Expert: Jene Aviram - 4/7/2009

Question
QUESTION: I have 26 month old boy/girl twins and have some concerns about my son's language development   

Now, I KNOW I shouldn't compare, but it is hard not to do so sometimes. Our daughter seems to be developing right on schedule in respect of milestones; has many words and can string 3-6 words together to make little sentances. She is very engaging and will initiate conversation with you.   

My son does seem to be developing his language a lot slower and there are some things that have been bothering me lately.   

The positive things first: -   
- Our son is a very loving, affectionate little boy with a fantastic sense of humour.  
- He has lots (100's) of words in his vocabulary (but is struggling to join them together).  
- He will put 2 words together such as - Mummy's toast, hot tea, Mummy's sleep (if I pretend to sleep), two eyes (he does this whilst pointing to them), please Mummy / Daddy (when he wants something), bird sky (telling us he saw a bird in the sky) etc etc.
- He often (but not always) points at things of interest (either in his environment or in books)  
- He will engage with us during mischievious play - LOVES to be chased and tickled and will often initiate this type of play
- His understanding seems fine - he will pick up his cup and put it in the sink if asked to, will bring us things (certain toys for example) if asked.  
- He is VERY sociable with his twin sister and they will chase each other and hide from each other whilst giggling away. He is not so bothered by other children, prefering instead to play on his own, but will sometimes join in if they engage him  
- He has a great sense of humour and will join in if everyone is laughing (even if he has no idea why!). He will also cry if I am upset, so seems to empathise well most of the time.  
- He knows who everyone is and will point at me and say "Mummy", Daddy and say "Daddy", and at himself and say his name (and the same for his sister too).  
- He is very good at counting and can count to 15 (in context too.. he will count things out).
- He is extremely affectionate and will kiss and cuddle anyone if asked too (and will freqently kiss myself, my husband and his sister without without being asked.. just because he wants to!)
- He is an excellent sleeper and eater. Likes a routine but has no problem being taken out of that routine if needed.
- Likes to be read to and has good concentration  
- Loves songs and will often sing the last word of each sentance in the song and do the actions   

Things that concern me: -   
- Slow language development - struggles to put more than 2 words together (if he wants me to open his train case he will bring it to me and say "please Mummy".. if I prompt him and say "O..." he will say "open please mummy".  
- In general he prefers to play on his own with his cars and trains - he lies on the floor pushing them along in deep concentration (but he has no problem if you take him away from what he is doing)
- He doesn't use words like "I", "me" or "you" (except for "love you" which he says every night before bed - but this is more part of a routine than spontanious.. although he did say "love Mummy" when I came in the room once.. bless him!). He also doesn't use words like "yes" or "no" but will gesticulate if he doesn't want something (i.e. push it away)or say "please Mummy" if he does want something
- Sometimes I can call him (just saying his name) and he will ignore me totally so that I have to go and get him. But if I call him by name and follow it up with "come and get your coat on" for example, he will usually respond
- When engrossed in play he can appear "deaf" - but again, has no problem if I go and get him. He can hear environmental sounds (dog barking, plane in the sky etc) with no problem so I do not think his hearing is impaired
- If I ask him questions about the day we have had (i.e. try to have a "conversation", he will look away and if on my lap try to get down. Sometimes he will just laugh at me - almost as if he is embarrassed as he doesn't know how to respond
- His eye contact is good if he is intiating dialogue with you but not if you are trying to involve him in conversation where he isn't interested.
- He doesn't engage in much pretend play (but neither does his sister) although will give you a pretend cup of tea if asked and sometimes puts his teddy to "bed" and calls it his "baby"!) He has no problems sharing and will often give his sister her drink if he has his and realises she doesn't have hers.
- If he can't do something he will show signs of frustration - throws or hits the toy, and has been known to bite (but only a toy or the sofa/cushions). He knows not to bite or hit others and won't do this. If he does hit me it is VERY gentle whilst staring at me to gauge my reaction. If I look "cross" he will then stroke me and say "ahh" or kiss me.   

Sorry for the long list! My husband isn't at all concerned and thinks I am being neurotic. Apparently (according to his Mother) he was exactly the same as a child. My parents and close friends also feel he is developing normally (my Mother has worked with autistic children and 2 of my 2nd cousins are autistic so she said she would tell me if she was even slightly concerned about my son). I may being paranoid as I am under a lot of stress with work at the moment, but I can't seem to shake the feeling that something isn't quite right (even though they both "passed" their check up with their health visitor a month ago with no problems).   I would be grateful for your thoughts    

Thank you   

Melissa

ANSWER: Hi Melissa,

Firstly let me say that your son sounds absolutely adorable.  He is obviously very bright with a great sense of humor, loves to laugh and he sounds absolutely delightful.

If there is one thing I've learned it's ALWAYS trust your instinct.  Regardless of my opinions, or anyone else - YOU ARE THE MOM, if you think something is not quite right, you MUST get him evaluated.  Even if it just gives you peace of mind, it's well worth it.

That being said, I know it's hard not to compare (actually it's impossible) but try to remember that girls do develop faster than boys on a social emotional level, while boys usually develop faster on a gross motor level.  

It's really great how your son points to things, engages with his peers and is beginning to string words together.  I do agree that there are some concerning factors, example not responding to his name, slow language development and appearing deaf when you call his name.  Please note that this does not necessarily mean autism but it's certainly worth an evaluation because if your son does not need services, it's better to get them sooner than later so he can catch up to his peers.  I can't help wondering how his play skills are.  You mention that he pushes his cars and trains back and forth in deep concentration.  That's pretty unusual and I wonder if he engages regularly in this same play.  I would like you to take a look at this article called "How do you know if your child has autism?"  I think it will help you.  You can find it at http://www.nlconcepts.com/autism-howdoyouknow.htm

The autism spectrum is very large and without a thorough evaluation it would be impossible to diagnose him.  That's why an evaluation is so important.  If he does require services of any kind, I can already tell that he is a fast learner.  You can use his sense of humor to your advantage.  Even now, try and encourage him to use his language as much as possible.  When he wants to play, prompt him to say "I want tickles" and when he does, immediately tickle him, then play peek-a-boo or fall on the floor - anything to make him laugh.  This way he'll learn that using his language results in something fun.

You can use this strategy from in all other areas from asking for a cookie to getting you to pretend to make a huge sneeze - anything that your son will enjoy.

Melissa, please don't let too much time pass.  Even if your son just requires some therapy for a bit of catch-up, the sooner you begin, the quicker the progress.  Please schedule a comprehensive evaluation with a developmental pediatrician right away.

I hope this has been of help. I wish you the best of luck.

Jene Aviram
http://www.nlconcepts.com


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

QUESTION: Thank you so much for your quick response Jene.

Regarding how he plays - this actually seems pretty "normal".  He does have a preference for his cars and trains but not an obsession.  He will also happily play with other toys and loves drawing (well.. scribbling!)and board puzzles.  He will also often join in with whatever his sister is playing with (and is great at taking turns).  He will also often try to engage us in his play by showing us / bringing toys.  

Since I have started worrying about this I have made a few changes such as not having the TV on (or if I do.. only for 20 mins a day in the evening).  I think this was a big factor in my son learning to "zone out" - as we often let them watch too much TV.  This already seems to have made a difference and his attention span seems to have improved a little.  

He has also started to engage more in pretend play coming up to me when I am sitting down and asking for "more slide" (he likes to pretend my legs are a slide and will get his sister to join in whilst patiently waiting his turn bless him!)  He also sits on the arm of the sofa and says "trit trot" pretending it's a horse.  One thing I also forgot to mention in my first email is that he imitates (i.e. actions to a song) well.

One thing that really made me feel more relaxed was when we were at a freind's house yesterday and he was playing a game with their son (who is 6 months older) where he led him through a garden course of tunnels & chairs etc.. laughing all the time and watching to check others were laughing too (as I said, he always plays well with his sister but not so much with other children his age .. until now).  He has also been initiating games - lying on the floor saying "bunnies?" which is a "sleeping bunnies" game we learnt at a music group we go to - he loves doing all the actions (much more than my daughter does funnily enough!)

I do know a little about autism and all of these things I have mentioned above do sound positive and not markers for autism - what do you think?  I am also aware that my husband as a child ignored people or "zoned out" when he was busy.  I have noticed with my son that he will always respond if you say his name followed by a command.. but if you just call his name and he is engrossed in something he will often ignore you (it's almost as if he thinks "well, you are just calling my name and not asking me anything so why do I need to respond?!)

I can tend to over-analyse things and am very aware that I have started to obsess about this - even seeing problems that when I think about it properly, aren't even there!  The Internet can be a dangerous tool sometimes as I will read other peoples thoughts on the subject (not professionals such as yourself) and get myself totally wound up!

Thank you for the great advice re. using his humour to our advantage in getting him to speak more - I will definitely start to do this.

As we have just had a check up with our health visitor I think I am going to watch his development over the next 3 months (until he is 2 and a half) and then arrange an appointment if we have not seen an improvement in his language - do you think this would be okay considering what I have said above?

Thanks again

Melisss

ANSWER: Hi Melissa,

If this had been your first post, I would have definitely told you to relax.  Everything you've just said about your son sounds completely on track.  As I said, a diagnosis can NEVER be made over the Internet but from your description on his play and social participation, there is nothing that indicates anything near the autism spectrum.

You are obviously analytical and a very loving mom.  When you put that combination together, it's impossible not to obsess over the well being of your child.  I think you have a really good plan.  It's a great idea to keep a watch over his development and if you don't see an improvement in his language, you can always ask for an evaluation at that time.

Warm regards,

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: Thank you Jene - I definitely feel more reassured from your response re. his play and socail participation.

I am still concerned that he doens't seem to be able to answer simple questions with a "yes" or "no" (this probably comes from me remembering that my severely austistic 2nd cousin had to spend ages learning "yes / no" and even now at age 10 will ask me a question such as "do you have a hoover yes or no?"

Melissa

Answer
Hi Melissa,

I hope things are going well with you.  I have been requested by someone to contact you on their behalf.  She feels she is in EXACTLY the same place you are.  She said when she read your post it's as if she could have written it.  

she also has 26 month old boy/girl twins and her son sounds just like yours.  She would love you to contact her because you have so much in common and are going through the same thing at exactly the same time.  Her name is Roxanne and her email is roxannemur@aol.com

I hope you and your family are well and I wish you the best of success.

Jene Aviram
http://www.nlconcepts.com  


BELOW IS THE PREVIOUS POST....


Hi Melissa,

Not being able to answer a yes or no question easily does not indicate autism.  I think you have a good plan.  You can always contact me if I can be of further assistance.

Jene Aviram
http://www.nlconcepts.com