Two year old kid. Side by side play. Extreme adherence to routine. Normal. The concern really peaked when my son was exactly the same at three. Those interactive skills which are usually exploding as children grow, were simply not there.
He would not look children in they eye or speak to them; he clearly saw them as completely different beings from adults. Even adults were not seen as people with feelings, they were concretes as well. For example, walking into his preschool classroom, I could greet a typical peer, "Hi Polly." The response was usually a smile, eye contact, and often something to engage like, "Hello. I had a birthday party yesterday and got lots of presents. Isn't that great?!?" Now, it's very normal for some kids to be more or less shy. However, my son would never interact this way, not even with comfortable adults. He would describe things in factual terms or seek sensory input, but not engagement. For example, his response to any greeting was occasionally a glance, but often nothing. He wouldn't bring a toy for evaluation, but if you asked him about it, he would tell you about it being white and made out of metal and having wheels and... the concrete description could go on and on. While it takes a long time for children to smoothly think about what another person is feeling, they usually have a keen grasp on reading emotional responses i.e. they know that a person is sad and can feel the response *.
Two year olds love their routines, but he wasn't gaining more perspective with time / experience. He saw routines as the essence of his world. For example, I needed to park my car outside the garage. For one week, I dealt with a solid thirty minutes of ballistic crying every time I came home because the car belonged in the garage. It was in the nature of his universe. It was as frightening and upsetting to him as it would be for us to wake up to a purple and green polka-dot sky. Cars in the garage were part of the metaphysically given and that's one example of hundreds.
His language was a grab bag of scripts that meant a concrete whole to him. He would say, "You want to give me the milk" in the same way another kid would say "milk". He didn't understand the pieces of language and took several years beyond his peers to get pronouns right (another big social issue if you approach peers and start telling them "You want water, toys, etc."). He maintained a concrete understanding of the world. He would spend hours watching how the wheels of a toy car rolled, but did not pretend until, again, several years beyond typical peers. The idea of imagining that the car was on a road when it was on a table made no sense at all to him. If you made vroom vroom sounds and rolled it around, he'd look at you like you were crazy.
Finally, there were huge sensory seeking issues. He would fling his body into people, need brushing therapy to get enough skin stimulation, have loud, shrieking verbalizations (auditory self stimulating), all sorts of behaviors that made people wary of getting close. This situation was heartbreaking. So, what changed?
Readers of my blog know this is not the child I deal with now. There are plenty of six year old, autistic children with the exact same issues that my son was showing at age three. Special needs preschool, speech therapy, and occupational therapy all helped, but there was a fundamental change that significantly altered his course. He developed hyperlexia. Part of his scripted language had been the ability to memorize forty page books which he would recite to himself in bed each evening. He showed an early affinity for letters and reading. He was reading basic books before age three and is currently reading chapter books at third grade level (he's in kindergarden). This was the key for turning his world around.
He took the experiences from the books, the hundreds of books, and made them his own. He learned about people, feelings, imagination, language. He filled in the huge gap in language that was below his extensively scripted communications and learned how to use pronouns correctly (after all, that was the way it was done in the books). He learned how people can feel different things when interacting and how he could observe expressions, body language, and tone of voice to understand. He gradually incorporated pretend play. First, it was just repeating a book. Then, he would put together two scenes from different books. Slowly, he started adding his own ideas to the pretend. Now, he has thousands of pretend, invisible students in his room that he teaches each evening. Now, I can write a social story that goes through what will happen in a new routine and he can read it, over and over. Now, we can read books about personal space and he reads them on his own too. I brought home one for 12 year olds that was done in comic book format and he sat down and read the 40 page book to himself, commenting to me on each page.
My son is still an incredibly sensory seeking kid. We find lots of outlets for that exuberant energy. He still has greater difficulty than typical with emotional storms, but it's been awhile since I dealt with a full melt down tantrum. (The How to Talk book helped the most with me facilitating his growth there.) He learns from the books and he practices. He can use words, and the right words too, to express his feelings in a controlled, non-attacking manner. He is highly cognitive and wants to discuss every idea, situation extensively. We read and read and read some more. He now spends at least an hour reading to himself in bed each night and comes down with more to discuss each day. So, he doesn't usually say "hi" to people or understand perspective and he often gets too loud/close, but he is intelligent, affectionate, energetic, and, most dear to my heart, passionate about learning! I have no doubt that, if he still wants it, he'll become the airplane engineer that he desires.
Reading to me when he was about three and half. (He's always been a big kid.)
* Fascinating research on mirror neurons indicates autistic children don't experience what another person is experiencing the same way that a typical person does. This is one of the key ways that people learn in childhood and interact with others as they mature. (I read the book of one of the key researchers, but here are some quick articles:
and a basic review of Autism Spectrum,
the key is really that the diagnosis is so broad, it doesn't tell you much except that there are some social difficulties. When I first heard the word applied to my son, I thought the doctors were crazy because, in my mind, autistic kids sat in the corner, rocking back and forth, not talking to you, completely secluded in their own world.
This is one of the best overviews I've seen in a quick video.
Temple Grandin is famous for her work in sharing the unique experiences and the difficult process of learning to interact socially which is characteristic of autism.