What is autism (autism spectrum disorder)?

Typical traits of people on the autism spectrum:

• They show less interest in contact with other people, in particular with people of the same age.
• They misunderstand or don’t pick up on other people’s signals, such as certain looks that others give them, emotional messages, or prompts to do something.
• They try to enter into contact with other people in an unusual way.
• They struggle to understand that other people have different views and needs than their own.
• They often don’t understand other people's expressions of feelings correctly and then they don’t react to them appropriately.
• They are less likely to make and maintain eye contact with others.
• They find it harder to form relationships.

Typical traits of people on the autism spectrum:

• Sentences are usually understood literally, regardless of the context and how they are said. Because of this, people with autism find it harder to understand sarcasm or figurative meanings.
• They repeat words or sentences that other people say.
• They use words that seem inappropriate and are mainly only understood by people who are close to them.
• Their voice tends to sound flat (monotone) when speaking.
• They have difficulties understanding non-verbal communication.
• They are less likely to use gestures when communicating with other people.
• Their gestures and facial expressions often don’t match what they're saying.
• Some people with autism don’t speak much (or at all) with others.

Typical traits of people on the autism spectrum:

• They keep repeating certain behavioral patterns, such as flapping their arms, rotating their hands, or always doing things in a very specific way.
• They are only interested in a few things, but their interest in those things is very intense. They then learn everything about a particular subject, like train timetables, astronomy, certain animals, or craft techniques.
• They are often interested in systems with a clear structure, and in technical details like numbers, maps, or scientific phenomena.
• They have a strong need for routine and order. They can become irritable or feel overwhelmed if things are disordered or happen in a different way than usual. That’s because the lack of order makes them feel anxious.
• They can react especially sensitively – or insensitively – to sensory input like sound, smell or touch.
• Sensory overload can make them feel very tense. That can cause them to freeze, stop speaking, or get angry. This is known as a meltdown.

• Some children on the autism spectrum show a delay in development. They may learn to talk later, for example, or have problems with fine and gross motor skills.
• About half of all people on the autism spectrum have below-average intelligence that remains for their whole life. The other half have average or above-average intelligence.
• Some children’s language skills or daily life skills get worse during a period of regression. This can happen at preschool or elementary school age and then get better again.

For a long time, autism was divided into distinct forms known as “classic autism,” “Asperger’s syndrome” and “atypical autism.” Nowadays it is seen as a spectrum (“autism spectrum disorder” or ASD for short). That’s because it's not actually possible to clearly distinguish between the above-mentioned forms. But it is possible to distinguish between different autism profiles (different clusters of traits and behaviors) within the spectrum. The main difference is whether somebody's intelligence is below average and how well developed their language skills are.

The following signs may appear by the age of 3 years: The child

• hardly reacts when their parents, other adults or children of the same age smile or try to interact with them.
• is not very interested in playing with other children, or refuses to interact with other children.
• hardly reacts when called by their name.
• doesn't copy gestures much or at all – for example, doesn't wave back when their parents wave goodbye.
• doesn’t point to things to make others aware of them.
• repeats certain behavioral patterns or has difficulties moving their attention away from an object.
• regresses in certain areas from the age of 2 or 3 – for instance, their speech may get worse or they might stop speaking altogether.

Parents sometimes get very worried if they notice that their child is “different.” It is important to take these worries seriously and have the signs checked out by a professional. It is best to talk to your child's doctor early on.

Some people only start to suspect they’re on the autism spectrum when they're already adults. The possibility is sometimes pointed out to them by others, like doctors.

By that point, they have often already been to see psychotherapists and doctors to find out what they have and how to cope with it, but have been given other diagnoses – such as depression, obsessive-compulsive disorder (OCD), or anxiety disorder. Conditions like that can indeed occur together with autism, but sometimes the diagnoses are wrong.

The traits mentioned above for children are usually also present in adults. Some are especially noticeable:

• constant difficulties interacting with other people, having longer conversations, and maintaining social relationships
• a strong desire for fixed routines and rituals
• very limited, often special interests and hobbies
• problems holding down a job (in the longer term) even though they are qualified to do it

But problems like that can be caused by something else. What’s more, not everyone with autism has all of those issues.

Many people with autism have trouble sleeping: They find it hard to fall asleep or frequently wake up in the night. That can make them tired and unfocused during the day. Sleep problems in children also take a toll on parents because they don’t get enough sleep either.

Eating disorders are very common too. People then typically only eat very particular foods, which can lead to malnutrition.

Other conditions that can occur together with autism mainly include epilepsy, depression, an anxiety disorder, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). Many people with autism have other developmental disorders too – for example, affecting their language skills, motor skills, or their ability to read and write. About half of people with autism have below-average intelligence.

Problems surrounding toilet use are also more common. Children in particular are more likely to wet themselves and have problems going to the toilet on their own.

People with autism see the world in their own way and have many positive characteristics. Like all people, they have strengths and weaknesses. Because the problems caused by autism are more obvious, the strengths are often overlooked.

People with autism can be very enthusiastic about things, particularly in areas that others may consider to be unusual or very specific. They may have an especially fine appreciation for details that other people barely notice. Some people with autism gather vast knowledge and pass it on to others. If they are enthusiastic about a certain subject, they can work with great determination and precision. So it's all the more important to identify and foster their interests. Acknowledging these areas of passion can hugely improve their self-esteem.

The need for order and rules can sometimes be hard work for others, especially in situations where they can't be that inflexible. On the other hand, it means that people with autism can be very reliable, sticking to rules and agreements.

About half of all people with autism have an intellectual disability. That means they find it harder to process information and understand tasks. They may not speak very well, or even at all, and have difficulties reading and writing.

Some are limited in certain areas and not in others. For example, a child might barely be able to talk or read, but have very good fine motor skills. With good therapy and support, it is possible to reduce the limitations or learn to cope with them.

The other half of people with autism have average or very good scores in intelligence tests. Their language development is good and they can perform intellectual tasks just as well as people without autism can. They may even have above-average abilities in certain areas. It is important to understand that many people with autism have special interests, but only few are especially gifted in certain areas (savant syndrome).

A lot of those with average intelligence still have problems with practical everyday things, though – like taking care of themselves or organizing themselves.

People with autism say they have difficulties adapting to social norms, “reading” situations, and spotting unspoken behavioral rules. Some tend to keep their feelings and emotions to themselves. Others are very communicative, but often share things that seem inappropriate or too direct. Many people with autism would like to have good friends but find it difficult to maintain friendships. Working and social activities with others can be challenging, too. Misunderstandings are quite common. This can make them feel lonely and isolated. On the other hand, some people with autism are very happy to be alone and don't need much social contact. Many people with autism feel more comfortable around other people with autism.

"Typically autistic" (stereotyped) behavior can be distressing for some people with autism, but have a calming effect in others – especially when they feel overwhelmed by sensory input and demands. Very restricted interests may result in other important things being neglected. But many say that focusing intensely on one particular thing can be very relaxing and satisfying for them.

Even if people with autism might communicate less, their inner life is just as rich as that of others. They simply don’t share it as much as many people are used to.

How people with autism get on overall depends on how they can shape their own lives and how much support they get from those around them. They need a way of life that fits their needs and those of their family. For example, predictable routines and rituals are especially important for people with autism. They give them a sense of security and a framework that they feel comfortable in.

It is also crucial that they get the help they need in order to cope with distressing situations and have a good quality of life. Places to go for this include early intervention centers, specialized practices and clinics, and autism centers. These don't only help people with autism, but offer support for parents and other family members too. Parents’ associations and support groups can also be helpful.