Expert: Dr. Sharon A. Mitchell - 11/24/2009

Question
My son has had increasing difficulty at his daycare center.  When they have a structured activity he very rarely participates, instead choosing to play by himself.  He has difficulty following directions - often needing the directions repeated to him.  For example - you need to put your pants on - he might say "look at the bird outside".  He gets focused on things and it's hard to draw his attention back.  

However, he is able to have a conversation, has good language skills, makes eye contact, likes to cuddle, will play with friends, etc.  So many of the other symptoms - he does not appear to have.  

Answer
Hi Lisa,

I can see how this is confusing for you as he can seem typical in some situations but not in others.

When I read your description, the first thing that comes to my mind is his hearing. Kids who have a history of ear infections can suffer some degree of hearing loss. It's possible that your little boy could have an ear infection without you knowing. If he does, that could make it harder for him to hear (and participate) in situations where he is outside of his familiar home surroundings, in crowded environments, where there are background noises, etc., similar to what you would find at a daycare center. Having his hearing checked with your physician certainly will not hurt and if he's fine, then you have ruled out one possibility.

What do you mean by increasing difficulties? As a rule, you might think that a new environment is confusing for a child, but as he becomes accustomed to the routine, fitting in there would get easier, not more difficult.

Can the daycare workers describe to you the changes they see?

Since you are writing to me, I take it that you are wondering if your little guy is showing symptoms of autism. Perhaps, but not necessarily from what you have written. A few things you said though warrant considering this possibility:

- gets focused on things and it's hard to draw his attention back
- difficulty following directions
- choosing solitary play often

If you are worrying that your son may be showing signs of autism, here is a free, online checklist you can do. It might be helpful to ask his daycare worker to try it as well.

http://www.childbrain.com/pddassess.html

At the link below are developmental milestones, describing skills typical children develop by certain ages.

http://www.firstsigns.org/healthydev/milestones.htm

This next site has a handy video glossary of children at various stages. Although you are required to register at the site, there is no charge or future obligations: http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Apart from looking into autism, you might want to contact a speech language professional to look at the language aspects that may be giving your son trouble.

The American Speech-Language-Hearing Association lists these skills as typical for three and four year old children: http://www.asha.org/public/speech/development/34.htm

If you are unsure how to contact a speech/language therapist, your doctor, public health nurse, or school division should be able to help you. Or you can find a qualified professional yourself through the search on this page: http://www.asha.org/proserv/

Your son has lots of strengths that you have mentioned, so whatever is behind the difficulties at the daycare center, he has a good basis to build on.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., Ph.D. candidate
www.autismsite.ca