Socially Awkward or Autistic?

Dear Dr. Debbie,

Our five-year-old son is the youngest of three. The older two have both been socially awkward with children and adults, although they can make friends and are good playmates one-on-one. The youngest seems to have much more difficulty being around other children.

His teachers have noted sensory overload (mostly to noises) and “silliness” when it’s not appropriate. Sadly, they’ve not been very concerned, nor observant, nor supportive, of his friend-making abilities.

Is his behavior just a holdover from starting life during the Social Distancing of the pandemic, or should we have him assessed for autism?

Might Be Good to Know

Dear M.B.G.t.K.,

Well, yes, the pandemic caused delays in social skill development as the National Library of Medicine suggests, “the mandatory lockdown during the CoViD-19 pandemic precluded children from essential social interactions, and the mandatory mask wearing similarly also prevented children from acquiring decoding skills of facial recognition and nonverbal communication.“

Then there’s autism. The word “autism” has “auto” as its root. In Greek, this means “self”. A person who is autistic gets a great deal of stimulation from their own brain. Outside stimulation, such as the actions, emotions, and language of a playmate, can therefore be overwhelming. The disorder is marked by social communication impairments and self-stimulating behaviors.

The Journal of the America Medical Association reports a four-fold increase in diagnoses of Autism Spectrum Disorder (ASD) in children and adults from 2011 through 2022. Most commonly, the diagnosis is made when a child is between 5 and 8 years old.

Below are some of the challenges that, in combination and or by degree of severity, could be professionally diagnosed as ASD. Whether or not an ASD diagnosis is confirmed, there are ways to support a child with any of these challenges.

Social Comfort

Don’t force social interaction. If a child prefers to play alone, avoids eye contact, misreads body language, and or recoils from being touched, this could be a sign that trying to interpret and respond to another person, or several people, is overstimulating.

This child will prefer playing with just one other child at a time, perhaps rotating among only a couple of friends and his siblings. Take time to point out emotions in his playmate and in himself as they play and between play sessions. When he has to be in a group, such as at a birthday party or a public playground, try to be among the first in the space so that he can accommodate additions a few at a time rather than entering a sea of people.

A friendship for a child who struggles with social skills is just as valuable as it is to anyone. So when a friendship has formed, keep it going. When someone is your friend, that’s validation of your worth. You’re acceptable. This is important for us all, but especially so for a child who struggles with reading and appropriately responding to social cues. One successful friendship might just lead to another and another.

Language

Some parents automatically act as a bridge between their child and someone else by repeating a question to their child and responding with complete sentences when their child merely grunts or uses few words. Although not universal among autistic children, language development may be slower or their language may have quirks such as unique intonation, an odd rhythm, asking questions without waiting for answers, and not directly responding to what the other person has said.

A normal phase of early language development – usually at two-years-old – is “echolalia” in which the child repeats back what you’ve said. Most parents naturally ask a child to repeat things, “Say, ‘Thank you’” and the child knows to repeat, “Ta tu.” A child with autism might repeat the whole thing, “Say ‘Ta tu’” and continue to echo words and phrases, regardless of being asked, for years. Another autistic trait is to repeat dialogue word for word from a movie – playing all the characters. Difficulty in keeping a back and forth conversation going may persist into adulthood for a person with autism. A friendship may be fueled just by being together.

Since it’s hard for an autistic child (or a child lacking in social experience) to get out of their own head to perceive what’s going on in the head of the person with whom they are conversing, an adult should stay close in order to intervene in case of a misunderstanding. For a person with autism, speech is often taken literally, without the ability to appreciate a metaphor, a pun, a double entendre, sarcasm, or irony.

Rigid Behavior

An adult can easily support the self-created structure that often dominates a child’s play – with dolls, cars, blocks, etc. For a child with autism this might mean repeating the same scenario over and over in pretend play. However, whether a child is autistic or not, it may be hard when playing with another child to accept not always being the leader. An adult can help two playmates with turn taking, and taking breaks, so that they can play together successfully. Playing alone is all well and good, but playing with others is how we must operate in the outside world. This essential skill develops from lots of practice in childhood.

An unchanging daily routine is similarly good for all children, but it importantly enhances predictability for a child with autism who is often confused by the goings on around him.

If there has to be a change, lead up to it with an explanation for the change, and several reminders. Understand that switching gears is especially tough for a child with autism, so reduce extra expectations that are not part of a well-known routine. For example, if an established friend has a new baby sister coming along with mom for the playdate, act this out with dolls or puppets beforehand. Better to practice what to expect using a doll a few times before meeting a newborn baby “in real life”.

Speaking of reality vs. fantasy, a child with autism is easily drawn to video games. There are predictable patterns, written in code of course, unlike much of human behavior, and control is literally in the hands of the player. Note that some children have a hard time “losing” a video game, even just getting a lower score than they’ve gotten before. As with all children, limit how much game playing your child can emotionally tolerate.

Sensing and Moving

It’s easy to spot a child’s sensitivity to noise, tastes, smells, lighting, and or touch because he’s probably been reacting strongly since infancy. Teachers, parents, and other adults can share their observations and work together to avoid overwhelming the child. For example, avoid an accidental overstimulation by routinely using the same trusted ingredients in his food.

 The need to move is higher in children than in adults, and often very high in a child with autism. Movement undoubtedly relieves stress, including the stress of successfully interacting with others. In addition to plenty of opportunity to run, jump, climb, dance, and tumble during a play date, introduce a fidget toy when whole body movement isn’t appropriate such as during a car ride or watching a movie together.

The advocacy group Autism Speaks acknowledges that increased awareness and improved screening tools might explain the increased numbers of diagnoses. Regardless of getting an official diagnosis, the above strategies may help your child develop more social comfort.

 Dr. Debbie

Write your question to Dr. Debbie! Please include age(s) of your child(ren) and other details about the situation or concern.

Deborah Wood, Ph.D. is a child development specialist and founding director of Chesapeake Children’s Museum, located at 25 Silopanna Road in Annapolis.

The museum is open daily from 10 am to 4 pm including most holidays. Online reservations are available or call: 410-990-1993. Each Thursday there is a guided nature walk at 10:30 am. Art and Story Time with Mrs. Spears and Puppy the Puppet are on Monday mornings at 10:30 am.

The 25th annual Kids ‘n’ Kaboodle – the totally free fair for all the kids of Annapolis will be held on Sunday, June 1, 12-4 pm at the Bates Athletic Complex, 935 Spa Road. Come for: live music, pony rides, games and prizes, career exploration, arts and crafts, lunch, big slide, and book giveaway. Thanks to our community partners for a day of creative fun and joyous laughter!