Expert: Dr. Sharon A. Mitchell - 6/30/2009

Question
Hi, I am desperately looking for someone's opinion, my pediatrician waved
me off today. My son turned one on 5/13/09, being born at 35 weeks. He
was in Nicu for 9 days, then suffered from terrible diarrhea for 6 weeks
without gaining back an ounce of the pound he lost in the hospital. After
cutting out everything from my diet to no avail, we finally gave up
breastfeeding, and once on nutrimagen, he did well. Until I started to notice
that his development was very slow. He sat up at 9 mo, crawled (on belly-
pushing with feet) at 10 mo, started to say dadada, mamama, bababa at 10
mo., he weighed 20 lbs 1 oz and was 28.5 inches at 10 mos.. Flahfoward to
now. He weighs 20 lbs 9 ozs (though he eats like a piggy), 29 in long, says
mamama, dadada, bababa, and wywy, is unstable on his feet (though he does
pull up), walks with you holding his hands, but does so on tip toes ALL the
time. does not point or wave, but he does raise his arms out, hands flat,
shake them back and forth, then rub his head at least once an hour. He
makes eye contact with us and is happy to be around us, but doesn;t seem to
be learning the things that we do. He looks like any other healthy, sweet,
smiling baby. But, to me, the best way to describe what i see is that he has
stopped, in all senses of the word. His language development is at a
standstill. His actions used to be cute, but now they are worrying me and our
pediatrician thinks im being paranoid and over protective (because we lost a
premature baby with hydrops in 2006). My first 2 children were perfect and
hit all their milestones early. But #3 has been different. He even cut teeth
late, at 11.5 months old. Other than a milk allergy, he's been healthy enough.
Please tell me what your take on this is. I hate to jump the gun and go to a
specialist, but our dr wont even entertain the idea that something is wrong.  
Thank you, Amanda M.

Answer
Good morning, Amanda.

I'm a big believer in mothers' instincts. In your case especially, your instincts might be right since you have already had two children so can't be classed as an over-anxious first time mother, with nothing to compare this child to.

It sounds like you've been through rocky times already with this little guy but it's good to hear that he's healthy now. What a worry that must have been when he did not gain weight in those first few months.

It's encouraging that he has a few words and is making sounds. Often kids with autism have no spoken language at all by your son's age. It's also encouraging that he's sweet and smiling since the smiling indicates that he's responsive to you, another thing that is often missing in kids with autism.

I'm not sure that what you describe is a stopping of development, since you mention that he was later in other developmental milestones such as sitting up, crawling, etc.

Since language seems to be your major worry, let's take a look at what's considered typical for babies at 13 months of age.

According to the American Speech Hearing Language Association, these are typical behaviors of children between the ages of 7 - 12 months:

* Babbling has both long and short groups of sounds such as "tata upup bibibibi"

* Uses speech or non-crying sounds to get and keep attention

* Uses gestures to communication (waving, holding arms to be picked up)

* Imitates different speech sounds
* Has one or two words (hi, dog,dada, mama) around first birthday, although sounds may not be clear (http://www.asha.org/public/speech/development/01.htm)

From what you report, your little boy seems to be meeting these milestones.

Over the next year, you might expect him to:

* Says more words every month.

* Uses some one- or two- word questions ("Where kitty?" "Go bye-bye?" "What's that?").

* Puts two words together ("more cookie," "no juice," "mommy book").

* Uses many different consonant sounds at the beginning of words. (http://www.asha.org/public/speech/development/12.htm)

These are skills under the expressive language category. Another part of language is how he processes (understands and responds to) language he receives from others.

By a year, most kids:

   * Enjoy games like peek-a-boo and pat-a-cake
   * Turn and look in direction of sounds
   * Listen when spoken to
   * Recognize words for common items like "cup", "shoe", "book", or "juice"
   * Begin to respond to requests (e.g. "Come here" or "Want more?")

If you are still concerned about the language skills your son is showing, take a look at this link to learn what the Speech/Language Association says about the possibility of language delays http://www.asha.org/public/speech/disorders/LateBlooming.htm

If after reading this, you continue to wonder, it certainly would not hurt to get an evaluation by a qualified speech/language therapist. To find ones near you, check out this link:  http://www.asha.org/proserv/

The Centers for Disease Control and Prevention has an excellent, short video on recognizing when there might be a problem http://www.cdc.gov/CDCtv/BabySteps/

Since you're writing to the autism section of All Experts, I presume that you're wondering in particular if your son is showing signs of autism. From what you describe, autism is not necessarily what would first spring to my mind. At your son's age, autism is not easy to diagnose but his responsiveness to people and the fact that he does have some language is a positive rather than a warning sign of an autism spectrum disorder.

But if autism is on your mind, then here are a few free, online checklists you can look at. If you do them and feel that the scores only increase your concern, print off the results and show them to your doctor.

Language http://www.cdc.gov/CDCtv/BabySteps/

PDD Assessment (PDD is the umbrella term under which all autism spectrum disorders fall) http://www.childbrain.com/pddassess.html

Modified Checklist for Autism in Toddlers (your son may be a bit young for this yet) http://www.dbpeds.org/media/mchat.pdf

Your son is lucky to have such a caring, observant mom. From what you describe, I'd say there is not an immediate cause for alarm, but more of a watch and see and record situation. Hopefully these internet links will give you more information to go on. If after looking at them, you still feel concerned, follow your gut and have your developmental questions checked out.

Best wishes,

Sharon A. Mitchell,B.A., B.Ed., M.A., Ph.D. candidate
www.autismsite.ca