Expert: Dr. Sharon A. Mitchell - 7/9/2008

Question
From birth, my son avoided our gaze.  He never, ever looked at us.  Nothing we could do could get him to meet our gaze.  It was obvious he could see well too, because he would follow the rattle, and also because he never accidentally looked at us.  If we moved left to get in his line of sight, he'd look right, up or whatever.  First impressions were that he was just otherwise engaged, but after a week or two of trying, everyone who tried to engage him realized that he wasn't just sleepy- he was ignoring them.  People wondered if he was blind/deaf.
He hardly slept (he still wakes atleast 5 times a night).  He'd nurse and cry for 2 to 4 hours then sleep 10 to 45 minutes, and wake crying.  He resisted cuddling and nursing.  He calmed only when he was swaddled, and held facing out and we moved.
He did not turn to our voices.  Truly his complete lack of awareness/attention to me left me feeling like a ghost sometimes.
He did not coo, or differentiate his cry.  He had one cry- we called it the nuclear scream.  We never had any clue if he was hungry or what.  
When he was 2 months old, I started showing him big pictures of faces I had cut out of magazines.  Around 3.5 months he suddenly became a big flirt to strangers, or whomever was not holding him.  (holding him means he ignores you still, although since he was 5 months, only I am allowed to hold him.)  He doesn't coo, or wiggle or engage the object of his stare-- just smiles with  unbroken eye contact.  Strangers at the mall, restaurants, gas pumps etc. came over to tell me my son was the happiest baby they had ever seen and how loving he was.  Sometimes he'd choose people to stare at who weren't into babies and they'd often move away due to the intensity of his stare.  One woman remarked that he seemed mesmerized by her and that she had not done anything to warrant it.

Fast forward to today.  I have worked endlessly on the eye contact since he was 7 months  I now require it from him for picking up or to grant a wish (toy, treat etc.).  He still resists it.   I've also worked on his pointing skills since 10 months.   Although he seems to have pretty good receptive language, it's hard to be sure.  He doesn't really use language to cooperate or communicate.  If you ask him if he wants juice or milk, he generally zones out and stares elsewhere, even tho I know he wants a drink.  it may take 5 minutes of me offering, him ignoring, me putting the drink down, him screaming, me offering again (I request he try to say drink or juice or sign for it) him ignoring me and over and over till he finally gives in and makes a slight attempt to say drink  (kk sound).  Often I think he just doesn't get it- even easy questions.  Othertimes it's like he can't focus long enough to get it and respond.  and sometimes he gets it and tries to respond.
He won't point to his body parts, or pictures etc. when named- but interestingly,  he does when the words are said in conversation, or on the tv, or if I use a Karaoke machine to ask him (although, he only will respond for a few seconds, then he seems to realize who is really asking the question and he quits).  He learns by watching (he will use a toy phone, lawn mower, hair brush etc. all correctly)- but not by showing.  For instance, you can't help him with a shape sorter as he will never try the hole you are pointing at.
As for language, he can say bye bye, uh oh, yes (ahjuh) banana (nana) cookie (ukeh) and uses these more or less correctly- albeit sporadically.  he also says mama, dada, rudy (dde) but these are often misused.  (mama means everything and everyone and is often just a sound he repeats, dada is only used in one situation (move rooms), and our dogs name is used for all dogs).
He generally doesn't point. he does a whole hand wave thing- without eye contact and only  when he wants something.  He doesn't share interest generally.
He is very interested in other kids, but has no idea how to interact.  He does kinda yak at them, but if they try to talk back, he zones out and stares past them.  But, he loves to give things to people (usually a handful of dirt) or some other odd item.
He often covers his ears and gets upset at car noise, busses going by, planes, blenders, fans, etc.
He walks on his toes and spins in circles often- but it seems to be for fun.  He has no other odd movements except for liking to try to make his elbows touch.
He has only lined up toys once.
Ok- so, he is going in for evaluation in 2 weeks and I am fully expecting to be told again that he can not be autistic since he is so flirty.  The examiner last time thought he was the lovingest baby ever!  although she could not hold him or touch him, and he screamed each time we tried to move stations.  
What do you think?  Can a kid be this much of a flirty starer to strangers and be on the spectrum?  Like I said he does not do any imitating, forth and back babbling, pointing with his index finger)

Answer
Iola, I know exactly what it's like when you say your son would nurse then cry for hours then sleep for 10 to 45 minutes. That and the resistance to cuddling. It's very hard on parents. And when a child is sleep deprived, it's a certainty that his parents are as well.

Despite these difficulties, it sounds like you've done so

You mention that he's going for an evaluation soon. That's a good idea. It's not always easy to diagnose a very young child as being on the autism spectrum unless he clearly fits all criteria. The differences between a typically developing child and one with autism become clearer with age.

Not every child with autism lines up toys or spins. But some of the other things you describe are found in kids with autism spectrum disorders.

From your description, I see many encouraging things. Although your child has been reluctant to meet your eye gaze, you've been working on this skill and now he can do it, albeit not willingly. Some of the other encouraging points are:

- Your son will now allow you to hold him, even if he's being held facing away from you

- He has an interest in people, children as well as adults

- through your perseverance, he'll now attempt to verbally approximate a request for what he wants

- you believe his vision and hearing are fine

- he's able to make some vocalizations

- you're using signs with him, allowing him to use a symbol for what he wants

- he's able to point to body parts or pictures

- you mention that he's walking, so he must be meeting the physical milestones typical for his age

- he's able to learn through imitation

Again, I'd like to commend you on all the things you're trying with your little boy.

You mention using signs. By that I'm assuming you mean baby signs or sign language - formed with hand motions. This is a method of communication that can often be helpful. Some kids who don't respond well to signing may do better with pictures. You can find information on how to use visuals (pictures - either photos or line drawings)at sites like www.do2learn.com.

Here's a site about American Sign Language symbols for babies: http://www.aslpro.com/cgi-bin/aslpro/aslpro.cgi

The American Speech/Hearing Association has a nice site that talks about typical language skills for one to two year olds: http://www.asha.org/public/speech/development/12.htm They also give suggestions for more things you can do to help your child's development.

Since your son has already been through one assessment, you have an idea of what to expect. It's hard for a professional to have a good, well-rounded view of your child is they only see him for a one hour office visit. You can help by supplying those doing the assessing with as much detail as possible on how your son operates day-to-day. Do you have any video clips of him that might show some of the things that concern you? Even though he may interact with strangers, does he do more than simply smile at them? Can you explain how his interactions don't proceed past that initial volley? How does he respond if the person comes to chat with him?

Often during these office visits, the parent will be asked to fill out various checklists to help in the diagnosis. Below are some that you could look at. Possibly if you fill them out and take them with you, they'll provide some additional information that could help:

CHAT - Checklist for Autism in Toddlers http://depts.washington.edu/dataproj/chat.html

The PDD Assessment Scale/ Screening Questionnaire http://www.childbrain.com/pddassess.html

Infant Toddler Checklist http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.htm

Whether or not your son does come away from the assessment with a diagnosis on the autism spectrum disorder, you've still done the right thing by pursuing an investigation. And whether or not your child has autism, the things you've been doing to help him are all good and beneficial, no matter what the diagnosis.

Hopefully through your inquiries, you might have access to a speech/language therapist and an occupational therapist to help guide you further in the things you can do at home with your child.

I'd be interested in hearing how your appointment goes.

Best of luck,

Sharon A. Mitchell, B.A., B.Ed.,M.A.
www.autismsite.ca