Expert: Trey McGowan - 3/14/2009

Question
My dear son has been in speech therapy for 8 months now with some progress but very slow progress.  He is on his second round of tubes due to many stubborn ear infections that started when he was 9 months old. His hearing has been checked recently, and it is fine now. We are concerned because of his speech delay.  He also walks on his toes some times and uses strange had gestures.  He is extremely loving and loves attention from people.  He has great eye contact and can communicate through some sign language and pointing.  His speech therapist keeps telling me that she doesn't think he is autistic but I still have a nagging feeling inside.  Have you found that some of these things to be just quirks and not an actual disorder?

Answer
Hi there, Carrie!

One thing that needs to be remembered about autism is that it is it has a number of symptoms, some of which are 'red flags' for the presence, and where others may never show up at all. Depending on the number of those symptoms, it can be diagnosed as 'high-functioning', 'low-functioning', or even as different varieties of the developmental disorder, thus the 'spectrum' in 'autistic spectrum'.

However, there are many people who show signs of autistic 'quirks' in their behaviour, without being impacted later in life. That is to say, they may walk on their toes, they may have difficulty reading facial expressions, they may be rooted in the 'reality' and be unable to understand 'fantasy'. These are all possible signs of an ASD, but the degree is quite low, or the social problems (which is really the biggest defining part of the developmental disorder) are nonexistent. What makes an ASD is the degree, severity, and number of these issues, essentially, rather than having just one or two.

So to get to the point of what I was trying to say above, showing one or two symptoms does not necessarily mean that a child, or adult as the case may be, has autism or even an ASD at all. They may be one of the individuals who has those quirks. Or, indeed, it's a possibility that the signs you are seeing are signs of something else. A speech delay is not at all unusual with a child that has ear problems, as he was possibly deaf or at least hard of hearing during some language-formative years. Therapy may be slow due to this, and slower due to the fact that the infections are still present. As for the other odd habits, as long as the most important parts, the social difficulties and the like, are not present, I would focus more on the problems which *are* definitely present (i.e. the speech difficulty which you are already treating) than on the worries of 'what may be'.

If you are genuinely worried about it even so, simply write down the concerns, so you have a dated mention of the issue, and keep it on-hand. I generally suggest putting it in their baby book if they have one; that way you can always just bring it out as memories later if you like, and it is very difficult to lose things there. If you notice problems persisting, or if you see them getting worse, that way you can bring the information that had been written down before to the doctor and have a fairly good timeline of issues.

I wish you all the best, and wish your darling child good progress in his speech therapy! Questions, comments, feedback, follow-ups, are always welcome here.

Trey