Most children learn how to interact with others through a combination of experiences and instinct. But for people on the autism spectrum, the struggle with social interaction is very real.
Autism and Social Interaction
Most people with autism have issues with social skills. Those who are more severely impacted by autism often rarely interact with other people and have limited verbal language skills. And many of those at the other end of the spectrum, diagnosed as “high-functioning autism,” seek interactions with others but may have a tough time interacting with other children.
As a child moves from infancy to adulthood, socialization and communication skills usually follow a fairly predictable path of development. The primary factor that distinguishes autism from other developmental disorders is the difference in social development. When an evaluation is done to determine whether a child has autism, doctors are looking primarily at social delays, communication differences and behavioral issues.
According to some studies, children with autism may be falling behind socially as early as 6 weeks of age. By the time they reach the age of 1, most children are doing the following:
- respond to their name
- participate in back-and-forth interaction
- understand gestures such as pointing and waving
During typical development, most children develop the ability to interpret facial expressions, humor and empathy as well as desires to play with others, seek comfort when upset and play with others. If your child does not develop these abilities or milestones, you should see a professional. Other serious indicators of autism are poor eye contact, not responding to various stimuli with facial expressions, and delays in imaginary play and self-help skills.
Children with autism typically have early delays in language skills and speak later than other children their age. Some never speak at all. Some on the higher-functioning end of the spectrum may possess large vocabularies and are able to form sentences, but do not develop an understanding of the non-verbal pieces of communication such as facial expressions and body language. When they speak, it may seem to be scripted, awkward or repetitive. They often have trouble following a conversation and understanding voice tones and humor.
When my son first came to live with us, he was almost 4 years old and very rarely spoke more than one word at a time. And that was after two years of working with a speech therapist! For example, we would be out walking and he would point and say “flower.” When he would do this, I would add a word to make a phrase such as “pretty flower” or “red flower” and ask him to repeat it back to me. Many times I would have to prompt him to look at me and watch my mouth so that he could say the phrase correctly; it took awhile, but eventually he was speaking in phrases and later in sentences.
Another example from my experience with Devin is that he tends to take things very literal. I will never forget one day when our daughter walked into the house during a thunderstorm and proclaimed it was “raining cats and dogs out there!” Devin quickly ran to the window, looked around and started crying. I asked him what was wrong, and he pointed outside and said, “no more cats and dogs!” We quickly learned to be careful in choosing how we phrased things because many phrases took a long time to explain to him in order to make him understand!
Individuals with autism also display some unique behaviors, including repetitive motion (such as hand flapping or spinning in place), obsessive interests in certain objects or subjects, or overly rigid thinking. In addition, many also face sensory challenges. Behavior issues alone are not a basis for an autism diagnosis; social and communication issues are the main challenges for the basis of a diagnosis.
ADHD impacts Social Interactions Differently
ADHD (Attention Deficit Hyperactivity Disorder) by itself impacts a person’s social interactions differently than autism does. Although ADHD can affect social, communication and behavior issues, children with ADHD usually know the social rules but because of their ADHD they have not yet learned how to follow those rules.
ADHD Social Issues
Understanding and being able to follow social rules are two different things. Children with ADHD are typically distracted, impulsive and off-task — these issues affect the ability of a child to show that they know what they should be doing in everyday situations. Most of the time, the child with ADHD would understand the social cues around them if they had just noticed the social cues.
ADHD Communication Issues
The risk of language delays is often overlooked in individuals with ADHD. Even if the child does not have a language delay, ADHD can still impact their ability to communicate. During an interaction, a child with ADHD will lose track of details, interrupt, stray off the topic, or be overly talkative. Because of the pace at which their minds work, they might speak or process information more slowly than other children. Typically, children with ADHD understand language; the ADHD itself gets in the way of them being able to process it.
ADHD Behavior Issues
ADHD is frequently found to be the cause of behavior issues. These issues include acting impulsively, being overly silly or disrupting situations in other ways. The short attention span of a child with ADHD can cause issues all by itself. People with ADHD constantly face the challenge of organization and planning needed for executive function; although this is clearly linked to ADHD, it is not as definite in autism alone.
Autism, ADHD or both?
In many situations, there is no definitive line between autism and ADHD. It is very difficult for professionals to know whether a child has autism, ADHD or both. The main objective is that the child gets the intervention for their personal situation. Many of the social and communication therapies available will benefit children with either autism or ADHD. It is not uncommon for either autism or ADHD to be accompanied by a secondary condition.
Screening for these disorders is important. Ask your school district to evaluate your child’s development, including language, play and self-help skills. Or you can seek a comprehensive evaluation outside of the school district.
Comprehensive care for a child with ADHD may include behavioral therapy for the individual (possibly including the parents), social skills groups, medication, or other treatments.
Behavioral therapy is the main treatment used with autism. These programs are not only used in cases of disruptive behaviors, but also to help teach social skills. One of the most frequently used programs is applied behavior analysis (ABA) therapy.
If a child has severe autism, they usually receive intensive behavioral therapy in a self-contained classroom. With milder symptoms, children are mainstreamed into inclusion-style classrooms and behavioral interventions are not used as often.
Regardless of the severity of the autism, one of the best indicators of success in the therapy is when the child receives ongoing behavioral therapy. One way to think of this is to think about a typical child; if you want them to be a professional dancer or musician, they should practice a lot each day. The same goes for social skills — the interventions should be continued until the child is fluent in the skills.
Children with autism by definition have communication challenges. It is very difficult to measure communication through testing, so regardless of test scores a child with autism should continue language therapies until proven that they are not needed by their social skills. If a child has both autism and ADHD, it makes it much harder for them to succeed.
Autism at school
Although placement in a mainstream classroom setting is always the goal, it is not always possible. Some students simply need a more supportive setting, and trying to keep up with the demands of being in a mainstream classroom with typically developing peers can be too stressful for some children. A more supportive setting also allows for more intensive behavioral therapy, which may make mainstreaming a more appropriate setting in the future.
Language and other delays often affect a student’s basic skills. Skills such as reading comprehension and writing can be affected by both autism and ADHD. Additional supports or modifications are often required when looking at homework and in-class assignments.
One of the most challenging times at school for children with autism or ADHD is unstructured time such as recess or gym. Social rules are much different in those situations, which is stressful for the child. Unfortunately, children may be subject to bullying, so additional social interventions may be needed for these times.
How are parents affected?
There is no doubt that parenting either autism and/or ADHD can cause stress for parents and put strain on a marriage. Seek help from family members or friends when needed. You may even talk to a professional about the challenges or join a support group. It is not a bad reflection on you to seek help when you need to! After all, if you are not at your best then your child will not be either!
Do you have a child who has trouble with social interactions? I would love to hear about ways that you have found to handle this! Please leave me a comment at the bottom of this page!