Expert: James Michael Roan - 1/9/2008

Question
Hi there - I am writing for some clarification on whether or not my 26 month old girl’s behaviour is 'normal' or showing signs of autism. This is driving us nuts.

My daughter is 26 months old and is not communicating needs/wants via speech or simple words/sentences. She does not call mum and dad, but is able to identify people in photographs (including mum, dad, grandparents, herself). When she wants something, she will lead us by the hand and places our hand at the object. E.g if she wants to open a door, she will lead our hand to the door. If she wants help in opening a can, she will bring the can to us. If she is feeling pain or itchy on parts of her body, she will put our hand on the relevant body part.

She is very close to her mother, even though she is being taken care of by a domestic helper in the day, and recently, childcare. She usually refuses to be carried by me (father), or sit in a pram when her mother is around.

In childcare, she sometimes plays with other kids, and sometimes plays alone, or wanders around. She likes circle time, and enjoys being read to. She also likes to paint/ do coloring.

Summary of good signs:
- recognize and count 1 to 10
- recognize (upper and lower case) and recite the alphabet, including singing the alphabet song
- sing some nursery rhymes (generally recognizable tune and words)
- recognize and read many words by sight
- sing along partially with audio CDs (children songs)
- able to perform action songs
- color with crayons/color pencils specific parts of a plain picture when asked to
- flip to and point out specific picture/words in a picture book when asked. She is able to recognize many pictures and words
- able to imitate animal sounds (dog, cat, rabbit, pig, elephant, horse)
- point to most body parts when asked to
- Smile at strangers, and plays peek-a-boo with them
- plays pretend (e.g. answering a phone, apply make-up, apply body lotion)
- attempts to comb her own hair, remove pieces of clothing (still not successful)
- able to perform simple instructions (e.g. clean up toys, go to the shower room, bring your shoes, stop doing whatever)
- plays with toys in the intended manner (e.g. hits drums with drumsticks, shakes rattles, stacks blocks, pushes cars back and forth, knead and cut out shapes using playdough, puts balls into relevant places for ball/slide toys, sorts shapes using shape sorters, etc)
- no preference for any fixed routines
- no compulsive stacking/lining up objects
- climbs, runs, normally. Able to stand on 1 leg for short periods of time (started to walk at 15 months)
- likes to play with small animals (e.g. stroking them, feeding them)

Summary of not so good signs:
- does not call daddy/mummy
- does not use words/sentences to communicate wants and needs
- does not point out to objects of interest. However she does say out excitedly sometimes when she sees it
- engage in some repetitive actions (e.g. putting colour pencils in container, emptying them, repeat). Lasts a couple of minutes each time. Still doing this
- stacking blocks, demolishing them, stacking again (no longer does this, unless we stack the blocks in front of her)
- at times, seem to ignore me when I call her to come to me. But she responds most times when her mother calls out to her
- needs to be prompted frequently to wave and say bye bye
- refuses to be put on a tricycle, or pedal-car
- slight toe-in walking gait
- walks on toes sometimes at home while cruising around the house
- becomes upset if we turn off her Barney shows halfway, but recovers soon after
- becomes upset sometimes if we keep her toys while she is playing with them, but recovers soon after

I have done the M-CHAT checklist and she passes most points. However, these points needs some clarification.

(2) - this is 50/50. Sometimes she plays with them, sometimes parallel play

(6) – She does not point to ask for something. When she wants something, she will lead us by the hand and places our hand at the object. E.g if she wants to open a door, she will lead our hand to the door. If she wants help in opening a can, she will bring the can to us. If she is feeling pain or itchy on parts of her body, she will put our hand on the relevant body part.

(7) – not really. But when she sees things that she likes (e.g. Barney, animals in the zoo), she will say loudly in an excited voice the object of interest. (e.g. Barney!, Elephant!, Monkey!). But no pointing.

Your feedback is appreciated.

Answer
Hi Steven;

You have a complex and very intelligent child! My only concerns in terms of autism is the pointing, specifically item 7: Pointing to objects or activities that interest her. On this issue I am interested to know the quality of pointing. Does she point at things that interest her and if she does, does she look at you to see if you are looking at "it?"

Remember, I do not diagnose just provide information and an opinion based on extremely limited information. I would have her evaluated for an expressive language delay. It sounds like her receptive language and speech production are age-appropriate. Provide details about her social development to include quantity and quality of:

1. Eye contact. When it does and does not occur.

2. Sharing. Does she share food, and things/toys that interest her?

3. Joint attention. When interacting with her such as reading a book, report on her behavior. Does she point to objects of interest? Does she look up at you. Does she seem to be passively participating or reciprocally interacting?

Regards,
James