Expert: James Michael Roan - 3/19/2008

Question
QUESTION: I am providing daycare for my niece and I suspect she is on the spectrum.  I have tried to point my Sister in law and our shared family doctor in this direction with no success.  Much of the information I can find online points to her having Asperger's Syndrome but as I am not her Mother I feel helpless in getting her help.  She has responded well to a strict schedule here and my consistency in everything I do, but over the past two months she has started to call everyone by the wrong name. She calls her Mother, myself my husband "Mommy" regularly (not exclusively) and she has woken from nap asking for "aunt Catherine"  I find the names or labeling getting worse, and her mother thinks her child has "quirks"  Is this normal for this syndrome, and how can I help her straighten this out?

ANSWER: Hi Heather;

Children with Asperger's syndrome often have trouble with pronouns and may confuse gender. She needs to be first assessed by a speech and language pathologist. Can you elaborate on what these "quirks" are please?

Kind regards,
James

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

QUESTION: Hi James and thanks for allowing me to get into this further and I apologize if it is a little long.  As I said she is just over 2 years old and I have noticed some things she knew slipping away.  When I ask her what color her shirt is she will say 47!  I don't have a relationship with her mother that I can out and out tell her what I think, because I’m no expert, and even though I have mentioned my concerns to out shared family doctor, I feel like I’m still alone in thinking something is wrong with this child.
I can give you a quick rundown of some of her "quirks":

-She copies my 3 year old in play to the point that I don’t think she has any independent ideas on playing or toys other than banging them together.  She will eat if my daughter is eating, she will cry if my daughter is crying and pretend to sneeze if it has been done by my daughter. She is also unable to tell when the kids don't want to play with her even if they ask her to "go away” She will continue to force herself into the situation until one of the kids hits her and pulls her hair.  She will take this punishment until I remove her from the situation.
-An extreme uncomfortable ness in any new situation or surrounding even if a parent is present.  She relies on her blanket and soother
-She has a very limited diet of hotdogs, pizza, chicken fingers and Kraft Dinner.  I can not get her to eat anything else, no potatoes, rice, bread juice or anything sweet.
-I can understand about %50 of her speech, yet she can recite with crystal clarity T.V shows.  She also appears to have "routines" with speaking and play.  She will say something then I must respond a certain way for us to continue with anything.
-She licks EVERYTHING!! The furniture, herself, toys, other kids.
-She doesn't bend her knees, making climbing impossible.  She is very clumsy altogether, falling all the time for no reason, or she walks into everything at head level, tables, counters, door knobs... Her entire body appears to be limp whenever I hold her; she will accept hugs, but will not wrap her arms around me to return the hug.
-I think she had a seizure here upon waking from a nap; she fell to the bottom of the playpen, went stiff and had a fine tremor through her body for ½ minute.  I found this very alarming, but her Mom said she would keep an eye on it.
-She will make and maintain eye contact for a limited time, she does ask for things, but she asks the sink for water, and the playpen for nap, not me. She is never able to put down an object then find it again after.

Thanks again for your help and any clarification or direction you can offer is greatly appreciated


Answer
Hi Heather;

You have got my attention now. I'm concerned. To keep the situation objective, the best way to approach this is for you to complete the M-CHAT and score it. If there is any risk noted for autism, we can take it from there. The M-CHAT is a screener for children at-risk for autism and is not a "test" for autism. It is however, recognized and respected by the health care community.

I'm also concerned about the seizure. Seizures are common in children on the spectrum and left untreated can do damage to the brain. This needs to be followed up on.

M-CHAT: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

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

Kind regards,
James