Expert: James Michael Roan - 7/11/2008

Question
I do hope I am not wasting your time. I seek some advise, although I realise it is very hard without seeing the child concerned. My 3 yr 4 mth old boy has given me concerns. His speech is very delayed for his age I would say a good 12 months behind his expected level ( he is my 3rd child ) he is sociable with his close family, although a little aggressive with his brother and sister.

I have just started him in a nursery in the hope his speech would develop. He does not play with the other children,or speak to them and covers his eyes when they try and interact with him.( he does the same with adults he doesn't know well ) He tends to play with the same toys all the time, watch the same dvds, to the extent that he knows the script, which I can hear him trying to recite, whilst he is watching, although he will stop if I walk into the room. In fact he talks to his toys and himself a lot more than he does any person.

He has a habit of running round and round in circles for hours, I'm not sure why, although he also can lay on the floor pushing his cars around talking and playing with them, for ages. I have also noticed he likes to do things in a set way, he lines his cars up ( which he loves ) in a very straight line, and, as an example, if I press play on his dvd player when he wanted to press it, he gets distressed, until I say " I'm sorry, you can do it next time" then he's fine, and replies ok.....if I say anything else or use a different wording, it doesn't seem to placate him.

We have terrible problems with his toileting, he was constipated a couple of times about 12 months ago. Now he seems to hold on for days until emptying his bowels. He may empty them once a week, twice at the most, but in that time we have 2 days of him crossing his legs, clenching his muscles and holding onto it for dear life, until eventually it gets to the point I have to catch him, whilst he is hiding in a corner with his legs crossed, physically hold them apart and make him poo.

I do realise that I can go to a health visitor ( I am in England, I donot know if you know what a health visitor is!) but I honestly don't know if I am just being a neurotic mother, and I know that they will probably tell me to wait until he goes to school. I feel this is too late if there is a problem, and I would rather any intervention if needed start sooner rather than later.

I guess I'm thinking I will take him to his doctor and request ( if needed, demand!) an assessment, but I just wanted somebody elses opinion before doing that.

Once again I apologize if I have wasted your time, and this is not your " field" it is so hard sometimes on the Internet to pin point the correct person.

Thankyou for your time, and I look forward to a response.
Amanda

Answer
Hi Amanda;

You are not wasting my time. Some of his self isolation at school may be due to speech delay, however, there are other behaviors that concern me. The best thing to do is to download the M-CHAT and scoring instructions at: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf
http://www.firstsigns.org/downloads/Downloads_archive/m-chat_scoring.PDF

If you are unsure what the scoring means and/or its interpretation, then please write back. The M-CHAT is a screener and NOT a test or a substitute for a full assessment. If your son does, in fact, fail the M-CHAT, then take it with you to your pediatrician for a referral for a full assessment.

Kind regards,
James