Expert: Dr. Sharon A. Mitchell - 2/17/2008

Question
Hi Sharon
My son is 5 years old and has 2 older brothers and one younger.  He talks slower than my 3 yr old and didn't start talking till he was 2.  I am concerned for him.  He always has dark circles under his eyes, he is always just staring off into space.  He is not developing like the other boys. I know children are natural at getting into things, but when I tell him no, he looks at like he isn't doing anything wrong and does the same thing 5 minutes later.  He has started almost 10 fires (one was serious) from candles or whatever else he can get his hands on.  He has tantrums where he will punch his brothers in the face, and then cry and cry about it. I'm scared not only for my son, but also for the safety of my other children.  Please also understand that he is average as far as knowledge goes, he is smart.  He just hardly vocalizes anything. I have been to doctors and they seem to have little concern about this. I don't know what to do....Can you give me some advice?

Answer
Yes, it is scary, isn't it Melanie?

I think what makes it even scarier is the fear of the unknown. You lay awake and worry. Sometimes finding out for sure, even if the diagnosis is what you feared makes it easier to handle.

But I'm not positive that what you describe necessarily points to autism. Possibly but maybe not. It is concerning enough to investigate though.

You obviously know boys and have three others to compare this son to. It sounds like you're being realistic about his development.

Sometimes kids who have dark eye shadows are bothered by medical concerns such as allergies. If he's not feeling well due to food sensitivities and this is something he's always experienced, he will have no way of knowing that this isn't normal, isn't how everyone feels and will not complain. A child who is not feeling well may have greater difficulty marshalling his attention and with developing as well as he might.

Sometimes we when take a child to a busy doctor, we give only part of the symptoms - the ones most pressing at that moment, rather than describing a full picture of what we see in our child.

I'd suggest that a return to your doctor (or a different physician) is in order. Give the doctor a written summary, including details such as:

- dark eye shadows
- eating habits - try keeping a food diary for a couple weeks
- bowel habits
- sleeping patterns
- speech/language development (I'll give you some guidelines in a minute)
- behavior - tantrums, socializing with other children
- crying - length of duration, reasons
- fire-setting
- history of ear or upper respiratory infections
- checklists such as I'll list below

For your food diary, keep a page per day. On the left hand column, put the time of day your son eats or snacks. In the next column, list the food. In the right hand column, describe any unusual behaviors, when they occur and their duration. If your son has difficulties with diarrhea and/or constipation, put that info in a fourth column.

Your child's hearing should also be checked. Kids with recurring ear infections (even ones you don't know about) can cause some temporary or even permanent hearing loss. This influences the child's ability to speak and his skills at listening, understand and responding to what others say to him.

Here is some information about what is within the expected speech and language skills for a five year old:

http://www.asha.org/public/speech/development/34.htm

http://www.investinkids.ca/Docbase/BrowseTopic.aspx?Portal=a0380b3a-4520-4d09-ba...

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

Since you mention that he doesn't talk much, good professional for you to start with is a speech/language pathologist. A speech/language path while assessing your son's language skills will be able to detect the likelihood of hearing difficulties and would then make a referral to have his hearing assessed.

Speech paths do far more than just look at a child's articulation (pronunciation of sounds and words) but assess also how the child uses language and responds to language compared to others of his age. They also can look at pragmatics, sort of the social niceties of our language that involve turn-taking, voice inflections, conversation openers and enders, etc. Receptive, expressive and language pragmatics can be areas of weakness for kids with autism. But children without autistic tendencies may also experience weaknesses in these areas.

Your speech pathologist, after assessing your child will be in a good position to recommend whether or not further investigation into the possibility of autism may be warranted. She may also be able to give you suggestions that your family can work on to help develop your son's language skills.

If you are unsure how to find a speech/language therapist near you, here are the listings for registered SLP's in the United States: http://www.asha.org/findpro/ If you live in Canada, try here: http://www.caslpa.ca/english/profession/find.asp

In the meantime, there are many things you can do to encourage your child's language development. Most of them you are likely doing instinctively but you may get some more ideas from The American Speech Language Hearing Association
http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm

and from here: http://www.hsdc.org/News/Speech/encourage.htm

Since you're feeling that some of your son's behaviors make you think of autism, below are some links about signs of autism in young children:

http://www.webmd.com/brain/

http://www.webmd.com/brain/autism/understanding-autism-symptoms

These are just generic lists of characteristics of autism. Each child is unique and few would exhibit all characteristics. Autism is a spectrum disorder with a wide range of severity of symptoms and also a wide range of intellectual ability.

If after looking at these links, you still feel that autism may be a possibility, here are some quick checklists you (or his mom) can do:

This one is scored free online: http://www.childbrain.com/pddassess.html

These next two are more specifically for Asperger's Syndrome (similar to high functioning autism):

http://www.udel.edu/bkirby/asperger/aspergerscaleAttwood.html

http://school.familyeducation.com/learning-disabilities/behavior/56323.html

Here is a medical explanation: http://www.autism-pdd.net/checklist.html

Next is a video glossary of checklists. You will have to join and log in but it's free and informative: http://www.autismspeaks.org/video/glossary.php

Is your boy in school yet? Even if he doesn't begin school until next fall, you can still contact them about your concerns. They may have some early intervention that you could access. Plus, with their experience at observing children, you might get some useful information as they compare him to other kids his age.

You're worried, not only for this son but for the safety of your other children. That's hard for a parent to say and I applaud your honesty and realistic attitude. The fire-setting is alarming and a real safety concern. I'd suggest that yours should be a household with no candles. Although they're not as nice, you can buy electric ones built to resemble actual wax candles. The pleasure you derive from the atmosphere candles create is likely not worth the possibility of having a house fire and risking your family's lives. Likewise, all fire-starting implements should be locked up, far from the reach of any child, or better yet, not be in your home at all.

Please let me know if I can help with more information.

Sharon A. Mitchell, B.A., B.Ed., M.A.
http://www.autismsite.ca