Expert: Catherine Ridenour - 4/16/2008

Question
QUESTION: Hi Catherine

My main concern is that my 2 1/2 son might be displaying autistic behavior.
He was not much of a talker but did use single words when you pointed to
things that he knew. I wanted to wait and see if his speech would improve
when he turned 2 , and it did. Now he is trying to string single words
together..for ex: want milk, or close the light..want watch movie..etc.
The thing that worries me is that he does use phrases and expressions I
repeat to him, if I say to him you want milk or juice he will say milk or juice.
Would that be considered echolalia? What is normal in terms of repeating? He
does seem to use phrases appropriately,  for ex. if something falls he might
say...its broken..or if I sneeze he will say bless you..He will say I am sorry if
he gets hurts or hurts someone by accident. or he will ask me to kiss  his foot
if it hurts..etc.
He does love to play with Tomas and when I try to talk to him , he is so
focused on playing he wont always pay attention. I can call him sometimes
many times and he wont listen , but then other times he will turn right away.
He know's when I get upset and he know's if he hurts his sister or does
something bad he will get time out..and cry :(
He enjoys playing with other kids and is very affectionate, he loves to hug us
and kiss us as well.
I find that sometimes he spins especially if he is playing with his car's and tip
toes sometimes as well, but I just sort of noticed that lately.

The thing is that I don't know what is normal and what is not normal
anymore. It was the speech thing that got me worried at first but then
reading a lot of the autism symptoms I feel like maybe he is autistic.

This is just all so confusing and scary. What should I be doing with him?

Sincerely

KB

ANSWER: Hi Katherine,

A two year old repeating part of a question in answer is probably not echolalia. He is learning language through repetition. This is normal. The key here is that is not the only thing he does, verbally.

Unless the spinning is really something he's into, it's probably not a worry, either. Tiptoeing all the time would worry me but not on an occasional basis.

Unless he starts losing language, I think you can relax.

At his age, play is his work. Get down on the floor, talk, laugh, sing. Go to the park, play in the pool, sift sand, swing on the swings...let him "help" make cookies. You get the idea. Limit television, read to him a lot.

The more he sees, hears and talks about, the better he will be prepared for school and life.

Feel free to write again if other behaviors show up.

Catherine

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

QUESTION: Thank you Catherine for you're fast reply.

I notice that when I did spend some time playing with him he really enjoys it
and tries to copy me and mimicks the things I do or say.
He ask's me to sit with him to play with his car's or trains. He does will copy
things he hears in movie and act out scenes with his toys from the movie..ex:
Lighting McQueen. That was concerning me since I read that it is also a
symptom for autism.
If I am playing with playdough he will ask me to make him things, or enjoys it
when I make things for him. He will just say..car? or snake? and I make it and
then he will copy me when I act out what the snake does.
He will also jibber jabber but add words he knows to it, a lot of the times his
voice sounds a bit nasal  like he is not pronouncing something right, sorry I
dont know how to explain this properly. It sound like when a deaf person is
talking , sort of if that makes sense.
If he hits me or slaps me he know's I get upset and he will say sorry or kiss
me.
One time someone commented that he is in his own world and that just made
me panic a bit. What in autism does in his own world mean? Does  playing
with you're cars alone for a while mean in his own world? Or when you don't
answer to you're name ?
He does not engage in back and forth conversations altough he will ask me
what happend to so and so..if he is watching something or seeing something
happening.
He will say where is daddy or where is Taylor ( sister). Where did it go ? He
wont ask why questions or when I ask him something answer me back.
If I say " you want milk he will say ..OK. If I say you want to go outside..he
will say go outside. or he will ask me want go outside..
He will walk up to kids and smile, he does not seem shy or not  wanting to be
around them but I am not sure if he know's how to share.
He sometimes refers to himself by his name, which I know is another sign in
autistic children.

I will take you're suggestions and make sure I read to him , something I did
not do .
He turns 3 in October and I am hoping he will improve with his language, but
if he is autistic will he start to regress by now? I am so afraid of loosing him.

Katherine

ANSWER: Hi Again,

Try to relax. Anxiety is contagious.

The fact that he asks where people he cares for are is good. His requests to play with him are also not symptoms of autism. Many children call themselves by their own name when learning to talk. Everything you have told me in this second note are normal 2 year old behaviors.

No, the ability or desire to play alone is NOT proof of autism. I have a niece who played with little toy animals and dinosaurs, all by herself for most of her childhood, talking for them and acting out elaborate stories. She was totally self-contained. She is now 15 and not a bit autistic.

Acting out stories one has seen on TV or in movies is not only done by autistic children. Most kids develop a favorite story book or videotape that they want read to them over and over. This is about establishing a feeling of safety. They can count on it being the same every time. I can't tell you how many times I read "Green Eggs and Ham" to our middle daughter (not the autistic one).

I think he is going to be fine, Mom. Enjoy him.

Catherine



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

QUESTION: Again I can't thank you enough for you're input.

I don't want to bother you to much and this will be my last questions. I was
researching on the net and found that grimacing is some sign as well, I do
find that especially today he was pulling his mouth down a bit..especially after  
finishing when saying something.
Plus what is the truth with a larger head and maybe some abnormalities in
the exterior earlobes that might relate to having autism? My son has a big
head, and of course all this info is making it a bit more scary. Yes you are
right anxiety is contagious.

Thank you again for all you're help. I will enjoy my little guy and hope for him
to improve more and more.

sincerely
Katherine

Answer
Hi Katherine,

Large head size could indicate hydrocephaly (water on the brain) BUT if he is seeing a pediatrician for his regular check-ups, they would have caught this a long time ago. Head circumference should be measured at each well child check. If he has NOT had a well-child checkup, schedule one right away. (This condition is dangerous and requires medical care. It can cause learning disabilities, brain damage and, in extreme cases, death.)

I have never heard of earlobe shape being an indicator of autism. If his ears are truly deformed, it could indicate some genetic abnormalities. Again, ask his doctor.

Grimaces that are involuntary and uncontrollable are common in Tourette's Syndrome. Some people with autism have this, but Tourette's, itself, is not considered an autistic spectrum disorder.

After all you have told me, I think it is important to consult a physician to be sure your son's health is not a problem. Since you have an older child, you may be seeing things that are not up to par that are more subtle than you can tell me. It's better to be sure.

Best wishes,
Catherine