Expert: James Michael Roan - 7/23/2007

Question
QUESTION: James,
I have some concerns about my son who is now now nearly 2. He has been babbling quite a bit and actually seems to wake up
every morning around 5:30AM and babble for 1.5 – 2 hours. He sings, talks in
low and high voices and it sounds just like a regular conversation but no
words. He has finally begun to use a lot of consonant sounds like the t sound
for truck, the c sound when he wants a cookie, cr for cracker, b for balloon or
ball. He will also point to what he wants and can use the sign language for
more as well as saying the mo sound. He has begun to imitate us if we show him
to put our finger to our lips and say shhh or wiggle his finger like a puppy’s
tail. He likes to look at himself in the mirror. He can point to at least 8
body parts and points at things that interest him. He will do things that we
ask him like go into your room and bring your stool out here or take a
washcloth from the bathroom and put it in the dirty clothes
hamper in his room. He plays with his stuffed animals making them run by
bouncing then on the floor or table. He is shy around people at first but once
he warms up tends to be all smiles. He was smiling at the lady behind us in
church yesterday, He doesn’t seem to want to play with other kids his age yet
but will play aside them and seems interested if he sees a child nearby. He
has been receiving an hour of speech therapy a week for about two months. He
will sometimes go in his room and sit by himself to “read’ his favorite books
and stand on his stool to watch the neighbor kids out the window. He also
loves when trucks or cars go by. My concerns: when we go to get him up in the morning he doesn;t seem to want to get out of his crib.  Hewill after a while but in his own time.  When we go into his room in the morning he often wants to look and point to pictures or logos on our shirts.  When he sees us after an abscence he does not run to us or seem very excited that we are back.  I work out of town and am gone for 3-4 night two or three times a month.  he also is not very affectionate although he will give a kiss when asked, by touching noses.   ; He still has no real words, he
will sometimes stare at his hands as he moves them as if examining what they
can do especially when tired. He can be difficult to change his diaper without
some type of toy to play with. He seems to grasp his own hands a lot and has a
funny way of stooping forward and looking at things clo
se up at times. He will also sort of turn his head to the side as he starts
to run but straightens it out quickly. He also will sometimes smell his mhands
and or toys. I don't know if that would even bother me if i had not seen it
mentioned as an autistic symptom. I have been going nuts about the possibility
of autism since his 18 month checkup and the MD seemed concerned about his
speech and asked if he ever pretended to make and pour tea.  I have looked at the Mhat and he seems to pass everything. I know that you
can’t diagnose over the internet but would you please give me an opinion. Am i right to be concerned?  what should we do if anything?  he sees his pediatrician next month for his 2 year checkup.
Thank you so very much in advance.


ANSWER: Hi Bill;

I lost my full answer to you in cyberspace a moment ago. I'll start over.

I don't think you have anything to worry about. Most of your son's behavior is either typical or the result of an expressive language delay.

I'd like more details about exactly what he does with his hands. What is his eye contact like? Does he have any eccentric behaviors like having to shut all the doors in the house? Is he overly fascinated by running water? Is he afraid of noises, not high volume, of sounds from a vacuum cleaner, hair dryer, or air hand dryer? Children have many diverse ways of expressing affection. Children at 2 have not developed what Jean Piaget calls object permanence, thus: "Out of sight...out of mind." You'll know he's past this point when he gets mad at you when you show up after a long absence!

Let me know about those other issues if you choose.

Kind regards,
James

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

QUESTION:
James,

Thank you so much for your response.  Have you worked with children with speech delays and autism?

As far as his hands, he will simply hold his own hands. Clasp one in the other.  Most times it seems gently but at times he is really clamping down.  He does it if he isn’t engaged with something else.  If he is talking to us or looking at us his eye contact is good.  There are many times where we may be speaking to him but his interest is elsewhere in those cases  there is no eye contact.  He was seen by EI and has speech therapy once a week.  All those involved in that said it was good.  I have not noticed any “sustained” eccentric behavior.  At times he loves to shut doors and a host of other things but nothing that it seems he “must “do.  He does love to watch as I fill his tub but he doesn’t seem overly fascinated.  He will leave the room with me , put his nad in the bowl filled with water and go and wipe it on the towel, play with his bath toys while the water is running..  if he sees a fountain he wants to go close but is easily taken away.  The last time we ran the vacuum he appeared terrified.  But about an hour later my wife said that he was pushing it with her while it was running.  We ran it the other day and he was fine.  He seems OK with noises.

I think the big things that have me spooked are the language delay and the things that I guess could be described as stims or self stimulating behavior of autistic people. ( I know that I have read entirely too much about autism)  He does a lot of them.  He will turn his head to the side for a second or two while running down the hall.  He likes to spin wheels on his cars and trains but will follow that by running the toy on the floor or table using it like it’s intended.  As I mentioned before he will get upclose to look at things sometimes. Bending over or forward.  He also has some strange movements with his arms and shoulders.  He is my fisrt child, I’m 46, and I may not know what a naormal typical toddler does.  Are these typical, caused by the speech delay or should I be worried?    
Thank you again!       

ANSWER: Hi Bill;

I wouldn't be worried. Download the CHAT and/or M-CHAT off the Internet and complete them every other month or so. My guess is he will pass with flying colors. Many behaviors associated with autism are part of normal development so it can be quite confusing at times.

Kind regards,
James

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

QUESTION: Thank you James!
So are those stim type things normal in developement?  Is there a time when i should be concerned about them?  The only thing on the MCHAT that would be more than occasional would be looking at his hands but he seems to be examining his hands and does not flap his fingers.  He can also be diverted from it quite easily.  He does have an interest in children just doesn't want to play with them yet and at times he zones out but can be diverted easily again.  Have i really been overreacting all this time.  I feel so sheated and stupid to be honest.  Thanks
ANSWER: Hi Bill;
Hey you are just being a good dad. Everyone is panicked about autism and should be. It is an epidemic. Early detection is essential so early intervention can begin as soon as possible. Every time our family gains a new member, there I am watching them like a hawk until I am comfortable they are okay! In fact, I have partnered with a colleague in developing the Autism Spectrum Disorder Foundation to help pediatricians and daycare providers to detect small children at risk for autism.

It is a very interesting fact, that all children will observe a group of peers playing and interacting and are somehow able to gauge their own social and linguistic competence and will, if they don't feel competent to join in, self-marginalize themselves. This is normal behavior for children with any sort of language and/or social delay.

Take care and let me know if anything comes up.

Kind regards,
James

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

QUESTION: James,
My son had his 2nd birthday party this past weekend. There were several
behaviors that he exhibited that concerned me.

He spent alot of time picking at
his shirt, right at the nipples. He has been doing this but it seems a little
more prevelant now.

He also was bending forward and looking very closely at
things that were on the table or that he was playing with. The last was that
at times he wanted to go inside. It was hot out but there were also alot of
people there. Usually he is quite social but this is the firsttime in a while
that he has been around that many at home.

I also have some questions about his speech. He continues to make new sounds.
the p sound the f sound. He seems to be stuck on ba though. He uses ba for
alot of things like more ball balloon. He also has been waking at night at
whining and talking alot in his own way. At times he is up for two hours at a
time. We think that he is getting his molars and he is able to be awake, if
crannky , for his normal hours.

Is it within the norm for a 2 year old to be up for that long in the middle of the night?

Do you have any thoughts on these things?"

ANSWER: Hi Bill;

His speech seems to be following normal development, although a bit slow coming on. His sleep pattern does not sound outside of typical development. Regarding his close examination of objects, this becomes a qualitative issue, or something I, or someone else, would have to see for themselves. I still am not hearing anything that concerns me.

Kind regards,
James

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

QUESTION: James,
My son had speech therapy today and the therapist suggested a sensory evaluantion.  She stated that she felt he might have some vestibular issues and that he sits down a little funny.  She stated that at times he has a short attention span and that sensory therapy might help.  What is the prognosis for sensory integration disorder?  Could that have something to do with him picking at his nipples through his shirt?  We see his pediatrician tomorrow.  Should we speak to him about all of this?  Is there anything that you have heard from me that warrents bringing up to his doctor.  By the way, he has begun waking at 6AM and just staying up through the morning.  On a bettter note at speech therapy the therapist had a puzzle with removable letters when he would pick one up she tried to get him to make each letter's sound.  He was interested for about 15 letters and was able to make just about every sound or close to it.  Also , my wife reads to him every night.  He has recently started to use the sign language sign for more to have her readf the same book again.  What should i make of all these recent developements.  I want to thank you so very much for your thoughts.  If there is any way i can repay you please tell me.  You have been very valuable to me!

Bill
ANSWER: Hi Bill;

He sounds good to go to me. Some children's neurological development is a little incomplete when they come into the world and they need sensory stimulation in some areas and sometimes become overstimulated in other sensory areas. It is no big deal in terms of the long run. It is necessary to understand their sensory needs so that we don't overexpose them to stimulation that they are unable to tolerate and, conversely, we stimulate those sensory neural pathways to complete the connection to the brain.

The philosophy was developed by Winnie Dunn and she has information in detail on the Internet.

I am glad this information has been helpful to you.

Kind regard,
Jim

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

QUESTION: Jim,
Thanks for your replies and I hope you had some relaxing time away.  My son has been starting to make animal and car/fire engine noises, he will say hi if prompted and at times will answer the question "how old are you" with the correct answer - Two.  Is it normal speech develpoment for him not to call us momma and dada?  He will say mama if prompted but really not on his own to his mother.  if asked who is who he point to mom dad cat and himself.  he points to himself when asked who is the good boy. When he sees other children he walks up to them and waves hi with a nad flapping kind of wave.  He has also started to hit and pinch us.  I think i already mentioned that he pinchs at his own nipples quite a bit and has started pinching his knee and belly button on occasion.  He will sit and build with his blocks for maybe 10 minutes at a time if i sit with him and hand him the blocks.  telling him the color and praising him for him for his block building prowess.  he continues to love story time at which he has begun to look intently at our faces for 10 -30 seconds at a time during his hour long story time.  Is the anything here that is of concern or especially contrary to mild autism?  Thank you in advance again.
ANSWER: Hi Bill;

He still sounds okay to me. He is demonstrating good nonverbal communication, social connectedness, and attention, which are not features of autism.

It should be understood that I am not able to observe him and the quality of his social overtures so please keep that in mind. High functioning autism is very hard to diagnose at his age.

I just returned from an intensive week-long training at the University of Washington's Autism Center, and again, early detection was based on a social delay and lack of social interest, low nonverbal communication, and no single words by age two.

Kind regards,
Jim

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

QUESTION: Jim,
Thank you again.  I hope that if my questions become a bother you will let me know.  You mentioned early indicators of autism.  Exactly how would one quantify "a social delay and lack of social interest, low nonverbal communication, and no single words by age two."  He has some words. Such as hi, bye, and letter sounds for words like the hard c for cookie tur for trutle that type of thing.  He points and looks to us when he hears sounds that interest him.  he brings us books to read to him. and pulls us to his play table when he wants us to help him with his toys.  Would these qualify?  Anything else that you could mention?


Answer
Hi Bill;

Your questions are not a bother at all. It sounds from your description that your son is socially on track. You wouldn't see those behaviors in children with autism. Eye contact and sharing are nearly nonexistent in a child on the spectrum. He's doing all the right things.

Regards,
James