Expert: James Michael Roan - 3/12/2009

Question

Hi, I have concerns about my now 18 month old son.  First off, a bit of history:  I have an older sister with SOME sort of behavioral problem and mental retardation (no specific diagnosis) and my mother has been diagnosed as bipolar.  As a result of this, I have been worried (obsessed) about my child having SOMETHING wrong with him from the time I knew I was pregnant.  Up until he was 9 1/2 months I had no concerns...he was developing normally and did everything on time.  Then, he had an accident and broke his leg and was in a spica cast for a month...at this point I was with him all the time and started noticing that he didn't respond very well to his name. I got very paranoid about this and told our Pediatrician, however, she said he acted very appropriate for his age and not to worry...I did.  By 11 months he was walking but he was not waving or clapping or imitating (no words either) and so I had EI come out for an evaluation.  They said that he was not significantly delayed except for the waving/clapping and to give it time. They also specifically said that he was not autistic.  Within weeks he was waving and clapping.  I was still worried though as he was not speaking, not even "mama' or "dada"...come to find out he had fluid in his ears for months that had impaired his hearing a bit so he was given tubes at 14 months...after which he began using words..."car", "kitten", "dada", "ball".  Now he is 18 months and I still fear something is off with him.  He has over 80 words, animal sounds, claps, waves, and according to his daycare teachers, he's VERY social and always wants to be involved with what the kids in class are doing.  He engages in some pretend play (will "talk" on the phone or pretend other objects are phones and will talk on them; will feed his stuffed animals or offer them his sippy cup), he usually plays with his toys correctly, however he gets bored with his toys fairly quickly and would rather mess with things that are off limits. He does like to "help" around the house...puts groceries away, "sweeps" the floor, unloads the dishwasher.  Can use his words in meaningful ways...he asks for the foods or drinks that he wants, says up, down, and requests toys he wants to play with.  He does point, and started at about 11 months, however, his point isn't always an isolated index finger.  Sometimes he points with his whole hand or a few fingers.  He does point to things that interest him or in order to "show me" and looks for my reaction about 70% of the time.  He usually points to things he wants though, and will most always look at me to make sure I get the message.  He has great eye contact from a distance however, when Im holding him he doesn't usually look me in the eyes.  He can point to several body parts on himself, others and representational figures or pictures.  He can recognize many things in books and loves to read (has a decent attention span for reading).  He can follow simple commands however sometimes he acts as if he does not hear me or he will look at me and simply say "no".  This is one of the main things that concerns me is that it seems the following directions is hit or miss lately.  I know he understands what Im saying but sometimes its like he's just ignoring me or he starts to do what I ask but then gets distracted by something else.  And, of course, there's the flat out verbalized refusal.  Also, sometimes he repeats the last word we say when asking him a question.  If I say, do you want some oatmeal?  He'll say "oatmeal".  If I ask him again however, he'll say "yeah".  I dont know what this means or if this is indicative of echoelia.  He's a pretty good imitator now, he likes to do what others are doing, especially if that person isn't mommy or daddy.  Im also concerned that he's able to recognize half of the alphabet and a few numbers, he also knows and can identify 5 colors and a few shapes.  I read that this could be a sign of hyperlexia.  He's a very good eater, likes a myriad of different foods and textures and is a pretty good sleeper when he's not teething or sick.  He does have several strange behaviors that concern me...he walks on his toes often, he seems to be in perpetual motion...always walking/running somewhere (cant tell if this is because he's just bored or what) unless he's focused on a task.  With his toys, he'll play with a new toy for a few days and once he figures it out he has no interest in it anymore it seems.  I've seen him spin and look out of the corner of his eyes while doing it, however I've only seen this a couple of times. If he does spin, he only does it for a minute or two and then its on to the next thing.  He has just started to be able to play alone for a period of time (not long)...typically if we are not giving him undivided attention he gets pissed off.  I guess that's all I can think of, I guess Im just looking for some piece of mind, or some advice.  My husband and family think that I am completely nuts for thinking something is wrong with my son.  My sis-in-law who works with autistic children said that he is fine, however she doesn't see him that often.  This is my first child, I have no form of reference and I just dont know what is normal 18 month old behavior vs. atypical.  From what I've read, autistic children CAN have good eye contact, be affectionate, social, have language, etc...so just when will I be able to breath?  Sorry this is so long but I'd appreciate any insight.

Answer
Hi J;

He sounds fine. Hyperlexia often takes the form of an obsessive and restrictive quality, preferring numbers and spelling to other toys, etc. Stereotypies associated with autism such as finger flicking and spinning also occur quite often and with a whole host of other related behaviors. Stereotypies occur in about 20 percent of typically developing children. Young children with high functioning autsim (HFA) such as PDD-NOS and Asperger's syndrome, may show hyperlexia but will prefer to play alone in EVERY case when around peers. They like to be around peers but are unable/unwilling to interact with them according to their agendas as well as their own. It is sort of the "litmus test" for HFA.

To settle your nerves now and in the months to come, download the M-CHAT and scoring criteria and use it as a checklist every 2-3 months or so.

M-CHAT: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

Scoring: http://psychlops.psy.uconn.edu/ED/downloads/M-CHATscoring.pdf


Kind regards,
James




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Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting psychologist responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.