Expert: Jene Aviram - 1/5/2010

Question
QUESTION: Hi Gene,
Its been 4 mths since my last post and my son is now 2 1/2.  I am still v.concerned about his expressive speech.  He has about 40-50 words but doesn't use them to communicate alot.  He will walk up and point and say dinosaur, Santa, cup, binki, open, shoes..things that are more motivating to him.  he has a couple of two words like bye bye daddy, there it is, i get it, all done.. but not too much. He uses them appropriately but there are alot of times he gets frustrated b/c i will say use your words and he can't.  His visual stim has practically gone.  I v.rarely see him playing that visual game he used to do.  During speech he does still tend to zone out when he doesn't want to do the activity.  He has improved with words a lot in 4 mths.  When i ask him do you want something--he will sign me but he won't shake is head yes but will nod "no".   Its so confusing.  Socially he is better, playing alongside his brothers and sisters but not really with, prefers his cars and trains.  Should i be considered for ASD and ask early intervention for a psych eval again?  My speech therapist says i certainly can ask for the eval.  He never gives me that assurance that he may have ASD or not.  He just is always complimenting him on how far he has come in behavior and speech.  He says in the beginning he was concerned but he is moving away from that feeling because he is improving alot-according to him.  How do you really know?  ASD kids may improve too correct?

ANSWER: Hi Cetta,

It's great how much your son has improved.  It sounds like you have a speech therapist who's working on helping him nicely.  I'm sure you'd like to get his opinion on your son and ASD, but many agencies require that their staff can't really tell you what he thinks.  That's probably where his hesitation comes in.  

I would undoubtedly request another evaluation.  At your sons age, he should be interacting more with his peers and really showing interest in what they are doing.  I'm not as concerned about the speech.  He is certainly delayed in this area but he can talk and his speech will pick up more and more with the services he is getting.  I wouldn't worry about him nodding or shaking his head.  A lot of kids don't do that.  As long as he can indicate in some appropriate way such as a verbal response or sign language.  By the way, statistically kids that learn to sign actually learn to speak faster.  I'm not suggesting you use sign but I know that many times, therapists suggest this to parents who shy away from it because they fear their child won't speak then.

Cetta - I'm not saying that your son is on the autism spectrum.  It's actually impossible to tell from this post.  But you ask how do you really know if your child has ASD and the only way to be sure is to get a thorough evaluation.  Kids improve all the time, whether they have ASD, a speech delay or anything else.  If you don't like the evaluator, then get another eval.  

Your son is so young and whatever the delays may be, he has every chance of being successful in every way.  You have nothing to lose by getting an evaluation and everything to gain.  You'll either find out that you're getting all the services he needs, or that you can add some additional support for him.  The younger you begin, the easier it is.  So I wouldn't worry too much but I would definitely get that eval.  Peace of mind is a wonderful thing.

Jene Aviram
http://www.nlconcepts.com

---------- FOLLOW-UP ----------

QUESTION: Hi Jene,
Thanks for the advice. My son has been attending a mommy &me 1x/wk for 6 mths. He is now 2 1/2 and most of the kids play w/their moms or with an activity they are interested in, not really "with" each other.  They look/notice each other but its not like a give and take play yet.  I wonder if its b/c the mommys are there.  My therapist is doing his 6mth eval tomorrow (social & emotional test).  She says she sees him take notice of the kids even if is v.brief he is starting.  I want to know what to look for when he's there to see if there are autism signs. What i do notice is he really enjoys playing with what he wants. He will look at you, but he is definitely more self absorbed-can tune you out.  He gets excited to show you things-cars, dinosaurs, etc..  In circle time he sometimes is reluctant to sit but once he sees everyone else he does sit and look at the other kids/listen to a book.  He cleans up pretty good. He likes playdo and paint one on one but not at school for some reason-too busy with other toys.  He plays alongside his 4yr old brother, he chases him, andwill roll/throw a ball back and forth(even if its short)Alot of running and chasing with him.  Can they diagnosis a 2 1/2 yr old?  I am so afraid of another eval b/c i was so disappointed with the first.  I guess i just have to do it-right??

ANSWER: Hi Cetta,

Things sound really positive with your son.  It's truly great that he is doing reciprocal play such as rolling a ball back and forth.  The running and chasing is fine too if it's reciprocal.  In fact, there are so many good things you mentioned.

In answer to your question, one can definitely diagnose a child who is 2 1/2.  So I hope you get exactly what you're expecting tomorrow.  I'm a little confused about who is doing the eval.  A therapist?  Typically a therapist is not qualified to make a diagnosis or proficiently do a diagnostic for childhood disorders.  That's usually done by a developmental pediatrician, psychologist or neurologist.

I don't remember if you ever downloaded the article called "How do you know if your child has autism?"  If you haven't I think you would find it extremely helpful.  You'll either relate to it or it won't apply.  Your son is at the perfect age for you to read it too.  Go to this website and you'll be able to download it right off the home page.  It will also give you an idea of what you should watch for.  http://www.nlconcepts.com/

I wish you great luck tomorrow.  Let me know how it goes.

Jene Aviram
http://www.nlconcepts.com


---------- FOLLOW-UP ----------

QUESTION: Its the EI therapist (Special ed) who is doing her 6mth eval. I haven't found a developmental therapist yet.  I got a recommendation to the McCarton center in NYC & we are playing phone tag.($$$-yikes)I am so nervous. I was moving away from my fears because he was improving so much on his communication, pointing, words, gestures, nodding.  All in all he is just a little off to me. I keep hearing his "self directedness" is holding him back from learning more.  He plays and uses words when he wants to--when hes done,he's done & if he doesn't like what you are doing and you make him do it he cries.  Now he is throwing things b/c he is mad if you make him finish. I will download as you said and I hope it helps me. Thanks again

Answer
Cecelia McCarton definitely knows her stuff.  Keep trying to get that appointment with her.  If she gives you a "thumbs up" you know you can relax!  She has also been instrumental in getting children services they need, regardless of their diagnosis.

I hope the eval goes well.  I'm pretty sure an EI Therapist is not allowed to diagnose or even disclose her thoughts on a diagnosis.  Regarding the self-direction, it's amazing how well some positive reinforcement can start turning that around.

All the best

Jene Aviram
http://www.nlconcepts.com