Expert: Trey McGowan - 9/26/2009

Question
QUESTION: Hi Trey,
My 26th mth old boy has been in speech therapy/special ed (EI) for 4 weeks.  He has about 15 words that he has said, about 5 new ones since we started therapy.  He is learning to sign and is regularly using "ME" and "ALL DONE!"  He says All Done but not me.  He points to things he wants and requests through signing Me which has cut down on frustration alot.

He has this sterotypy behavior that he does on average 1x/2x a day.  He runs by an object or a line of objects and dips his head.  Its like a game to him.  For instance in the morning he will play with his push cart, build legos with his brother, play with his cars/animals/trains, do his sterotypy thing, watch TV, go outside on the swings.  Its like part of his play activity.  If we are out at parties he will usualyy do it as well-not all the time.  

The therapists are saying no to autism or at least telling me to wait as he is responding to therapy rather quickly.

I went to a ped neurologist and was disappointed.  She did not do a thourough exam w/questions.  She observed him, had him build blocks, ran some sort of belt w/trains across his eyesight i think to see if he tracked them. She saw him point to the clock in the room.  I had a video of his stereotypy but she said it didn't appear he was stuck on it b/c he laughed w/his brothers as though playing tag in the video.  

In the end she said she would lead to expressive speech delay and not to come back unless the behavior intensified or no progress.  

I thought she would do a thourough exam and it didn't appear to be.  She asked me some questions about throwing a ball back and forth and socially and she said he appeared to be on track for other 2yr old activities.  His gross/fine motor skills are good.

I asked if ABA would be appropriate, she said no, first b/c he was responding to his current therapy and ABA is for autistic children who don't recognize language through normal therapy, as if talking to them doesn't register.

My concerns are his sterotypy, speech delay, doesn't say mommy or day, doesn't say "Yes" but will nod and say NO.

Do you think i should go for a more thourough second opinion, if so should i be asking for a specific exam?  I thought she would give me rest in my uncertainty but unfortunately she didn't only b/c she appeared to be rather quick in her observation.

HELP

ANSWER: Hi there, Chetta!

First off, let me apologize for the delay on answering this question. A week emergency hospitalization kept me away from my computer, and I have been unable to answer questions. I'm working my way through the backlog as we speak!

You say that, during only four weeks of speech therapy, he has already picked up 5 new words, is learning to sign, and points and requests? It seems to be that when it comes to speech therapy, he is doing quite well. Patience is a virtue, and while I know that it is difficult to wait, I think that you should, indeed, wait. Your therapist is right: he is very definitely responding to his treatment, and quite well from what you've said here.

Your concern about his stereotypie is understandable. However, one thing that people forget is that 'autism' is not simply 'stereotypies'. Instead, it is a much larger collection of various symptoms that make up the syndrome. The only two that you have mentioned is the speech delay and one single small oddity in your child's play. He is social, he is improving in his speech and communication, and he doesn't seem to be delayed in anything but the speech and communication.

I can't tell you not to go for a second opinion in all of this. However, IMO, I would save asking for a second opinion for if your child shows more strong signs of issue. The speech problem is being treated. The stereotypie doesn't seem to really class as a 'stereotypie', as he does it '1 or 2x a day', as opposed to the multiple times that a true one would take. It may very well just be that your child has discovered a new game. And as odd and unusual as the game may seem, there is no single pattern for 'play'. Different children find different enjoyment in different ways.

I wish you and your son all the best, and good luck *especially* with his speech therapy! If you have further questions, comments, feedback, and follow-ups, feel free to ask!

Trey

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

QUESTION: Hi Trey,
New developments since my last post. My son (27 mths) has said a few more words and sounds; is sitting better for speech & special ed; has identified eyes,ears, head, tongue, belly button, etc... is starting to identify pictures by pointing; better eye contact, and imitating gestures with songs but other "new" things have developed:
   --- started grinding teeth (some days minimal others alot)
   --- covers his ears;randomly & not at loud noises, he doesn't scream or get upset, he just does it randomly.
   --- won't sit in bathtub he will only stand.  He got in the pool during the summer but for some reason feels insecure by sitting in the tub.
  --- that oddity with his play (drops his head by an object) has decreased dramatically but once in awhile he still walks close to things looking out the corner of his eyes.
  --- never obsessed with lights or fans but will always notice them immediately upon entering a room- will point.
  --- also notices sunlight & shadows.  Its like he enjoys seeing the shadows & plays in/with them.  Very curious behavior.

Do you know if these are sensory things?  Do you think i should try getting OT for him or ask for another eval?  These aren't severe but i just notice these new behaviors.  Could they be impacting his speech?  I have heard about 30 words and sounds but he doesn't use them regularly.  Last night the new one was "french fry" when we got McDonalds.

Last night i watched a video on the "autism speaks" website where they show typical children right next to "atypical kids" who could be at risk for ASD's and got myself nervous again.  They are new videos and their purpose is to help parents and health professionals screen for possible ASD's at an earlier age.

What do you think?  

Answer
Hi there, Chetta!

First off, I'm glad to hear your son is doing so well with his speech therapy. I know that 30 words may not sound like much, but communication can be a long, slow road for a child with a speech disability, and communication advances are always heartening!

Now, for the meat of your question: getting him reevaluated. I would definitely get the teeth-grinding checked out, as that alone can be an issue. Not because it is a symptom for autism, but because tooth-grinding, especially in a child this young, can be awfully hard on their jaw and teeth. Whatever is causing it, whether stress, a physical problem, or a stereotypie, it's definitely something that should be checked on.

As for the rest, I told you in the first question to save asking for a second opinion unless your child is showing stronger signs of issue. If you are, indeed, seeing stronger signs of issue, then by all means! What you are seeing and what I am hearing may be two totally different things, after all. What you are describing here, to me, seem like new behaviours, yes. However, to me myself, they do not seem like anything I would consider a 'red flag'. Remember that children are constantly 'reinventing' themselves. They notice new things, learn new games (which may not seem like normal games to the usual world), and find new sensations.

Hopefully I was able to give some reassurance, or some semi-good suggestions! Questions, comments, feedback, follow-ups, are welcome!

Trey