Expert: Jene Aviram - 7/25/2009

Question
QUESTION: Hello, I know you are not going to be able to tell me if my child is autistic but i would just like your personal opinion on certain "red flags" that he has. My son is 21 monthes old. He just had a meeting with a speech and developmental therapist and I am awaiting the results.Before the speech therapist left my house she said that he had a mild speech delay but he was making good consonant and vowel sounds so it isnt something to worry about right now but he should be learning more words over the next six monthes...right now he says 10 words (mama, dada , no, go, bye, hi ,wow ,why...he also says "o no" . He makes great eye contact..he points at things of interest and also if i point to something he usually will look and point at it too while babbling. he usually responds to his name and when he doesn't it just seems like he is "ignoring" us we know he hears us but think he is just being a kid. he understands simple commands most of the time. He is a good eater, will usually try anything we offer him..He is affectionate, loves to hug me and likes to cuddle on the couch before he falls asleep. Whenever my boyfriend and I walk in the door he almost always runs up to the gate and says "hi" to greet us..The things I am worried about are.. he walks on his tippy toes a lot when barefoot or in socks, rarely
when in shoes..He will shake when hes excited..its hard to explain..for example when the developmental therapist handed him a marker to see him draw on a piece of paper he pressed the marker tip down really hard and shook and his other hand he had in a tight fist and the way she looked at him when he did it really worried me.. It was as if she had never seen that before..he also opens and closes his hands a lot...I am sorry this is so long I would just like your opinion on what you think about his behavior..Thank you for reading this.

ANSWER: Hi Christine,

As you said, I can't possibly diagnose your child on the Internet.  However, by the description you've given, it doesn't sound like you need be concerned about autism.

The behaviors you describe are in line with sensory defensiveness.  You'll be amazed what a difference a good OT (occupational therapist) can make.
Walking on tip-toes is most certainly sensory defensiveness.  You're lucky he's such a good eater.  Sometimes sensory challenges affect this area too.  
And I am not phased at all by your description of the incident with the marker.  Pressing too hard or too light is common.  And as for the "tight fisted shaking" - that's synonymous with sensory challenges too.  So is the opening and closing of his hands.  Some kids open and close doors, drawers, jump up and down, spin around, crash into things etc.  These are all typical of sensory processing challenges.

One positive aspect about mild sensory challenges is that they usually lessen with age anyway.  If your speech & developmental therapist does not recommend OT service, I would request an evaluation with an Occupational Therapist.  Your child is still covered under early intervention which makes it so much easier.

It sounds to me that your son could benefit from some OT and Speech services would be a bonus.  But overall, I think in the long run that everything will be just fine.

I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: Hello, thank you so much for your input. I received the results from my sons evaluation earlier today and i just wanted to share a few things with you again for your opinion. I told you in my previous question that Dominic makes good eye contact. In the eval that my son got the developmental therapist noted that he made very little eye contact with either one the the evaluators during his assessment. Now when he is at home he always looks at us in the eyes and seems to always make eye contact with our friends that come to visit, so that concerned me a little bit.Is it something to worry about that he didn't make eye contact with "strangers"? I don't know if it was just because they had a lot of new toys that they brought and he just was preoccupied..but when they asked me to call his name to see if he responds of course he didn't..i just think it was because he was excited about the toys but I'm not sure.They also noted that while he was sitting and playing he was sitting in a "W" position with his legs..I don't know what that means??

Answer
Hi again,

If you received the results, what did they say? I wonder if you're receiving services of any kind.  Sitting in a W position generally indicates low tone and is nothing major to be concerned with.  With some OT, PT or natural development, this can easily be fixed.  If your son is making eye contact consistently with you and with friends, then I would not be concerned.  Perhaps he was shy or preoccupied when they arrived.  I think there is only cause for concern when I hear a child is making eye contact with his immediate family only, and not others.
If they did a full assessment of your son, then you have the right to question them as much as you like.  Make sure you get a full understanding of what they're saying.  And if you're not happy, you can always request a different evaluation, such as with an OT or a Speech Therapist.
It's your child, so please don't feel shy to ask for what you need.  You are doing all the right things and are a great mom.

Jene Aviram
http://www.nlconcepts.com