Signs of Autism in School-Age Children: What Parents and Teachers Notice

Why autism can become clearer in the school years

NIMH describes autism as a neurological and developmental difference in how people interact, communicate, learn and behave. Signs generally appear in the first two years of life, but autism can be diagnosed at any age, and plenty of children are first identified in elementary or middle school.

School asks a lot of a child at once: group work, recess, changing classrooms, noise and unwritten social rules. NIMH notes that caregivers and teachers are often the first to recognize autism in older children and adolescents, and that the differences can be subtle, such as trouble reading tone of voice, facial expressions or body language.

Autism is called a spectrum because autistic children have a wide range of characteristics, needs, strengths and challenges. Two autistic children in the same class can look very different.

Signs parents and teachers often notice

The Centers for Disease Control and Prevention (CDC) and NIMH describe two broad groups of signs: differences in social communication, and restricted or repetitive behaviors and interests. In a school-age child, that can look like:

• Friendships: wanting friends but finding it hard to join in, keep up with group play or make friends with peers
• Conversation: difficulty with the back and forth of talking, or talking at length about a favorite topic without noticing the listener's cues
• Literal thinking: trouble understanding figures of speech, humor or sarcasm
• Eye contact and expression: little or inconsistent eye contact, or a tone of voice that sounds flat
• Routines: becoming upset by small changes in a routine and having a hard time with transitions
• Deep interests: a lasting, intense interest in specific topics, such as numbers, details or facts
• Repeated words or movements: repeating words or phrases, or movements such as hand flapping or rocking
• Sensory differences: being more or less sensitive than other children to light, sound, clothing, taste or temperature

Meltdowns and tantrums are not the same

MedlinePlus describes temper tantrums as outbursts that often happen in response to unmet needs or desires. They are most common in toddlers and preschoolers, and after age 5 they rarely occur.

A meltdown is different. In one study of 46 parents of autistic children, parents described meltdowns not as willful bad behavior but as intense responses to overwhelming situations, such as bright lights, unusual noises, darkness or crowds. A child in a meltdown is often not trying to get something. They have run out of ways to cope.

This difference matters for how adults respond. For any outburst, MedlinePlus advises staying calm, moving to a quiet place and keeping your child safe until it ends. It also advises talking to your child's provider if outbursts get worse or happen often after age 5, or if a child hurts themselves or others.

Why some children are identified later

Some autistic children learn to copy the social behavior around them. Researchers call this camouflaging: strategies used to appear less autistic in social situations. A study of children and adolescents found more camouflaging in autistic girls, and the authors note this may delay recognition and support. Several studies have found that autistic girls tend to be diagnosed later than boys.

Camouflaging takes effort. In research interviews cited in that study, autistic teenage girls described masking as demanding and said it affected their well-being. If your child seems drained after school, that is worth mentioning to a doctor. The CDC also lists anxiety, worry, unusual mood reactions, attention differences and sleep or eating differences among characteristics many autistic people have, and these can be noticed before autism is.

The CDC is careful to say that some children without autism show some of these signs, and that autistic children may not show all of them. A list can point you toward a question. It cannot answer it.

Practical next steps for parents

1. 1Write down what you seeNote specific moments at home and school, and ask teachers what they notice. NIMH suggests keeping records of conversations with health care providers and teachers.
2. 2Try an informal checklistOur free autism signs checklist can help you decide whether to talk to someone. It is an informal checklist, not a screening test, it is not validated and it cannot diagnose.
3. 3Talk with your child's doctorThe CDC encourages parents to contact their child's doctor with any concerns about development. Bring your notes and examples.
4. 4Ask the schoolNIMH notes that a school's special education team may do an initial evaluation and then recommend further evaluation by a health care provider. A school evaluation and a clinical diagnosis are different things.

How we can help

Locascio Wellness offers a child and teen autism evaluation by secure video. Evaluations are offered only to people physically located in Pennsylvania, West Virginia or Arizona, and a parent or guardian arranges the evaluation and takes part. It usually involves an intake appointment, then one or two sessions, then a written report, which at the moment is usually ready about a month after the first evaluation appointment. No evaluation can promise a particular result.

Evaluations are private-pay, with a sliding scale available; see what evaluations cost. To start, use the short evaluation request form or book a free 15-minute consultation on our booking page.

We do not offer an autism therapy service, ABA, speech or occupational therapy. Therapists on our team offer child therapy for worries, big feelings and confidence, and family therapy for stress at home, by secure video with a therapist licensed where you live. A diagnosis may also open other supports that families arrange with their doctor or school.

If your child is in crisis or talking about harming themselves, call or text 988, or call 911. Locascio Wellness does not provide emergency services.