Expert: James Michael Roan - 12/12/2008

Question
Even if autism is an epidemic, I think many parents are being spooked half to death, esp those whose children have speech delays. My concern about my own son is this- he does NOT perform on demand. My husband and I have amazed evaluators getting separate results from theirs, proving that while our son clearly has a serious expressive language delay, he understands ALOT. Here's the deal James-he follows commands when he wants to, in terms of identifying things, it has to be a game or he needs to be asked in a lilting voice. What is missing from our son- if he is doing something, he does not pay attention to you. we freaked out over his nonresponse to his own name but if we're outside the house playing and he hasnt seen us in a bit and we call his name, he comes running. we ask him to identify himself and he always points at himself in response. We know he knows who he is. Its hard to say he's in his "own" world, as in not accessible because you can always "reach" him but he can really tune us out. Something like eye contact- fantastic when he's engaged. And he seems to be more attracted to adults. But as far as giving eye contact freely, he does not. If an adult is boisterous or doing an attention grabbing behavior they will get his attention. Sometimes he responds to kids, he used to more, now not really. mainly he is attracted to them for whatever toys they have. I know hes not paying attention to them but theyre walking advertisers. if theyre on a toy, he wants to be on it. if they have a specific ball, he wants THAT ball.
but he is not as "up" as kids his age and I really feel this immaturity is due to language delay. is that possible? I dont notice much of a difference between him and kids 6 months younger but i really notice the difference in his contemporary age group plus or minus a few months. He has some exceptional skills to the point where I feel he can do certain things better than me. Motor wise, he is completely normal and is a little bit preoccupied with climbing. He has used objects for climbing which is not too thrilled. He was once better motor wise than other kids but theyve definitely caught up and may be better though Id note my son is pretty short and so certain tasks just dont come as easily. He isnt a good sleeper. We made huge mistakes with his sleeping, we were insane oversoothers for a really long time. Eventually we got him to sleep relatively normally although we always thought he was one hour or so short of ideal (we think this because when he slept that extra hour, his alertness was palpably better) though recently (and we read this is normal) he's shrieking in the middle of the night. Maybe we should leave him but we just cant. Now we think he's two hours short of sleep in the sum total for the day. Actually his naps have improved dramatically since his night sleep went to hell. Food wise, he's a normal eater though he is fussy about trying new things, less so when he's out of the house. We've never had him in day care or school (and we kind of consider all schools day care at this age). Affection wise, we have no complaints. He runs to us though he can be a little insulting on his way towards running to us and then he'll see something more appealing (than mom and dad) and he'll make a beeline for that. He has strong preferences but we've never had a problem rerouting him. He only points up close almost never in the distance. He knows a few signs and seems to love signing but we have no idea how to teach him these. He has maybe 3-4 words. He likes to take us to items he wants or he makes a herculean effort to get them himself (which unfortunately will include climbing) He's a "grabber." He does respond well to sternness in certain cases and "honey" in others. Overall he's pretty well behaved, there have been tantrums that come when he doesnt get his way, we almost always know why he's having the tantrum,excepting when he wakes up from a nap groggy- we learned not to take him out of the crib immediately if he isnt smiling. We read that one tantrum a day could be normal, he's def. much lower than that. The thing is he is very independent and "self directed" seems to be a dirty word for autism or some other delay but everyone who has evaluated him has strongly said something to the effect of "wow, he wants what he wants." "he's strong" etc.  The problem with MChat and the like is that its always a matter of degree. I cant say he's obsessive or repetitive. But Im sick of hearing that he needs to pretend play. Sometimes I dont even know what that is. Even though my son has limited "gesturing" I didnt even know raising his arms for "up" was a gesture. He wont feed a doll but he feeds me. He likes dolls, he has collected them all to keep with him but he doesnt animate them in any way. I think it would be unlikely to have quality pretend play in the absence of language. Plus I always thought that came at age 3 plus. Also, it seems like they push kids to do X and Y so much sooner now. I definitely didnt use play dough at two but now they do. All he does with the playdough is rip it apart and he seems to respect anything cool that I build with it. My son has changed alot over his life. He was a strong babbler early on but once he walked, it dropped off alot. He also was unbelievably social, returning smiles and engaging other kids when he was pretty young (ive seen a couple of kids like this) but he changed. I dont want to see it as a "regression" because he's changed in so many ways and he never really lost language, only babble. He does babble now, has a few words but its hard to expand on. We taught him a word to add to a sound he was making but frankly, he did so much better with words that came naturally. He is so smart, and the reason I dont want to detail what he can do way ahead of his peers is because I hate braggy parents and I hate that I feel I have something to prove. What he can do well is not valued although people will "wow" and then be obnoxious and say something about "Scattered skills" or "amazing but not typical" (thanks for making me feel awful). Its hard to say attention span is the problem even though he will ignore you entirely (though again, easy to get his attention) when he can sit for hours if engaged and participate. He's on and off in terms of what I would say most people would expect from a child this age. I am so terrified that he wont be talking by three and then all sorts of horrid diagnoses will be slapped on him. Any thoughts?

Answer
Hi Leila;

Language delay and social delay go together. Gesturing is communication, and in the absence of autism you often, but not always, see gesturing emerge to compensate for expressive language delay. I get concerned when there is low social interest as indicated by low eye contact, no gesturing, no social overtures such as social smiles, sharing, etc,, and no genuine joint attention between the child and others. If you live in the U.S., I suggest you call the special education department in your school district and refer your child for an evaluation by their Early Intervention program. A full assessment will provide a clearer picture of your son's issues or lack there of.

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.