Expert: Tim Runner - 10/17/2008

Question
I have been taking care full-time (10 hrs. a day, 5 days a week) of a little boy for 5 months now, who is turning 16 months old this week.

Since the day he came to me, I noticed very strange behaviors, but thoght it was due to him being in day care for the first year of life. I have since researched his symptoms over the last few months, and feel like he is probably autistic.

Here are some of the things I have noticed.

Physical development: When he came to me at 12 months, he was still scooting on his belly, dragging his legs behind him. I also noticed the touch with his hand was very light, and almost no tight gripping movements. Eventually, he crawled and now walks, but is very poorly coordinated, and even falls down (trips over his own two feet) for no apparant reason sometimes. His legs seem to be almost useless when climbing. It's like his muscels are extremely weak. I have been working a lot with him on climbing toddler play sets, etc. but he still has a lot of trouble, and struggles with even stepping over an object on the floor, including stepping up/down into or out of a doorway. I am convinced he cannot march. He is very clumsy, and falls when making the slightest movement, such as attmepting to dance. (which is a rare attempt anyhow.)When sliding down a slide, he cannot keep his balance, and often falls over. He typically falls onto his butt at the bottom of the slide if he makes it down, but cannot put his feet out in front of him to catch himself instead. When he falls, or trips in any situation, he seems to not be able to try to "catch" himself. He tumbles like a newborn. When you old him on your hip, he doesn't hang on with his legs or arms like other kids. He is like a wet noodle, and doesn't hold up any of his own weight.

Eye contact: Some days are better than others, but he rarely makes eye contact with me for more than a split second. Even turning his head completely away from me at times after a quick smile. I noticed that if he looks at my face at all when I talk, he is looking at my mouth, and avoids my face for the most part.

Every now and again he will point to something, but not often. I have never seen him wave or clap, even after my spending a good deal of time on these areas. He refuses to copy any hand gestures I try to show him, including sign language. He doesn't use his hands for play, such as pretending to hold a phone to his ear. Often, he plays with just the wheels of the car, or a part of the toy, instead of the actual toy.

He is very still, and will often stay where I place him for long periods of time if I let him. (i.e. sitting on a couch, laying on the floor after a diaper change.) As well as still struggling with standing up from a sitting or laying position without help, or using his arms. He does not "squat" down.

Language development: When I started watching him, he said "dada" & "mama" a lot. Unfortunately, I haven't heard him say those words in 4 months. Or ANY other words for that matter. One day, it was odd, becuase we were at a friends house, and he kept repeating the word "dog" and playing with the dog there. That was the first and last time. His mother claims he said "apple" one day. I have yet to hear anything. In fact, he doesn't even babble that much, some, but little, though his parents claim he babbles constantly at home.

He absolutely shows no interest in playing with my son, who is almost 18 months old, my 3 1/2 year old, or any of the other kids he has been around while in my care. *Which is A LOT as I have MANY friends with babies, toddlers, and preschoolers. In fact, they seem to target him, and pick on him. Usually he just sits there, and sometimes doesn't even cry, even though it is obvious he feels the pain. He doesn't protest at all when another child snatches a toy or snack from his hand. When we visit places such as parks, playsets, mall play areas, etc. he almost never joins in the fun. Recently I have begun a lot of prompting, and reminding him to "play" and guiding him, and over doing the positive reinforcement, and that is helping, but usually for that moment. It is a constant battle. I'm not sure if he's actually enjoying the play sometimes?

He rarely smiles. Although, his parents say he smiles frequently at home. He smiles maybe once every other day, and it is only for a second. (Although there have been days when he smiles a particularly good amount, but then regresses back to not doing it for a while). I have heard him laugh a FEW times since he has been in my care. This seems odd to me, because I consider myself to be very good with children, and usually have no issues in these areas. Even tickling doesn't get much of a rise out of him. I almost seems like he enjoys it, but doesn't know how to express it? Or maybe it even hurts?

I noticed this week as I was getting on to my older child, that this little boy was standing right next to me, but seemed to have no idea that I was upset. It makes since, because he doesn't seem to notice when my little one cries.

A few positive notes: I have been working intensely to teach him to "give 5" lately, and it has finally worked, even though, I don't think he has a clue why he is doing it, or what it means. I feel like he is actually smart in some ways. One day I looked over at his high chair tray and he had lined up his cheerios in a long row. He follows certain direction pretty well, such as when I look at him and tell him to "go to the playroom," or "get to your seat" (in the van), or "go into the house," (when setting him in the driveway outside the car.

The odd thing is that sometimes I feel like he is ignoring me, or doesn't hear me. I can call his name, and no response. Sometimes he also stares off into space. Another quirk is that he shakes. Not huge, but when he first wakes up, seems scared, or cold. It isn't a normal movement. It is very subtle, but noticeable. Oddly enough, that has greatly decreased in the months I have been keeping him.

Eating issues: He (most of the time) seems like he doesn't know how to chew. He will eat baby food, or other soft foods easily from a spoon (fed by me), but has trouble with solids. He does okay with toddler type snacks, such as goldfish, etc. (though chokes often), but eating tiny cubes of meat, cut up fruit pedicels, macaroni & cheese noodles, etc. is difficult for him. he will put the food into his mouth, try to push it to the back of his mouth with his tongue like a baby does, and then just sit there. Even though, he is still hungry. he has quite an appetite, so this is strange to me. He will leave a mouthful of food for as long as I will let him. I discovered this early on, when I put him down for a nap after lunch, only to wake him up 3 hours later with a little chunk still in his mouth. You can imagine I was startled and a little scared for his safety.

I know I have described a lot to you, and it would be much better in person, but I felt like I needed an opinion.

I have subtly tried to mention things here & there to his parents, but I don't think they took the bait! They are a great couple, very intelligent, so I can't believe they have not picked up on any of this. I'm not sure if they are in denial, or simply have nothing to compare him to, since they don't really have any friends with small children, or family around, etc.

I guess my question is, do you think this should be checked out? And how should I (if at all) approach the parents? And mostly, why on earth has his Dr. not caught this, Atlas with the obvious speech/language delay??? My children's Dr. always asks about their verbal development. And is there anything I can do here to help him out? I have fallen in love with this little boy, and would hate to see him "slip through the cracks" of society because of late treatment.

Thanks!

Michele Miley

michelemiley1@hotmail.com

Answer
Michele,

Neither you nor I are doctors. Therefore, neither of us can diagnose autism. The long list of behaviors you listed in your questions can be a result of various conditions. The child should be diagnosed by a medical doctor.

From what I have been told by doctors and what I have read, it is almost impossible to diagnose autism in a child only 16 months old. It is still important that he be seen by a doctor right away.

My suggestion is that you give a copy of your question and my answer to the parents.

I wish you and the child the best,
Tim Runner, Education Advocate
You can learn more at my web site:
www.special-education-answers.com
www.education-advocates.com (for DSL and phone)