Expert: Paul Johnson - 2/3/2008

Question
I've had a feeling for over two years now that my nephew is not developing at a "normal" pace.  He is almost 4, he is not potty trained, he is fixated with cars/trains and very rarely will do anything else (sometimes he will scribble on paper or build with blocks but it never lasts more than a minute or two).  He is still very difficult to understand when he speaks and lately he has been very loud and saying things he should not (ex: Go away!; You're crazy).  It's as if he's heard it and is mimicking what he hears but it just comes out of the blue.  He also won't say "hi" to anyone when they say hi to him and you can forget about eye contact!  My sister just says "oh, he's shy".  When he was younger, he would bang his head against things over and over again.  My sister insists he's made alot of progress in the past 6 months and I'm afraid to approach her about it.  I've asked how he did at his 3 year app't but I got the impression she didn't even take him.  I think my sister is like a turtle with her head in the sand about him and I'm not sure how I can help him and her w/o making her angry and pushing her away.  I also don't have much experience w/ raising a boy as I've had two girls.  I've heard that boys don't develop as quickly but my gut feeling is my nephew is much further behind than he should be.  I've mentioned it to my parents but I think they too just chalk it up to late development.  Does this sound like it falls into the spectrum of normal behavoir and if not, any ideas of how I can approach this w/o pushing my sister away?  Thank you!

Answer
Hey Beth,

Thank you for your important and thought provoking question.

I laud you for your concern regarding the welfare and development of your nephew. Your description of him includes symptoms of Autism.
I point to the lack of lanquage development, the lack of attention to his play toys, Sounds like he engages in echolalia,(the desire to repeat exactly what he hears). These things should raise concern about his development. I would suggest that he submit to a full peadiatric examination with a clinician that is well versed with an understanding of children on the Autism Spectrum of Disorders.

Regarding your approach with your sister. I would suggest you introduce her to a book on Autism. There are many excellent books out now that spell out the details of the disorder and hopefully she will avail herself to broadening her understanding of what she is dealing with.

Of course this is only as helpful as your sister's willingness to investigate the "problems" concerning her son.