Expert: James Michael Roan - 12/8/2006

Question
Hello.. I was wondering if you could give your opinion on my 16 month old. He'll be 16 months next week, he has not said his first word,  he babbles ( though not extensively)  and can reproduce some sounds , such as the roar of a lion. He has not clapped, waved or pointed, the only gesturing he does is he reaches to be picked up ( recently started doing this)  and reaches toward objects.  He has also just recently started to bring me some toys, but more so that I can help him with it, not to show me. He will play by himself unless I interject myself, but will play with me once I am there.  He often ignores us when we call his name , but I am quite sure he hears us, he'll at times "yell" at us if we call him too many times or too loudly.   He will look at my face for my reaction and will run to me if scared. He will look up at me and my husband for approval ( and we always clap vigorously and implore him to clap!)  if he's done something like stacked a few blocks sucessfully. He had an obsession of playing with plastic containers and tops, spinning them on the floor, for many months. He could play with them for hours. Since we found out about possible autism we took them all away and he doesn't seem to miss them , he has since started to play with other toys, although if he gets hold of one of his "tupperware" he'll spin it delightedly .  I could kick myself now because I taught him how to play with them and thought he was oh-so talented for learning to spin them. He likes to open and close doors, and turn on and off the faucet, but he is not obsessive , he won't do these activities for more than a few minutes before moving on. He also does some other odd type things such as runs back and forth between 2 posts on our porch, trailing his hand along the screen  , runs from one surface to another very excited, like from grass to pavement or tile to carpet, again he won't do these things for a long period of time but will do them several times a day, he does have an odd sort of spacey look on his face when he does them as well.. and he LOVES tickers such as the the ones that display on the bottom of the TV screen on CNN. He'll stare at it for a good bit of time. ( maybe 5 minutes)  He will not ride on any of his ride-on toys, he prefers to push them around.  He will turn cars and such over and spin the wheels, but he'll also play with them appropriately. He has started stacking nesting cups and blocks.   He does not pretend play at all and will not imitate us other than laughing when we laugh, coughing, that sort of thing. He sometimes will look at objects when I point them out, but not always, I'd say 50% of the time.  His receptive language is good I believe, he understands simple commands such as bring mama the book, bring me your shoes, go get dada... He makes good eye contact, is affectionate, and likes to play hide and seek, chase games, and peek-a boo. He loves his grandmas and responds really well to them, runs to them to be picked up and huge smiles. He shows an interest in other children and what they are doing although does not try to engage them in play.  He does not seem to be bothered by changes in routine or loud places such as carnivals, restaurants, etc.  His motor skills are excellent, he's running, climbing,  and walking up steps without holding on to any support.  

I am concerned about autism because of the odd behaviors and the lack of gestures and language.  He seems to have some aspects of joint attention, but it is very weak.  My main question is, is it possible that he can develop joint attention, imitation ,and pretend play in the upcoming months or is the absence of these a big warning sign at this point?  when do most children develop this, is it at all connected to language development?  We have a history of speech delays on both sides of our family but no autism.  He fails the CHAT test at this point but it is my understanding that the CHAT should be taken 18 months and after is that correct?

Thanks- sorry this is so long

Answer
Hi Patti;

I prematurely/accidentally sent an email so I'll start over!

I do not formally diagnose over the internet. The CHAT is for 18 months and up. I suggest you download off the internet the Modified Checklist for Autism in Toddlers (M-CHAT) http://www.firstsigns.org/downloads/m-chat.PDF Also download the scoring instructions at http://www.firstsigns.org/downloads/m-chat_scoring.PDF If there is any risk noted then do two things:

1. If you live in the U.S., make a special education referral to the school district in which you live. They are responsible for the assessment of children 0-21 years of age, and if they qualify for special education, responsible for education and related therapies.

2. In addition to the special education referral, take the M-CHAT to your pediatrician and ask for a referral to a multidisciplinary team expert in this area. Again, if you live in the U.S., you can go to the autism unit at a university near you, or a Children's Hospital.

It's absolutely essential to get the right diagnosis and appropriate services going right away.

You can retake the M-CHAT every few months to track improvement or decline. In any case, based on your description of your son's skills I am fairly confident he will develop joint attention, imitation, and pretend play with your focused help. These skills are generally present by 12 months. The best intervention is to enroll him in a language-rich and socially rich preschool. I have personally witnessed miracles. You will be hard pressed to find one though.

Kind Regards,
James