Expert: James Michael Roan - 4/11/2008

Question
My son is 26 months old.  He is my fourth child but my only boy so I can only compare him to his elder (8, 7 & 7 years old) sisters who were all advanced in their development.   He has no speech whatsoever (along with some other red flags which I'll explain) and has an appointment next month for a hearing check, then with a paediatrician and speech & language therapist from a referral by my health visitor.  He is quite vocal with noises which are like babble with sing song sounds.

My son is adorable, very easy going and good natured, he laughs a lot, smiles frequently and has excellent eye contact (although I'm not sure what his eye contact would be like with unfamiliar people).  He is very cuddly and shows emotion.  He is unafraid of crowds and loud noises and enjoys interaction with his sisters, although it would be tickling, picking up, chasing, boo, that type of play.   He does understand many basic instructions but wouldn’t understand something like 'pick up the paper and put it in the dustbin' or 'your toy is on the table'.  

He has never pointed, or been able to follow a point, although sometimes he seems to and other times not.  He enjoys songs and being sung to and joins in with 'row the boat' and 'round and round the garden'.  For the latter he can point his finger but will give it me to partake in the action. He plays with a only few toys correctly but not his toy cars, he just fiddles with the wheels.  He brings me things but does not share in play, nor does he imitate often, only very occasionally. He mainly enjoys physically play, such as the park or activity play centre, plus climbing things is his passion!  He does not copy or pretend play.

When he wants something he takes my hand (or whoever is with him) and leads us to it and he claps when he is happy about something.  He used to shakes his head when he heard the word 'no' and wave goodbye, but this has stopped. He does spin objects but not obsessively, mainly plates and bowls.  He used to spin balls as a baby but now bounces and throws them.  He is not bothered by a change in routine or lines up his toys.

So many people tell me it's because we are comparing him to girls and boys are different, but we are very concerned that he has ASD.  Also, my health visitor said it could be severe speech delay but we do not want false hope.  I have done the m-chat and he scored 96 (or showed mild PDD) but I found it hard to score him on the speech section.  I know you don’t diagnose but I would like to be prepared if you think he could be on the spectrum.  

Answer
Hi Claire;

There is a degree of social delay here, however it sounds like he has come on. What is needed is an observation of him in a group of peers to observe his behavior interacting or not with his peers. Notes on qualitative and quantitative social and communication behaviors would have to be done. My guess is that, unless the assessment team is highly trained and experienced in high functioning autism at this age, that they will NOT diagnose him at this point preferring to wait until later. If this happens contact me back.That is not to say I think he has high functioning autism, I cannot say without a good observation.

Kind regards,
James