Expert: James Michael Roan - 1/4/2008

Question
QUESTION: My 38 month old shows some signs of Autism / PDD-NOS but the developmental pediatrician does not think is autism . He has a blood test for fragile x , although the pediatrician said it is unlikely he has that either .We are waiting for the results. However Ifeel he is in the high functioning autism . He has good eye contact , but doesn't play with other children at a birthday party for ex he is watching them , he is not aloof ,but seems shy to interact. At home he plays well with siblings . He rarely answers or talks to strangers . He has 3-4 words sentence but doesn't really communicate or asks questions. He lines up cars/toys but not obsessively and doesn't mind if I remove any . (one of the reasons the dr said he doesn't have autism is that he doesn't do anything consistenly ) He touches his eyelashes when stressed or tired . He is very affectionate and likes touch.Noises ,crowds or store never bother him
Fully potty trained and training was not an issue
Doesn't flap hands
no rocking
no echolalia
no sensitive to noise

He walked at 17 months
he doesn't play much with toys or pretend but he does a little

We are worried about him . He was tested by the school and they said he is average to above average in cognitive area but delayed in expressive speech. At home he talks ok , but the speech pathologist couldn't get more than one word sentence from him. The psychologist said he is very anxious . We are very anxious to do whatever he needs. Any ideas on what to do, who to see, or who to talk to would be welcomed.

ANSWER: Hi Elisa;

Did the school do any Asperger's-specific testing? If not, request a reevaluation and ask them to assess this area. Anxiety can certainly impair social interaction as can an expressive language delay, however, I am concerned about the lack of pretend play given his age. Try and elaborate more on his pretend play or lack thereof. I suggest you go to my web page at: www.autismspectrumdisorderfoundation.org and take the M-CHAT and score it and send me the answers. The M-CHAT will not really tell you whether he has Asperger's syndrome, but provides some good data.

Kind regards,
James

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

QUESTION: Hi James,
Thank you for your quick answer. I did the M-Chat and all the answers are Yes except
7. No
20. No
22.No
They did not do an Asperger test because he is too young (3 yr old) and he does seem he has a little language delay.
Thanks,
Elisa


ANSWER: Hi Elisa;

Your son just meets the criteria for a recommendation for an autism/ developmental evaluation. This score of 3 does not mean he has autism just that he is at-risk for having autism and should be evaluated further. He failed items 7., 11., and 18. I'm interested most in item 18. Does your child make unusual finger movements near his/her face? Please describe what this looks like.

Kind regards,
James

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

QUESTION: Hi James,
Thank you again for answering . He touches his eyelashes sometimes when tired or anxious .Also I noticed he twirls his hair -his hair is curly and a little long.
I am confused because the developmental specialist pediatrician said he does not shows signs of autism or PDD . But to me there are many signs.
Here is the list I gave to the specialist and he said there is nothing to be concerned about that he is just shy .
What is your opinion?
Thank you so much!

Luke is 38 months

Started to be concerned about him at 15 months when he wasn't walking yet. He walked at 17 months.
18 months he had a good vocabulary-12 words
2 yr old - 2 words sentence
He had good eye contact until last month when I first noticed sometimes he avoided eye contact with strangers .


Social
Shy with strangers, doesn't talk to them or say his name
Give a blank look when people are talking to him,but has  eye contact most of the time.
At the library doesn't participate in games with other kids but likes watching them .
Sometimes he withdraws from me and his siblings (4 yr old boy / 20 month girl) , goes in another room and reads books or plays music or just lays down in the bed . When I go there , he says "Sad mommy" but at the same time he smiles .
At inappropriate times he says "scared mommy" .

Communication
Doesn't always answer questions properly (how old are you - Luke) , doesn't communicate much but has
3-5 words sentence sometimes words are unclear
Sometimes gibberish words
Sometimes talks to imaginary people

Behavior
Lines up cars/animal toys but doesn't get upset if I remove any of them and this is not consistently
Throws up ripped paper towel or newspapers (also leafs,light toys,any small parts)
Sometimes he spins  
Little imaginary / pretend play
Not excited about opening gifts for special occasions and not interested in new toys , but later he may play with them.
Flips pages in books over and over
Touches his eyelashes when stressed or tired
Sucks on his lower lip when tired or bored
Very attached to a few blankets ,but he accepts any of them if we don't find the others
Takes off running in stores,parks
Plays a lot numbers and ABC puzzles
Plays a lot musical toys
Fascinated with musical notes from songbooks


In the past used to:
Be fascinated by number plates, switches and a moving ball hanging from the ceiling in the garage
bang his head on me when I said NO .
Open/close doors / light switches
Cry when praised (it happened only 2 times)



Positive Signs
Good academical skills--average or above average for his age
Knows almost all letters, shapes, numbers to 10 ,can count to 10 in two languages , sings nursery rhymes
Fully potty trained and training was not an issue
Doesn't flap hands
no rocking
no echolalia
no sensitive to noise
Responds to name
He is ok if we change his routine
Plays well with siblings
Tells me about his achievements ,interests
very affectionate
likes touch

Answer
Hi Elisa;

I truly think there is a solid chance that he is on the high functioning end of the autism spectrum. I am not diagnosing, however, your most recent behavior descriptions are rare in nonaffected children. When I have personally observed the following behaviors you listed, those children eventually met diagnostic criteria, so I hope you follow this thing through until you can prove he is not on the spectrum.

Here are the behaviors that catch my attention based on experience although they are not commonly listed as standard red flags:

-At the library doesn't participate in games with other kids but likes watching them .

-At inappropriate times he says "scared mommy" .

-Sometimes gibberish words

-Sometimes talks to imaginary people

-Lines up cars/animal toys but doesn't get upset

-Throws up ripped paper towel or newspapers (also leafs, light toys, any small parts)

-Sometimes he spins  

-Little imaginary / pretend play

-Not excited about opening gifts for special occasions and not interested in new toys

-Flips pages in books over and over

-Takes off running in stores, parks

-Plays a lot numbers and ABC puzzles

-Be fascinated by number plates, switches

-Open/close doors / light switches

I'm not saying here that I think your son has high functioning autism, just that it certainly warrants a full evaluation to rule it out.

There are a few instruments for assessing Asperger's syndrome at this age. I use the Gilliam Asperger's Disorder Scale (GADS) for ages 3-10 years.

Kind regards,
James