Expert: Trey McGowan - 1/27/2009

Question
am writing about my son who is 40 months old. He has been having good motor skills and upto 30 month his communication was quite ok (able to identify 20-30 objects, 3 nursery rhymes, asking for things, reading book etc.). Suddenly he stopped taking interest in learning and was always itching to go out after his sibling was born. We put him in a play school where he was crying a lot and they told us that he was aloof & not interacting much (which was a surprise as earlier he was very fond of childrens and always playing with older children if he found a companion).After suspicions of autism, we saw an ENT specialist who prescribed medicine for wax removal from his ear. Suddenly his behavior changed he again started taking inteeests in books and at play school playing with the kids, the caretaker took back his words about autism. Then again after a month his crying started & he use to sleep v infrequently, eat very less and would calm down if we took him in a car. We went back to India where he had all sorts of test (MRI, EEG, ENT..) which came out ok. Afterward he was diagnosed as having liquid behind eardrums & enlarged adenoid for which he was operated. His crying stopped he is reading books again but not speaking much only repeating most of the times (also speaking a whispering tone which we can't follow as if to calm himself). Also he is hyeractive doing something or other. He is affectionate with his brother, plays properly with toys, shows proper expressions, chooses the right key to open the door, has good eye contact, responds to his name, follows simple instructions. But in the M-Chat test I could see him failing in item in pointing to parent object of intest or failing to look at something if pointed. Is it symptotic of severe autism because Aspergers are highly vocal.What you suggest to look out as we don't have good diagnostic facilities in India and he will be coming back to Europe next month.

Answer
Hello, Tabrez!

As I have said many times, and will again, I am not a doctor. This means that even if I could observe your child, I could not give a diagnosis, nor would I even try. However, I will point out that Asperger's and indeed any of the ASD are not a single symptom, but a number of them all adding up to the full developmental disorder. From what you are describing here, your child is only showing a couple of symptoms, and neither of them are being shown regularly, but instead sporadically. Even while not being a doctor, I can say for certain that while ASD children can have 'good days' and 'bad days', this suggests something else to me.

For a long time, Asperger's and other early age developmental disorders were often diagnosed, or at least suggested as, hearing difficulties. In the case of your child, I think what you could be looking at is the other way around. Occam's Razor suggests that if the child is having problems with his ears, then the first thing that should be considered toward this sort of thing is hearing difficulties.

Also, again: I am not a doctor, but 'severe autism' would definitely show more than one or two symptoms. You've already mentioned a number of 'green lights' in his behaviour which pretty much eliminate the chance of severe autism (good eye contact, interaction, showing expressions).

As with always, questions, comments, feedback, follow-ups, are more than welcome! I'm not hard to find!

Trey