Expert: James Michael Roan - 7/15/2008

Question
QUESTION: Hi,

in doing some research related to my son's one year vaccinations, which are coming up in three weeks, I stumbled upon some literature relating to early symptoms of autism and I think my son may be displaying some of the symptoms.  He's very healthy, happy (super smiley, loves people), laid back, and an excellent sleeper - people often tell us that he is, literally, the happiest baby on the block.  But the following things have me concerned...
+calling his name - sometimes he will turn the first time I call to him, but other times I can call him several times without response.  The more stern or terse my voice is (eg. if he's about to touch an outlet), the more likely I am to get a response.
+no pointing - he's never pointed in the traditional sense (finger extended).  Occasionally he thrusts his entire arm and fist towards something (Cheerio box, or balloons in the supermarket), but that's really the extent of it.  He does clap, and once in a while waves (but not often).  He doesn't do "so big".
+doesn't follow my finger when I point to something
+doesn't mimic or try to repeat words
+doesn't have any words that are associated with an object/person - he babbles a ton, but I can be dada, or mama, or blahblah.  I think he does say the cat's name (Mao) when the cat is present.

I've called my pediatrician who does seem too concerned, but said to mention it at the 1 year WBV.  I know that's really all I can do right now, but waiting three weeks seems like a lifetime.  Just wanted your opinion and to see if I should just relax for the time being or maybe start researching early invention treatment.  Thanks in advance.  This is an amazing resource!


ANSWER: Hi Ambra:

I am not hearing anything that worries me. At this age we are looking for socially unresponsive children or children with limited social interaction. He's still young and expect pointing to come on by 11-15 months. After that we get worried. Here are some red flags for autism at early ages and tell me what you think:

6-12 Month Markers:

•   Passivity and decreased activity
•   Extreme distress reactions
•   Fixation on objects

By 12 Months:

•   Decreased positive affect and social smiling
•   Delayed gesture and language
•   Poor or no eye contact
•   Poor disengagement of attention
•   Inability to shift attention back and forth between different stimuli
•   Failure to orient to name
•   Poor imitation
•   No babbling by 12 months
•   No gesturing by 12 months

By 16 Months:

•   No single words by 16 months
•   No pointing to objects or interesting events in an attempt to share them with another

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick response.  I took the day off of work today to observe my son with his caregiver and he's actually doing a bit more than I thought (he will follow your finger if you point to something, but he won't necessarily do the back and forth between you and the object).  There are two items from the "by 12 months" list that stick out at me... 1) failure to orient to name - there were several instances that I called to him today and he didn't respond b/c he was either enthralled with something else (kids playing) or just sort of staring off (not looking blankly, but definitely a "lost in thought" type of look), 2) poor imitation - he's never been an "aper" (has never stuck tongue out at us or blow raspberries, etc).  He will clap if you clap or drum with his hands if you drum with your hands, but he likes doing those things anyway.  Another thing that he really doesn't do is the anticipatory reach to be picked up or passed from person to person.  It's not on your list, but it was on another list that I read.  He never did it a ton, but he used to do it more often, now it's rarely.  Does any of this change your thinking?  Also, do you think we should proceed with the 1 year vaxs as scheduled or do you think it would make sense to delay based on the info above?

Answer
Hi Ambra;

It's o.k. not to "always" respond to name as you described. I'm a little surprised he doe not reach to be picked up but it is not always seen in typically developing children either. In autism I look for a profile of behaviors. Certain things occur with one another that point to autism not just one or two isolated behaviors "associated" with autism.

Keep observing him more playing alone and around other babies if you have that opportunity. As far as the vaccinations are concerned:

1. Make sure the preservative does not contain Thimerisol.

2. If there are multiple vaccinations such as with the MMR, be on the safe side and break them up into separate ones 6 weeks or more apart. Make sure his immune system is as good as it can be.

Kind regards,
James