Expert: Valerie Herskowitz - 2/3/2009

Question
Hi Valerie!
I am writing because I am concerned about my 14 month old boy (just turned 14 months today).  His pediatrician has been concerned about him since he was 6 months old, and he was evaluated by a speech pathologist at his 6 month well baby visit.  She said she thinks he is okay, but that was 8 months ago.  He has never liked close-up eye contact, will not look at the person holding him, but will look at you most of the time if someone else is holding him.  He makes pretty good eye contact if I am in the floor playing with him.  He makes decent eye contact in his high chair and on his changing table when he wants to.  He has always been extremely interested in his environment and less interested in people at times.  He does interact with his family members and people he knows well, but tends to ignore strangers.  If they try to talk to him, many times he will point at something and ask "whas zat" to distract the fact that he doesn't want to look at them.  Sometimes though he will look at people and smile and wave.  The pediatrician thinks it is just his personality and temperment.  I am more concerned, however.  Ever since she mentioned the word Autism, I have been a nervous wreck, constantly observing and watching him for any clues.
His receptive language skills are pretty good.  He follows simple commands such as "bring mommy the baby", "throw it in the trash", and he will point to some body parts when asked.  He has pointed to things since 9 months old saying "whas zat", however, most times does not look back at us to see if we are looking at him.  Ped thinks he assumes we are looking at him.  He sometimes points to things of interest in books at bedtime and will point to things when named in his books.  Now, he does sometimes point to things or reach for them and look back at us, asking for the object.  HE also has just started pointing to things asking "dat" and will look back at us for a response most times.  He has gotten better with this.  HE will most of the time look where you are pointing to if it is not too far away.  He does not say mama or dada yet (has made the sounds though and knows who we are because if you ask where is mommy or daddy he will look at us), but has several other words such as ba for ball, bay for baby, hat, cat, hello on his cell phone, whas zat and dat for that, used to both say and wave bye-bye (now only waves), bang, and light.  He has never imitated language much, but will imitate other sounds and especially actions well.  A lot of times when you talk to him, he turns his head.  Again, he has gotten a little better with this more recently.  Now, sometimes, he gets right in my face if I am not paying attention to him and will jabber at me to get my attention.  He jabbers constantly.  He also will bring us things to share, always smiles in response to others smiles, responds to name most of the time (if he is engaged in an activity or in a noisy atmosphere it is harder to get his attention some times, but I think all kids are this way), feeds us bites of his food since 10months, enjoys peek-a-boo sometimes, blows shuberts on my belly, and will imitates gestures such as all gone, where, etc.  He has begun feeding himself with utensils now also (still messy, but does pretty good).  His fine and gross motor skills are very good.  He is very bonded to me, his dad, his grandmaw's and papaw's.  
I do not think he has any sensory issues, although he does not like having his nails cut, and he is a picky eater ( I do not think it is because of texture though because he eats many different foods) and will not eat large amounts of food at one time.  He has recently began to have mild tantrums when you take something away from him that he wants or if he can't have what he wants.  If I tell him no, he gets mad and will shake his hands at me telling me no, or shake them furiously for a second or two.  He has also started to flap his arms briefly sometimes when excited.  He does play with toys appropriately, although he is obsessed with hats.  He will play with a hat for 15 min sometimes (although not by himself, he always involves us in his hat play).  
My mother in law is an OT and she thinks he is fine, but she works with elderly and I am afraid she has not had enough experience with autism to know what is on the milder side of the spectrum.  She does not think his flapping, eating concerns, or hat play is abnormal in nature.  I would like to get someone's opinion who is experienced with autism.  Any help or insight would be greatly appreciated.  I am sorry this post is so long, I am sure I tried to mention everything I can think of.  Again, thank you so much for your time and opinions.

Answer
HMMM. Well, I can't be definitive as he certainly seems to be moving along well in certain skills while others aren't going too well. You can have me look at him over the Internet using SKYPE so I can get a first hand look, or take him to a autism specialist or someone that really knows developmental issues. Where do you live?

Valerie Herskowitz, MA CCC
valerieherskowitz.com