Expert: James Michael Roan - 5/26/2009

Question
QUESTION: Hello.  My son is 10 months old and is very very smiley, especially with new people.  Every now and then he has cried with a new person, but it is quite rare.  The extent of his shyness usually that he smiles at the new person, while clinging to mom or dad and put his head on our shoulder, which has caused us to dub this his "flirty" smile.  Despite this, I have some concerns.  

1. If he is playing with something, he doesn't respond to his name.  It seems he doesn't hear us.
2.  He says dadadadada and lots of oooooooos and ahhs, just started mama.
3.  He laughs when we say no to him, and at times, makes sure we are watching him . . . seems as if he wants us to say no.
4.  When he sees something he wants, he screams at it.  He doesn't look at us to give it to him though.  Rather, he just keeps saying "AHHHHHHHHHH!" at the object until we give it.  This usually happens with vacuums, balloons, and animals.  He does not point, and he loves ceiling fans.
5.  He wimpers a little when we leave the room, but not usually for long.  He often follows us.  He recently took five steps independently, but I'd still consider him a crawler.
6.  This is the most concerning.  When nursing, he rolls his eyes back to look at what is in back of him.  He seems to be avoiding eye contact with me.  Its happened for months, but because he seems to have good eye contact the rest of the time, I have ignored this behavior.  If I am acting ultra-silly, he will make eye contact.  A few months ago, I'd swear he was staring directly into my eyes, no blinking, but when I'd move, he'd just keep staring in the same direction.  When he was younger, he would make eye contact and smile and "coo".  He doesn't make eye contact with me when nursing or holding him, unless I'm doing something super-intering (brushing teeth, etc).  And when he does, it is brief --5 seconds or so--and then he looks away.  With my grandmother and others, he gazes lovingly (it seems) into their eyes while they hold him.  

This is all so confusing and I don't know whether to worry.  My doctor told me that because he is so young, early intervention would not take me seriously.


ANSWER: Hi Sandra;

I have some concerns regarding his social and communicative development. You should follow up with a referral to Early Intervention for an assessment. In the meantime, work on getting him to look at you by selectively responding only to a scream combined with an eye gaze. You may have to work hard for the first couple of eye gazes using physical prompts by directing his head toward you. Eventually work on extending the length of the eye gaze rewarding the longer but not shorter ones. Pointing comes on some time between 9-14 months, so you have some time to work on that. I highly suggest you purchase one of Stanley Greenspan's books on his DIR Floortime Model for establishing joint attention. The only research based predictor for autism at this age is "failing to orient to name" when you enter a room and calling the child's name. We are looking for around a 60% response. This varies according to the interest level of what the child is engaged in. The interest in the spinning fan has me slightly concerned. Is this interest extended to washing machines and other spinning things?

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 assessment professional 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: He does love cars and wheels, but he will drop them for a new toy put in front of him.  He has this singin-spinning alphabet game by leap frog that he enjoys, but I avoid giving it to him often.  I would say he responds to his name 75-80 percent of the time.  But if he is really engaged with a toy, he won't turn . . . although the past few days this seems to have changed a bit.  He almost always turns when someone new enters a room, if that is what you meant.  I also forgot to mention that he seems to understand certain commands, such as "go to sleep", "give a kiss", "come over here".  He does enjoy tickling and chasing games (in addition to other games), and will make eye contact with us as a way of letting us know "hey mom! come run after me" or "tickle me".  In fact, if we are ignoring him, he will say "''ah!" and keep staring at us to make eye contact until we give in to him.  I'm also concerned bc he still does not sleep thru the night, but will lay back down in his crib once I have walked back in the room.  He was exclusively breastfed for 6 months and is still nursing at night.  How concerning is this?: When he sees something he wants, he screams at it.  He doesn't look at us to give it to him though.  Rather, he just keeps saying "AHHHHHHHHHH!" at the object until we give it.  This usually happens with vacuums, balloons, and animals.

Answer
Hi Sandra;

He sounds good to me. Like I stated earlier, make him use eye contact or pointing to get things rather than when he makes the
ahhh" sound.

I am sorry, I cannot advise you on his sleep and nursing patterns.

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 assessment professional 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.