Expert: Trey McGowan - 6/29/2008

Question
Hi Trey:

I have a 23 month old son who was diagnosed at 18 months with mild pdd.  I have an older son (14) with fairly severe autism, so I knew exactly what to look for in this child.  He puzzled me a bit in the beginning because he has a lot of skills that seem atypical of children with autism--he will point, make eye contact with us (though not as much as a typically developing child would) and vocalize.  He brings me things all the time.  He initiates things like reading books frequently. He is extremely responsive to games like peek a boo, etc.  In the past 5 months, teaching incidently through an ABA approach, I've gotten him to the point where he's gone from having no words to having a vocabulary of 20-30 words.  He uses 5-6 words spontaneously all the time (like up, open, juice, etc) and he uses them with eye contact.  He imitates actions upon request, follows simple directions, and is really beginning to imitate words and sounds with ease.  He engages in a good bit of social reciprocity with me and my husband.  But . . . he has extremely limited and immature toy play ( still into cause and effect types of baby toys), he shows little interest in markers and crayons, blocks, sand or water play, etc), he shows limited interest in other children and most disturbingly, he is exhibiting increasing stereotypic behavior.  He likes to run down the hallway and look at the baseboards and door jambs (this behavior started around 17 months, faded away for about two months, then re-appeared).  Within the last 6 weeks, he started to frequently rub and wring his hands together.  I generally see him engaging more in this behavior when he's excited (like during a favorite video), bored, or very tired.  He rarely does it in the car, in the swing, in the high chair or when I've managed to capture his attention during an activity like reading a book or playing with a toy.  These behaviors really scare me.  If not for them, I would be feeling very confident in a fairly decent outcome for this boy--he's seems like such a fast learner.  I'm desperately trying to give him alot of sensory input--swinging, bouncing, etc (all things that he loves and prefers) in the hopes that it will reduce the stereotypy.  My questions for you are the following:  is the stereotypy indicative of greater severity?  My older son was constantly engaged in stereotypic behavior, but he didn't have any of the skills and abilities of this younger child.  Should I be doing everything in my power to disrupt or redirect the stereotypy?  Is that even possible?  Has it been your experience that stereotypies naturally decrease over time in children who are rapid learners?  Or, do these behaviors tend to worsen over time?  Again, I can't use my older son as a basis of comparison because these two boys could not be more different--my older son had no receptive or expressive language, no eye contact, no ability to imitate and no appropriate toy play at age 2--only stereotypic behavior.  Any advice, etc that you could provide would be most helpful and appreciated.  Thanks.

Answer
Hello there, Teri!

I know that it is going to be difficult to hear, but as I'm sure you have been made aware by this, autism does indeed run in families, and while there are no official genetic links as yet, it seems to be something that is very definitely genetic. What this means, as you are seeing, is that if one child is born autistic, there is the chance others will be. However, and in the same vein as this thought, remember that 'autism' is not an 'all-or-nothing' thing. There are varying degrees of it, from severe to a few autistic stereotypies.

The point I am trying to make here is that, yes. It is very likely that what you're seeing is autistic, but *not* that seeing it is an indcator of greater severity. It may very well just be a mild case, and one that, with some work, will not be an issue. Having raised an autistic child, you have at least a leg-up in understanding how to deal with the more minor effects, and letting yourself panic that you will be seeing *major* ones may distract from this. Take it as it comes, and be assured that a lot of the most successful people in the world show stereotypies (either in private or in public) without ever officially being 'autistic'. Rocking, pen-tapping, hand-wringing, chewing, spinning... they're all varieties of stereotypie, and yet they're also all varieties of 'eccentricities' that many successful and apparently neurotypical people have shown.

Your question about doing everything in your power to redirect the stereotypie worries me a bit on one level, however. Remember: that stereotypie is *not* some great and horrible thing, but simply how your child expresses himself with great extcitement or nervousness (or whatever other extreme emotion. To that end, disrupting it will not fix the problem of autism if it is indeed there. It would be like assuming that a child with allergies no longer has those allergies because you demand he stop sneezing. While depending on the behaviour, you may need to have it curbed either in public or altogether, the redirection or cessation of it will not 'fix' a problem, but possibly make it worse, as your child is taught that the behaviour that he uses to relax is potentially 'evil and wrong'. Some children will get worse over time with stereotypies, some will get better. Unfortunately, there is no 'tried and true' when it comes to that; it's all in the individual, and while I wish I could give a solid 'Yes It Will' or 'No It Won't', it can potentially go either way. But I will hasten to note that while hand-wringing may be an unnerving thing to one who has seen the severe behaviour in one child, it is an extremely healthy release of energy for even neurotypical people. And the staring at the jambs is likely something you'll want to adjust in public, though primarily to keep him from running into dangerous situations, or stopping to stare where people may need to be passing by him.

In the end, take every day as it comes. Stereotypies tend to form themselves up in the early years, and may well start to taper off in the later years as the child matures. At this young age, there is really no way to tell what the future will hold, so by taking it as it comes and being prepared for the more common 'issues', you can simply enjoy the days, rather than dreading them. If you start seeing worsening severity of these stereotypies, or loss of skills, only then would I genuinely start worrying and would quickly bring it up with the doctor (as more than just a 'heads up'). Until then, my advice is simply to do as you have been doing, and take the reassurance that even Bill Gates rocks!

Hopefully that answered your question! Comments, questions, follow-ups, whatever else, are quite welcome as always!

Trey