Expert: Trey McGowan - 7/10/2007

Question
QUESTION: I am writing with a question about my 19month old son.  I first became concerned when I realized he was not reaching his verbal milestones.  At 15 months, he did not have a true word, only limited babble (baba, mama).  His speech evaluation reveled a significant delay in both receptive and expressive speech.  He has since had a full eval, and also showed some features of autism.  He is now 19 months, and has begun babbling much, much more, lots of consanants, vowels, and now even has about 4 words (milk, dog, bubbles, off) although they are truncated, and not pronounced perfectly, he uses them consistently.  Here is the autism concerns:  he only recently started pointing, and still not a lot- but he does point.  He does not pretend play, he does not imitate a lot.  Otherwise, he makes terrific eye contact, laughs, initiates play and games, brings me over to play with him, eats great, sleeps great, loves to see other people and kids, has assimiliated beautifully into a Montessorri daycare/preschool, rarely has tempertantrums, follows some commands, responds regularly to his name, brings me toys, shows me things (not a ton).  I am on a wait list to see a developmental ped, and this uncertainty is driving me crazy.  Can you offer any insight into what might be going on.  

Thank You

ANSWER: Hello there, Andrea!

Now, I am not a doctor of any sort at all. I can't make a diagnosis. I can only offer my own guesses, which may or may not be better than yours. Whatever you read here, take it with a grain of salt, and make certain that your doctor's word is first and foremost in your mind. That being said, I *am* willing to offer some guesses.

My first and foremost guess/question: have you had his hearing tested? It's possible that his problems with speech could be related to hearing problems. If he is deaf in one ear, or has some other hearing deficiency, it's very possible that he's not able to pronounce them because he's not hearing them properly. If he's not had his ears tested? I strongly suggest that this is the first thing you should do. If he has (and 'full eval' suggests he likely has, but I wanted to cover all bases), then read on. ;)

With the high social skills that he is showing, it doesn't sound to me as if he is classically autistic. I am not saying 'rule it out', but I am saying that, if I had my guess, he's likely either extremely minor or not autistic or Asperger's.

You mentioned that he showed 'some features of autism'. Which ones do you mean? If I knew the idiosyncrasies you were seeing, it might make it easier to make a guess. As it is now, if the speech is the only sign of it, I have a feeling that your issue lays more in a purely speech-related deficiency. The developmental ped will know best, though. As would a speech therapist, who you should probably prepare to contact anyway; they'll help with that language issue.

Hopefully that helped at least a little!

Trey

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

QUESTION: Thanks for your reply.  We have had his hearing tested, and if he does have a hearing problem, it is not too bad, although we can't say the test was conclusive because he didn't cooperate for the whole test, and thus did not respond to some lower frequencies, but he does hear voices and high frequencies.  I still have to bring him back to try to rule out the middle and lower frequencies which he did not resond to at the first two tests.
The austism features are: not pointing to show me things of interest.  He has just started to point to features of my face and things on the TV, but he does not point often.  He does not pretend play at all, he plays with his blocks, play phones (pushes buttons, but doesn't pretend to talk), he likes to play with baby musical instruments, balls, etc, but he does not do any real pretending.  He doesn't hold things up to show me, he brings me things and puts things in my hand and looks at me for me response to things, but does not hold anything up just to show.  His responsive speech is not great, it has gotten better, but still very low compared to his peers.  He does not wave bye bye or blow kisses or things like that.  He will run to me and hug me often, but not give kisses.  He does not have any sensory issues, OCD components, doesn't favor any certain toys, or need them in any order.  He loves motion and to be swung played.  He is very physical and walked and climbed early.  He loves going into new places and running around.  The thing that troubles me is that he can say mama but still does not call me mama, and I refer to myself as mama ALL THE TIME.

I am wondering if he will be diagnosed with pdd-nos?

Thanks for your help.

Answer
Hello again!

It's a possibility, though the therapist would know better for sure. It definitely sounds to me as if the speech is the biggest issue, and thus a speech therapist should be able to help with that. From the sound of things, he seems to be adapting extremely well with everything else, so if it *does* turn out that he's got some PDD-NOS, it should hopefully express itself mildly, and the small things that you've noticed can be worked with if they need to be.

I would like to give you kudos for being a very attentive and educated mother. I'm sure that whatever gets found out, you two are going to be just fine. :) It's a big relief to see someone who's done the work enough to study up and get ready for the situations. My hat's off to you... if I wore one!

Trey