Expert: James Michael Roan - 2/24/2008

Question
QUESTION: I think my little boy has autism. He turned 2 in November and he is still not speaking. He used to say "hi" occasionally, but he seems to be saying it less frequently over time. He would never do the typical things like wave bye-bye, or point to body parts.

He loves to be near his older siblings, but he doesn't try to play with them. He loves to flip through the pages of books, but is resistant to be read to.

What is considered poor eye contact? In a room full of people, he likes to run from person to person, smiling up at each one for a few seconds and then running away. When it's just the two of us in a room, it seems that he is constantly glancing over at me with a smile on his face, acknowledging my presence, but it's only for a few seconds at a time. I've watched him out of the corner of my eye and it seems that he'll look at me, wait for my look in return and then glance away. When I hold him close, he usually looks over my shoulder. Even when he was very small he would look away from my face as soon as I would try to position myself in front of him. He seems to think that it's funny.

He loves to be tickled and chased. He occasionally likes peek-a-boo. He usually responds to his name when I call him and he understands when I tell him "no", and "stay here". He does absolutely no imitation and exhibits no imaginary play. He likes to carry small toys around in his hands or soft toys in his mouth. He won't stack blocks, which I understand is a typical autistic behavior. At first glance he seems like a very happy, easy-going little boy with his own agenda. But his independence and lack of interaction is very concerning.

He never points or tries to show me anything. His babbling often sounds like a chant or a sing-song, but no talking.

How do you distinguish between autism and other disabilities?

I've had it suggested to me that he might have a hearing problem, but don't hearing impaired children reach for their parents when they come to lift them out of the crib? My son has never reached for me. He smiles at me all the time, but never reaches. He never looks at pictures that I point at. He doesn't rock or swing his hands that I've noticed, but he pulls his hair out by the handfuls when he's upset. So, what do you think?

ANSWER: Hi Brookee;

The best screening device available is the M-CHAT. Download it and the scoring key below:
http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf


http://psychlops.psy.uconn.edu/ED/downloads/M-CHATscoring.pdf


If your son fails the M-CHAT write me back and we'll take it from there. If your son does have autism, it sounds to be in the high functioning range, which has a VERY good prognosis.

Kind regards,
James

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

QUESTION: Yes, he fails the M-CHAT. He passed 9 out of 23 and he passed 2 out of 6 critical items. The two that he passed were: he takes an interest in his siblings by wanting to be near them when they play, and he usually responds when his name is called.

With that many items failed, is he still able to be considered high-functioning?

Answer
Hi Brookee;

Yes, it is possible that he is still high functioning. The M-CHAT is only a screening device kind of like a fish net. It's purpose is to identify children "at-risk" for an autism spectrum disorder and that is all. You'll need a team or psychologist expert in this area to determine for sure.

If you live in the U.S., call your school district's Special Services/Education department and tell them you want to make an immediate referral to their Early Intervention program for a full assessment. Tell them you you suspect autism. Take the M-CHAT to your pediatrician and ask for a referral to an autism team at a Children's Hospital or university autism team immediately. DO NOT let your pediatrician talk you into a "wait and see" situation. You must act now. Early intervention services can make a HUGE difference, and they are free through your school district if your son qualifies. If he has any social or communication delay or autism, he will qualify.

Don't assume your son has autism based on my reply, but if he does, you need to know as soon as possible.

Kind regards,
James