Expert: Jene Aviram - 8/19/2009

Question
My 9 month old baby girl was recently diagnosed with "benign shuddering" by a pediatric neurologist. Since that doctor's visit, however, her daily frequent arm waving (when excited, frustrated,upset, transitioning between one activity and another), almost daily pulling at her ears, clothes, and pressing her hands over her eyes and objects over her eyes, has become more of a concern to me. The shuddering includes grimaces, and sometimes involves her putting her arms tightly behind her neck. The shuddering comes and goes on a daily/weekly basis but the arm waving etc is so constant that it has taken me a while to recognize it as (possibly) something other than "just the way she is."

I think all of her other developmental milestones have been met OK - she is walking with help, she crawls fine, she smiles, she orients to her name, she loves to be tickled and look at her typically developing older brother. But she bangs and drops ALL of her toys because of the waving, and it almost looks like she is confused that she can't always hold and manipulate an object deliberately. When upset, although she wants to be with my husband or I, she does not like to be held close and instead thrashes around in my arms. I have not noticed her "playing" with toys other than mouthing or banging/shaking/dropping them. She is very easily startled and does not habituate well to noises. She blinks when she hears sounds that I would describe as moderately loud. She shows no concern if her brother cries.

I guess my question is, do you know of any connection between infant shuddering syndrome(s) and autism? Are any or all of these symptoms likely to lead to an ASD diagnosis? Any suggestions, questions I should be asking the doctor, etc., would be most welcome.

Answer
Hi Joanna,

As far as I know there is no link between "benign shuddering" and autism.  In fact, I believe a lot kids tend to grow out of benign shuddering as they develop, and it certainly isn't harmful or dangerous.  

Many people on the autism spectrum have sensory issues, and this is where I think you're equating the two diagnoses.  Please keep in mind that if you have sensory issues, it does not mean you have autism.  It does appear that your daughter might have some sensory defensive behaviors.  The fact that she doesn't like to be held close, aversion to noise, has trouble transitioning are all signs that she could benefit from some help in this area.

If I were you, I would talk to my pediatrician and let him know that you see the behaviors increasing and would like to get in touch with early intervention.  Ask him for a contact number you can call.  Then explain that you would definitely like an OT (Occupational Therapist) to do an evaluation.  A good OT will be marvelous at helping your child through this, and if she sees anything to be concerned about, she'll let you know right away.

Please keep in mind that autism is hallmarked by a "social disorder."  As long as your daughter is maintaining eye contact, seeking you out, interested in yours and other people's reactions, then you're probably just fine.  The best place to start is with early intervention.  Either just an OT evaluation or a full evaluation - but make sure you get to see an OT as well.  All services and the evaluation is most likely covered by your state and free of charge.

I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com