ACTNOW Fact Sheet 5

CORE FEATURES OF AUTISM : SOCIAL SKILLS

by Dr Avril Brereton

One of the key features of autism is a range of problems with interpersonal relationships, such as reduced responsiveness to or disinterest in people, an appearance of aloofness and a limited or impaired ability to relate to others.

The DSM – IV criteria for social skill impairment in autism is:

Qualitative impairment in social interaction, as manifested by at least two of the following:

1. Marked impairment in the use of multiple non-verbal behaviours such as eye- to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;
   
   
2. Failure to develop peer relationships appropriate to developmental level;
   
   
3. A lack of spontaneous seeking to share enjoyment, interests or achievements with other people;
   
   
4. Lack of social and emotional reciprocity.

(American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000)

Autism affects the development of social skills in children from a young age and may be apparent in infants with autism.

INFANTS WITH AUTISM:

• often do not assume a normal anticipatory posture or put up their arms to be picked up.
  
  
• are usually not cuddly babies. They often do not snuggle in when being held. Some infants may resist being held by wriggling or becoming stiff. Others prefer to be held facing outwards with their back to the person holding them.
  
  
• may not respond to their name, may respond inconsistently to their name or may be late to develop this skill.
  
  
• will often avoid eye-contact or only make eye-contact quickly and then look away. Other children may look you in the eye but stare for too long or be looking at their own reflection in another person’s eyes. Some mothers notice problems with their baby’s eye contact at a very early age.
  
  
• may have difficulty sharing their interest in things and may not point out interesting objects to others. Some infants with autism may point but the point will be vague rather than a protodeclarative (direct) point.
  
  
• tend not to engage in social imitation, such as waving bye-bye and pat-a-cake games.

PRE-SCHOOLERS WITH AUTISM:

• may show very little variation in facial expression in response to others. For example, if smiled at they may not smile back. Preschoolers with autism generally do not make eye-contact with their peers or their eye-contact may have a staring quality to it.
  
  
• usually have impairments in the ability to make friends. They may latch on to another child at preschool and want to be with them all the time regardless of the child’s reaction to them. A child with autism may have a preference for some peers based on their appearance. For example, hair colour rather than their personality or temperament. Some children may be rejected for a particular reason. For example, a 4 year old who would not go near a certain boy because of the shape of his ears.
  
  
• find playing with other children difficult, particularly understanding the rules governing social behaviour. Taking turns and sharing can be difficult concepts to understand and these skills usually need to be taught in a concrete way. Preschoolers with autism usually find group activities, such as mat time at kindergarten difficult and often do better in small, structured groups. Others may avoid the other children altogether preferring to play alone.
  
  
• rarely develop an age-appropriate empathy (the ability to feel for others) or the ability to understand that other people have feelings. They may not share other people’s happiness or sadness. At preschool the child with autism may not respond to another child who is upset and crying or offer comfort. Some children with autism may be distressed at the noise a crying child makes and react to the noise rather than the emotionality of the situation.
  
  
• are unlikely to spontaneously share with others things they have done. To ‘show and share’ is difficult. For example, children with autism will rarely take work out of their bags to show their parents or bring a drawing to show them. They are also unlikely to show what they have done to other children at preschool.
  
  
• usually have difficulties with joint attention. Joint attention is the sharing of attention on one task. For example, a child and parent looking at a toy together. Usually joint attention is maintained by making eye-contact with the other person and then looking back at the object of interest. Children with autism also tend not to use pointing to direct other people’s attention to things they are interested in.
  
  
• often do not respond to their name being called and seem to become absorbed in whatever they are doing or whatever they are looking at.
  
  
• have difficulty interpreting the feelings of others. They find it difficult to read facial expressions such as detecting when others are sad or angry. Even if they are able to determine that a person is unhappy, the child with autism will usually not attempt to offer comfort. They may also not seek comfort themselves when upset or hurt or if they do so it is on their own terms. For example, a child with autism may want mum to kiss a hurt better, but if she tries to comfort him with a cuddle this may be rejected.

All children with autism have impaired social skills, however, the nature of these impairments can vary and may modify as the child grows older. For example, there may be an increase in interest in other people and the development of some social skills often learned as rules in a mechanical or inflexible manner. In the past it was thought that children with autism were not attached to their caregivers, however, it has now been demonstrated that most children with autism do show selective attachments to their primary caregivers.