the edge of a room
- keeping still.
When involved in group social interaction, how often has your child gone to excessive and obvious lengths to avoid drawing attention to themselves?
For this question the point of focus could be a certain person the child comes into regular contact with or a particular character from social media, TV, films etc.
Costume play, also known as “cosplay”, can enable an autistic child to make social connections despite challenges with social interaction. Rather than actively hiding their autistic traits, cosplay can provide a way of camouflaging positively and encouraging self-acceptance.This question explores whether your child's behaviour takes them excessively beyond cosplay or simple inspiration to consciously or subconsciously- using facial expressions and body language that wouldn't come naturally to them but mirror those of another person
- mimicking another person's speech patterns and use of language
- excessively copying another person's dress style and other elements of appearance.
How would you rate your child for becoming fixated on another person and excessively copying them?
This question explores whether your child feels a need to hide their special interests or fake enjoyment in the interests of others.
Examples can include- concealing or not discussing their special interests for fear that they might be interpreted as unusual or socially unacceptable
- minimising or hiding their own special interests and pursuing the same interests as their peers
- choosing a specific interest based on its social acceptability but taking real pleasure from some peripheral aspect, such as supporting a popular sporting team but taking particular interest in their scoring statistics.
When involved in social interaction, how often has your child been known to intentionally hide their personal interests?
This question explores challenges your child might face with communication when trying to navigate social situations.
Difficulties with speech can include- avoiding spontaneous or unscripted conversation
- using pre-planned or scripted conversations or responses for different social situations
- despite being verbally capable, having difficulty describing their thoughts and emotions so using as few words as possible to do so
- having difficulty expressing their wants or needs
- difficulty understanding expressions or phrases that have a meaning beyond their literal interpretation, such as sarcasm.
Difficulties with behaviour can include- carefully managing their facial cues to match expected social responses, such as pretending to be relaxed
- forcing themselves to make eye contact when it does not come naturally to them
- excessively adjusting tone, pitch, or pace to mimic normal speech, such as pretending to be interested
- artificially adjusting their body posture, gestures, or physical reactions to try to appear more “normal”.
Social indicators can include- coping during organised and structured social experiences but becoming confused if faced with unplanned situations.
- overcompensating when interacting with other people and possibly being labelled as “too quiet” or “too nice” or “too good”
- avoiding social interaction altogether despite not being naturally reclusive.
When involved in social interaction, how often has your child been known to change their behaviour in an attempt to make themselves more socially acceptable to other people?
This question explores whether your child tries to supress self-soothing behaviour when presenting themselves for social interaction with other people.
Behavioural distortions can happen in formal situations, such as at school, and in informal situations, such as in the company of family or friends.Examples can include- switching from an overt behaviour such as arm or hand flapping to a less noticeable stimulation such as excessively playing with a pen
- switching from an overt behaviour such as finger-flicking to a less noticeable stimulation such as excessively twiddling their hair.
When involved in social interaction, how often has your child deviated from their natural behaviour in an apparent attempt to reduce or hide a known need to perform repetitive and oversimplified movements that fit a pattern of self-soothing?
This question explores whether your child tries to hide or control heightened or reduced sensory sensitivities when presenting themselves for social interaction with other people.
Examples of sensory suppression include- being very sensitive to touch but attempting to endure uncomfortable clothing or not flinching or wincing when someone touches them
- tolerating overwhelming sensory inputs whilst hiding the discomfort caused by overstimulations, such as certain tastes, textures, loud noises or bright lights
- downplaying the distress or discomfort caused by sensory overload
- suppressing a known urge to engage in behaviours that provide sensory input, like touching specific textures.
When involved in social interaction, how often has your child tolerated actions that are known to be uncomfortable or unnatural for them in an apparent attempt to reduce or hide their sensory sensitivities?
Physical affection is a commonly recognised way to help build relationships with expressions of love and support.
Affection hyposensitivity describes a reduced responsiveness to sensory stimulation caused by intimate touch and a consequent heightened need for physical affection, such as- wanting to be overly touchy
- a frequent need for hugs, cuddles or kisses from those close to them
- wanting to kiss and hug strangers
- being unusually tolerant of people entering their personal space.
Affection hypersensitivity describes a heightened responsiveness to sensory stimulation triggered by affectionate intimate touch. Adverse reactions to physical affection can range from mild discomfort to severe distress or meltdowns, and symptoms can include- avoiding physical contact
- a visible show of distress if approached for a show of physical affection
- pulling away or flinching during a show of physical affection
- verbal expressions of discomfort before, during or after a show of physical affection
- experiencing increased anxiety or meltdowns during or after a show of physical affection.
Hyperalgesia causes a child to experience amplified pain from a normally painful stimulus, resulting in a pain response that is far more severe than would typically be expected.Allodynia describes a condition in which a pain response is triggered by a stimulus that would not normally warrant it. Individuals with chronic pain conditions may experience increased pain and discomfort which can significantly impact sleep, mood, and overall quality of life.
The three types of allodynia are- tactile allodynia, including
- static mechanical allodynia being touched causes a pain sensation
- dynamic mechanical allodynia where light stroking causes a pain sensation.
- thermal allodynia, where pain from normally mild skin temperatures in an affected area elicit a pain response
- movement allodynia, where normal movement of healthy joints or muscles elicits a pain response.
In crowded sensory-intensive public environments, accidental physical touch or compressed personal space can trigger bolting or a meltdown, or contribute to multi-sensory overload or autistic burnout.How would you describe your child's approach to participation in simple shows of physical affection?
Clothing hypersensitivity describes a heightened responsiveness to sensory stimulation caused by touch sensation associated with certain types of clothing or textures of cloth.
Examples include- distress or refusal to wear situation-appropriate clothing, such as a school uniform or the right coat for the weather conditions
- forcibly undressing themselves or tearing clothes off, regardless of the surroundings.
Reasons for negative behaviour surrounding clothing could include- having sensory challenges that cause them difficulty with the sensation of wearing clothing that is
- too tight or too loose
- too heavy or too light
- has scratchy seams and tags that rub against their skin in an uncomfortable way.
- a lack of language skills frustrating their ability to describe their distress or discomfort
- being less aware of appropriate behaviour or the idea of imitating their peers
- not understanding what is being asked of them.
How would you describe your child's level of hostility towards being clothed or their aversion to certain cloth types?
Feeding and eating can present multiple challenges for an autistic child because of the heightened responsiveness to sensory stimulation caused by certain foods.
Examples can include- a clear reluctantance to try new foods
- craving very specific foods and only eating foods of a certain colour, texture, or shape
- eating too little or too much
- pica (eating things which are not edible)
- problems when eating, such as
- extensive choking, coughing or gagging
- foods or liquids emerging through their nostrils
- loss of oxygen, possibly to the point of turning blue or purple.
Additional challenges can include- difficulty sitting for meals
- refusing to touch certain foods or utensils
- exhibiting extreme food fads, such as
- only eating certain foods on certain days of the week
- only eating specific brands or food from particular food outlets.
- spontaneously eliminating food from their diet despite having previously eating it.
It is also possible for an autistic child to develop avoidant restrictive food intake disorder, also known as ARFID, which can cause them to restrict their diet for reasons including- sensory food aversion leading to an avoidance of certain types or textures of food
- anxiety brought on by the distress of negative experiences when eating food, such as choking
- accumulated distress from eating leading to a lack of interest in food.
In sensory-intensive environments such as busy restaurants or school cafeterias feeding and eating hypersensitivities can trigger a meltdown or contribute to multi-sensory overload or autistic burnout.How would you describe your child's level of hostility towards foods that irritate or repulse them?
The complex skill of keeping clean combines multiple smaller skills and can overwhelm the senses of a child with autism, leading to below average personal hygiene.
Examples include- substandard washing habits
- distress when having their nails clipped
- distress when having their hair cut
- an inability to brush their teeth thoroughly
- heightened distress when visiting the dentist, reasons including
- not understanding why they need to go to maintain healthy teeth
- sensory overload from cold instruments entering their mouth, the noise of the drills and cleaning instruments, or the taste of the dental chemicals
- the dentist severely invading their personal space.
For autistic children the process of developing a toilet routine can take longer than for a typical child and can involve some unique challenges, such as- difficulty coping with the transition from wearing nappies to using a toilet
- not understanding the social requirement to use a toilet
- impaired interoceptive awareness affecting their ability to recognise the signs that they need to go to the toilet
- difficulty communicating the need to go to the toilet
- finding the combined sensory experiences of toilets, hand dryers, or smells of cleaning products very stressful
- impaired proprioceptive function making it difficult to wipe themselves properly
- liking the sensory experience of fecal smearing.
Underdeveloped personal hygiene and toileting habits can have significant negative social implications as a child ages, and autistic children can also be prone to- gastrointestinal problems such as
- irritable bowel syndrome
- stomach aches
- acid reflux, nausea and vomiting.
- chronic diarrhoea or constipation
- bladder problems or incontinence.
How would you describe your child's ability to practice good personal hygiene and toileting habits in their daily life?
Interoception is the conscious and subconscious collection of senses that provide a person with information about the internal condition of their body and enables them to manage their physical and emotional states.
Markers of reduced interoceptive awareness can include- having difficulty self-regulating emotions, such as
- becoming anxious before realising it
- becoming frustrated before realising it.
- difficulty recognising body signals and self-managing them, such as
- not linking a rumbling stomach to being hungry
- not linking a need to drink to being thirsty
- not recognising a need to go to the toilet in good time
- not linking being tired to a need to sleep
- having to be prompted to act on body signals.
How would you describe your child's ability to recognise physical or emotional changes within themselves and act on them?
Proprioception is the body's ability to sense its position, movement, and orientation in space and provide the brain with the information it needs to coordinate movements, maintain balance, and navigate the surrounding environment effectively.
Proprioceptive dysfunction can be caused by the heightened sensory processing challenges attached to sensory input related to body position and movement.Reduced proprioceptive ability can lead to difficulty with motor skills, such as- a lack of awareness of where their limbs or body are in relation to their surroundings, potentially leading to
- clumsiness or awkward movements
- difficulty judging personal space.
- difficulty determining the correct amount of strength to apply to different tasks
- difficulty gauging the appropriate amount of pressure or force when interacting with others
- problems with successfully employing tools or utensils for simple tasks
- placing or holding their body in strange positions or turning their whole body to look at something.
In some autistic children the vestibular system, located in the inner ear and used to help maintain balance and body position in space, may be oversensitive to movement and balance cues.Symptoms can include- difficulty with sports or activities which involve movement and balance, possibly to the point of prompting a fear response
- struggling to maintain balance while walking
- difficulty walking on uneven surfaces
- becoming distressed if their feet leave the ground.
How would you describe your child's ability to coordinate and control their movements and maintain balance?
Sensory hypersensitivity describes over-responsiveness to sensory stimulation and this question focuses specifically on sounds or noise and certain light types or colours.
Auditory hypersensitivity can lead to- strong avoidant reactions to certain sounds or increased noise levels
- a need to cover the ears to avoid loud or unpredictable sounds
- increased anxiety at the possibility of an action resulting in a loud sound and that leading to heavy breathing, panic attacks, and possible headaches
Misophonia, a disproportionate emotional reaction to certain everyday sounds that should be relatively easy to filter out, is often triggered by- mouth, nose and throat sounds, particularly those produced by chewing or eating and drinking
- repetitive environmental sounds produced by other people or objects
- sounds produced by animals.
Ligyrophobia is a fear of devices and activities that can suddenly emit loud sounds, such as speakers or fireworks.Visual hypersensitivity can be triggered by environmental factors such as- sunlight, bright or flashing lights
- flickering lights created by certain light wavelengths from LEDs or fluorescent lights
- mirrored reflections
- bright, bold, or intense colours.
Symptoms can include- avoiding eye contact or looking away from visual stimuli as a coping mechanism
- covering their eyes or squinting to reduce light exposure
- staring at lights, repetitive blinking, or finger-fluttering as a way to self-soothe or manage overwhelming visual input
- strong obsessions with certain colours or intense aversions to other
- headaches, physical discomfort or nausea
- adverse emotional reactions to exposure, such as irritability, anger, anxiety or meltdowns.
Multi-sensory overload occurs when more than one sense is over-stimulated simultaneously and the brain's capacity to sort through and process the resulting stream of information is exceeded in sensory-intensive environments such as- school classrooms and cafeterias
- supermarkets and shopping malls
- crowded or busy restaurants
- public celebrations such as parades and carnivals
- visitor attractions such as fairgrounds and theme parks
- concerts and sporting events
- public transport, lifts, escalators or travelators.
Sensory-intensive environments can lead to agoraphobia, a fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless.How would you describe your child's level of hostility towards uncomfortable experiences that tested their auditory or visual senses?
Sensory hyposensitivity describes under-responsiveness to sensory stimulation and a consequent need to increase sensory input from the environment.
Symptoms can include- an attraction to bright lights, reflections, and vibrant colors
- an attraction to loud noises or vibration, such as putting their ears right up to volume-producing objects like speakers
- frequently mouthing or licking inedible objects, needing strong tastes or eating anything
- frequently smelling themselves, other people and objects or seeking out strong odours
- excessive sensory seeking, such as
- a heightened need for physical affection
- touching or bumping into people or objects in an overly strong or clumsy way
- excessively enjoying rough and tumble play
- moving their arms or legs for the sole purpose of feeling them moving
- rocking back and forth or spinning for an extended time without getting dizzy
- running or stomping rather than simply walking
- chewing on their fingers or on objects.
- having an unusually high resistance threshold to pain and temperature.
Patient ratings of pain intensity and pain duration are fundamental to clinical assessments of pain but they can be distorted by atypical pain presentations associated with autism. Suffering can be unintentionally overlooked or underestimated leading to difficulties with appropriate diagnosis and treatment.How would you describe your child's heightened need for additional sensory stimulation from the world around them?
Autistic children may engage in repetitive self-soothing actions, also known as self-stimulation or “stimming”, to regulate their emotions, cope with overwhelming situations, or stimulate their senses.
The form and frequency varies between individuals, but examples can include- Auditory, which uses the senses of hearing and sound and can include behaviours such as
- snapping their fingers
- repeatedly tapping on objects or their ears
- covering and uncovering their ears
- listening to the same sound over and over again.
- Olfactory, which involves tasting or smelling and includes behaviours such as
- sniffing or smelling objects or people
- chewing or licking objects.
- Tactile, which involves touching or feeling and includes actions such as
- rubbing or scratching skin with hands or objects
- finger-tapping
- opening and closing fists
- flapping arms or hands
- playing with their genitals
- the overuse of an object such as flicking a rubber band or twirling a piece of string
- repeatedly feeling a particular texture.
- Vestibular and proprioceptive, which involves movement or balance and includes repetitive behaviours such as
- body rocking
- jumping, pacing, twirling, spinning or swaying
- hanging upside down.
- Visual, which includes repetitive behaviours such as
- staring or gazing at lights or spinning objects
- repetitive blinking or eye rolling
- moving fingers in front of the eyes
- peering from the corners of the eyes or eye tracking
- arranging objects and toys in a particular way.
- Vocal, which also uses the senses of hearing and sound and can include behaviours such as
- coughing or clearing their throat several times
- repetitive humming
- repeating words or phrases.
How would you describe any visible uncontrolled urges your child displayed to perform repetitive and oversimplified movements that fit a pattern of self-soothing?
Elopement by wandering describes a situation where an autistic child sets off unnoticed, without permission, warning or appropriate supervision, on a whim or quest in search of sensory stimulation.
Examples of wandering include- the pleasure of running and exploring whilst completely oblivious to the world around them
- a single-minded desire to go to a favourite place, such as a park or a body of water
- a desire to seek out or visit the location of a particular type of object they find fascinating, such as
- a “DANGER: DEEP WATER” sign
- specific road signs.
- an urge to visit a place of thrilling stimulation, such as roads or railway tracks for
- the visual stimulation provided by the spinning wheels or the variety of colours, shapes and sizes of the vehicles
- the sounds and sensations of moving vehicles rushing by.
- a desire to pursue a special topic of interest, such as watching trains.
How would you describe the consequences of your child's attempts to experience sensory stimulation by wandering off?
Emotional dysregulation describes the inability to control the intensity of stress reactions to everyday changes and events, resulting in habitually excessive negative behaviours that are out of proportion to the situation that triggered them.
Symptoms can include- frequent negative moods and crying
- refusal to engage in social activities, including a lack of interest in maintaining existing friendships or making new friends
- the loss of friends due to unpredictable or unsocial behaviour
- aspects of intermittent explosive disorder, such as
- long angry speeches or heated arguments
- easily-provoked frustration and irritation
- volatility and hair-trigger outbursts
- threats or shows of aggression, including shoving, pushing, slapping, or physical fights
- severe temper tantrums or meltdowns
- obvious physical signs of heightened anxiety, such as shaking or chest tightness.
- struggles within the home environment
- developmental delays, including substandard academic performance and attendance.
As a child ages, uninterrupted dysregulated emotions can become increasingly crippling and potentially lead to- thoughts of self-harming
- physical self-harm, possibly to the point of causing significant pain and injury
- suicidal ideation
- planning a suicide attempt
- attempting to commit suicide.
How would you describe the intensity of your child's negative emotional reactions, particularly when faced with everyday changes and events?
The emotional bond formed by a child with an inanimate object as they grow and develop, such as a certain blanket, toy, or item of clothing, can provide a sense of comfort, continuity and security. Over time, the child should naturally outgrow the need for them.Children with autism may exhibit a more intense and enduring attachment to such objects and, particularly in times of distress, assign emotional feelings to those objects as a way of processing and describing their own emotions.
Examples include- feeling lonely so describing a toy that is not played with as lonely
- feeling upset so describing a broken toy as upset
- feeling sadness for old toys discarded in favour of new ones or sympathy for once-loved objects that have been thrown out.
When faced with explaining how they feel, how often has your child referenced an inanimate object as feeling a certain way instead of themselves?
If a child externalises their emotions, it means they express them outwardly, typically with behavioural excess.
The externalised distress spectrum is highly visible and includes a variety of disinhibited behaviours, such as- problems with hyperactivity or attention deficit
- oppositional defiant disorder, or ODD, where the child might display behaviours such as
- being prone to anger and short temperedness
- often being argumentative with authority figures
- being stubborn or noncompliant, often defying or refusing to comply with instructions
- regularly annoying other people or getting easily annoyed with themselves
- becoming resentful, spiteful or vindictive, and often blaming others for their mistakes.
- conduct problems and antisocial behaviour
- delinquent behaviour, such as deliberate fire setting, destruction of property, or theft
- displays of excessive physical aggression.
An autistic child might also develop a habit of swearing or becoming verbally abusive, and reasons can include- sensory overload and a lack of emotional regulation causing them to react in ways that may seem rude or insulting
- an inability to understand the need for manners or limited empathy for other people's feelings leading to comments that seem hurtful or vulgar
- difficulty understanding tone of voice, facial expressions or body language, leading to frustration and inappropriate responses.
How would you describe the level of interference on your child's daily functioning and emotional wellbeing of excessive shows externalised of emotion?
Hyperactivity, translated as “above normal activity”, describes the inability to control excess body movement in such a way as is appropriate for the setting, especially in calm or quiet surroundings. When applied to a child, the focus is on behaviour that cannot readily be explained away as youthful high energy, such as- fidgeting, the small subconscious and uncontrolled movements made with the hands and feet, for example
- repeatedly drumming fingers or foot tapping
- repeatedly crossing and uncrossing legs
- repeatedly tapping an object such as a pen.
- being unable to control their energy levels, for example
- uncontrollable physical activity, such as running around or climbing things
- acting impulsively without thought for the consequences, risks or dangers attached to their actions.
- an inability to sit still due to issues arising from understimulation or overstimulation, for example
- repeatedly shifting in a seat
- repeatedly adjusting position.
- difficulty sitting for long periods of time due to pain so often adjusting their position to relieve discomfort.
Neurodivergent children can be prone to- joint hypermobility syndrome, in particular
- problems with unstable joints that click or suffer from full or partial dislocations
- pain and stiffness in joints or muscles and being prone to sprains and strains that take longer than usual to heal
- gastrointestinal problems such as irritable bowel syndrome, stomach aches, acid reflux and nausea.
When answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, including- at home or in other people's homes
- at school or when out in public
- when travelling between places.
How would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to control their body movements and keep their activity levels within generally-accepted limits?
For this question you are looking at your child's ability to focus, pay attention, or put effort into tasks that similarly-aged neurotypical children should find achievable.Symptoms of attention deficit can include- difficulty paying attention when someone is talking to them, even if they are being spoken to directly
- struggling to maintain concentration and being too easily distracted
- an inability to stick to a task and complete it without becoming bored and switching to something different, especially if they found it tedious or time-consuming
- difficulty carrying out instructions or completing tasks that should be within their capability without making careless or silly mistakes.
ADHD paralysis refers to the inability to start, sustain, or complete tasks due to overwhelming feelings of anxiety and stress or mental fatigue.- Mental paralysis involves a feeling of being overwhelmed by racing thoughts or excessive sensory stimulation. The “brain chatter” or “brain fog” can lead to an inability to make decisions or act.
- Task paralysis is the inability to start and complete tasks. It can involve a lack of motivation, putting-off or avoiding a task, or becoming easily distracted from it. Even if tasks are important, reduced focus and effort can lead to them being left unfinished or abandoned.
- Choice paralysis occurs when the child is overwhelmed by the multitude of choices or options available to them. An inability to make decisions or fear of making the wrong choice can lead to putting-off or avoiding tasks or relying on other people to make decisions on their behalf. It can be difficult for the child to pick up where they left off.
The child may experience difficulty in one or more of the above categories at any time, depending on the situation.Markers can include- anxiety and somatic anxiety, the physical symptoms of anxiety, such as increased heart rate, sweating, or difficulty breathing, when faced with a task
- an inability to make even the simplest of decisions
- confusion caused by an inability to prioritise tasks leading to indecision and a lack of action
- procrastination, the act of unnecessarily delaying or postponing a task despite knowing that it could cause problems, when anxiety or perfectionism make it difficult for the child to take the first step towards starting a task or completing it
- mental disorganisation and general messiness
- task avoidance as a coping mechanism to avoid triggering mental overload
- a lack of confidence and low self-esteem reinforcing a belief that they are incapable of completing tasks and likely to fall short of expectations.
When answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, including- at home or in other people's homes
- at school or when out in public
- when travelling between places.
How would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to maintain focus, pay attention, or put effort into tasks when expected to?
Symptoms of impaired organisational abilities can include- a reduced or absent ability to perform a task or activity as and when required without needing to be reminded
- a reduced or absent ability to successfully organise tasks or activities to which they were expected to apply themselves
- a reduced or absent ability to be organised about how they store the things they need to use to complete tasks or activities in accessible and sensible safekeeping without losing or misplacing them.
When answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, including- at home or in other people's homes
- at school or when out in public
- when travelling between places.
How would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to organise their time and activities?
Hyperverbal speech, translated as “above normal word use”, describes the disrupted regulation of speech and thought processes in the brain resulting in a flow of speech that is difficult to follow or engage with in conversation.Types of hyperverbal speech include- logorrhea, talking uncontrollably at an excessive rate with excessive wordiness and repetitiveness to the point of becoming incoherent
- circumstantial speech which strays away from the main point of a conversation
- pressured speech and verbal overactivity, such as
- monopolising conversations and not giving other people the opportunity to speak
- an inability to wait their turn in a conversation so interrupting
- talking over other people whilst they are speaking
- blurting out comments at inappropriate times.
- compulsive speech, possibly linked to severe anxiety, where the child seems unable to talking.
Hyperverbal speech can severely impair the use of speech as an effective form of communication and adversely impact social interaction.When answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, including- at home or in other people's homes
- at school or when out in public
- when travelling between places.
How would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to control excessive verbal output and keep their talking within generally-accepted limits?
Sleep is a critical component of mental and physical health. Sleep-wake disorders can be both a symptom of and a trigger for mood disorders, so creating a cycle of negative impact.
Common symptoms include- difficulty falling asleep and staying asleep
- distressing dreams, nightmares or night terrors
- nighttime incontinence or bowel control
- unsatisfying sleep and trouble waking up in the morning or waking up fatigued and unrefreshed
- excessive daytime tiredness and difficulty focusing
- mood changes, particularly depression or being easily upset.
Sleep apnoea is a disorder which causes breathing to repeatedly stop and start during sleep, and additional symptoms include- waking during the night gasping or choking
- a habit of snoring loudly
- regularly waking with a dry mouth, sore throat, or headache.
Circadian rhythm disorders are conditions that disrupt the body's natural sleep-wake cycle, the circadian rhythm, and affect- how well a person sleeps
- when they are able to sleep
- how well they function when awake.
Sleep disturbances can also be linked to additional serious complications such as an increased risk or worsening of certain medical conditions and difficulties with learning and concentration.How would you rate the impact of disturbed sleep patterns on your child's ability to function?
Anxiety is the internal emotional and physical state that involves persistent worry and a prolonged, internal feeling of apprehension or dread around imminent or imagined future events that can persist even without a clear cause and can interfere with daily life.
Cognition is the umbrella term for how the brain takes in, processes, and makes sense of information to interact with and understand the world and visible symptoms of cognitive anxiety can include- difficulty with concentration, memory, and decision making
- panic attacks, a rush of intense mental and physical symptoms that can come on very quickly and for no apparent reason and generally last between five and twenty minutes
- discomfort or excessive reactions to
- transitions between activities or changes in routine or environment, particularly if sudden
- specific textures, sounds, or lights
- busy or brightly coloured places.
- a marked increase of repetitive self-soothing behaviours that appear to serve no useful practical function, such as shredding paper or ripping clothing.
Somatic relates to the body and physiological refers to its normal functions, processes, and mechanisms. Somatic anxiety describes the physiological response to cognitive anxiety and symptoms can be single, multiple or varying and range from mild to severe, and can include- dizzying or painful headaches
- a racing heart or chest pains
- intense breathing or shortness of breath
- abdominal pains, stomachache or an upset stomach
- uncontrollable bodily trembling or shaking
- profuse sweating, even when cold
- fatigue or weakness
- tight muscles and muscle tension
- aching in one or more groups of muscle
- panic attacks, overwhelming rushes of intense mental and physical symptoms that come on very quickly, often without any obvious trigger, and last a few minutes.
Severe anxiety can also increase the risk of- feeding and eating disorders
- self-harming behaviours.
Children may self-harm in private and the warning signs may not always be obvious, but more visible ones include- bald patches where hair should be
- unexplained cuts, scars, burns, or bruises, usually on the arms, wrists, chest, or thighs
- unexplained blood stains on clothing or tissues
- an insistence on keeping fully covered around others, such as an obsession with wearing long-sleeved clothing.
How would you describe the impact of known episodes of mental anxiety or anxiety-driven physical stress on your child's daily functioning?
Depression differs from occasional sadness through being a prolonged mental state typified by low mood and an aversion to activity that significantly interfere with daily life.Symptoms can include- prolonged periods of sadness or low mood
- being uncharacteristically weepy or crying with little or no obvious cause
- an increase in the number and severity of mood swings or becoming uncharacteristically irritable
- a lack of enthusiasm for things that would normally bring pleasure
- seeming overly tired or having less energy than usual
- expressing feelings of extreme tiredness that are actually indicators of severe emotional exhaustion and a desire to escape emotional pain
- increasingly severe or frequent repetitive and compulsive behaviours
- self-harm or suicidal thoughts or urges.
If a child internalises their emotions they suppress their feelings, try to avoid talking about them or deny the way they feel. The internalised distress spectrum can be difficult to observe and children may self-harm in private. The warning signs may not always be obvious, but more visible ones can include- bald patches where hair should be
- unexplained cuts, scars, burns, or bruises, usually on the arms, wrists, chest, or thighs
- unexplained blood stains on clothing or tissues
- an insistence on keeping fully covered around others, such as an obsession with wearing long-sleeved clothing.
As a child who is predisposed to depression grows older they may become increasingly drawn to- suicidal ideation, the thought process of having ideas or repetitive thinking about the possibility of dying by killing themselves
- strengthening urges to kill themselves, to the point whereby they actively start to form a plan of action
- actual attempts to commit suicide.
Visible warning signs that a child might be severely depressed or at increased risk of suicide can include- openly expressing unbearable emotional pain
- talking or posting on social media about death, dying or suicide, or making comments such as “I wish I was dead” or “I wish I had never been born”
- withdrawing from social and daily activities
- giving away prized possessions
- saying goodbye to people for no apparent reason
- suddenly becoming calm or cheerful after a long period of depression.
To what extent has your child's known behaviour been typified by low mood, a loss of pleasure or interest in people or pursuits they used to enjoy, and an aversion to activity?
A phobia is an irrational reaction to a non-existant danger that leads to a fear response.
In autistic children these phobias can go beyond common childhood fears into the unusual, examples being- mechanical things such as household electrical appliances or toilets
- non-mechanical objects such as balloons or things that are tall, sway or are mounted up high, such as trees
- certain rooms or buildings, closed or small spaces, large or open spaces
- heights and, by extension, lifts, escalators, steps or stairways
- weather systems such as clouds, thunderstorms, or wind
- visual media such as characters in or segments of motion pictures or computer games
- specific events such as germs or contamination or running out of certain things.
Also take into account the level of everyday adaptation required to ensure that your child is protected from their phobias.How would you describe the visibly heightened pattern of emotional distress that your child has suffered as a result of exposure to any of their phobias?
Situational mutism can cause a child who can speak freely at home and with family to become nonverbal in public settings, particularly around strangers or people in authority, possibly to the point of becoming paralysed with fear or shutting down completely.
Symptoms can include- becoming behaviourally inhibited when in public settings, examples being
- struggling to make eye contact when uncomfortable
- speaking in whispers through a trusted individual
- relying on pointing, nodding, writing, and other forms of nonverbal communication to answer questions.
- having difficulty forming friendships with their peers due to an inability to speak in public settings
- having difficulty participating in events in a public setting.
Situational mutism is indicative of a very high level of anxiety.
How would you describe your child's ability to cope when faced with having to openly verbally communicate in a public setting or with people they are unfamiliar with?
Elopement by bolting describes the sudden act of running off, when an autistic child instinctively tries to escape from situations that they find immediately frightening or overwhelming.
Examples of bolting include- running out of the front or back door of their home or escaping altogether when unsupervised
- leaving a room unexpectedly or without required permission, either via a door or a window
- bolting from a busy public place or running out onto a road without warning
- escaping from a place where they do not live and returning home
- trying to exit a moving vehicle
- running away from an authority figure.
Triggers for bolting can include- anxiety-inducing situations, such as demands at home or school
- uncomfortable sensory stimuli, such as fireworks or a phobia
- people or groups that they see as posing a threat or presenting danger.
How would you describe the consequences of your child's attempts to escape from overstimulating situations by bolting?
A meltdown is an involuntary and uncontrolled response whereby difficulty with sensory processing triggers a nervous system overload.
There are three main phases to an autism meltdown- the rumbling phase: the initial phase after the child's sense of calm and order has been interrupted by a trigger. They may start to display signs of rapidly increasing anxiety such as
- pacing, twitching, shaking, rocking or becoming very still
- if verbal, showing agitated speech patterns such as talking more quickly or more loudly than usual, or seeking reassurance through repetitive questioning.
- the rage phase: the child is totally emotionally overwhelmed and excess rage, panic or despair is released as a meltdown, example behaviours being
- unrestrained crying, shouting or screaming
- uncontrolled kicking, flapping or stomping about
- repetitive movements or zoning out.
- the recovery phase: the child may be tired or sleepy, apologetic or embarrassed, deny or have no recollection of the meltdown.
Meltdowns are distinctly different from temper tantrums, which are brief purpose-driven episodes of largely deliberate extreme behaviour in response to frustration or anger at not getting or being allowed to do something. Whereas a tantrum will typically subside when the child is either rewarded or realises that their behaviour is pointless, after a meltdown individuals cannot usually respond to standard calming techniques and recovery takes an extended period of time.How would you describe the visible negative impact of meltdowns on your child's ability to function?
Catatonia is a psychomotor disorder that creates a state in a person whereby they are awake but lose responsiveness to environmental stimuli, the things happening around them that should trigger a response, and exhibit a dramatic change in bodily movement from previous behaviour.
Symptoms may come and go and may become more or less intense. A catatonic state can last from a few hours to weeks, months, or years and can reoccur frequently for weeks to years after the initial episode.Akinetic catatonia causes a person to appear slowed down, and symptoms can include- fixed facial contortions or expressions, usually with stiff or tense facial muscles, such as appearing to stare blankly into space or having a fixed smile regardless of the circumstances
- acting out normal motions or movements but doing so in ways that are oddly unusual or exaggerated, such as difficulty coming to a stop
- placing themselves in strange or inappropriate postures which might typically be considered uncomfortable, or freezing during actions
- holding any new bodily position they are placed in by another person
- having slight resistance or pushback to an attempt by another person to change their position, followed by their limbs gently collapsing into a new position
- an uncharacteristic lack of reaction to or nonsensical resistance to environmental stimuli
- appearing immobile and unresponsive to environmental stimuli despite being awake, such as not reacting to the pain of being pinched
- an unusually quiet or complete lack of verbal response, despite being awake and capable of speech.
Hyperkinetic catatonia causes a person to appear restless and agitated, with symptoms including- excessive and accelerated physical movements and actions that have no apparent purpose, such as being upset or irritable without being provoked
- repetitive movements that do not have any obvious purpose, such as patting or rubbing their body or finger play, a type of early childhood activity
- mimicking or repeating another person's movements or words and phrases.
Malignant catatonia disrupts the autonomic nervous system which controls vital body processes such as breathing and heartbeat. It can be potentially fatal without urgent professional medical attention, and symptoms include- a bluish discolouration of the skin due to low blood oxygen, especially around the lips and fingernails
- a rapid heart rate affecting the heart's ability to adequately fill up with blood in between beats
- dangerously high body temperature and excessive sweating
- unstable blood pressure with significant fluctuations.
How much of their time has your child spent seemingly trapped within themselves, displaying significant distortion of reactions and responses, bodily movement and speech?
A shutdown is a quietly-expressed involuntary and uncontrolled response whereby difficulty with sensory processing triggers a nervous system overload and the individual is totally emotionally overwhelmed then withdraws mentally and physically.
Example behaviours include- fleeing the trigger or completely freezing
- being unable to move or speak
- withdrawing to a quiet, dark space
- experiencing sudden exhaustion
- suffering a loss of coordination or slowed movement
- suffering a loss of communication skills.
A shutdown will continue until the child feels able to cope again and, once the initial shutdown lessens, they may show signs of exhaustion, confusion, or detachment. A shutdown can follow a meltdown if exhaustion reaches crisis level.How much of their time would you say your child spent in a state of emotional and physical shutdown?
Neurodivergent fatigue occurs after the body's mental, sensory, and physical resources are overworked for an extended period of time. If the fatigue continues uninterrupted it will lead to burnout, a state of physical, mental, and emotional exhaustion following a chronic episode of severe stress and frustration.
Reasons include- constantly trying to manage sensory overload
- the strain of suppressing self-stimulatory behaviours
- the challenges faced when navigating social situations
- the effort involved with masking or camouflaging autistic traits
- pervasive feelings of failure.
Markers include- increased prevalence of exhaustion, depression and a potentially increased risk of suicidal ideation or intent
- increased levels of anxiety and stress, including suffering from headaches, gastrointestinal problems or physical pain
- increasingly disrupted diet, rest and sleep patterns
- noticeably increased sensory sensitivity
- increased difficulty with concentration, memory or making choices
- becoming increasingly withdrawn and isolated, possibly to the point of physically shutting down
- an increase in both the number of meltdowns and the time needed to recover from them.
How much of their time would you say your child spent in a state of emotional and physical exhaustion?
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