Expert: Trey McGowan - 9/16/2007

Question
QUESTION: Hi,
I am a mother of a healthy 18 month old who does not speak much.  He points and makes ugh sounds.  And seems to have his own language.  He also rocks quite methodically and has developed a very violent temper, where he hits or tries to hit other children.  He only interacts with myself and my husband and his 2 siblings and wont even smile or engage with other people.  My other 2 children were very social, I don't know if I am over reacting but the word autism keeps popping up in my thoughts.  Should I just wait and see as a lot of my friends are telling me, or does this sound like something I should take immediate action towards.

Much obliged for any feedback
Betty

ANSWER: Hello there, Betty!

While I wouldn't immediately start jumping up and pointing a finger at 'Autism', there's obviously a lot of warning signs, with the lack of speech, the lack of engagement, and the rocking. Maybe take some time to examine his way of playing and eye contact to see if there's more there. Your child is still young, so there are many possibilities behind these things, autism being only one of them.

However, ASD or otherwise, I *would* immediately start considering speaking with a therapist, doctor, child psychologist, or other authority on the subject. The main reason is his hitting other children. A violent temper at such a young age is something that should quickly be curbed, before he starts considering that it's 'OK to act like that'. However, I suggest a specialist before you start handling personal discipline and teaching so you *can* be sure that there aren't ASD tendencies to deal with as well. After all, the usual way of disciplining may not always work if the child is ASD. But it, for me, would definitely be something to be concerned about. Maybe not panicking, but definitely something to be curbing at an early age.

Now, if I had to make a call on what might be the biggest cause of the violent temper (aside from 'autism'), I think it would be a safe bet that frustration is part of it. Whether your child has autism or otherwise, I would say that the lack of speech capability is probably a big part of it. Maybe see if you can try and teach other means of communication. At 18 months, he's obviously going to be too young to write, but see if you can start teaching some gestures. Sometimes, the spoken word can be extremely difficult, while a language of images and/or concepts is easier. See if by finding a way for the child to communicate, it might help him relax in his temper some. A speech therapist might be a help as well. I know, I recommend them a lot, but communication is a very important part of life.

All in all, to sum up: yes, there are autistic tendencies, yes I highly suggest speaking with an individual, and yes you should begin some speech therapy or other communication intervention, especially if the doc suggests that there might be autism there.

I hope my answer and feedback were helpful to you!

Trey

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

QUESTION: Hi Trey,
Thank you so much for your quick response.
My husband thinks he does engage with other people/ children but it takes him a while to warm up to a person, and not everyone.  I have noticed if there is a group of children he walks around and plays with toys but not the children.  He does like to play running if the children are doing that, but the hitting is quite concerning.  When we are at his playgroup he will seek out a child for no reason and will not rest until he tries or succeeds in hitting her.  Me and the teachers just keep holding him and try to distract him and the only way he stops is he hits me and then he no longer wants to hit the child he sought out.  I don't know if he does this because he can't talk and gets frustrated or if there is something else that is causing him to be violent.  
Also I forgot to mention that he has asthma since he was 3 months old and has been prescribed pulmicort nebuliser 2 times a day although his doctors said no side effects but I wonder if there is a link?
I will speak with his doctors again and I have already called early intervention to set up an appointment.  
Again Thank you for your quick response
Hope to hear from you soon
Betty

Answer
Hello again, Betty!

Well, as I state many times (and just in case will continue to do so!), I'm not a doctor. However, I do have access to Google, and an investigation of the inhaler that you have him on brought up the following page: http://www.rxcarecanada.com/Pulmicort.asp?prodid=1461. On it, I found the following two remarks:

"Children Under 6 Years of Age: Budesonide Turbuhaler is not presently recommended for children younger than 6 years of age due to limited clinical data in this age group."

This doesn't mean that it is dangerous. They would not have used it on him if it is dangerous. It is simply a warning that because of the lack of a testing group, they don't know what other side effects it regularly has, and what level of dosage causes (or doesn't cause) those. However, more telling for me was:

"Psychiatric symptoms such as nervousness, restlessness and depression, as well as behavioral disturbances in children, have been observed."

Therefore, while I won't promise that there's a link, if this is a recent thing, and the prescription is *also* a recent thing, it is something to bring up with the doctor. Especially with the child's history of autistic symptoms; self control on a child at that age, and on a child with that possible developmental disorder, is already low, and with a possible aggression and nervousness put into it, you can see why the urge to hit might be there. What dose is he on? Possibly, the doctor just needs to lower the dosage.

Now, there's a reason I'm not an expert in inhaled steroid use; you will want to bring it up with the doctor to be sure of things, or go for a second opinion if it is genuinely concerning and your doctor doesn't seem to have answers. After all, having the regular inhaler is necessary, or he wouldn't have put your boy on one. It's simply a matter of finding the *right* inhaler, or the right dosage. So if you find it *is* the medication? Don't give your doctor too hard a time. ;) He's doing the best possible thing for the asthmatic child by giving the regular treatment.

Now, for the part I *am* an 'expert' in? Frustration is a possibility with the aggression, but the 'seeking out the child' doesn't sound as much like frustration-aggression. Generally, frustration-caused aggression is seen when the other child is playing with a toy and the child plays 'wrong', or if the other child is playing with a toy they like and they do it to attempt to get the toy from them. This is the child simply trying to express himself in the only way he knows how that he 'disapproves'. This, obviously, is something that needs to be curbed as soon as possible, and more appropriate ways taught. However, the reason I suggest the *real* expert is that with an autistic child, 'appropriate' can sometimes be difficult to find, depending on the level. So always make sure before you end up being the frustrated one!

It may also be done if the other child is doing something else the autistic (or possibly autistic in this case) child doesn't like. Making a strange noise? Walking a certain way? Wearing a specific perfume? Maybe even a particular texture of clothing? Essentially the lashing out in *that* case is because of the child being unable to stand whatever is causing the unpleasant situation/noise/whatever, and is trying to stop it. Again, it needs to be curbed, though in this case, curbing it may be more a point of either trying to get them used to the unpleasant situation, or avoiding it altogether. Earplugs, for instance, in a sound-triggered child might be a help, or at least the teacher preparing for distraction if they see the child beginning the uncomfortable situation.

See if you can monitor when the child lashes out. Try and keep in mind if there are common reasons behind it, and you might be able to put two and two together as to why he's lashing out. Take everything into account when you do monitor him. It's amazing how many things can be a trigger in cases like this.

And finally, a statement rather than information: I'm glad that you've made the call and appointment. I'm sure that it will be a big help for the both of you, since even if he's not autistic, the communication disability getting helped-out-with will no doubt be a big help to the both of you.

Good luck with both the doctor and the intervention,

Trey