Expert: Jene Aviram - 7/14/2009

Question
I hope you can help me, i'm so worried about my daughter.  She is 19 months old.  I have been worried she may have autism for a few months now.  We have been to see a developmental paediatrician who said that for now he would not diagnose her, we are waiting for blood tests and have been to see a speech therapist who says she is 9 months behind in her communication. We are hoping for a diagnosis before she turns 2 in November.

My husband and I know something is wrong but still hold out some hope it may not be autism.  Our daughter has great eye contact with us and strangers, is a very happy child, sleeps well, eats well, loves to run and can kick a ball very well if you ask her to.  She babbles a lot and does say 4 or 5 words but they are not meaningful words.  She loves to play peekaboo and will initiate this with us and with others.  She does not mind being around others and is happy to join other kids in the ball pit at playgroups.  She does not necessarily join in with other kids in playing with a toy but will sit with them and play with her own toy.  She can turn the pages of books and loves to sit with books and read them.  

Our main concerns are that she does not point to anything she wants, she has only recently started to even stick out her index finger, which she usually does when i'm pointing and she puts her finger to mine.  She doesn't usually repeat what we say although 3 weeks ago we started trying to get her to say 'more' when she wanted more food and occasionally she will now say it without prompting when she wants to eat more.  Generally if she is unhappy or wants something she will sort of grunt/cry out instead of pointing or leading us to what she wants.  

She also does not do any real imitative play.  She is not interested in stacking blocks or pretend play in her kitchen etc.  Occasionally she will bring us a toy to show us but when we show her how to play with them she will go back to whatever she was doing.  She also has a repetitive behaviour in that she will toss a toy/anything over her shoulder when she's done with it.  She also loves stones and will happily sit for 15-20 minutes in our garden picking up stones, licking them and then throwing them over her shoulder.  We try to move her onto other things and she will move without throwing a tantrum.  She does not line up toys and she is not set to a routine.

Her overall behaviour is I think quite normal for 19 months, she has a few tantrums in the week but usually only when she doesn't get what she wants.  

My daughter also has no interest at all in scribbling or using a pen/pencil, she will just chew them and if you try to get her to scribble something she gets very annoyed and just throws the pencil.  She can feed herself but with her hands only, she's more into chewing the spoon than feeding herself with it!

I know children can be all over the spectrum and we have braced ourselves for a diagnosis of autism but from what I have described do you think perhaps she may be in the higher functioning side of the spectrum?  Can autistic children be smiley and have good eye contact?  We are starting her on speech therapy asap and hopefully once we have a diagnosis we can get more treatments for her.  

I would appreciate any insight you have and also any advice you could give to us at this anxious time.  

With thank and good wishes,
Eloise  

Answer
Eloise,

I can feel your panic and my heart goes out to you.  Waiting to find out what's wrong with your child is the hardest thing.  People feel that if they know, they can at least develop a plan of action, but the waiting game is the toughest part.

Firstly, let me answer your question "Can autistic children be smiley and have good eye contact?"
The answer is - Children with autism can be very smiley and have a great sense of humor.  It's not unusual for them to make great eye contact with their family, but it is unusual for them to have great eye contact with strangers.  They are far more prone to having good eye contact with people they feel comfortable around.

You mention a few times that you are waiting for a diagnosis, and I can't help but wonder if someone indicated what this might be.  Regardless of whether your daughter is on the autism spectrum or not, I can tell you already, that she is very bright and a fast learner.  I predict that with the correct therapy and support she will go far.  Look how quickly she's learned to say "More" with some insistence on your part - and even without prompting!  This is a wonderful sign indeed.

She doesn't yet have the language to communicate effectively, but she will learn.  She definitely has social interest as she'll happily parallel play with her peers and bring you items of interest, even if she's not yet willing to play your way.

She loves to read books and you can take advantage of this wonderful asset.  If you have a digital camera, take pictures of all your family members and things she likes to do.  Create a book about her in a small photo album with very simple language.  For example.  
My name is .... (pic of her)
I have a mommy (pic of you)
A daddy (pic of your husband)
A brother ..
A sister
I live in a house in ... (pic of outside of your house)
When I want to eat chicken I say "Chicken please" (pic of food)
When I want to drink Apple juice I say "Apple juice please" (pic of drink)
When I want to see a DVD, I say "Dora please" (pic of DVD)
I like to play with my cousins (pic of cousins)
You can obviously add any details you like but it's probably a good idea to keep it fairly short.  Read it to her frequently.  My bet is she'll respond really well to this book and I highly recommend you take the time to put it together.

Regarding her chewing objects or licking stones, this is related to sensory issues and something that can be helped with some Occupational Therapy. Make sure that your diagnosis includes some OT services and you're bound to see a big change in this department.

I'd like you to read an article called "How do I know if my child has autism?"  Although your daughter is still very young, I think it will help you and give you a better idea of what autism might look like in young children.  You can find the article at  http://www.nlconcepts.com/autism-howdoyouknow.htm

Lastly - as difficult as this time might be, please know that you're doing all the right things.  You are an extremely proactive mom.  The majority of people wait a lot longer to follow up on their concerns.  Your love for your daughter is clear, you're on the ball and she is lucky to have you as her mom.

I wish you all the best and I hope this has been of some help.
Jene Aviram
http://www.nlconcepts.com