Expert: Jene Aviram - 12/2/2009

Question
I have a 13-month-old son, and I am currently having a meltdown worrying about his development Please give me some insight. Two days ago I thought my baby was perfect! He started walking at 9 months and has been walking exclusively for months, now practically running, climbing stairs, exploring, very sweet and friendly, babbling increasingly, loves to play ball. Then I casually decided to google "when should baby wave bye bye," because he isn't doing that yet. Well, I found a whole world of stuff telling me that not gesturing to communicate by 12 months (pointing, waving, nodding, etc.) is a ''red flag" for autism.

Pointing at things seems to be especially important. My son does not point. He does not wave except for MAYBE a couple of times ever, with just a small movement of his hand. He doesn't nod yes or no. Recently, he has started pushing or "waving" things away with his hand when he doesn't want them, but I doubt that counts. At the same time, I have never had any trouble figuring out what he wanted. I just didn't know he was supposed to be pointing! We aren't around other babies his age hardly at all. Now (just the last two days) I have started putting things out of his reach just to see what he would do. He just tries to get them for himself, cries a little, and looks at me or comes over to me for help.

The one other thing besides gesturing that I'm a little worried about is that he doesn't imitate me very much, like with sticking out his tongue, peekaboo, funny faces, etc. He loves all those things and will watch me delightedly, laugh, and reach out to me. He has barely stuck out his tongue a couple of times. Sometimes I can see the "wheels turning," though, like he's watching my mouth and moving his mouth and thinking about it. (Honestly, I used to do more faces and sounds with him before he started walking, back when he was a captive audience.) He does also respond to faces in terms of mood. If you smile, he will smile. If you are angry or scolding, he will look concerned. Also, he will imitate some with actions, like put the ball in the basket or kiss the stuffed animal.

Anyway, here are other things he DOES do:

He was babbling before 12 months, and the babbling is increasing and gaining inflection. He uses many different sounds and definitely whines "mama" to me when he has a complaint. He does still say "mama dada nana" at random times, too, though. He mostly babbles while playing at home and will sometimes outright yell and sometimes muse quietly to himself over sounds. Sometimes we think he is just on the verge of saying "ball" or something like that, but he doesn't honestly use any real words yet for objects.

He has excellent eye contact with us and with strangers. When someone talks to him in public, he looks them in the eye and often smiles. He cries when his dad or I leave and is a little shy of strangers, but he adapts well to other people and situations. The comments I have heard consistently about his are that he is "serious" and very "observant." FWIW, his dad and I were both very shy kids. My mom says I was very timid and reticent, like I would just stand and stare at my Christmas presents and have to be prompted to open them.

He is easy going, will eat anything, and is not overly fearful. He responds to his name (pretty well) and also looks at us to check our reactions to things, looking for resassurance or approval, or sometimes seeking a reaction when he does something naughty. He brings toys and books to me and gives them to me. I can say "Get your ball" or "Take the ball to Daddy," and he will do it, pretty well, if not perfectly. He LOVES to play ball. He will throw the ball to me and then I toss it, and he retrieves it and throws it back, etc. He does like to do whatever we're doing. If I get on the floor and play with something, he will come and join me. If I'm ignoring him, he will eventually come over and seek my attention, banging on the computer keyboard or whatever. We read every day, and he loves it (though he doesn't point at the pictures). Also, I just started testing this in the last couple of days, but he does follow my point/gaze and command to look at something nearby, pretty well though not 100 percent. It helps if it is something familiar. In fact, he is generally better at following commands if it is in context with what we're already doing.

How serious do you think this is? Should I be calling his doctor, waiting for his 15-month appointment, or what?


Answer
Hi Edie,

Firstly let me say your baby is still the same baby as he was a few days ago.  It's hard not to panic but hang onto your old thoughts.  He's still the same perfect little baby who lights up your day.

I so much want to put you at ease.  You're going through what millions of parents go through.  When our babies are born they are just perfect, but if something rocks our world and we fear that something is wrong with our child, it feels like the bottom of our world literally drops out from underneath us.

Babies all develop at different rates.  Your baby is still very young.  Typically it's almost impossible to diagnose autism before a child is 18 months.  But I will tell you that when I read your post, I don't see any reason to think your child is on the autism spectrum.  It's true that many toddlers with autism fail to use gestures, but this alone is not enough for a diagnosis.  If you had told me that your baby doesn't gesture AND has poor eye contact AND you can never guess what he wants AND he is the world's pickiest eater, I would be far more concerned.  But you've said the opposite.  Your son doesn't gesture much but he does everything else.  He also follows your point and gaze which is wonderful.  That's called joint attention which is usually absent in children with autism.

I will say that your baby should be waving, clapping and imitating you.  But some babies definitely do this more than others.  And some do it a lot later than others.  I don't think it's any reason to freak out but I always believe if you have any concern, you should certainly mention it to your pediatrician.  They are able to see your baby in person and view him as whole entity.  This way they will be able to guide you.

Although your baby is still a bit young, I'd like you to read two things.  The first is a document called "How do you know if your child has autism?"  This is typically for a child that's 18 to 36 months but you can keep it on hand because I think it will reassure you.  You can find it at this link     http://www.nlconcepts.com/autism-howdoyouknow.htm

The second thing I'd like you to keep on hand is this small test.  It's called the M-CHAT.  It's also designed for babies that are at least 18 months old.  Take the test and when you're finished, click "Should I be concerned?"  It will tell you which questions are most important.  You can find this over here http://www.nlconcepts.com/autism-mchat.htm

I think that everything is going to work out just fine.  But please also keep in mind that if you ever feel like you need extra reassurance, you can always request a free evaluation from early intervention.  Your pediatrician can give you details for your area.  But if I were in your shoes, I would keep doing what you're doing, which is loving your baby, playing with him and interacting as much as you can.  You're a wonderful mom and your love for your baby just shines through your post.

I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com