Expert: Dr. Sharon A. Mitchell - 5/30/2008

Question
My friend and her 14 mo old daughter recently moved in with me. (I also have a 14mo old son) I know all children are different but there are some things my friends daughter is doing that I'm not so sure are normal at this age. She continuously shrugs her shoulders and winks. In the middle of playing, eating or while she is cuddling with her Mom, she will shrug her shoulders and wink. I know this sounds like no big deal, but she does this so often and I don't think she knows she is doing it.
Her winking seams more like the entire side of her face tenses up and causes her to wink. Again, it appears that she isn't controlling this action. She doesn't seem to notice she is doing it. Aside from being extremely bold legged she appears to be on top of all her developmental stages. Could involuntary muscle movement be a sign of Autism? Thank you in advance for your time.

Answer
Crystal, may I add something else? When the mom goes to the doctor and says that her daughter winks and shrugs, he'll likely ask how often and when. The severity and frequency of these actions could have a bearing on any diagnosis and subsequent treatment.

While you're waiting for the appointment, you could try keeping track of when during the day the child winks or shrugs, what she's doing at the time and for how long she continues the shrugs (does she do it for two seconds, continue for two minutes, etc.) The doctor will appreciate hearing if it happens twice a day or twice an hour.

Sharon A. Mitchell

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From what you describe, neither developmental delay nor autism would be the first things that spring to my mind.

First, you say that this little girls seems to be on top of all her developmental stages. And, while two kids develop a precisely the same time, having a son the same age would give you a comparison.

While some kids with autism may rock, walk on their toes or do repetitive actions, involuntary movements such as you describe are not a hallmark of autism spectrum disorders.

Winking is a complex skill requiring discrete muscle control. I'm not sure that most children, at just over one year of age have the muscle control to wink accurately at will. Little kids who try to wink, often have trouble isolating just one eye, not scrunching up half their face at the same time, etc.

You're right that simple shoulder shrugs or winks are no big deal on their own, but if done with great frequency, are out of place in the context of what's going on, or if the actions interfere with what she's trying to do, they warrant attention.

I'd be concerned about the possibility of some neurological involvement causing involuntary movements. Perhaps the actions are a reaction to stress (you mention that there has been a recent move), but even so, this is not a typical way for a fourteen month child to respond to stress or anxiety.

A pediatrician or neurologist may want to investigate what may be behind these movements. I don't want to alarm you as there may be no underlying concern but you and the child's mother will feel better once you've looked into this medically.

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca