Expert: James Michael Roan - 1/18/2008

Question
Hi James -
Please let me apologize in advance because this may be a long question, but I want to be as thorough as possible. I know you don't diagnose autism on-line, but I'm hoping for some guidance. I am worried about my 13.5 month old son and the possibility of autism, and I don't know if it's me being an overly-worried first time mom, or if my concerns are valid. I want to preface this by saying (silly as it may sound) that I've been nervous about autism since before he was born because my husband and I had to use IVF for severe male infertility of unknown cause (all tests revealed nothing), and it haunts me thinking maybe my husband has a genetic problem that could harm our precious little boy. Paranoid, I know!

I'm going to try to be organized here:

My son had pretty severe GERD from 1 to about 6 months. He also had therapy for a weak, disorganized suck and low oral tone. He had oral aversions (maybe from reflux pain?) and can still be funny about food textures. He can be very "gaggy" with food, and also when he's angry, he sometimes gags himself. He's pretty resistant to being fed but does self-feed(maybe he just wants his independence?). He's a picky eater. Meals aren't fun.

Motor Skills:
My son has always seemed physically on target to quick, pulling up at 6.5 months, crawling at 7.5 months, first steps at 10 months, walking at 11 months, going from sit to stand/walk unassisted at 12.5 months. Pincer grasp by 9 months.

Language Skills:
His language seems slow, but my concern is just as much that he is a pretty quiet guy who doesn't verbalize a lot (although he does a lot more now than he did as a younger baby), and he does not imitate our speech sounds or do back and forth verbalizations at all.  He started cooing at 3 months, babbling at 7.5 months, and still, he has no words at 13.5 months(not even mama/dada). Even if there is no autism, I think he has a speech delay, perhaps tied to the earlier feeding issues?

I wouldn't worry as much about his expressive language except that his receptive language seems behind too. He can't consistently follow an instruction (definitely not without us also adding a gesture, and his response to his name is inconsistent (although this seemed fine up until about a week or two ago and I wonder if maybe he's just in a funk right now?). He doesn't seem to understand "no." He doesn't point to pictures/body parts when asked to. However, just today, I was on the phone and said "ear"...I happened to look over at him and he was tweaking his ear just like I do to him when trying to teach him, and also today, he heard his toy singing "head/shoulders/knees and toes" and put his hands on his head like I've been trying to get him to do....so maybe he is starting to get a few things?

Social Skills:
He is a friendly guy as long as people let him warm up and don't get too "in his face" too soon. He doesn't want to be held by anyone except mommy and daddy though. He is very attached to mommy and daddy, and greets daddy with huge smiles when he gets home from work. He makes great eye contact and has the best smile (his eyes light up a room and he has two dimples!). He is quick to smile at strangers across a room and to wave back. In fact, we were just on vacation and he spent the whole plane ride peeking over the back seat smiling/flirting (he even does a smile with a "shy" head tilt that is too cute).

He waves hi/bye-bye (since 8 months), and not only when prompted/copying, but also initiates on his own to get attention. He also claps (since 12 months), does "so big," and "high 5," although not consistently, and as with responding to his name, has been less into these things for the last 1-2 weeks. He loves for us to chase him around, catch him, and tickle him.

He points to things he wants (since 11 months), but I'm not as sure about pointing to things to get our attention in something he's interested in....maybe once in a great while? He does turn his head to look when we point to something. As far as imitation, I haven't seen much although in the last week, when daddy got the vacuum out, he got out a push toy and pushed it, and he has also put the phone to his ear once or twice. I was shocked tonight when he took a water bottle, "poured" it into a cup and "drank." He brings things to us to "share" sometimes, and also shares his food with the dog (a bad habit he must have picked up from seeing mommy do it). I've even seen him take a toy/object to acquaintances to "share."

Play and Other:
One of my other worries is that he won't focus on anything for any time, such as learning a toy or letting us read him a short book. I don't know how he will ever learn to use a toy appropriately because he just fiddles with them and moves on quickly (he is perpetually in motion). He doesn't like to play alone, but he also won't sit and play with me (with a toy or in social games - we've pretty much taught him the clapping, "so big," etc while he's on the go). He does a lot of roaming, picking things up, and dismissing them quickly. He comes over, climbs in my lap for a few second snuggle, then is off again. He can put things in and take them out of a container, and also can bang two things together, but doesn't stack blocks. He seems easily frustrated when playing, getting fussy/irritable pretty quickly (and sometimes I have no idea why).

He picks the tiniest things off the floor (as clean as I keep it, he always finds something) and is always putting them in his mouth, and also mouths his blocks/some of his toys. He loves to chew his "lovey" blanket to soothe himself (like when falling asleep). He also pulls his hair behind his ears/moves his hands around through his hair behind his ears when upset. I never worried about this next thing before, but in one of your posts, you said something about running water. He loves baths but also he does like to put his hands in the water coming out of the faucet, and sometimes he even puts his mouth there as if to "drink" it. What does that mean in terms of autism? I'd never heard the running water thing before.

He is not a great sleeper at all, either waking a lot and going right back down, or waking once and staying up crying for an hour. He still often needs to be rocked/walked/cuddled to sleep and soothed back to sleep.

He gets angry/cries/tantrums when we take away something off-limits that he's trying to play with (like the remote, which we took away because his favorite game was throwing it and making the batteries spill out!).

I should also note that he loves being out and about, and I try to take him out as much as possible. Whenever we're out, he's very curious about watching other people, and as I said, smiles at them all the time. He seems very alert when we're out. Also, he adjusts pretty well to change - for example, while on vacation, my entire family commented about how well he adjusted to the trip. He loved it.

I'm so sorry, I know this is very long, but I wanted to give you a detailed picture about my little guy. He is the most important thing in my life and if there is the potential for a problem, I want to address it as soon as possible so he can get the help he needs. I lost my mom to cancer mainly because she wasn't proactive about seeking a diagnosis for her symptoms, and I refuse to let something like that happen to my child. The fear of autism breaks my heart, and as time passes and no words come, I fear he'll never say "mama" or "I love you." I'm afraid if he has autism, he'll never understand emotions and how much his mommy and daddy love him. This has been torturing me, and I just don't know if my judgement is clouded by worry from IVF and what happened to my mom, or if I actually have valid concerns. Thank you in advance for your advice, I am so appreciative.  

Answer
Hi Sara;

He sounds fine to me! He is in the oral sensory stage of development learning through oral sensation. His exploratory behavior is normal and good. He has great skills. Don't worry about the water unless you find him doing it all the time.

If you live in the U.S., you need to call the special education dept. at your school district and make a referral to their Early Intervention program for a complete speech assessment. The info gave me leads me to believe his gag reflex and oral sensory problems are preventing speech production. Just a guess, I am a psychologist not a speech and language pathologist.

Make sure he is not allergic to gluten (wheat) or casein (milk,etc.).

Enjoy your little guy!

Kind regards,
James