In brief
In school age there are only few reliable warning signs. The British guideline on which the 2016 guideline drew found only two features with sufficient evidence for children aged 6 to 11 years: "no social play" and "does not sustain conversations with others". For adolescents aged 12 to 17 years, no symptoms and warning signs were found; for the whole school age, only "repetitive talking about one topic" met the criteria. The quality of the studies was rated very low for all age groups. [2, Ch. B.2.2] More important than individual features: concerns of parents, other carers and older children themselves should be taken seriously, even if others do not share them. [2, Ch. B.2.2]
This English translation was produced with AI assistance and has not yet been independently reviewed.
Status of the guideline: This article draws on the S3 guideline on diagnosis (text version 23.02.2016). It has expired: according to the overview of the DGKJP it was valid “until 04.04.2021”. [1] The document carries a note that it is currently being revised. [2] Newer studies are not taken into account. We will update the article as soon as a new version is available.
What the guideline named
The features above are not a test. They mainly show how little established warning signs are in school age. The guideline also named areas in which autism shows: social interaction, communication (including use of language, non-verbal communication, understanding of figurative meaning) and repetitive behaviours, interests and routines. [2, Ch. A.2.1] For Asperger syndrome (term of the ICD-10 at the time), prospective studies were lacking; parents reported in retrospect that they had often been worried before the third year of life. [2, Ch. B.2.6]
Autism without noticeable signs in childhood
Features are not always noticed before nursery or school. [2, Ch. B.2.1] Good eye contact, smiling and affection towards the family do not rule out autism. [2, Ch. B.2.2] In cognitively gifted children, strategies they have worked out themselves can mask features. [2, Ch. A.2.1]
Where it can be noticed
The school entry examination (at ages 5 to 6) can show noticeable features that should lead to a specific assessment. [2, Ch. B.2.6.1] Behavioural problems in autism are not infrequently interpreted differently at first, for example as defiance. [2, Ch. B.2.6.1] For teachers: Pupils with autism in lessons.
What you can do
- Write down observations (practical tip from the editorial team): situation, frequency, what helps.
- Talk to the paediatric practice or an advice centre. On the process: Diagnosis in children: who, where, how?.
- Regardless of a diagnosis, support at school can be discussed: Good cooperation between parents and school.
What else you should know
- If your child does not want to go to school: School avoidance and school absenteeism.
- Not covered: warning signs in girls compared with boys. We have no checked evidence on this in this article; see Women and autism.
Note: This article offers general information. It does not replace an assessment or medical advice.
Sources and literature
- DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Textstand 23.02.2016. – Guideline (in German) (expired; according to the document note under revision)
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