Expert: James Michael Roan - 4/6/2009

Question
QUESTION: Hi James,

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).
-  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;

Moms always sense things in their children that dads don't. My guess is that he's fine. Low communication skills translate to low social interaction. A delay in one causes a delay in the other. I'm not worried because his receptive language sounds strong by your description and he uses nonverbal communication techniques. You should probably have a speech and language therapist who is experienced in oral motor/sensory assessments look at him to rule out oral motor dyspraxia.

You can always call me if you are not comfortable with what I have provided here. You can email me here: roanpsych@gmail.com

You are 8 hours ahead of me.

Kind regards,
James


Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


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.






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

QUESTION: Thanks for the speedy and reassuring response James :-)

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!   

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

Melissa

Answer
Hi Melissa:

You are right in limiting television. Poor programming prevents or limits development of the frontal cortex and thus executive functions of which attention is a major part. This same area is responsible for AD/HD as well as some aspects of autism spectrum disorders.

His behaviors sound very positive and not reminiscent of autism. I'm sure if his speech improves so will his desire to engage peers socially.

You are right, the Internet is a dangerous place with too much information that is not well consolidated in a meaningful way.

Kind regards,
James







Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


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.