Expert: James Michael Roan - 12/12/2007

Question
QUESTION: Hello, just recently my wife took our son for his one year check up. The doctor asked if he points at things,responds to his name, & what words he is saying. Since this visit about 6 days ago we have been obsessing over everything in fear.
My son will point at stickers & pictures in a book that interest him, but does not point at things he wants. At 10 months he began to wave & say bye bye at times, and now he will say it with us exerting a lot of effort. He responds to his name inconsistently, he will be playing & we will call his name. At times he will look up at the second try, third, & sometimes first try. But there are times when he just doesn't respond to his name. Honestly I would say it's about 50% response rate. At ten months to 11 months he would say our dogs name chloe, and ada "DAD", and ma "MOM" only when he cried. We noticed that after he turned 12 months he has stoped saying chloe & ma. He will say ada sparingly. My son grinds his teeth, and once a day when frustrated he will bang his head against the wall or with his hands.
My son has no sibblings and has'nt had the opportuinty to interact with other children. My wife & I work, we had a nanny watching him. But we feel that he needs more stimulation, my wife has decided to stop working full time & will work 2 days a week. My mother will watch my son for those 2 days.
He makes great eye contact "the doctor mentioned that he makes great eye contact". Is a happy baby. Will smile when we smile. Plays peek a boo, reaches upward when he wants to be picked up.
My son as a newborn has always been very observant, studying objects, flipping them over, etc. He loves to pull toys or clothes out of his draws & then puts them back in no specific order. He pushes his toy car around house. He loves baths, or anything with water.
My son recently will go towards our dog and hug her?
We went to Spain when he was 9 months, and he had a mental & physical explosion.  AT 11 months he learned to stand up and walk alone. Other than walking at 11 months, he has tappered off.  
I'm sorry for the long post, but since the doctors appointment these have been the worst 6 days of my life. I don't know what to do. I'm afraid of buying him blocks out of fear that I might find him stacking. Our parents say that we are crazy, I pray to God that we are.

ANSWER: Hi Jose;

I don't hear anything that really alarms or worries me. "Failure to orient to name," is the only research based criterion for an autism spectrum disorder at this age. There are other, more qualitative based, evidence that we look for such as poor eye contact, low social interest or social aversion (turning away from parents and others), sensory play to the exclusion of function play such as lining cars up but not driving them around, or even just spinning the tires. We also look for an unusual interest in things that spin and unusual finger movements to the side of the eyes. Also, an unusual sensory interest in running water. This would stand out as unusual versus a pleasurable experience associated with water play. Below I have included a list of "red flags" at different ages:

6-12 Month Markers:

·   Infrequent eye contact
·   Failure to orient to name
·   Does not smile in response to smiles from others
·   Social and emotional passivity
·   Fixation on objects

By 12 Months:

·   Poor or no eye contact
·   Failure to orient to name
·   Poor imitation
·   No babbling by 12 months
·   No gesturing by 12 months

By 16 Months:

·   No single words by 16 months
·   No pointing to objects or events of interest in an effort to share

By 24 Months:

·   No spontaneous two-word phrases
·   Loss of any language or social skills at any age


If you have more behavior to share with me I am happy to review it. We are looking for examples of social interactive kinds of behavior.

Kind regards,
James

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

QUESTION: Do you think we should avoid the MMR?

Answer
Hi Jose;

Here is my view and advice on the MMR:

1. Unless your son is suspected of having a very weak immune system or a head circumference above the 97th percentile at birth, go ahead and follow your pediatrician's advice with regards to having the MMR making sure that it does NOT contain thimerisol. Also have the shot broken down into separate injections at least six weeks apart.

NOTE: Please note that I am NOT a physician and this only reflects my opinion and are NOT medical recommendations. I urge you to carefully review this issue with your pediatrician before making a decision.

regards,
James