Expert: James Michael Roan - 1/19/2008

Question
Mr. Roan,
I completed a CSBS DP Infant-Toddler Checklist at my son's 9 month well check.  He scored just below no concern in two categories.  The doctor wanted to wait a month and "retest" but I pushed for a referral for the Early Intervention Program in our state.  He is having a developmental assessment within the next few weeks but the wait and worry is torture.  I was told he scored low in the areas of communication and social development.  I wanted to get your feedback on the following questions:

1.  He scored low in the areas of social and communication.  If he is found to be delayed in these areas, could it be caused by something other than Autism or one of the other ASD's?

2.  My biggest concern is that he responds well to his name when I call from a distance, but rarely when I am right next to him.  Is this cause for concern?

3.  He engages in a lot of eye contact and sharing of big smiles, but when I am holding him, he often is looking everywhere but at me.  Is this normal?

4.  He plays peek a boo.  He will initiate it often when holding a blanket.  Would this type of back and forth play occur if he had Autism or another ASD?

5.  How detailed of an assessment can be done at 9 months?

Answer
Hi Julie;

I'll attempt to answer your questions one at a time. It is difficult to assess at this age and what you're looking for really is to decide whether or not intervention is of benefit.

1.  He scored low in the areas of social and communication.  If he is found to be delayed in these areas, could it be caused by something other than Autism or one of the other ASD's?

1a. All ASDs are pretty much the same with the variable being intelligence, which determines response to intervention. Social delays occur hand-in-hand with communication delays.



2.  My biggest concern is that he responds well to his name when I call from a distance, but rarely when I am right next to him.  Is this cause for concern?
2a. This is hard for me to answer without observation.



3.  He engages in a lot of eye contact and sharing of big smiles, but when I am holding him, he often is looking everywhere but at me.  Is this normal?
3a. Yes, unless if it occurs during interactive times.



4.  He plays peek a boo.  He will initiate it often when holding a blanket.  Would this type of back and forth play occur if he had Autism or another ASD?
4a. Generally no for classic autism but I have observed it in very high functioning forms of autism.



5.  How detailed of an assessment can be done at 9 months?
5a.

If there are any communication, cognitive, or social delays you should place him in an Early Intervention program to be safe.

I have attached a list of red flags for his age and older for you to watch for:

6-12 Month Markers:

•   Infrequent eye contact
•   Failure to orient to name
•   Does not smile in response to smiles from others
•   Social and emotional passivity
•   Fixation on objects

By 12 Months:

•   Poor or no eye contact
•   Failure to orient to name
•   Poor imitation
•   No babbling by 12 months
•   No gesturing by 12 months

By 16 Months:

•   No single words by 16 months
•   No pointing to objects or events of interest in an effort to share

By 24 Months:

•   No spontaneous two-word phrases
•   Loss of any language or social skills at any age


Kind regards,
James