Expert: Valerie Herskowitz - 7/24/2009

Question
QUESTION: Hi,
My 25mth old  was seen by a speech path & special ed teacher (early intervention).  He hums with alot of inflection and crunches his nose to try but nothing is coming out.  He will say WOW for his favorite TV show WOW WOW wubsy or Ugh Oh! or a slurred there-it-is.  He tries to sing Row Row your boat and gets the row part.  He does SHH when i put him to bed.  He points to pictures in a book but will look at you to repeat. He tries to count and it sounds like six, seven and eight are kinda there.  He will make the sound of a snake and a lion (Roar)

The other odd thing he does is he will throw an object or look for an object, focus on it and run until he gets to it and then all of a sudden put his head down right when he gets to the object. Its strange. There are days he seems to do it alot and other days not at all.  You can redirect him and no tantrums if you do.  I mostly see it outside and sometimes in the kitchen.

I explained to the teachers all that i have said and they are telling me not to "go there" with the autism. He answers to his name, he points to things to show me (not alot but he does it),he makes great eye contact, but doesn't show that he gets what i am saying all the time.  Things like do you want a cookie, go on the swing, go in the car, he seems to get, but when i tell him to close the door or pick up something its hit or miss.  He likes to be around his brothers and sisters (4) and all kids, smiles, imitates (jump, kick, throw),but is v.attached to me for his needs.  He will pull me everywhere to show me what he wants.  He won't let anyone else do it for him.  As the weeks go on he is becoming more frustrated if i don't come when he is pulling me and is throwing tantrums.

My question is, if i listen to my advisors at this point without a second opinion and they want to give him speech 2x/wk and special ed 2x/wk would the therapy change if he was autistic and we missed the DX?  I am so confused and i feel like i am a paranoid mom.  



ANSWER: Hi Concetta

I understand how you feel. However, not knowing what they are working on in therapy, it's hard for me to know if it would be different. I have very distinct ideas about what he should be working on-but I don't know what they are doing? Can you find out what his plan of treatment is and let me know?

As far as whether he has autism or not:
Usually we like to distinguish between a child that is having just expressive language issues versus a child with other behaviors as well. It seems to me from what you have described, that your son is having behaviors in addition to the language delay that warrant concern. So, no, I wouldn't just ignore them. The big issue is the fact that he is pulling you to what he wants-I find that to be a big concern, plus the frustration, the fact that he is not understanding things and the weird behavior with the object. These are red flags. He seems like he may be in the developmental delay spectrum, which if not truly autism, is related.

Basically, Concetta, for a child to be as delayed in language as he is, there is probably more to this than just a language delay. You have two choices: just wait and see what happens for six months while you give him therapy, or take him to a developmental pediatrician,psychologist or neurologist for a diagnosis. Where do you live?

The actual diagnosis doesn't concern me as much as what is being done about it. There is the right things to do and the wrong things to do. Again, not knowing what they are planning to do, puts me at a disadvantage to know if they are doing things correctly or not. Get me the plan of treatment and write me back. We can go from there.



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

QUESTION: I live on Long Island.  Is the IFP (individualized family plan) is the exact treatment plan?  In reading it, it looks like using play to get him to speak and express himself better.  

When i asked the special ed teacher the same question posed to you about the change in therapy if we missed a Dx, she really appeared confident he as going to respond to therapy. She reassures me that his running thing although quirky isn't obsessive and can be interrupted.  She keeps trying to tell me not focus on all the things he is doing right that says NO to autism like pointing, waving, engaging in play,liking to be with the kids, clapping for gratification, bringing me thinggs, imitiating the kids.)

Am i asking for a specific type of therapy like ABA or a known method?  Help, i am so confused.  I took the MCHAT questionaire and he scored 2 maybe 3 on that b/c speech and that running thing is not on it.  He didn't have any critical items.  I feel like i am all over the place.  I know i have help coming on Tuesday but i really want to make sure , like you said, IT'S the Right Therapy.

When you say he is pulling me and guiding me to what he wants, isn't that a form of communication, even though he can't say, OPEN the door or Put me on the swing.  When i am not around, i do see him doing it to my other kids, but if he sees me, forget it...TAG I AM IT!!!

Thanks in advance for all your advice.  I never knew how subjective a topic could be since my background is numbers and finance.

ANSWER: HI Concetta

I am not a play therapist, so that is not my way. I am a structured oriented therapist that sets up specific activities to work on specific goals.

Well let's just not worry about the diagnosis and focus on the therapy program. Like I said, you can take him to a specialist if you want a diagnosis later on.

Again-regardless of the diagnosis, he needs a structured communication based program that focuses on establishing appropriate communication systems. Pointing and pulling are communication systems, but are not appropriate and need to be replaced with appropriate ones that will lead to good communication skills. This I am adamant about.

Find out if they are planning to introduce any systematized communication systems with your son. If not, then I would highly recommend that you and I set one up. This is step 1.

Let's try to do one thing at a time so that you do not get overwhelmed. Let's focus on the communication system now.


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

QUESTION: Sorry to bug you again, but can you recommend a book i can read to help me decipher all this.  I am going to take your advice and focus on his communication.  There is so much info out there it is overwhelming and while i wait for the appointment with the neurologist (aug 19th), i want to educate myself to help my son.  If he is on the spectrum, it is clearly his ability to understand and communicate that concerns me.  I feel like i want to jump start his brain, all the books i keep reading to him and objects i give him aren't working.  I know i am not being patient so i figured a book may calm me while i wait for the professionals to help guide me.

Answer
Let's focus on his communication. I want you to register for my web class that is next week on Communication Strategies for Low and Non Verbal Children. You will learn a lot for the $10 that it costs and be able to ask questions. Here is the link:
http://www.valerieherskowitz.com/store/cart.php?m=product_detail&p=131

After the class, we can maybe schedule a short consultation to discuss what you learned and how we can make it applicable to your son.

Visit my website and look around. I also wrote a book:
http://www.valerieherskowitz.com/store/cart.php?m=product_detail&p=156

Talk to you soon