Expert: James Michael Roan - 12/4/2008

Question
QUESTION: My son is 10 1/2 months old & does not babble at all.  He does not point/gesture(wave bye bye, blow kiss etc.)
He will imitate making a funny face when I do it or if I ask if he is sick, he will cough. That is all though.He does play w/toys normally. He doesn't spin anything inappropriately & is not fixated on things. If I show him how a toy works, he will try to do it on his own.
If I call his name, there are times I do have to do it a few times, but I think its usually because he is just preoccupied with what he is doing. If he hears me come into the room, he looks immediately, and if I say "look at the doggie" or some other thing he enjoys, he looks at me immediately and smiles and laughs. He has always been very alert and inquisitive. If I sit him on my lap, its always been hard to get him to stay there & pay attention because he is always reaching for something, wanting to get down & play etc. He never wants to sit still. He has been cruising for 2 months & has started taking steps a couple of weeks ago. So, it seems all he wants to do is get down and try to walk rather than sit and listen to me try to teach him things. As soon as he hears a noise in the house, he jumps up & listens. He is social & loves to be played with. Again though, he doesn't babble/gesture/point. He is quiet most of the time besides squealing when he is excited. He will roll a ball back & forth to you & also loves patty cake, ring around the rosie, & he anticipates certain activities we do every day(like when I take his socks off he immediately starts laughing because I always smell his feet and say stinky feet!)He also understands "no no" and if he is bothering something that I have told him "no" for before, I will just have to say his name in a stern manner and he will stop. I have so many worries about this though because both my brother & sister have autism. Perhaps I am overanalizing everything he does b/c I know I have an increased risk of having an autistic child.

Another thing which worries me a lot is that a couple of weeks ago he has started this habit of grasping his right hand with his left hand and staring at it for about 10 seconds. He does it I've noticed when he is being changed or when he is upset. Today he did it when he bumped his head and hurt himself..he immediately grabbed for his hand.
2 weeks ago he had a bad cold and I had to suction his nose up to 6 times a day which he was so scared about. I did this on the changing table each time..and, it seems as if the behavior of the hand staring/grasping started after I began the suctioning.
Is this something some children may do for comfort like hair twirling, thumb sucking etc.?

My mom mentioned that my sister who is autistic did not become fascinated with her hands until she was 18 months old. Her opinion was that my son would be doing it at other times and be preoccupied with it if something was wrong.
Also, I should note that if I give him a toy to hold before I put him on the changing table, he will not do it.
And, if he has his pacifier, he usually won't either.

Sorry this is so long, but I am really worried about this and would love some input.

Thank you!

ANSWER: Hi Ann;

I do see some very positive social behaviors and good receptive language, usually absent in children with autism. On the other hand, I have experienced hand grasping in front of chest in children later diagnosed with Asperger's syndrome or high functioning autism. It can also indicate a difficulty with "crossing the midline." The latter refers to poor development of the fibers connecting left and right brain, which is not my area of expertise.

My overall sense is that he has a speech and language delay, which will also delay gesturing. In any case, if you live in the U.S. call the special education department in your school district and ask to make a referral to the Early Intervention program. The referral and services if he qualifies is at school district expense.

Please ask more questions or provide more details of your son's behavior if you like.

Kind regards,
James



James Roan Bio:

James Roan (roanpsych@gmail.com) has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disability and with enforcement of their rights. James Roan was the consulting psychologist responsible for many of the autism and ADHD screening tools and other content for www.accessspecialneeds.com. James Roan is the past president and current board member of the autism Spectrum Disorder Foundation. James Roan consulted with the graduate department of the Waterford Institute of Technology in the development of their graduate program for the certification of private autism tutors.



---------- FOLLOW-UP ----------

QUESTION: Thank you for the information James. I spoke with Caleb's pediatrician and he suggested waiting until he has his 1yr check-up next month to see how he is doing speech wise before having an evaluation or therapy.
I have also enrolled him in infant classes which he will be starting this Saturday. Its a structured play session with other children his own age.
I'm hoping perhaps if there is nothing wrong, this will encourage him to begin communicating more.
If the hand grasping is a sign of Asperger's, will we start to notice him beginning to do it more frequently?
Right now he probably spends less than a minute total out of his day doing it. Usually 5-10 seconds at a time a few times a day.
Are there any other early signs of Asperger's we should begin looking for?

Thank You.

ANSWER: Hi Ann;

You are on top of it! The structured play will help a lot. Also, to stimulate eye contact and joint attention, pick up a book on Stanley Greenspan's "DIR Floortime." They may be using these techniques in the play group.

The hand grasping thing is something I have observed during hundred's of observations. It occurs when the child is excited and in a high state of arousal so you will not likely see it increase at all.

Based solely on my experience, early signs include low eye contact and playing with others according to own agenda. When slightly older, we see these children interested in other children but will not join in play with them, preferring to play near them. In groups of peers they appear very serious about their own play and will play with others if they follow their agenda but who are just as happy to continue on without them in order to follow through with their own agenda.

Kind regards,
James



James Roan Bio:

James Roan is a school psychologist and has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disability and with enforcement of their rights. James Roan was the consulting psychologist responsible for many of the autism and ADHD screening tools and other content for www.accessspecialneeds.com. James Roan consulted with the graduate department of the Waterford Institute of Technology in the development of their graduate program for the certification of private autism tutors.


---------- FOLLOW-UP ----------

QUESTION: One last question...could the hand grasping just be something he has gotten in a habit of doing for the past couple of weeks?
If I notice it stop, should I still be concerned?

I guess its just a wait and see game.

I've been trying to get him to point and I'm hoping with more stimulation he will.
If you ask him where the dog is, he looks at the dog or if you ask where the baby is while you have him near a picture of himself, he will look at the picture.

But, again, no pointing.

I will definitely check out that book.

Anything else you can suggest to promote speech/babbling?

Thanks Again for all your help!

Answer
Hi Ann;

I would not get overly concerned about the grasping thing. It's still within limits (9-13 months) to develop pointing. We are interested in two kinds of pointing:

1. Protoimperative: Pointing to something they want you to get for them, and

2. Protodeclarative: Pointing to an object or activity in an attempt to "share" it with you. This type of pointing is a higher order social skill compared to protoimperative pointing.

The good news is his receptive language appears fine, although I am NOT a speech and language pathologist.

Reading books to Caleb is a great way to establish joint attention, to teach that inflections in voice carry communicative information, and to develop a hypothesis about "what's next?!" Simple imitation games like peek-a-boo will help him to imitate all kinds of behaviors including speech sounds. For simple words that he is attempting to say, break the speech sounds, or phonemes, down into their basic constituents (see: phonemic awareness). For the word "cat" say: ca/a/t, then slowly blend them together. Do this while pointing to a picture of the word in a book he likes. When and if he looks up at you, smile broadly and excitedly and tickle him! This mother/child interaction will stimulate his social development and will eventually generalize to others.


Kind regards,
James





James Roan Bio:

James Roan is a school psychologist and has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disability and with enforcement of their rights. James Roan was the consulting psychologist responsible for many of the autism and ADHD screening tools and other content for www.accessspecialneeds.com. James Roan consulted with the graduate department of the Waterford Institute of Technology in the development of their graduate program for the certification of private autism tutors.