Expert: James Michael Roan - 12/5/2006

Question
Hi James,

Well here I am back again and still wondering about the autism. My son will be 20 months in the next few days. He has made nice progress in all areas. He can spontaneously imitate now (some of the time), his Speech Instructor gave him a formal language test to test his progress and he scored 40th percentile expressively and 80th percentile receptively. He could put the bear to sleep, feed it ect. in the test when she asked. He has 50 words (10 functional like up, open, all done) the rest mostly names of people, TV caracters and labels. He only uses two word combinations to say something is gone ex. "dadda gone" and all done. He does seem to have trouble using yes and no appropriately, seemingly saying yes when he means no and vice versa. He points to things of interest and things he wants, will play with figures (put them in a car, talk on the phone and look when you point to something.

Now here is where there still is not a lot of improvement. He avoids eye contact. When you ask him to say bye-bye or hi he will say it but will turn his head or avoid looking at the person. He has recently begun avoiding answering to his name by not looking. He hears you because he will come over but keep focused on what he is looking at. Same thing with asking him if he wants a cookie. I will hold it up and say do you want a cookie and and he'll answer but never look at my face. He appears to have sensory issues and are starting OT. He likes strong face to face contact and has upper body low muscle tone which has delayed his fine motor skills and oral motor skills for speech. When I pick him up from school he runs over but social smiles are spontaneous not in response to your smile. He recently saw a cartoon he loved and would say the "ya hoo" part the cowboy said while pretending to use a lasso all day long. He also hums (in perfect pitch) any song and will be heard humming these (twinkle twinkle when he sees a star) clean up (while cleaning up), elmo's world etc. and sometimes randomly like they are playing in his head. With other children he will look them in the eye, smile and play IF it is something he is interested in like trains. Otherwise he will play by himself. He has a strong interest in toy vehicles but does not line them up or spin the wheels. He will put them more at chest or eye level to play or lay down. I thought this could be because of his poor trunk stability. He also like books and will point to pictures, copy sounds and interact perfectly with my requests. I would say though that books and vehicles are really the only things he is truly interested in. Other than the eye contact, socially he just doesn't seem to be 100% connected. He doesn't always look at what is going on around him (but he knows it (not his own world type of thing) just doesn't look. The other night he was pointing at a toy he wanted and was calling me "mama mama" to get him the toy, but never took the focus off the toy to look for me  and I was 3 feet behind him. He also seems to lack the intuition that comes naturally to most of us.

Please tell me if this is Autism, Aspergers etc. He is so sweet and made so much progess with EI but I still feel like everything is not quite right!

Best Regards, Kate

Answer
Hi Kate;

Although I do not diagnose over the internet, I am fairly certain that your son meets none of the criteria for autism according to the DSM-IV. Some characteristics you mentioned in your email could be consistent with Asperger's Syndrome. These characteristics are:

1. "trouble using yes and no appropriately."
2. "He avoids eye contact. When you ask him to say bye-bye or hi he will say it but will turn his head or avoid looking at the person."
3. "avoiding answering to his name by not looking."
4. "He likes (or lacks?) strong face to face contact."
5. "With other children he will look them in the eye, smile and play IF it is something he is interested in like trains. Otherwise he will play by himself."
6. "socially he just doesn't seem to be 100% connected. He doesn't always look at what is going on around him (but he knows it (not his own world type of thing) just doesn't look. The other night he was pointing at a toy he wanted and was calling me "mama mama" to get him the toy, but never took the focus off the toy to look for me  and I was 3 feet behind him."

By "intuition," do you mean social understanding?

Your son is very young and it is impossible to reliably diagnose Asperger's Syndrome (AS) until he is at least 4 years of age. I suspect he may be "subclinical" AS. Many children have low social interest and low social cognition and never meet diagnostic criteria for an autism spectrum disorder. Good luck and stay in touch with his progress.

Kind regards,
James