Expert: Trey McGowan - 4/1/2008

Question
My friend recently asked for my advice about her 25 month old. My son is the same age.  I have in the past noticed something "off" about her daughter, and was happy to hear her voice her concern also.
She is worried her daughter is "retarded"(her word not mine). I asked her to explain and she said she will often play with her hands for hours on end, rolling them over like she's washing them.  She's almost completly non-verbal.  She says only about 5 words and only when prompted.  She said she also appears to have a hearing problem, although she dosen't think so, she thinks the toddler is mostly just ignoring her.  I set up a play date to see if I could identify anything spicific about her behavior.  What I saw was very alarming.
My son and another friends son who's 4 played beautifuly together,  running, copying eachother, chasing eachother, engaging eachother, everything you would expect from a couple of kids.  They tried to engage her daughter several times, and it was as though they weren't even there.  She wouldn't look at them she wouldn't even acknowledge their presence, or anyone else's for that matter.  Adults or children.  
She continualy rubbed her hands together,  numerous times I got face to face with her and tried to get her to look at me and she wouldn't.  When her mom came home there was absolutly no reaction from her at all.  She didn't even acknowledge her mommy came home.  Didn't even look at her.
I tried to engage her in different activities with absolutly no response.  Her mom told me she never engages in pretend play.  She extremly sensitive.  She was always an extremely sensitve baby, and her mom rarely could take her out of her house because she would just cry hystericly the entire time till she got home.  She never responds to her name, or any other social cues.  It's almost as if she's completly deff.  
We have the same doctor and when she addressed her concerns the doctor only wanted to do a hearing test, and she seems pretty satisfied with only having her hearing evalutated.  I however am certainly not.
Everyone adult who has seen her is very concerned.
I'm pretty sure she might be autistic.
I have a couple questions.
1. Could a hearing loss be causing these symptoms?
2. They don't have health insurance, is there somewhere she can get a free or low cost evaluation.
3. As her friend and out of genuine concern for her beautiful girl should I keep encourageing her to push our doctor for more evaluation,  or am I oversteping my boundries?
4. What should her next step be?  I know autistic children do better the sooner they are diagnosed.

Answer
Hi there, Piper!

I'm going to answer these questions in the order asked. Easiest that way for us both!

First off, you ask if a hearing loss could be causing these symptoms. Indeed, the lack of reaction to having her name called is a big symptom of a hearing loss in a child. Not reacting to other children's audible cues could be another one, definitely. I honestly don't think there would be anything amiss in having her hearing tested. I won't guarantee that's what it is... I'm no doctor or specialist, after all... but there is the slim possibility that it is causing many of the problems, and the problems themselves are causing other problems in a big cycle.

Secondly, you ask about the insurance. I don't know for a fact where you are, so I can't give many suggestions. If you give me a location, I can look around, but without knowing exactly whether you're looking for an assessment, a treatment, or something for hearing, it's difficult. In addition, the hardest part about this is that you're looking for an evaluator *for her*. I'll go into it more in detail in the third answer, since it could be the most important of the bunch.

The third being: while you are not necessarily overstepping boundaries by encouraging, you *may* be making her uncomfortable with doing so. Denial can be a very powerful thing in some people. If there is an issue, particularly something that could be autism, many parents do not want to deal with it because they want to pretend it isn't there. 'If I don't see it, it will go away', they think. Or 'I don't want to admit my child is imperfect'. The problem with this mode of thinking is that you can't *force* them to think otherwise. When push comes to shove, they will simply reject the help and walk the other way.

Do I think that means you should *not* press her? No. I don't think so at all. In fact, I think that while you should try not to push, you should definitely be there as support and encourage. But at the same time, know that if she is in deep denial, it will be difficult, if not impossible, to change her mind. Don't go on the offensive; you will only make her retreat from the aid more. Instead, express sympathy, empathy, and passive logic rather than in-your-face. The 'gentler' you are, and the more you let her feel in control of the whole situation, the easier it will be to bring up the fact that there is an issue (because there is, whether it is hearing, autism, or something else) and to get it dealt with.

Onto the fourth, which is 'What should her next step be'? This is part of the 'Be empathetic', because her next step shouldn't be to be forced into doing something with her child. Her next step should be coming to terms with this issue *herself*, because without that knowledge, she can't help her own child. Once there has been some coming to terms, with whatever the problem is, getting a direct assessment with a specialist is the best thing to do, because the earlier they are diagnosed, the easier they can begin to learn how to deal with ingrained issues.

It's been a while since I've come up with links, but here's a few to try and get you into the right mindset to be able to speak with her about the issue:
http://29marbles.blogspot.com/2006/04/some-thoughts-on-denial-and-autism.html
http://www.associatedcontent.com/article/61018/autism_awareness_when_denial_gets...
http://groups.msn.com/TheAutismHomePage/gettingadiagnosis.msnw (not so much about denial as about 'what to do' when there is definitely an issue and you can't get anyone to listen)
http://pediatrics.about.com/od/weeklyquestion/a/04_autismdenial.htm

See if any of those help out. And remember, comments, questions, feedback, follow-ups, or whatever have you are always welcome. I wish you genuinely the best of luck, and obviously your friend and her child as well!

Trey