Expert: James Michael Roan - 1/29/2008

Question
QUESTION: Hi:

I am very panicked right now about my 17 month old.  I have 13 year old son by a previous marriage who had autism and is fairly low functioning-despite intense ABA since the age of 2.  I've been on the lookout for signs in my little guy and here's what I've seen.  The scary stuff:  running down the hallway and looking at the baseboard or at corners out of his peripheral vision (does this most times he walks down the hall), chewing on his blankets at night, no words except NO used appropriately, very poor motor imitation (he had clapping hands, but that is gone and I have to reteach it).  The good news:  he answers to his name, he makes great eye contact, he brings me things all the time (often with eye contact) either to show me something or to have me do something with him like read a book; loves games like peek a boo, seems to have some decent receptive language and can identify stuffed toys like Elmo and things like a fork or cup; points (not for stuff he wants) but occasionally at stuff like balloons or pictures of things he recognizes, he vocalizes and interacts with babysitters and other family, etc.  

Given the speech delay and what it appears to be the presence of stereotypical behavior, I'm convinced he's on the spectrum and I am terrified. I have tons of evals set up for him in the coming weeks and I'm spending everyday "in his face" interacting, labeling things, trying to get some language out of him.  What I'm wondering is are there any indicators early on as to whether a child will be higher functioning.  My older son didn't have any of the social skills that this child possesses.  He also didn't have receptive language.  It took a long time to teach him how to talk. Are there any predictors of a good outcome in the research literature and can I make a big difference in my little one over the coming months by working with him all day?

ANSWER: Hi Teresa;

Out of the past 900 or so questions I have answered, this is the most interesting and challenging. You obviously have a good education about the autism spectrum. I am not aware at the moment of research supported predictors of good outcomes other than intelligence, which is the best predictor in the research and my experience. My answer to your question to follow is based on my experience and opinion as a practicing psychologist specializing in autism and Asperger's syndrome and who has assessed children in the U.S. and Ireland over the past 10 years:

1. General intelligence is the best gross overall predictor for response to intervention on all levels. Specifically, abstract thinking capacity is the best predictor of academic, social, and behavioral learning. It can be formally measured many ways and informally by your child's flexibility in adjusting to change and transition on a continuum from no adjustment (very literal/concrete thinking) to very flexible adjustment with no behavior (nonliteral), being able to understand the "situationality" of circumstance.

2. Early intervention services.

3. Response to intervention. This sounds like a no-brainer but if a child starts responding to intervention or is coming on with their development you can rest assured they will do better in the future. The trend, when it appears, almost never reverses itself.

Based on your desription I feel comfortable assuring you that he is a high functioning child. He does show some indicators of an autism spectrum disorder, but they are minimal.

Yes, you can make a huge difference working with him. Joint attention type games and good "cognitive language" and discussion at his level. When speech is combined with love and feel-good physical activities, learning is significantly enhanced.

Kind regards,
James



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

QUESTION: Hello Dr. Roan:

Once again, many thanks for your earlier answer and my apologies for bothering you again.  But, I'd like to ask you a few more specific questions regarding my now, soon-to-be 18 month old son.  I had him evaluated by a neuro-dev pediatrician (and have an appt for a second opinion this Friday) who did not believe, at this time, that he appears to be on the spectrum.  He felt he just appeared too "connected" and well within the normal ranges of development, including language because some kids simply talk later.  He had no real explanation for the behaviors that appear stereotypical.  Nor, did he seem to find the fact that my son's head circumference grew rapidly between birth and 10 months significant.  

I have managed in the last two weeks to successfully teach him to sign for "more"--took 10 days, but he got it and I am getting some decent gross motor imitation now (waving bye bye, etc).  Also getting him to say "Ooo" for juice (I consider this a major victory).  But, most troubling, he is still engaging in what appears to be stereotypical behavior.  I've watched this closely and he is not doing what my older son did--running up and down lines and looking out of his peripheral vision.  When he runs down the hallway, he actually turns his head and looks at the baseboard as he runs.  When he turns a corner, he turns his head and either looks at the corner or, if he's going through a doorway, turns his head and looks at the spot on the floor where the doorjamb meets the floor.  He is actually looking straight at these things.  I've been searching all over the net for some description matching what I've seen in the common stereotypies, and I just can't find anything that sounds like this. Is it a fixation?  Is it a stereotypy?  Does it matter in terms of intervention?  When he goes down the hall in our house (or in my parent's house or at the gym--just about anywhere), he does this behavior about 75% of the time.  Lately, I've been leaving balls to kick, push toys, etc in the hallway and these will divert him 30% of the time.  He also doesn't persist at this. He'll do it for a few minutes, and then go play with toys, etc.  Should I interupt this?  Should I redirect?  Should I not allow him to "practice" this odd behavior?  And, if this is somehow sensory driven, do you have any suggestions as to appropriate activities with which I can replace the inappropriate behavior?

Finally, in your last answer, you mentioned good "cognitive language".  Could you tell me what you mean by that?  Whew--sorry to write a book.  Thanks a ton for sharing your expertise!!!  You're awesome.

Teresa

Answer
Hi Teresa;

I chose this career to help parents, children, and families so ask as many questions as you like.

This does sound like a stereotypy, but I would have to observe in the context to get the true "flavor" of it.

Cognitive language refers to dialogues that go beyond the superficial and involve questions requiring intellectual processing. You are probably already doing it.

You are handling the stereotypy thing appropriately. Try to find activities that "compete" for his attention and reinforce his appropriate behavior. Stereotypies provide comfort and have a calming effect. Look for other things that achieve the same end.

Kind regards,
James