Expert: James Michael Roan - 7/14/2008

Question
Hi i am a mother of 3 from the uk and have many concerns regarding my 11 month old daughter.From day one my husband and i felt she is different somehow to our other children.As a tiny baby she has never cried for a bottle and has been very slow to feed.We had to set alarm to wake her every 4-6 hours.At two weeks old we stopped waking her through the night and she slept through till morning.To this day she is happy not to eat,she often refuses and still does not ever come across as hungry.I honestly think she would happily starve if left.She does not attempt to chew food at all,she swallows it whole and chokes on lumps.
 She is under a paedatrican and has been from 7 months due to feeding problems and development delays.She has started to crawl and stand recently so we are not concerned regarding her motor skills now.
 I am concerned about autism as my cousin (aunts son) is autistic so it is in my family.
At 11 months my daughter does no gestures at all,no pointing,no reaching to be picked up,no waving,no nod/shake of head,no mimicking games e.g peek a boo,no clapping.
 She very rarely babbles though she can do ba ba and ma ma.
She does not copy sounds or say ba ba back to me if i say it.
She will give eye contact if she iniates it and look away if i iniate it.
She pushes away from affection/cuddles unless ahe iniates it,
She constantly does a high pitched shriek/screech that is ear piercing.
She is very hard to console when upset.
she will go to absolutely anyone,including strangers.
She smiles alot but will not laugh(unless tickled and it sounds very forced).
She will respond to her name,but does the same if you shout any name.
she does not understand no.
she is often very quiet and people comment how well behaved she is.she does not demand attention,food/drink,nappy changes etc..
I feel peds here are not listening to me as they have said they will not think about autism till between 2-3 years of age.Everything was put down to reflux,however a 23 hour ph study proved she does not have reflux.
i did your csbsdp checklist and here are results.
emotion and eye gaze-5
communication 0
gestures 0
total social composite 5

sounds-2
words-0
speech composite 2

understanding-1
object use 4
symbolic composite 5
total-12

Please can you email me with your opionion,i feel here in uk i am not being taken seriously at all.Do you think i am right to be concerned and is it relevant that autism is in my family.My daughter also has epicanthal folds to her eyes and so does my cousin.He has a genetic syndrone as well as autism and has some dismorphic features.I am concerned as my daughter has never been physically examined naked and my aunt said that she had not noticed my cousins features.e.g nipples too far apart.
Do you have any suggestions as i keep reading that early intervention is important yet here in uk there is nothing.
I just want to be taken seriously as i know something is not right.
She also rocks backwards an forwards,and constantly sucks her hands(has from birth).
I will look forward to hearing from you many thanks Donna Green.
email: donna-green-@hotmail.com

Answer
Hi Donna;

Actually your daughter's risk for autism is the same as for any family with no autism in their history. Since autism affects the Y chromosome, many gene deletions of that chromosome give the appearance of autism. It is important to clarify this because certain syndromes associated with th Y chromosome come with heart defects. In any case the behavioral intervention is the same.

I just came back from Ireland and won't be in my office for a week or so to get at my CSBS-DP stuff.

Kind regards,
James