Expert: James Michael Roan - 9/24/2007

Question
QUESTION: Hello - I am concerned that my 10 and a half month old son may be displaying signs of autism.  He is crawling and pulling himself up, as well as cruising along furniture and standing with support.  He does not flap his hands but will occassionally look very closely at his hands like he is inspecting them.  He does not seem overly attached to me, his mother, and he does not cry when I leave him with another person.  He is not waving goodbye, clapping his hands or saying any words.  He does babble regularly and makes a variety of consonant sounds.  He squeals when happy and is relatively easy to make smile and laugh, but when I am upset he does not seem to notice or care.  He does make eye contact.  He does respond to his name but not all the time, particularly when he is busy doing something.  These are most of the things I am worried about.  I'm sorry for the long "laundry list", but I hope you can give me your opinion - is he displaying early signs of autism?  Any advice would be greatly appreciated.  Thank you!

ANSWER: Hi Sarah;

The only reliable predictor of risk for autism at this age is a consistent (but not all the time either) "failure to orient to name." That is, most of the time when you walk into a room does he look up at you? Does he turn around and look at you if you call his name with his back facing you? Most toddlers stare at their hands in odd ways. Nonverbal gestures and pointing develop between 9 to 14 months. Can you establish joint attention between you, he, and an object or activity? Does he look back and forth between the object/activity and you?

I didn't hear anything from you that alerts me to autism.

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: James,

Thanks so much for your reply.  I would say most of the time when I walk into the room he looks.  He will often turn around if I say his name but it really depends on what he's doing.  If he's very interested in a toy, for instance, he often will not respond when I call his name. But if he's just in his highchair having a snack he will turn around and look almost every time.  I can usually establish joint attention with him if we are playing with a ball, blowing bubbles, etc.,  and he loves to be read to.  But with other toys such as blocks he really just focuses on the objects and often will not look at me while playing.  Often he prefers to play alone.  And one final thing - do you think I shouldn't be concerned about his seeming lack of attachment to me?  That is, he really does not seem to prefer me over other people that he knows and he has not developed any separation anxiety.  I'm home with him almost full time, so it just seems strange to me that he isn't more attached.

Thanks again for listening and for any advice you can offer!

Sincerely,
Sarah



ANSWER: Hi Sarah;

Separation anxiety can occur as early as 6 months or later. It really is a function of cognitive development when the toddler becomes aware of dangers around him. It is also a function of temperament. Generally, separation anxiety appears around the time a toddler learns to walk, which is not a coincidence. I am sure your son is attached to you. Please describe who you leave him with and how well do they meet his needs? Attachment (see: Bolby), refers more to the predictable nature of having the child's needs met quickly and accurately. Most of us think of emotional attachment and they are really two different things. Separation anxiety generally occurs when the child finds himself thrust into a new, and therefore unpredictable environment where the child is completely unsure how, if, or by whom their needs will be met. It is fear of the unknown. If your child is left, let's say, with the same person who reliably meets their needs, they are far less likely to become distressed.

Does he smile when reunited with him or during affectionate interactions? What is the quality of his eye contact? If your child's lack of separation anxiety was related to social aloofness associated with autism, you would not see good eye contact or social smiles on your approach to him.

Kind regards,
James



---------- FOLLOW-UP ----------

QUESTION: Hi James,

I hardly ever have to leave my son, and when I do it's usually for a short time and only with his father, aunts or grandmother (and all of them are extremely attentive to him).  He usually will give me at least a small smile when I'm reunited with him.  He also has "favorite" people, his aunt being one of them, who he gives huge smiles to every time he sees her.  I think his eye contact is pretty good, but he is a very busy baby and his attention is often fleeting (which I believe is normal?) He just does not seem to be as friendly as other babies his age, and he is more to himself and even prefers to play on his own most of the time.  But maybe he is just more solitary?  Both his father and I are not extremely outgoing people, so I'm hoping that this is what I'm seeing and that I'm just overreacting. :)

Thanks so much for your insight,

Sarah

Answer
Hi Sarah;

He sounds fine, but just to keep an I on him I recommend you go to my website at: www.autismspectrumdisorderfoundation.org and download the M-CHAT and scoring instructions (on first page). It will give a guideline on what should be emerging in the months to come. The M-CHAT is intended for children beginning around 18-24 months.

It's O.K. to be low socially, it's probably his personality. Just keep an eye on him.

Kind regards,
James