Expert: Dr. Sharon A. Mitchell - 1/17/2008

Question
My daughter is 11 months and I'm already wondering if she may be autistic..

I realize that she young, but things she does/doesn't do, do worry me.

She doesn't wave, point, recognize her name..
She completely ignores you talking like she doens't hear, but there are obvious things she responds to with sounds.  So I know it's not her hearing.
She does do the rocking and flapping hangs, but mostly when she is excited.
She does smile, laugh, play with mom and dad.
But she won't make eye contact or respond to you.
She was recently hypothermic and they are now thinking it may have been due to flu vaccine.
Now I'm seriously worried about mmr vaccines at 12 months.  For one, her reaction to flu and for 2, the stories of vaccine and autism.

I've talked to my pediatrician and have read until my eyes are dry and can't decide what to do.  Pediatrician wasn't much help.  ANy ideas thoughts I'd appreciate.

I'm curious if autistic children would play with us the way my daughter does.

Other things we've noticed are..
banging head on wall (only few times)
Loves movie credits (but excites her)
and she really doesn't babble at all.  No words.
Since she started sounds, it's always these seriously different animal sounds.
When she was younger she seriously sounded like a lion, poeple coudln't believe it was my infant.
And now she  wants more cherrios or something, she won't point, she'll just make this horrible grunting type sound and slam her tray.
She has also been having tantrums for no reason playing with her toys.
And isn't a very cuddly person, even with parents.
To this day, grandparents can hardly hold her.
But she is a mommas girl and crawls to mom and cries when mom leaves room.

Answer
Autism is a spectrum disorder with a wide range of abilities and characteristics. No two children with autism will show exactly the same symptoms and characteristics.

Yes, some kids with autism do enjoy playing with their parents and may be very affectionate to them.

But it can be worrying, can't it? Some children are diagnosed before they reach their first birthday but that is not the norm. Some of the things you describe could be early signs, but not necessarily. Rather than just worrying though, there are lots of things you can do right now to help your little girl. I'll get to those in just a moment.

If you're concerned, I never think it hurts to consult with a physician. If you're wrong, then you'll be relieved. If there is suspicion of autism or some other condition, then you'll be armed with information and can begin helping. At just under one year of age, it may be difficult to make a definite diagnosis about her development. That does not mean you cannot begin helping her right now.

A physical check-up never goes amiss. It would be important to mention to the physician or nurse your concerns about hand flapping, lack of pointing, lack of eye contact, or response to her name.

You mention that while she does not respond to her name, she does appear to hear some sounds. A hearing assessment would not hurt as other things, such as recurring ear infections could be affecting her. It's possible for a child to have an ear infection without giving signs of distress. And a history of ear infections, especially when experienced at certain stages of development can affect the ability to hear certain frequency of sounds and this can influence the acquisition of spoken language.

But before going to seek a professional opinion, you may feel better prepared if you first read up on the wide variations of what is considered "normal" for a child of your daughter's age. Even though we expect kids at certain ages to do certain things, there is a range and no two children develop at exactly the same stages.

Here are some sites that talk about typical physical milestones:

http://www.med.umich.edu/1libr/yourchild/devmile.htm

http://www.nncc.org/Child.Dev/ages.stages.12m.18m.html

http://parenting.ivillage.com/tp/tpdevelopment/topics/0,,4rwc,00.html

Below are a few websites that can help you sort out what is within the normal speech/language parameters for a child your little girl's age. Armed with this information, you can then speak to a public health nurse, pediatrician or speech/language specialist.

http://www.asha.org/public/speech/development/child_hear_talk.htm

http://www.comeunity.com/disability/speech/milestones.html

http://www.ldonline.org/article/6313

Even without professional guidance, there is a lot parents can do to help their child's developing communication and socialization skills. You'll find some suggestions here:  

http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm

http://www.hsdc.org/News/Speech/encourage.htm

If after looking at this developmental information,you're still concerned, I think you should speak to a Speech/Language Pathologist (SLP) to get the best advice. If you live in the United States, you can find a local Speech/Language Pathologist through this site:

http://www.asha.org/proserv/

In Canada, try here: http://www.caslpa.ca/english/profession/find.asp

For other countries and general information on finding SLP help, check out this site:  http://members.tripod.com/Caroline_Bowen/find-slp.htm

While an SLP might be one of the first professionals you want to see, a developmental pediatrician or child psychologist might also be helpful. They'll ask you questions about things like:

- age at which your daughter rolled over, sat up and walked
- if she babbles and at what age she began
- is she able to say any words
- if she enjoyed pee a boo games
- if she plays imitation games
- will she try to repeat sounds you make to her such as ma ma ma
- if she has a favorite toy
- how does she play with that toy
- her sleeping and eating habits
- how she responds to strangers
- does she point to get what she wants
- if you point, will she look at what your finger is directed at
- is she easy to settle when upset

Below are two versions of a Checklist for Autism in Toddlers that your physician might use. It may be helpful for you to look them over to get an idea of what sorts of things a diagnostician may look for. The first link explains a bit more about the CHAT:

http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=128&a=2226

http://depts.washington.edu/dataproj/chat.html

http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

It can be distressing as a parent when a small child is not very cuddly and does not love to be held by relatives. Some people find it hard not to take this personally. Your daughter is not shying away from physical contact because she does not like people. More likely she is responding to sensory sensitivities. While most babies and toddlers are comforted by hugging, so kids are uncomfortable with touch. There are things you can do to help her feel more relaxed and accepting of hugs. An Occupational Therapist may give you good advice.

From your description, there is cause for concern, as I'm sure you've gathered from the reading you've done. There are also some real positives:
- she smiles and laughs
- she enjoys playing with her parents
- she responds to sounds
- she's proactive when she wants something like Cheerios
- she's affectionate with you

The hypothermic incident must have been very worrying and I appreciate you concern over the upcoming MMR vaccines. The debate of the possible connection between autism and vaccines has not been laid to rest. You can find many studies that have concluded that there is no link. And for number of years now, the supposed culprit, Thimerosol (a mercury-based preservative) has been removed from vaccines in North America. Yet the incidence of autism continues to rise.

There are some parents who report that their child was typically developing until the MMR shot after which regression occurred. There are parents who knew that there was something different about their child from birth and the autism did not begin with a vaccination.

There is some debate that if you're worried, it might be safer to request individual vaccinations that don't combine several vaccines in one. That would of course mean that you'd need to take your daughter back to get jabbed many more times.

I recently attended a lecture by pediatrician Dr. Karen Streiland where she posed the possibility of delaying vaccinations until after age three for children where there is a concern about the possibility of autism. The reasoning behind this is that by age three the child's immune system would be more developed and this more mature system would be better able to cope with the vaccine. These are options to discuss with your public health nurse and pediatrician. Perhaps your nurse could recommend to you a pediatrician with experience with autistic children.

Knowing is better than not knowing and continuing to worry. It's obvious that your instincts are telling you that something may be amiss with how your child is developing. I'd suggest that you heed that little voice and have this investigated. Your daughter's very young yet, giving you lots of time to work on early interventions that can be so helpful.

Sharon A. Mitchell, B.A., B.Ed., M.A.
http://www.autismsite.ca