Expert: James Michael Roan - 8/6/2008

Question
Hello,

The internet has proven to be a source of serious paranoia for me lately and I just want to know if my fears are founded.  My son just turned 11 months yesterday and I am very worried about his social/communicative development.  First off, he's always been very observant or intensly aware.  He seems to enjoy being around people and watching them.  He's quick to flash a smile to ladies at the store and when we take him out to restaraunts, he typically watches the people around him and "flirts" with our neighbors at other tables.  He's usually a very happy baby...smiles and laughs a lot...he loves our cat, I think its his favorite toy.  He plays peek-a-boo (however, will not initiate it) and likes chasing his dad and I around.  What concerns me is that while he has been babbling for a while, he has no words yet (he says mama and dada but with no context) and he doesn't seem to understand anything we say to him.  When we ask him to give us what he has in his hand, he either ignores us or stares blankly at us.  When we tell him "no" he does the same thing.  He has no gestures...he doesn't wave, clap, or point.  Also, he does not let me know when he is hungry or thristy...Im not sure if thats because I've always just anticipated his needs (Im a SAHM and am with him all the time) but sometimes I feel like he'd allow himself to starve if givin that opportunity.  As far as play goes, its really hard for me to pin down whether or not there is "shared attention" because sometimes he will look to me for my reaction or look at me when I read to him...but most of the time he just plays with his toys.  I use the word "play" loosely because his attention span is absolutely zero...he'll pick up a toy, and just as quickly put is down and is then off the next one.  He has no interest in patty-cake or similar interactive games.  He will imitate us SOMETIMES although its usually an action that he already can do or a sound he can make.  Lately he's been a lot more fussy, especially when I take away something that he shouldn't have or remove him from an area where he shouldn't be.  He will whine and cry (however he gets over it fairly quickly).  I haven't noticed any obsessions or preoccupations with anything and can typically divert his attention (unless its a brand new toy or a brand new place) fairly quickly.

Our pediatrician saw us a few weeks ago and said he seemed perfectly normal to her (I dont know how much you can gather from a 10 minutes observation) but of course he waved to her at the appointment (never did it before, hasn't done it since).  I guess I just want to know when I really need to worry...because right now it seems like he is very behind in these social milestones and Im so afraid that he will not catch up. Sometimes it just seems like he is way too active and on the go to "learn" anything at all.  Nothing holds his attention and yet, everything attracts it.

Answer
Hi Jelena;

The first thought I had reading your description was attention issues. In autism, we looking primarily at a social delay accompanied by verbal/nonverbal communication delays, receptive language delays, and attention (executive functions) delays. Attention problems by themselves can cause social and behavioral problems.

I really need examples of social development such as sharing, interaction, social interest or lack thereof, etc. Meanwhile I have provided some red flags for autism below:

Possible symptoms at 6 -12 months:

-Not making eye contact with parents during interaction
-Not cooing or babbling
-Not smiling when parents smile
-Not participating in vocal turn-taking (baby makes a sound, adult makes a sound, and so forth)
-Not responding to peek-a-boo game
-Passivity and decreased activity
-Extreme distress reactions
-Fixation on objects


At 14 months:

• No attempts to speak

• Not pointing, waving or grasping

• No response when name is called

• Indifferent to others

• Repetitive body motions such as rocking or hand flapping

• Fixation on a single object

• Oversensitivity to textures, smells, sounds

• Strong resistance to change in routine

• Any loss of language

Kind regards,
James