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Understanding autism

Social communication and interaction in autism

Who is it for? For anyone who wants to understand what is meant by “differences in social communication and interaction”: people on the autism spectrum, relatives, professionals.

In brief

Differences in social communication and interaction are one of the two core areas of the diagnosis. They refer to persistent differences in how people engage with others: in the reciprocity of feelings and conversation, in nonverbal behaviour (gestures, facial expression, eye contact) and in starting, maintaining and understanding relationships. [3] How this shows itself changes over the lifespan and differs from person to person. [1, Ch. A.2.1] It is not about a lack of affection or interest; in an experiment, people on the spectrum exchanged information with one another as well as people without autism did with one another. [4] The 2016 guideline has expired. [2]

This English translation was produced with AI assistance and has not yet been independently reviewed.

What the diagnosis means

According to the 2024 expert overview (following DSM-5), the core area comprises three aspects, all of which must be present: [3]

  • Differences in social-emotional reciprocity (for example little back-and-forth communication or little shared enjoyment in interaction),
  • Differences in nonverbal communication (for example gestures, facial expression, eye contact and how they work together),
  • Difficulty starting, maintaining and understanding relationships (for example when making friends).

The 2016 guideline likewise described that disturbances of interaction concern relationships in the family, friendships, partnerships and dealings with peers in nursery, school and work; disturbances of communication concern language development and above all nonverbal communication. In cognitively able people, understanding figurative meaning (proverbs, humour, irony) is added. [1, Ch. A.2.1] The second core feature (repetitive behaviour, interests, sensory stimuli) is covered in Repetitive behaviour and special interests.

How it changes over a lifetime

The clinical picture changes considerably from toddlerhood through school age and puberty to independent adult life; each stage of life makes different demands on social skills. [1, Ch. A.2.1] In toddlers, nonverbal signs are in the foreground, such as eye contact or pointing (First signs); in adolescents and adults with fluent speech, the symptoms increasingly appear more abstract, for example in social insight and empathy. [3]

Hidden adaptation

In people without additional intellectual disability, self-developed compensation strategies can mask features of autism and make diagnosis harder. [1, Ch. A.2.1] A systematic review (8 qualitative studies) found that “masking” (camouflaging) is often used to make friends; for most people it is exhausting and often not very effective, and it calls social authenticity into question. [5] More: Masking: when adapting is exhausting.

Misunderstandings often run both ways

An experiment with nine groups of eight people compared how a story was passed on: groups made up of people on the autism spectrum passed on details as well as groups without autism; in mixed groups considerably more information was lost, and rapport (understanding of one another) was lower. The authors conclude that problems arise above all where people with and without autism meet. [4] This is a single, small study; it does not mean that all difficulties arise from the environment. The study had 72 adults (24 each with autism, without autism, and mixed), the sample was rather small; the authors stress that replication is needed, that participants knew who was on the spectrum, and that the indication of lower rapport in mixed groups was not particularly strong statistically. [4]

What do we know – what is still open?

Finding (classification and guideline): the core features and their change over a lifetime, as described above. [3; 1, Ch. A.2.1]

Individual studies: the experiment on passing on information [4]; the review on masking and friendships (qualitative studies only, a small number; several without involvement of researchers on the spectrum) [5].

Open:

  • Why social communication and interaction develop differently in autism has not been conclusively explained; the sources we read do not support any single explanation.
  • The results on mixed groups cannot be transferred to all everyday situations.

What else you should know

  • Concrete rather than “between the lines”: The 2021 guideline named, among other things, concrete, direct communication, the possibility of nonverbal contact and structure as helpful in everyday dealings. [6, Rec. 3] More: Communication in everyday life: avoiding misunderstandings.
  • Affection is shown too, just not always in the expected form. Good eye contact and smiling do not rule out autism. [1, Ch. B.2.2]
  • Not covered: empathy and alexithymia in detail (separate articles are planned).

Note: This article provides general information. It is not a substitute for diagnosis or advice.

Sources and literature

  1. 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 (Kap. A.2.1, B.2.2). – Guideline (in German) (expired; according to the document note under revision)
  2. DGKJP. Aktuelle Leitlinien (Eintrag 028-018: „Gültig bis 04.04.2021“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
  3. Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie 2024;(4+5):27–32. – Expert overview (in German)
  4. Crompton CJ, Ropar D, Evans-Williams CV, Flynn EG, Fletcher-Watson S. Autistic peer-to-peer information transfer is highly effective. Autism 2020;24(7):1704–1712. https://doi.org/10.1177/1362361320919286 – Experiment
  5. Ridgway K, Cooke K, Demmer DH, Hooley M, Westrupp E, Stokes MA. Camouflaging Autism in Pursuit of Friendship and Intimate Relationships: A Systematic Review. Autism in Adulthood 2025;7(5):543–557. https://doi.org/10.1089/aut.2023.0160 – Systematic review
  6. DGKJP, DGPPN et al. S3-Leitlinie Teil 2: Therapie. AWMF 028-047, Stand Text 02.05.2021 (Empf. 3). – Guideline (in German); expired on 23 March 2026 (see no. 2)

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