Expert: Ettina - 1/27/2009

Question
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: There is a stereotype that autistic people are either high functioning or low functioning, but in reality, many kids are in between. For example there are some who have language delays and then catch up around 4-6 years old, and some who have good speech through much of their childhood but often don't understand much of what's being said (although many can fake it well enough that others think they understood).
The ear problems are not typical for autism. I'm not sure if your son is autistic as well as having ear problems, or if his ear problems are in fact causing his issues - although he has some features, most notably lack of pointing, would not be explained by ear problems. It sounds like he lost some skills around 30 months, the same time his ear problems started, which suggests that they are related. That gives me the impression that if his ear problems are successfully treated, he'll probably improve quite a lot.
Since he can read, this could probably be used to help communicate with him. You could try writing what you want to tell him on a piece of paper (making sure it's within his reading ability) and see if that helps.

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QUESTION: We never taught him to read yet but he does follow simple instruction. One typical question that I have is it possible for an autistic child to behave alternately for some period like an autistic one showing the symptoms or for some period to behave very differntly having none of the previous symptoms. With my son its typical that his intercativity and behavior to surroundings changed dramatically both the times he underwent ear treatment.

Answer
Autism can be associated with a lot of variability. For example it seems that some autistic people have unusual reactions to stress, which can show up as acting more autistic. The fact that the ear treatment caused your son's behavior to change strongly suggests that his autistic traits are caused or exarcerbated by ear problems. It reminds me a bit of the Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS) Syndrome, in which obsessive-compulsive disorder is set off by strep throat. I wonder if some forms of autism can be set off by certain infections in the same way that PANDAS is? I don't know enough about medicine to say if that's the case, though.