Expert: James Michael Roan - 9/4/2008

Question
I'm trying to decide if I'm being an overly concerned parent or if I need to have my son evaluated.

My son is 22 months old.  He seems to be developing normally except for a couple of areas that concern me.

He has never made good eye contact.  He will look at us and people but doesn't hold the contact for long.  I would say his eye contact is not as good as others his age and even younger.  When we pick him up he doesn't look at us.  At about a year old I had him in a swim class.  A few times when the coach tried to get his attention by calling his name I noticed that my son did not look at him.

 He also does not initiate affection.  He will come to us to pick him up but he doesn't give hugs.  We will hug him and he usually will accept the hug but doesn't hug back.  He will sometimes give us a kiss if we ask.  He doesn't seem overly interested in other children just yet.  

Just this week he began attending a twice a week Mother's Day Out program.  He did not appear to have any separation anxiety even though he has been at home with me since birth.  I've never left him with anyone but my husband or my parents once or twice.  He has never shown signs of separation anxiety.  Is this normal???  A couple of other kids in his class were crying because their moms had left but my son didn't seem bothered by this.  He was already playing with his cars.

My husband and I think he is rather independent.  Last week my inlaws visited and he did not seem overly interested in them as far as wanting them to pick him up or wanting them involved in what he was doing.  He only sees them every 3 or 4 months.

He does have 50-100 words including some 2-3 word phrases.  He can count to 10, knows shapes and colors.  He does respond to people he knows by smiling, but I don't think he always responds to his name when other people call it.  He does bring toys and books to us to share with us.

The main things that concern me are the poor eye contact and lack of affection.  Do you think this is something to investigate further?

Answer
Hi Leah;

Yes, I would investigate further. If it is found or suspected that he is on the autism spectrum, I can assure you it would be on the high functioning end. For this reason it may be difficult to get an accurate diagnosis at this age.

The best way to approach this is for you to complete the M-CHAT and score it. If there is any risk noted for autism, we can take it from there. The M-CHAT is a screener for children at-risk of autism and is not a "test" for autism.

M-CHAT: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

Scoring: http://psychlops.psy.uconn.edu/ED/downloads/M-CHATscoring.pdf

Also, I have included some "red flags" for autism. If he "fails" the M-CHAT and/or has some of the red flags we can discuss it further. If he fails these then take them to your pediatrician for a full evaluation at Children's Hospital or an autism team at a university near you. Meanwhile, if you live in the U.S., call the special education department in your school district and say you want to refer your son for a referral to their Early Intervention services. They will assess and if he qualifies, provide services he needs. The assessment and therapy, if he qualifies, is at school district expense.

6-12 Month Markers:

•   Infrequent eye contact
•   Failure to orient to name
•   Does not smile in response to smiles from others
•   Social and emotional passivity
•   Fixation on objects

By 12 Months:

•   Poor or no eye contact
•   Failure to orient to name
•   Poor imitation
•   No babbling by 12 months
•   No gesturing by 12 months

By 16 Months:

•   No single words by 16 months
•   No pointing to objects or events of interest in an effort to share

By 24 Months:

•   No spontaneous two-word phrases
•   Loss of any language or social skills at any age


Kind regards,
James

Kind regards,
James