Expert: Dr. Sharon A. Mitchell - 10/21/2008

Question
Hi,
my son is 18 months old. he is our first child.
He babbles a lot. says his name not correctly though.
make eye contact when we get his attention.
listens to when we call provided he is not playing with a toy or watching TV.
he does call me ma ma..but not always his usual way for asking some thing is to cry if i am busy cooking or some thing he will go to a corner and cry as if he got hurt..

if i give him pen and paper he will hold the pen in writing position and write a few lines and dots then starts flapping the paper ..
if we give him blocks in a box or a box of toys he throws all the toys and then sits in the box and tries to move..
he does close lids of my boxes in kitchen and tries to put the back in place...
he has thalesemmia minor so he is anemic his usual hb count is 10 ..
i really worried if he is autistic?

thanks for the help


Answer
Just based on what you describe, I'm not sure that autism is necessarily the first thing I would think of.

I think your doctor is quite right - an evaluation by a speech therapist is the first place to start. I know it's worrisome to thing of having your child evaluated, but what could it hurt? You're already worrying. At best, the speech/language therapist will tell you that your son's development is normal. If that's not the case, then she can give you suggestion as to how you can help him at home and she may be able to provide direct therapy to help him develop his language skills.

The American Speech/Hearing Association has a nice site that talks about typical language skills for one to two year olds: http://www.asha.org/public/speech/development/12.htm They also give suggestions for more things you can do to help your child's development.

Even without professional guidance, there is a lot parents can do to help their child's developing language 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

It's a positive sign that your son is babbling, says ma ma and attempts to say his name; I'd be more worried if he made no sounds. He'll respond to your call and will make eye contact with you.

I'm not sure that many year and a half year old boys are interested yet in pencil and paper activities. It's great that you introduce him to paper and crayons, but making a few scribbles then losing interest in the task does not seem atypical for a lad his age.

Boxes make fascinating toys for kids. Crawling into boxes, making tents, hiding under tables, etc. is engaging for many small children. It is more concerning though if he NEVER plays with toys.

From what you've written, I gather that your main concerns are:
- lack of appropriate play with toys
- he's not talking as much as you'd like
- he cries rather than asks for things that he wants

Again, a speech therapist appointment would steer you in the right direction. But while you wait for that to come through, you might consider trying pictures of signing with your little boy. Some kids who find it difficult to acquire expressive language will cry to get what they want or tantrum out of frustration.

Baby signs are a type of simple sign language - formed with hand motions. This is a method of communication that can often be helpful.

Here's a site about American Sign Language symbols for babies: http://www.aslpro.com/cgi-bin/aslpro/aslpro.cgi

Here's some more information on signing:

http://www.handspeak.com/index.php?home=babysign

http://www.signingbaby.com/main/

http://www.handsfirst.ca/

Some kids who don't respond well to signing may do better with pictures. You can find information on how to use visuals (pictures - either photos or line drawings)at sites like www.do2learn.com.

These other sites will give you information on why and how to use pictures:

http://usevisualstrategies.com/pictures.html

http://autism.healingthresholds.com/therapy/visual-schedules

http://card.ufl.edu/visual.htm

http://lindahodgdon.com/newsletters.html

http://pdictionary.com/

There are pros and cons with each system. Some children catch on to the idea that pictures represent actual objects more readily than they grasp the meaning of hand positions. For kids who have trouble with black and white line drawings, you can use actual photographs you take with your camera. Then the child can touch the picture of what she wants, choose between two pictures you show her, etc.

A drawback with pictures is that you or your child may have to hunt through a stack of pictures to find the one you want. You may not always have the correct picture with you. But with signing, you always have your hands.

Studies have shown that augmented communication methods like pictures and signing don't take the place of spoken language in kids; rather they encourage communication and can foster more speech.  After all, it's far easier to say "milk" than to find and point to the picture of a glass of milk or even to get your attention then make the hand sign for milk. These methods certainly won't hurt and they may help your son better communicate his wants and needs.

Play is really a child's work and they learn tremendously through play. If your little boy's play is concerning you there are certainly things you can do at home to help without a lot of formal training or expense.

I like therapies that both fit into the lifestyle of a family and are play-based. One such one you could consider is PRT (Pivotal Response Therapy). What's nice about it is that it's a way for you to play with your child. You don't need to slot in an hour a day at a consistent time but can just play with him whenever you get a few moments. It's something you can get started with after doing just a bit of reading.

Another nice thing about PRT is the low cost to get started. Most of the training manuals are about $7 each http://kady.education.ucsb.edu/autism/behaviormanuals.html

Here's some information on PRT http://www.brookespublishing.com/autism/prt/interview.htm  PRT was featured on one of the Super Nanny episodes http://specialchildren.about.com/b/2005/11/04/more-on-tonights-supernanny.htm The main PRT manual is available here: http://tiny.cc/AeTcB

Here's are three short video clips of a young boy prior to PRT then during subsequent PRT sessions: http://www.brookespublishing.com/autism/prt/video.htm

If you don't want to or nor have to time to do some reading on PRT or similar play-based approaches, you could focus just on enhancing your son's language while you play. Sites like this one give good but practical tips any mom can incorporate into the child's day: http://www.tr.wou.edu/perc/documents/INDIRECTLANGUAGESTIMULATION.pdf

Another form of play with your child that I really like is that offered by Dr. Stanley Greenspan's DIR Floortime. You can learn more about it here and see how to buy a book on the technique: http://www.icdl.com/dirFloortime/overview/index.shtml

Many things go towards a picture of normal or typical development in a toddler. As a starting point for you, here are some sights that talk about normal physical developmental milestones for toddlers that you can use to compare with what your son does:

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

http://parentcenter.babycenter.com/refcap/preschooler/pdevelopment/1496593.html

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

There are specific symptoms associated with the various autism spectrum disorders. You can read about them and diagnosis here:

http://www.psychiatry.emory.edu/PROGRAMS/autism/pdd.html

And in more medical detail here:

http://www.nichcy.org/pubs/factshe/fs20txt.htm

Here's a checklist on characteristics of autism:

http://www.hmc.psu.edu/psychiatryservices/child/outpatient/autism/Revised%20Auti...

Here's another free, online checklist for PDD. PDD stands for Pervasive Developmental Delay, which is the umbrella term for all autism spectrum disorders.

http://www.childbrain.com/pddassess.html

These checklists are not definitive and do not mean that your child has or does not have autism. They may provide you though with some information that you can take to your doctor, or speech/language therapist.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca