Expert: James Michael Roan - 8/12/2008

Question
QUESTION: My son is currently 18 months old and I noticed following behavior (or the absence of it) that is a cause of concern for both me and my wife:

1. Absence of using index finger to point, to ask for something

2. Absence of using index finger to point, to indicate interest in something (he only did that on a set of stickers but I am unsure whether it is to indicate interest or to imitate us)

3. Manipulate our hands to lead us to his toys or bring his toys to us

3. Absence of waving goodbye at us when we are leaving

4. Only know how to utter 1-2 words such as "milk"; don't really know how to say "daddy" and only called out "mommy" when in distress

5. Will breakdown in fears whenever there's noises that's similar to that of drilling

6. Refuse to eat solid food and will always throw tantrum before accepting his first mouth for each every meal.

7. Hit his head whenever we failed to submit to his request

8. Has phobia towards some new objects introduced to him, such as apple, oranges, etc

I came across some CHAT checklist for autism in toddler on the Internet and point 1 and 2 seems to indicate a high risk of autism. However, on a positive note, he does have good eye contact with us, actively interact with us, and smile at us when we smile at him, play peek-a-boo with us and play with my wife's nephew. In addition, he does know simple instructions such as "NO". He shows no signs of repetitive behavior though he's attached to a certain toy at different point in time.

I am very unsure whether he's autistic and am actually quite worried, though many told me to wait till he is 2 years old. I read online that early intervention will be good if the child has autism. However, I am not sure when is the right age to go for an accurate diagnosis and whether he's just slow in development with some weird behavior or truly autistic. Therefore, your advice is greatly appreciated.


ANSWER: Hello Mr. Ming;

Early intervention can make a dramatic difference in a child who has an autism spectrum disorder. Do NOT wait until he is two. Have him assessed as soon as possible. Even if it is determined later that he only had a developmental delay socially and communicatively, he will still benefit from early intervention.

Do you live in the U.S.? If so, I can provide you with some next steps.

Kind regards,
James

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

QUESTION: Hi,

I live in Singapore. In your opinion, are these clearly signs of autisim? I am getting all kinds of information and mixed opinions from different websites and people, and thus would hope for a more professional view on this, in order to be mentally prepared when I bring him to a specialist for assessment. I hope to book an appointment with the specialist soon.

Thany you for your reply.

ANSWER: Hello;

He does show some signs of autism and I would recommend you download the M-CHAT and the scoring instructions. Most specialists are familiar with the M-CHAT and it would be very helpful to take that with you.

You can send me your answers to the M-CHAT with some elaboration and I can give you a better opinion.

M-CHAT:
http://www.firstsigns.org/downloads/m-chat.PDF


Scoring:
http://www.firstsigns.org/downloads/Downloads_archive/m-chat_scoring.PDF


Kind regards,
James

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

QUESTION: Hi,

following are my answers to M-CHAT:

1. Does your child enjoy being swung, bounced on your knee, etc.?
Yes, he will break out in laughter.

2. Does your child take an interest in other children?
Yes, he does play catching with my wife's nephew.

3. Does your child like climbing on things, such as up stairs?
Yes, he will attempt to climb a stairs when he encounters one.

4. Does your child enjoy playing peek-a-boo/hide-and-seek?
Yes, we will hide at a corner and call out his name. He will try to search for his and break into laughter when we suddenly appear and gave him a fright.

5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things?
Yes, we use a plastic spoon to feed a toy lion and he will do that as well when we gave him the spoon. But that's the only pretend play we attempted so far.

6. Does your child ever use his/her index finger to point, to ask for something?
Unsure. He only ever did that on a set of stickers and that’s after we point at the different stickers and ask him which one he wants. Therefore, I am not sure if he is imitating us or really pointing at the sticker and requesting for it.

7. Does your child ever use his/her index finger to point, to indicate interest in something?
Unsure. He only ever did that on lights and I am not sure if he is imitating us or really pointing at it. He won't point at other things but would rather lead our hands to the toys he wants.

8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them?
Yes, he can stack up blocks.

9. Does your child ever bring objects over to you (parent) to show you something?
Yes, he would share some of his toys with us.

10. Does your child look you in the eye for more than a second or two?
Yes, he always does that.

11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)
Yes, he will cry to drilling sound or noises similar to that but so far, that’s the only noise he is sensitive to

12. Does your child smile in response to your face or your smile?
Yes, he always does that.

13. Does your child imitate you? (e.g., you make a face-will your child imitate it?)
Yes, we have some insect toys and he will imitate us screaming when we kind of release them around the room.

14. Does your child respond to his/her name when you call?
Yes

15. If you point at a toy across the room, does your child look at it?
Yes, he will look at the item we are pointing when we call out his name and point at the item.

16. Does your child walk?
Yes

17. Does your child look at things you are looking at?
Yes, he does that when we call out his name and look at the item

18. Does your child make unusual finger movements near his/her face?
Unsure. Is slapping his head when he’s frustrated considered? There isn't any other movement other thanthat.

19. Does your child try to attract your attention to his/her own activity?
Yes, he always likes to lead us to his play area to play with him.

20. Have you ever wondered if your child is deaf?
No, he’s has very good hearing

21. Does your child understand what people say?
Some, for example: he understands what a “NO” is and we have this toy with a yellow face which he told him its "yellow face", so whenever we say yellow face, he will go and pick it up.

22. Does your child sometimes stare at nothing or wander with no purpose?
No.

23. Does your child look at your face to check your reaction when faced with something unfamiliar?
Yes, he will come and find us. He is quite afraid of unfamiliar faces.

My child is just 18 months and therefore, I am not sure whether failing some of the items above indicate high risk of autism or simply slow development. Thanks again.

Answer
Hello again;

I would say he probably passed the M-CHAT. He is young and we expect pointing to happen between 12-15 months. That by itself means nothing. The question reflects a more important aspect of pointing, which is sharing. Question 20. really means that when you walk into a room and call his name, how often will he turn around and look up at you. Does he do this?

All in all, at the very least, he has a receptive and expressive language delay and perhaps a social delay.

If it is found later that he has an autism spectrum disorder it would most likely be on the high functioning end.

Kind regards,
James