Table 4

Sign guidelines

Additional warnings of possible ASD in adolescents*: warning signs
General picture
    Difficulties in social behaviours, communication and coping with change, long standing and more obvious at times of transition (eg, change of school, leaving school)
    Significant discrepancy between academic ability and “social” intelligence, most difficulties in unstructured social situations (eg, in school or work breaks)
    Socially “naïve”, lack common sense, not as independent as peers
Language, non-verbal skills and social communication
    Problems with communication, even if wide vocabulary and normal use of grammar. May be unduly quiet, may talk at others rather than hold a to and fro conversation, or may provide excessive information on topics of own interest
    Unable to adapt style of communication to social situations (eg, may sound like “a little professor” (overly formal), or be inappropriately familiar)
    May have speech peculiarities including “flat”, unmodulated speech, repetitiveness, use of stereotyped phrases
    May take things literally and fail to understand sarcasm or metaphor
    Unusual use and timing of non-verbal interaction (eg, eye contact, gesture and facial expression)
Social problems
    Difficulty making and maintaining peer friendships, though may find it easier with adults or younger children
    Can appear unaware or uninterested in peer group “norms”, may alienate by behaviours which transgress “unwritten rules”
    May lack awareness of personal space, or be intolerant of intrusions on own space
Rigidity in thinking and behaviour
    Preference for highly specific, narrow interests or hobbies, or may enjoy collecting, numbering or listing
    Strong preferences for familiar routines, may have repetitive behaviours or intrusive rituals
    Problems using imagination (eg, in writing, future planning)
    May have unusual reactions to sensory stimuli (eg, sounds, tastes, smell, touch, hot or cold)
  • NB: difficulties are likely to be more subtle in older individuals or those without learning disability. Reproduced with permission from Scottish Intercollegiate Guidelines Network (SIGN).7

  • *Developed by the guideline group based on their knowledge of the evidence base and their clinical experience.