The term “Features” is used to describe a set of behaviors, conditions, physical characteristics or traits of an individual that can be attributed to a disability. There are many features of autism spectrum disorders. While most people with an ASD will present with some (if not many) of the features listed below, each individuals will have a unique set of features and may have some that are not discussed here. The extent that the individual is affected by any particular feature will also vary from person to person. While the features listed are common to ASD, they also occur with other disabilities. In fact, it is not uncommon for neurotypical persons to be affected by one or more of these features to some degree.
Understanding the common features of autism will help you better understand what behaviors can be expected when interacting with a person on the spectrum. In addition, EMS providers who encounter a person that is exhibiting multiple features may form a reasonable suspicion that the person has an ASD, even if the diagnosis is not known; however, it is not the job of an EMS provider to diagnose an ASD.
Ordering and Arranging - the methodical arrangement of items, usually in a line or specific pattern of arrangement (large to small, short to tall, etc.).
Wandering - Also described as “lost,” “running” or “elopement.” The person with an ASD who is “wandering” may not consider himself or herself “lost” and most likely will not seek assistance (including a young child who has been separated from their parent or caregiver). He/she may be perfectly content doing so for no particular reason (ie, Forest Gump) or might be seeking a favorite place or activity.
Affinity for Water – People with an ASD, and in particular those with autistic disorder, tend to have a strong affinity for water regardless of their ability to swim. Drowning is a leading cause of death among both adults and children with autism. Important: Consider ALL public and private water sources (including natural, decorative and utilitarian) during searches: fountains (including coin fountains), open wells and wishing wells, ponds, lakes, streams, creeks, rivers, pools (including pools enclosed in buildings and fenced yards), spas and hot tubs. Check water sources that have been covered, are no longer in service, are locked up or not easily accessible or are not commonly used.
Running in & out of traffic – often with what appears to be a blatant disregard for safety. This may occur due to perceptual issues (unable to tell traffic is standing still or moving).
Climbing / Acts of Balancing / Jumping – In & out of trees or windows or even on the outside of building. May not have regards for their height or safety. May “balance” on edge of walls and roofs, window ledges, bridges, utility towers and similar structures. May jump with no purpose, no motive and without regards to how far they are jumping or the likelihood of injury from jumping (may be perceptual).
Literal perception – takes what you say at face value.
Difficulty recognizing humor, sarcasm, slang, teasing and idolism.
"Flat” personality with little or no sense of humor
Brutally honest, blunt and tactless.
Little concern about social norms or appropriateness of comments/actions.
Difficulty respecting others opinions, interests or ideas.
Frequently will be argumentative, stubborn and belligerent, even over minor issues.
One of the hallmarks of all autism spectrum disorders is communication impairment. We most often associate the word “communication” with spoken and written language. However, there is more to communication than just words. In addition to language skills, we use tone inflection, phrasing, and speech patterns as forms of verbal communication. We also use non-verbal communication, including “body language,” gesturing, pointing, waving and eye contact. One’s behavior is also a method of non-verbal communication, often driven by the subconscious. Although communication is impaired in people with autism, it is not completely absent. The extent of the impairment varies significantly from person to person.
Approximately 25-30% of those with an ASD will stop speaking, usually between 15-24 months of age (Johnson et al 2007). Turner et al (2006) found 22% of persons with ASDs who stopped speaking remained non-verbal at age 9. In other cases, persons with ASDs may never begin speaking, their speech may develop late, their speech progress may be very slow to develop or speech progress is otherwise abnormal or irregular.
May answer all questions “no” or “why” incessantly (inappropriate for age).
Echolalia (“parroting”): Echolalia is when someone repeats something that they hear, exactly as they hear it; it may be immediate or delayed (hours, days, weeks, even months or years). Speech: Often will be a passive, monotone voice or speak with inappropriate volumes; they may have unusual inflections in their voice and mispronounce words, sounding like they are trying to talk like a computer.
Difficulty distinguishing questions from statements. The individual may try to answer a statement or rhetorical question or may react to a question as if it were a statement or order.
Difficulty in recognizing or repairing a breakdown in communication.
May have difficulty in asking for clarification if something is not understood. May acknowledge understanding even if he or she is unclear of what is being asked or he/she is unable to comprehend the subject at hand.
Difficulty clarifying their statements: If you ask the individual to clarify something that he or she says, the individual may repeat the thought exactly as it was expressed the first time. The individual may become frustrated by requests to rephrase what he says, because the thought is clear to him. May infer that either the request or the person making the request is stupid.
It is also important to note that even when spoken communication is either absent or significantly impaired, it does not mean that the person with autism is incapable of understanding or expressing their thoughts using language skills. In fact, some people with autism who have very restricted verbal abilities are able to use language skills very effectively, with a great deal of thought, insight and even eloquence through the written word or the use of sign language.
Albert Mehrabian (1981) describes that, in specific situations, communication can be described by the “7-38-55” rule (7% language, 38% speech patterns, 55% facial expressions). This rule is limited to some respect, but it is a good example of how much communication is based on factors other than the words we use.
Non-verbal communication includes:
It is not likely that the individual with autism will be able to interpret (or even be aware of) non-verbal forms of communication. Similarly, their ability to use non-verbal cues will be limited and may be inappropriate or inconsistent with the message they are trying to send.
To assist with communication, the person with an ASD may use certain tools to help them communicate, whether or not they have verbal language ability:
The person with an ASD may present an identification card or may wear medical alerting jewelry to make you aware of their communication impairments and disability. Other forms of identification may include shoe tags or non-permenant tattoos.
Definition: frequent repetition of the same posture, movement, or form of speech. The most frequent forms of stereotypy in autism are rocking back and forth, flapping hands & arms, repeating a favorite phrase over and over, spinning self, spinning objects or incessantly arranging of objects (see ordering).
Self-Stimulatory Behavior (SSB) is a form of stereotypy
May be referred to as "stimming"
May be in response to hyperstimulation or hypostimulation of senses
Stereotypy is not exclusive to ASD. Mild forms stereotypy (including toe-tapping, "twiddling" thumbs, tapping a pencil) are common in the general population and even in other species.
Strong preference for the expected and predictable.
Rigid routines and schedules that are adhered to with precision.
The routines may be quite complex and well defined
Routines may be "transparent" to those who do not know the individual well.
May be purposeful or nonpurposeful in nature
Disruption of routine likely will result in a great deal of stress and frustration.
Even minor interruptions in their routine may be a “big deal” (Inability to adapt and overcome)
Persons with ASD have strong preference for the predictable and can be expected. Change, particularly unexpected change, can cause extremely high levels of fear, frustration, anxiety and stress. The person with an ASD may be able to manage a big change better than small change in some cases.
Difficulty judging personal space. May need more personal space than is typical. May not be able to judge your personal space & may not respect your wishes to increase your space, particularly if you are vague in your request. Unlikely to willingly “yield” personal space to medical professionals trying to do an assessment.
When approached, may move or run away. May not respond to commands to “stop,” even when made by police or uniformed personnel.
May not recognize public safety personnel, understand our roles or know what public safety personnel’s expectations are.
They may assume that anyone in a uniform is a public safety agent, even if they are a parking attendant or janitor. He or she may not know where to seek help or may avoid seeking help.
When dealing with public safety personnel, persons with ASD may not be able to provide essential information (name, address, etc.) or answer your questions.
May appear as if they are not paying attention or are uninterested (“being a poor listener” or “off in their own world”). Many times they are attentive to the speaker and are actively listening. (Don’t assume they are not listening)
Many people with an ASD have good receptive language skills, even if they have poor or no expressive language skills. (Don’t assume they don’t understand!)
Usually have great deal of difficulty eye contact. (The part of the brain that senses threat and fear is stimulated when a person with an ASD perceives facial features and eye contact and causes a sensation of fear and anxiety, regardless of the situation or facial expression and even if the person observed is a close family member or caregiver
Perseveration is very common. Focuses on a specific topic or subject that they select because it holds an interest for them, which may or may not be related to the “business at hand” and cannot be redirected, regardless of the importance or urgency.
Johnson, C. P., Myers, S.M. & the Council on Children with Disabilities (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics. 120(5), 1183-1215. Mehrabian, A. (1981). Silent messages: Implicit communication of emotions and attitudes. Belmont, CA: Wadsworth.Turner, L.M., Stone, W.L., Pozdol, S.L., & Coonrod, E.E. (2006). Follow-up of children with autism spectrum disorders from age 2 to age 9. Autism. 10, 243-265.
Footnote: Additional updates on this page is scheduled to improve the citation of literature used to develop the information that is contained herein.