Expert: Jene Aviram - 8/17/2009

Question
Im sure you get tons of posts like this one, seeking opinions on whether what their children do is normal or indicative of ASD so I dont mean to add to those, but Im lost.  My DS is 23 months and I've been concerned about him since he was 10 months.  He was late in waving, clapping and his first word didnt come until 14 months.  He did start pointing on time, however.  I voiced my concerns to our Ped, but she felt that nothing was wrong with him.  I got EI to evaluate him anyway at 12 months and they found nothing concerning either.  Literally the next day he started waving and the next day he started clapping.  We found out that he had fluid in his ears and had tubes put in at 13 months, and afterwards he started with the words.  Anyway...now he is a HIGHLY active little guy!  He has a good sized vocabulary, started 2-3 word sentences last month...now we're hearing 4-5.  He's very social, and I say that meaning that he has friends he plays with regularly at daycare and he always makes a friend at the playground.  He can follow commands well, but often say's "no" when we ask him to do something, or daudles.  He knows his ABCs, can count to 10, knows his colors, and has some pretend play (he'll feed a stuffed animal, pretend a block is a phone, or puts a stuffed animal in a car and says "it driving!"  These are all very positive things but, something still seems off to me, and I dont know if its because Im paranoid and this is my first child (I have an older sister with a PDD of some time) or if I should be worried.  DS has a lot of odd behaviors.  He likes to roll objects, like round blocks or other round objects...its a new thing so Im not sure if it will pass or if its here to stay.  He likes to touch things to his face, sometimes he'll just walk around with an object and touch it to his face, his lips, his head, etc.  He seems like when he's excited or upset that he has no sense of where his body is in space, if that makes sense.  He just lets himself go, flings himself around, throws himself back, etc.  He moves his fingers and hands in weird ways, alot, sometimes in front of his face, but ususally kind of as if he's making the sign for "more" (we started signing a few words with him after he turned 1).  He shakes his head sometimes, just for fun and he'll look at stuff from strange angles sometimes or tries to do things with his eyes closed...however he always looks for our reactions when he does this, and thinks its funny.  He loves music and likes to dance, but his dancing usually is just him running in circles and shaking his head...he loves fast music.  Incidentally, we had him evaluated by EI again at 20 months and I got the impression that the women who came to the house thought I was crazy...he sat down and did all the activites with them, was very attentive and didn't do any of the behaviors he does with me and DH.  He smiled, waved and said bye bye to them and they were like, um, just enjoy your child please.  Im sorry this is so long but Im really at a loss.  Are these odd behavoirs normal toddler behavoir?  At what point does normal toddler behavoir or experimentation become concerning?  He doesn't do any of this strange stuff for excessive periods of time but he just seems to have a lot of quirks.  His Daycare providers think he's a great kid and never have any complaints about him or his behavoir.  (Also, he is an angel at daycare but at home he can have very intense tantrums when he doesn't get his way...will scream, flail, kick, jump up and down flapping his hands, for over 30 minutes)  He does adapt well to change and is generally very well behaved in public...its really just the tics, wierd movements, and what looks like stimms to me that Im worried about.  What are your thoughts?  Any advice would be great! (Also, his speech is functional, he doesn't just repeat phrases or words, he can vocalize his wants and initiates communication, ie. "Mama, look...I see bird!")


Answer
Hi,

Your son sounds too cute for words and it would be my bet that you can safely rule out autism.  Your son has tremendous social skills, play skills, speech and is able to follow directions.

I totally understand that it's very hard not to be concerned, especially since your sister has PDD.  It must be very frustrating and confusing when you feel that something isn't right with your child but just can't put your finger on it.  And then each time he gets evaluated, he is a model child.  What a smart kid :-)

As you've said, his skills are really great.  But what about the other things?  Well, I've seen those behaviors time and again.  Although one can't possibly diagnose over the Internet, your concerns sound synonymous with sensory integration.  This isn't alarming and can easily be overcome with a good OT (Occupational Therapist).  In fact, many kids who exhibit sensory defensive behavior often grow out of it alone.  

Sensory issues can be depicted in a variety of different ways.  Actually, you'll be surprised how many people use your exact words, that their child "has no sense of where his body is in space."  Running, jumping, flapping are all affects of trying to cope with sensory stimuli, and although many people on the spectrum also have sensory issues, they are not one and the same. Some people with sensory issues crave routine and get very upset when it's altered unexpectedly.  They find it very difficult to calm themselves down.  Many parents with sensory defensive kids talk about how their kids keep it together at school but when they get home, they just lose it after an entire day of self control.  Others hate loud noises, some are very fussy with tags, some love textures such as silks and smooth surfaces and constantly seek them out, some mouth inedible objects.  The list is long and here is a great link to read about how it can exhibit.  Scroll down the page and you'll see a check list of sensory behaviors.  http://www.sensory-processing-disorder.com/sensory-processing-disorder-checklist...

If I were in your shoes I would read the checklist and write down what is applicable to your son.  I would request an OT evaluation so that she's looking for sensory behaviors rather than general development.  In the meantime, I would video your child doing all the behaviors you're concerned about.  This way if the OT arrives and your son is a model student, at least you'll be able to show your concerns on tape.

In summary, it sounds like your son is delightful with a very caring and loving mom!  Your son might benefit from some services but I do believe that everything is going to be just fine.

I wish you the greatest success and I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com