Expert: Michelle Fattig - 6/9/2008

Question
I have a 2 1/2 year old little girl who has been very verbal since 1 years old she loves people and is pretty affectionate towards most family members and friends.  I shook bad behavior off as simply "terrible twos"but recently my mother in-law expressed concerns with her answering to her name and could she have autism.  I have noticed that if she is watching TV or at large family gatherings she will not answer and especially if we are at someone else house she will play with her cousins initially but then goes off and does things alone...this is when she doesn't respond to her name.  At home she almost always responds.  Is this a sign of autism or is she overwhelmed socially? any insight would be appreciated.  Thanks
Dawn

Answer
Some experts indicate that the best predictor of Autism, both classic and high functioning include the lack of response to her name being called.  The following is from a website regarding communication differences:

Autism Spectrum Disorders
Autism spectrum disorders (ASDs) are a group of related brain-based disorders that affect a child's behavior, social, and communication skills. They include 3 of 5 disorders known as pervasive developmental disorders (PDDs). These are autistic disorder, Asperger syndrome, and PDD-not otherwise specified (PDD-NOS).

Autism spectrum disorders are lifelong conditions with no known cure. However, children with ASD can progress developmentally and learn new skills. Some children may improve so much that they no longer meet the criteria for ASD, although milder symptoms may often persist.

Symptoms

No 2 children with ASD have the exact same symptoms, but the criteria are somewhat standardized. The number of symptoms and how severe they are can vary greatly. The following are examples of how a child with ASD may act:

Social differences

Doesn't snuggle when picked up, but arches back instead
Doesn't keep eye contact or makes very little eye contact

Communication differences

Doesn't say single words by 15 months or 2-word phrases by 24 months
Repeats exactly what others say without understanding its meaning (parroting or echolalia)
Doesn't respond to name being called, but does respond to other sounds (like a car horn or a cat's meow)
Refers to self as "you" and others as "I" (pronominal reversal)
Often doesn't seem to want to communicate
Doesn't start or can't continue a conversation
Doesn't use toys or other objects to represent people or real life in pretend play
May have a good rote memory, especially for numbers, songs, TV jingles, or a specific topic
Found at: http://www.aap.org/publiced/BR_Autism.htm

If you are concerned, the following checklists can be helpful:
Checklist for Autism in Young Children (Susan Mayes, PhD, Penn State College of Medicine)
PROBLEMS WITH SOCIAL INTERACTION
__(1) Social isolation
 withdrawn, aloof, avoids contact with others, or prefers to play alone rather than with peers
 parallel play along side but not with peers
 difficulty establishing friendships
__(2) Limited reciprocal interaction
 limited social smile or eye contact (looks away, looks through people, looks at speaker’s mouth, needs to
be prompted to make eye contact, or does not make eye contact when communicating)
 limited sharing and showing (e.g., does not show a toy to an adult, seek recognition, or share an
experience or accomplishment with others)
 excessively rigid play with peers (dictates play according to his/her peculiar and repetitive interests and rules)
 enjoys physical or sensory play with others (e.g., tickling, chasing) but has limited reciprocal social
interaction (e.g., does not play social games or games involving turn taking)
__(3) Self-absorbed
 self-absorbed or in own world (e.g., engages in self-stimulating behaviors, talks to self, or fantasizes
excessively about things such as movies or cartoons)
 oblivious to the presence of others or unresponsive to the social overtures of others
__(4) Socially indiscriminate behavior
 inappropriately talks to or hugs strangers
 invades personal space (gets too close to or touches others)
 no stranger/separation anxiety when young (not wary of strangers or upset if separated from parents)
 socially inappropriate, insensitive comments or behaviors (picks nose in public, asks personal questions)
__(5) Problems with social skills
 does not appropriately initiate or sustain peer interaction though may interact well with adults
 poor social reasoning (difficulty understanding social cues/comments, facial expressions, body language)
 wants to have friends but does not know how to make friends
PERSEVERATION
__(6) Narrow or unusual range of interests and play behaviors
 obsessive preoccupations or extreme fixation on things such as certain movies or TV shows (reenacts or
watches the same movies over and over), computer games, letters, shapes, numbers, counting, objects
or topics (e.g., trains, dinosaurs, NASCAR, maps, planes, electricity, Yu-Gi-Oh, cartoon characters, etc.)
 unusual attachment to and holding or hoarding objects (e.g., small figures, string, other______)
__(7) Stereotyped and repetitive play
 repetitive play (e.g., excessively lines up, sorts, spins, or throws objects; opens and closes things
repeatedly; plays with the same toys without variation; draws the same pictures repeatedly; other_____)
 disinterest in toys or lack of normal and varied imaginative play
 unusual preoccupation with parts of objects (e.g., repetitively spins wheels on a toy)
__(8) Upset with change
 distressed by change (e.g., change in routine or schedule, parent takes a different car route home from
school, furniture or child’s toys are moved, seasonal change in clothing, other______)
 difficulty with transitions (e.g., from one activity to another)
 extreme need to finish what he/she starts
 idiosyncratic or ritualized patterns (e.g., drinks only from a certain cup, wears only certain clothes, insists
that food be arranged a certain way on a plate, other_____)
 insists that things be in a certain location or a certain way (e.g., doors must be closed, coats zipped, etc.)
 insists on doing things the same way every time
 overly precise and inflexible, upset if someone breaks a “rule,” rigid and literal thinking
__(9) Stereotypies (unusual repetitive movements such as hand flapping when excited, toe walking, body
rocking, head shaking, body tensing, teeth clenching, teeth grinding while awake, finger movements, facial
grimacing, repeatedly running back and forth, twirling or spinning, pacing, playing with saliva, skin picking)
SOMATOSENSORY DISTURBANCE
__(10) Excessive atypical craving and love of spinning, tickling, climbing, rocking, swinging, bouncing, jumping
__(11) Unresponsive at times to verbal input (not react when name called or spoken to, hearing questioned)
__(12) Hypersensitivity
 unusual hypersensitivity to some sounds (e.g., distress or covering ears in response to loud noise,
motors, vacuum cleaner, hair dryer, baby crying, sirens, clapping, alarms, toilet flushing, people singing)
 unusual hypersensitivity to smell, light, or temperature
__(13) Distress with commotion or crowds (uncomfortable/anxious in large groups, theatres, cafeterias, parties)
__(14) Extreme fascination with spinning or repetitive movements (e.g., revolving fans, Wheel of Fortune,
running water), linear patterns (e.g., credits on TV, window blinds), minute details, lights, shiny surfaces
__(15) Abnormal sensory inspection
 excessively smells, mouths, chews, licks, or rubs inanimate objects or surfaces
 repetitively visually scrutinizes objects or finger movements close to eyes
 places ears against things that vibrate or hum or presses objects against face to an unusual degree
__(16) Tactile defensiveness or extreme dislike of:
 being touched or hugged
 touching certain things or getting hands dirty or sticky
 water on self or clothes
 having face washed, teeth brushed, hair combed, or nails cut
 walking in bare feet
 clothing that is tight, seams in clothes, or certain textures of clothing
__(17) High tolerance for pain (e.g., does not cry when hurt or does not respond normally to painful stimuli)
__(18) Sleep disturbance (e.g., difficulty falling asleep, waking during the night, waking early in the morning)
__(19) Feeding problems
 very picky eater, limited food preferences, insists on eating only a few foods
 hypersensitivity to textures (e.g., lumps in food)
 retains food in mouth without swallowing
 eats inedible substances
 other peculiar eating patterns (e.g., eats only one brand, color, or shape of a food, other____)
ATYPICAL COMMUNICATION AND DEVELOPMENT
__(20) Language regression or slowing at approximately 1 to 2 years of age (e.g., speaking a few words at one
year but then losing speech or normal early language development and later language is delayed)
__(21) Visual-motor skills (e.g., assembling puzzles, building with Legos, operating the VCR) significantly higher
than language skills during the preschool years or walking at a much earlier age than talking
__(22) Communication impairment
 absent or limited communicative speech but gestures to communicate (e.g., pulls an adult by the hand
and leads to what wants, hands an object to an adult for assistance, brings a cup to an adult for a drink)
 communicates verbally with others only when stressed or needing something
 difficulty with reciprocal conversational speech (initiating and sustaining conversations, listening and
responding to what others say), talks at people, or one-sided conversations on topics of interest to self
__(23) Atypical vocalizations or speech
 unusual voice quality or modulation (e.g., high pitch, sing song voice, lack of intonation, etc.)
 screeches or makes other odd noises (e.g., growls, hums, etc.)
 unusual repetitive vocalizations and sounds
 idiosyncratic jargon as if talking in own language
 echolalia (inappropriately mimics what others say, such as repeating instead of answering a question)
 sporadic speech (says a word or phrase once and rarely or never says it again)
 excessively recites from movies, cartoons, commercials, etc.
 uses rote or memorized phrases that are excessive, out of context, or not relevant
 makes pronoun substitutions (e.g., says “you” when meaning “I”)
 excessively repetitive speech and questions
 idiosyncratic thoughts and speech (makes up words, nonsensical speech, unique views and perceptions)
__(24) Special abilities that are significantly higher than other abilities
 exceptional rote memory (e.g., at an unusually young age, identifies numbers, letters, shapes, logos, and
colors; sings or hums tunes; memorizes car routes; counts; recites the alphabet; reads; spells; etc.)
 phenomenal vocabulary or ability to memorize movies, books, or factual information
 remarkable ability to mimic movie or cartoon characters
 outstanding visual-mechanical skills (e.g., at an unusually young age, assembles puzzles, matches
shapes, operates a computer or VCR, figures out how things work, complex constructions with Legos)
 remarkable artistic or musical talent
 extremely well-developed gross motor skills with delayed development in other areas (in contrast to high-
functioning children with autism who often have writing or coordination problems)
MOOD DISTURBANCE
__(25) Overreactivity, irritability, low frustration tolerance, agitation, tantrums, meltdowns, explosiveness,
aggression, or self-injurious behavior (distressed by minor events or occurrences most children can
tolerate, such as intrusions, activity interruptions, proximity, confinement, performance demands, writing
tasks, or when things are not the way the child thinks they should be)
__(26) Moodiness and emotional lability (the cause for mood changes may not always apparent, such as
laughter or distress for no apparent reason)
__(27) Difficulty showing and recognizing emotions, emotionally unresponsive in some situations, lack of
empathy or emotional reciprocity (e.g., does not respond appropriately or provide comfort when
someone is hurt or sad), or misinterprets the emotions or responses of others
__(28) Unusual fears, such as fear of elevators, steps, toilets, balloons, vacuums, tornadoes, other_____
PROBLEMS WITH ATTENTION AND SAFETY
__(29) Selective attention, ability to hyperfocus on activities, objects, or topics of interest to self (e.g., lines up
toys, spins wheels, watches the same movie, assembles puzzles, builds with Legos, or draws pictures
for long periods of time), but is inattentive, impulsive, and fidgety at other times
__(30) Limited safety awareness, fearless, or oblivious to danger (e.g., unsafe climbing, wanders about house at
night, runs off by self, goes into traffic or water, walks off with strangers)

Also, a checklist at:  http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist...

And:
EARLY CHILDHOOD/PRESCHOOL PARENT QUESTIONNAIRE

Name of Child:  _____________________   Date of Birth: ________  Age: _______
Name of Referrer: __________________   Relationship to Child: ______________
Parent/Guardian: ______________________________________________________
                                               Names         Address            Phone

Date of Referral: ____________
Referral Concern (Please list any concerns about child’s communication, behavior, or development):  _____________________________________________________
______________________________________________________________________
Medical History:
Pregancy: _____________________________________________________________
Prenatal: ______________________________________________________________
Birth: _________________________________________________________________
History of Chronic Illness, Head Injury, Ear Infections, Hospitalization, or Accident: ______________________________________________________________
_______________________________________________________________________
Mother: ____________________________ Father: ____________________________
Siblings: _______________________________________________________________
Family History (Special Education, Developmental Delays, Learning Disabilities, Mental Health): _________________________________________________________
Who lives with the child: __________________________________________________
How does the child relate with:
Mother _________________ Father __________________ Siblings _______________
Family activities: ________________________________________________________
Does the child experience difficulty with peers, extended family, or social settings?
_______________________________________________________________________
As an infant, did the child experience difficulty with colic or soothing (stiffen or pull away when cuddled or stroked)? ___________________________________________
Communication:            
   1) Does he or she respond to his/her name:    Never  Sometimes   Often   Always
     __________________________________________________________________
2)   Does he/she express her needs or wants:  Verbally  Pointing  Pulling  Tantrums
___________________________________________________________________
3)   Does he/she talk like children his/her age? ______________________________
___________________________________________________________________
4)   Does he/she follow simple or complex directions? ________________________
____________________________________________________________________
5)   Have you ever wondered if he/she is deaf? _______________________________
6)   Does he/she seem to hear at times, but not at others? _______________________
7)   Does he/she ever seem lost in own little world or stare off? _________________
_____________________________________________________________________
8)   Does he/she mimic, copy, or like to immitate?  ____________________________
_____________________________________________________________________
9)   Does he/she seem to have lost words, or say fewer words than before? _________
_____________________________________________________________________
Social Concerns:
10)   Does he/she smile at family members? __________________________________
11)    Does he/she smile at strangers or become overly frightened by strangers? ______
____________________________________________________________________
12)    Does he/she prefer to play alone or overly dependent on parent/caregiver for entertainment (you are his favorite/only toy)? ____________________________
____________________________________________________________________
13)    Does he/she get things for self? _______________________________________
14)    Is he/she very independent or overly attached (extreme separation anxiety)? ____
_____________________________________________________________________
15)   Has he/she met milestones early or unevenly? ____________________________
_____________________________________________________________________
16)   Does he/she seem to avoid eye contact or have too much eye contact (watching without mirroring or reacting like a little professor)? _______________________
_____________________________________________________________________
17)    Does he/she often seem “lost in own little world”? ________________________
____________________________________________________________________
18)   Does he/she seem tuned out or uninterested in other children? _______________
____________________________________________________________________
Behavioral Concerns:
19)   Does he/she seem to have excessive tantrums or emotional outburst with little or
     no provocation? ____________________________________________________
20)   Does he/she express frustration or over react to small changes or routine? ______
_____________________________________________________________________
21)   Does he/she demonstrate a lack of understanding in playing with toys (excessive mouthing, banging, lining up, sorting, focus on one part like spinning, or lack of interest)? __________________________________________________________
     _____________________________________________________________________
22)   Does he/she seem to get stuck on things regularly (wants to stick with one activity over any others, watch the same movie over and over, read the same book over and over, or other)? _________________________________________________
____________________________________________________________________
23)   Does he/she have unual attachments to objects? ___________________________
_____________________________________________________________________
24)   Does he/she toe walk or have unusual facial movements/grimacing? __________
_____________________________________________________________________
25)   Does he/she make any unusual hand movements or spin for long periods of time?
_____________________________________________________________________
26)   Does he/she seem overly sensitive to textures or sounds? ___________________
_____________________________________________________________________
If Age Appropriate:
27)   Did he/she babble by 12 months? ______________________________________
28)   Did he/she gesture (point, wave bye bye) by 12 months? ____________________
29)   Did he/she use single words by 16 months? ______________________________
30)   Does he/she seem to have an unusually advanced vocabulary? _______________
31)   Does he/she seem to have an extremely good memory? ____________________
32)   Does he/she demonstrate two-words spontaneously (not echo) phrases by 24 months? _________________________________________________________
33)   Has he/she demonstrated any loss of language or social skills of any kind? _____
_____________________________________________________________________

(3-4 years of age)
Cognitive:
34)   Show him/her a doll or stuffed toy, touch one to a box and have the other  
     pretend to look in the box.  Ask him/her “Which one knows what’s in the box?”
     Response: ____________________________________________________________
     
©Michelle Fattig, Flower by the Water Publishing PO Box 579 Genoa, Nebraska 68640 www.anniebooks.com
Adapted Questionnaire: Recommendations National Autistic Society: What should health professionals look out for when parents express concerns? And ToM “Seeing leads to knowing.” (Baron-Cohen, 2000, p. 5)

These are instruments that I frequently use in diagnosing autism educationally.  If you have any other questions, please let me know.