Expert: Catherine Ridenour - 8/18/2006

Question
Hi Catherine,

I have a question about my son who is just over 16 months. He points to things of interest to get our attention and sometimes names at same time, but rarely will point things out in a book. He has about 10-14 words. Some are appoximations. He has some receptive language but seems to answer accordingly when he's in the mood. My main concerns are his motor planning development, he just started waiving a month ago and it is with two hands. He has trouble imitating or sometimes it seems he will only do what he wants when he wants to. For example, loves to dance will dance anytime you ask but doesn't do "so big" or clap very often. He is in early intervention and his eye contact is very poor with instructors  but fine with parents and sibling. He looks at them more after they have physical contact with them. One has the theory that he is hyposensitive and needs OT. He seems to avoid eye contact when someone is asking him to work! He does approach children although sometimes to hit or poke (I'm told all 16 month olds do this from his school so it is age appropriate)He has pretended to talk on a phone for 30 seconds or so and sweeps the floor, like to help with the dishwasher etc. My question is does this seem like it could be Aspergers because of the language or something else entirely. As I understood it, regular autism has no language development at this age even though his is not in the high range. He is engaged at times but does seem "out there" for short periods everyday. Desperately looking for answers. I sometimes feel like early intervention is looking for things. Do they really appaer to be there?

Answer
Hi Kate,

It is often difficult to separate "normal" stubborness from developmental delays. A 16 month old child who has 14 words or approximations of words (kids can't say L's, and R's very well at that age), points to things to get your attention and imitates some behaviors sounds pretty okay. Resistance to performing on command is pretty normal. He may be thinking, "I can already do that, why are they asking me to show them again?".

Most, but not all, Asperger's kids talk very early, have huge vocabularies (100 words at age 1), poor eye contact with strangers and no clue as to the thoughts and feelings of others. They also are hypo-sensitive to some things like pain or instructions from others but hypersensitive to loud noise, flashing or bright lights, unexpected touch, and often very picky eaters or refuse to wear clothing with certain textures or colors.

It is said that "mutual attention" is a good indicator. That is, when you see something interesting and look at it, "Look Johnny, a blue bird!" does he turn his eyes in that direction? Does he seem to expect you to do the same if he sees something of interest? If he does, I doubt he has autism.

Being "out there" can be autism or it can be just his personality. If he feels overwhelmed, he may be shutting out stimuli just to get a break. There is one possibility that should be considered and that is a petit mal seizure disorder. You would recognize it by the sudden cessation of engagement, almost as if he is frozen in time for a few seconds, and then a sudden return to the activity as if nothing has happened. If that is not happening, forget I ever mentioned it, you have enough worry already.

It is possible he has an auditory processing disorder. This can be part of autism or a separate learning disability on its own. That means he can hear you, but making sense of the words is not happening. Something is not wired in the usual way in his brain. There are very good specific teaching strategies for this.

Early intervention will not hurt him so long as the focus is kept on helping him develop as he is ready. Some kids just don't talk very much until 2 or 3. Boys usually talk later. Firstborns talk sooner than subsequent siblings.

My best advice is to relax a bit for now. Take him places, play on the floor, sing, read to him, dance and run. Time will tell and since he already has contact with intervention specialists, if anything definite emerges, it will be dealt with in a timely manner.

Here are some web links to more information and resources:

http://www.patientcenters.com/autism/news/resources.html (books and resources)

http://www.ninds.nih.gov/disorders/asperger/asperger.htm (the definitions and government links)

http://www.autism.org/temple/meds.html (about medication)

http://www.autism.org/ (many links to information)

http://www.autismasperger.net/intro.htm (Stephen Shore’s web site)

http://www.angelfire.com/pa5/as/asteachersites.html (teaching resources)

http://groups.msn.com/TheAutismHomePage/toilettraining.msnw (toilet training)

Best wishes,
Catherine