Expert: Jene Aviram - 8/9/2009

Question
QUESTION: Hello,
My son just turned 17 months old and was born 5 weeks premature.  He has reached all of his developmental milestones although on the late end.  I had him evaluated by Early On a couple of months ago and they said he is developing perfectly normal, but I can't seem to get passed a few things I think are a little odd.  When he goes to sleep he will lay there with his eyes open, sometimes for 5 minutes and he has done it up to 45 minutes, but I don't know if he's just fighting it.  When he wakes up sometimes he will lay there and other times he will call out my name to come and get him.  (I must make a note that sometimes he does play with his pacifier and make babling noises so he's not just laying there the entire time with his eyes open and staring, but most of the time.)  He also likes to match his Lego blocks by shapes, although we can get him to build stuff and put different size shapes and colors on top of each other.  He also laughs at the garbage disposal when it runs and if you drop something and it makes a loud noise.  For instance, he has a wagon and the handle dropped on the floor and he laughed and kept doing it. He also laughs when he closes cabinet doors.  He also likes things in their place and seems to have OCD (which I do too).  For instance if the bar stools are out of place, he will move them back. I must tell you though that I can say no to any of these behaviors and he will stop and move on and it's not like he does them for a long period of time.  He just started pointing with his index finger at 15 months and then stopped for a couple of weeks because he started walking and started again a couple of weeks ago.  (He has always gestured with a whole hand and grunted to what he wants while looking at us.) He also has great eye contact when we are playing on the floor, but when you get really close to him like when we are holding him, he doesn't want to look us in the eyes.  He also use to smile at the camera when I held it up to take a picure of him and now he really doesn't, he just want to have it for himself.  But he does smile a lot throughout the day. I don't know if I'm just hypersensitive to Autism because I have a cousin with a son with Autism and I see him monthly and are looking at anything that could be a sign with my son, knowing that normal kids do these things too.  He does so many good things that I'm trying to keep those in mind but I don't want to have blinders on either. I also know that I have to keep is prematurity in mind and know that he is going to be behind most kids. Some good things he does are: He LOVES to be around me all of the time and gets upset when I leave the room and comes after me saying mama.  He can say mama, dada, up, bye bye and has started trying to imitate us when we say things like green, he will say gree or diaper is iaper.  He loves to feed us and will feed a stuffed animal.  He will give kisses and hugs when we ask him too.  He loves to wave to people.  He understands everything we say and will follow simple instructions.
He loves to play hide and seek, peek-a-boo and gonna get you.  He is always looking to see if we're looking at something he's doing and will follow our point and our gaze.  He sleeps well and will eat pretty much anything.  The only sensory issue the OT said he has is with this vibrating toy she had, but he would touch it at the end once he got use to it.  Other than that he doesn't really have any other sensory issues.  He does flap his hands if he gets mad or excited but I've seen other normal kids do that also and it's not any other time.  He doesn't line things up or spin the tires on his truck.  If he does turn something over say to look at the screw holes on the bottom, it's for a second and then he's done and it's only once in a great while. One other thing, is that he likes to turn the on/off switch on and off, but he looks at us and laughs.  Sorry this is so long.  I'm just trying to figure out if he's just normal but behind and will catch up ( which everyone says to me) or if these things are really red flags and I need to go to a specialist. Thank you.

ANSWER: Hi Shannon,

Although it's not possible to diagnose over the Internet without a comprehensive evaluation, from everything you've written, I do believe you can safely rule out autism.

With that being said, let me explain why.  Your son has many incredible social skills that are not typically present in a child on the autism spectrum.  I have yet to see a child that calls out for his mom from the crib (it doesn't need to be consistent), that has great eye contact, that looks at you while gesturing to what he wants (I wouldn't be concerned that it's not a solid point), that calls after you when you leave the room and that loves playing with you!

I know it's hard not to be paranoid when someone close to you has autism, but I truly think you have nothing to worry about at all.  If you do the MChat, and you possibly have, I think it will reassure you even further.

Let me address some of your concerns.  I think it's perfectly fine how your child lies awake in the crib, even for an extended period of time before he goes to sleep.  In fact, many parents are concerned if their child can't lie calmly before they fall asleep!  With regards to the other things you mentioned, like getting a kick out of different noises, wanting the bar stools in place, matching his legos by shapes and opening and closing the cabinet doors, this does sound like a sensory issue to me.

I know your evaluator said he was fine in this area, but you would really have to bring your sensory concerns to the fore, for her to provide an evaluation.  Please bear in mind that a lot of children outgrow sensory issues as they mature.  When children have sensory defensiveness, they try to control their world.  The only way they can do this is by controlling other things.  Insisting on routine is one way, matching things up, switching on and off the lights, making sure all cabinet doors are either open or closed, moving the bar stools back in place, and repetitive behavior in any way is indicator for sensory stress.

Your son is way too young for any predictor of OCD.  If children are likely to be OCD, these behaviors only occur when they are a lot older.  Behaviors that look like OCD in children under 5 are typically a result of sensory issues.  By the way, enjoying noises is a very sensory behavior.  Children either seek them out or avoid them.  I don't think you need be concerned about sensory defensiveness in your son because he would be showing a lot more behaviors if this was a real concern.  However, just for interest this page has a number of sensory behaviors that might be of interest to you. http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist

Shannon, as an overall, I think you can absolutely relax about your son.  It sounds like he is right on track and developing perfectly.

I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com



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

QUESTION: Hi again,

We spoke with the OT from Early On about the sensory concerns and she isn't worried about them.  She said they only get concerned if the issues start disrupting their learning and development and daily life.  So far that's not the case so I guess we will just keep in eye on them.

My husband wanted me to ask a question about opening and closing cabinet doors and drawers.  Do typical kids open and close them and also sometimes do this and not get things out of them?  And if a cabinet door was open, would they just walk by and leave it alone or close it?  And is it a good sign that we can tell him to leave it open and he just walks away?  We don't know what typical kids do since he is out first, so we were just curious.  

Also another question I had is do some typical kids have low muscle tone or is that mainly common just with sensory issues and autism?  The reason I ask is because the OT noticed that he is walking on the inner parts of his feet and that he has low muscle tone in his ankles.  She thinks that we will just need to get him some arch supporting shoes to develop his arch, but it seems wierd to me that he has low muscle tone.

Thank you again for your advice.

ANSWER: Hi Shannon,

I must tell you again that I don't think you have cause for concern.  It's amazing to watch a child grow and form his own personality and preferences.  Just like the rest of us, children are full of their own little quirks.  Tell your husband not to worry.  While most typical kids have no need to close a cabinet door if they walk past it, it's OK that your son does.  And yes - how wonderful that you can redirect him to leave it open.  Only if it were obsessive, would I begin to be concerned, and that behavior alone is still not enough to imply any lifelong condition.

With regards to muscle tone, there are a lot of kids that have low muscle tone.  It's certainly not restricted to sensory processing or autism.  You can have low muscle tone by itself, and as your OT said, it's something that can very easily be fixed.

Shannon - enjoy your little one.  They grow up so fast!

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: I know he does a lot of good things that autistic kids just don't do, but then some things will happen like today that just make my husband and I think, "Why doesn't he do that?"

We were on a walk in our neighborhood and he was in his wagon and there was a fire truck parked on the street and we walked by and he just looked at it and didn't say or gesture anything.  The next day we walked by a big blow up slide that was colorful and kids were playing on and again nothing, but when we were coming back to our house he pointed at our house.  I know that showing things that interest him with us is important, so that's why it worries us, but should it worry us at this point?

After this, I promise I will try and relax.  Thanks again.  

Answer
Hi Shannon,

I truly don't think it's a concern.  If you told me that there was a fire truck on the street and all your son did was stare at his fingers, despite your efforts to get him to see the fire truck, I would be concerned.  If you told me that he kept leaning out the wagon to see the wheels turn, despite your efforts to distract him, I would be concerned.

Yes, he might not have been as interested in the fire truck or the big blow up, as you'd like.  But next week he might be.  Or he might not.  We all have our interests and your son is no different.  Some things will grab his attention, and others might not.

All kids are different and they reach milestones at different times.  The way he pointed at your house as you were coming home is great.  I would tell you not to worry, but I know that you will anyway.  It comes with the territory of being a parent  :-)

Jene Aviram
http://www.nlconcepts.com