Expert: James Michael Roan - 1/10/2008

Question
QUESTION: Hi Dr. Roan,

my 15 month old has a few signs of a developmental delay or autism. For a few months I have been concerned that he never responds when his name is called. often it seems he is deaf or just ignoring us. He doesn't speak any words other that da da and other babble. He doesn't point or wave either but will reach for items he wants. He has a knitted blanket that he constantly works at pulling apart with hi teeth. He is very interested in his older brother who is three. He chases him and follows him around. His pediatrician suggested I contact the intermediate unit for an evaluation which I have done. I'm awaiting a call back to set up the appointment. I guess I'm wondering can they diagnoses him this early with autism? Can they tell how severe it is at this point? Could there be any other reason for his behavior? I am so upset and concerned for him and his future. Thanks for any insight.

ANSWER: Hi Nancy;

Yes, they can diagnose "risk for autism" this early so that he can start receiving early intervention services. Not responding or "orienting to name" is the most reliable predictor of autism. Severity of autism at this age can be inferred based on his ability to tolerate change to his routine, degree of receptive language delay, and sensory issues. Stereotypies usually develop later. That having been said, there are other circumstances that can come together that can look like autism such as a stand alone social delay. Early intervention can work miracles, I see it in my private practice all the time. If your son gets a diagnosis I can tell you what to look for in terms of an early interventon program. There are also things you can do to help him develop socially and communicatively if you are interested.

Kind regards,
James

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

QUESTION: Thanks for the quick response. As soon as I get some type of diagnosis I'll be looking for more advice. You mentioned things I can do to help develop socially and communicatively. I would love any suggestions.

Thanks again,
Nancy

ANSWER: Hi Nancy;

You are welcome. Play lots of interactive games with him like peek-a-boo or slowly taking his spoon of food and say "here it comes...!!!" Use lots of exaggerated vocal tone and facial expression. Make it fun! This will help him to learn social thinking skills and that your face, body language, eyes, and vocal tone carry important information, information he can use to make predictions. Try and carry the same expressions and vocal tone across games and settings so that he knows exactly when he's getting the big pay-off!! You can use this routine for others things as well. Stimulate nonverbal communication like waving bye-bye, finger to lips for sh-h-h. If there's a dad and you know your son hears him drive up, then say: "Who's that?! Is that grandma?...No-o-o. Is that the mailman?....No-o-o. [Now more slowly and deliberately just before he walks in say: "Is that Daddy?!!!.........YES!! It's Daddy!!! Have Dad pick him and tickle him and raise the excitement level. It helps form the learning bond in the brain. The more you can do this with him the better his social-communication development will be. Play games that require him to imitate you like Itsy Bitsy Spider and reward attempts at his imitation.

And by the way congratulations on your you almost-new son!

Kind regards,
James

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

QUESTION: Hi it's me again. I am having a really hard time dealing with this. The more I watch him the more signs of autism I see. I used to always' do "airplanes" to feed my son. He would laugh and smile. I've tried it again and he just pushes my hand away, wont make eye contact. Sometimes he will respond to peak a boo and he will laugh and engage but only for a short time. It seems he wants me own his own terms. He will come to me and hold my legs if he wants me or something like food etc. Hardly makes eye contact, doesn't answer to his name,doesn't communicate with gestures and doesn't seem to understand anything I'm saying. To me his symptoms seem so severe yet the rest of my family including is Dad, my husband, thinks "oh he is just a little slow" or "maybe its his hearing. He doesn't even flinch when I bang pots together but if his favorite TV show comes on he looks up.I am getting it checked just to cover all basis. I am having a hard time getting early intervention getting back to me which is frustrating. I also contacted CHOP to have him evaluated/diagnosed. We have to wait 6 to 9 months. I'm sure that the same everywhere, seems like forever especially when time is precious. After all that I guess my question is have you personally seen Autism this young in a child? Does it mean it is more severe since its so noticeable or are we just more aware of symptoms these days? You mentioned how you have seen early intervention work miracles. I'm so afraid he will never talk or communicate or cuddle and kiss me like his older brother does. It makes me sad to see my 3 year old trying to engage him in play and getting frustrated that he doesn't respond. The only game he wants to play with us is chase and he laughs it up!Have you seen moderate/severe cases with good outcomes? I'm just so worried we will be robbed of the dreams we had of raising our boys and him being successful and independent.  Do you know of any other good testing options for us in the Philadelphia area? Sorry to keep coming at you with this, just so upset.

Thanks,
Nancy

Answer
Hi Nancy;

I am sure this is very stressful for you right now. I will help you through this as much as I can.

1. First, expend your energies on getting that first meeting date established through Early Intervention (EI). Keep a log of when you called/emailed, and who you talked to. If you don't get a definitive response in a week or two contact the Office of the Superintendent of Public Instruction for your state and be ready to file a "citizen's complaint." Threatened such action first in order to get the EI people moving and moving quickly. Remember, you don't need a diagnosis to get EI services, just have some degree of developmental delay in communication, social, cognitive, and/or motor areas.

2. Now, as far as your stress is concerned, let me point out that early intervention will make a huge difference in your son's social and communication development. If he is moderately autistic, then EI after a year or so will move him up the scale to mild or high functioning autism. That's how IE works with children on the autism spectrum. He sounds, according to your brief behavioral descriptions, to be more in the mild range IF he has autism at all. Your last email raises red flags for me though.

3. Yes, I have seen autism in very young children and "no" seeing it early does not mean it's more severe just that you are very aware of his development more so than others around you. My experience, internationally, is that moms are very brave and always the first to notice something wrong and dads tend to be in denial and discount the mother's observations and concerns. It's almost a given.

4. With early intervention almost all children develop speech and demonstrate affection, though not quite at levels of typically developing peers.

5. Look for university autism centers and Children's Hospitals for autism assessments if they will do them for toddlers. Also check your health insurance, almost all HMOs provide coverage for speech and language and occupational therapy and other EI services.

Kind regards,
James