Expert: Dr. Sharon A. Mitchell - 8/22/2009

Question
Hi Dr. Mitchell,

At 18-24 months old, my son's pediatrician noticed a few delays (she called them developmental delays).   I thought it was because he wasn't around kids to begin with.  I told her that my mother, which is his grandma kept him for the first year.  You know how some grandma's are...she showered him with love and good soulfood cooking but not with the structure.  He did learn to love The Golden Girls, The Jeffersons, Matlock, grits, eggs, collard greens, peach cobbler etc...LOL!!  Then my mom went to work part time so we let him go to a small home daycare owned by a friend of our family with 2 other kids (sometimes it would be just him and one other kid).  While at the home daycare, he learned all of his alphabets by the age of 2, learned how to pray before he ate, learned some songs, learned some structure.  Although I loved this home daycare setting, after a year, I still felt he needed to be around more kids and structure to  help with his social skills and  speech (and the comprehension of the spectrum of speech).  I think he's the type of kid who has to be stimulated by being around all types of kids.  But nevertheless, at age 2 we started all kinds of testing (Psych, OT, Speech, etc...).  A few of the tests said he showed red flags for Autism (pointing at things, not talking but doing that "jibber jabber", watching the ceiling fan, spinning the wheels on his bike and cars,not looking at you in the face, etc). They didn't want to diagnose Autism for they wanted to give him a chance to catch up with the other kids and possibly close the developmental delay.   Besides, they said he scored "normal" on certain parts of the tests.  So we immediately started intervention (speech and OT). I also signed him up for the Headstart program, but he couldn't attend until he turned 3.  He has made great strides while being in the program.  He has his fits sometimes when he doesn't get his way, he adapts to change well, sometimes he does okay with parallel play but I think he prefers to play alone although the teachers says that he does play with the other kids if you make him.  He was released from OT about 6 months ago.  Also, 6 months ago, we added PT but I think I did that just to be on the safe side and come to find out, he was pretty much on target with the large gross motor skills.  He will be released from PT in a few weeks. He is now 3 1/2 years old (will be 4 on Sept. 15)and I (and his speech therapist and some of the other teachers still notice some developmental delays and maybe some mild autism).  Thanks to preschoolprep.com, leapfrog and the Your Baby Can Read DVD's he knows all 10 colors, all of the letters, 10 shapes, can count and read numbers 1-15.  He also knows about 60 sight words and can spot them in a book.  But that speech and the comprehension still worries me.  He is not able to have a conversation with me or tell me how his day went.  But he understands everything I tell him to do and will do it (get me the remote, turn the light on/off, go potty, give me a hug, don't touch that, etc...).  I use a lot of praise because I see that it helps (actually, when he does something right, he'll come and look me directly in my face waiting for the praise or he'll tell me what he did using 1 or 2 word phrases.  When he does something wrong, he'll say..."Oohh, trouble".  Lately he loves the NOGGIN channel... and he'll repeat the saying "Swiper, no Swiping...Oh Man" from Dora the Explorer.  He can repeat alot of what I say when I say it slowly.  He is just now beginning to actually understand certain questions and will answer appropriately like (What's your name?, What's my name? You want to potty?, You wanna go outside? How you doing?).  It took forever for him to catch on to those questions and answer them correctly...Whew!  But that speech is still the big issue.  It seems as though without proper communication, it's hard to know where he's coming from.  He repeats the phrase "Aushawan" only when he doesn't want to do something. Of course no one knows what it means.  I'm taking him to a Pediatric Neurologist next Thursday because his pediatrician says that it's a start because I want to get him tested again for Autism.  There is something there, maybe not as pronounced as other kids but there's something there.  It gets confusing because we don't know if he is just acting up at times, spoiled, or if he really doesn't know.  Oh yeah, his hearing tests are normal. And also, when his dad takes him to get his haircut, he's the perfect little kid.  He'll sit and wait 2 hours, but he's not that way with me.   

I know you can't diagnose, but what are your thoughts and what in the world should we expect at this Neuro appt.

Answer
Hi Lisa,

You're quite right. It is not possible to diagnose via the internet but I can talk to you about what you might expect at your neuro appointment.

You are certainly on the right track and have already done a lot to help your son. I agree with your pediatrician that there are enough possible signs to warrant a referral to a pediatric neurologist.

Autism is a spectrum disorder. Some people with autism have a severe intellectual disability; others have high intelligence. Some people are so severely affected by the autism that it permeates every facet of their existence; others have symptoms to a much milder degree. Some people with autism will require full care all their lives; others will finish high school, possibly get a graduate degree, hold down a job and have a family.

It does sound like your little guy made good strides in his preschool program and has in place many of the readiness skills in preparation for school. But you obviously still have some concerns.

Language might be at the top of your list of worries. It's good that you've already connected with an ST as well as OT.

Unfortunately, there is no one definitive test to diagnose autism. Instead it is diagnosed based on observations by professionals, detailed developmental history from the parents and a variety of tests, such as those already done by the speech therapist, occupational therapist and psychologist. For a child this young, much of the diagnosis will be based on the information you present to the doctor.

Here are some websites that might help you:

The Centers for Disease Control information on autism disorders: http://www.cdc.gov/ncbddd/autism/facts.html

These are developmental skills you might expect of a typical three year old: http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/3Year.pdf

On these three pages are the diagnostic criteria for the various diagnoses that make up autism spectrum disorders: http://www.autism.net/content/view/195/93/

FirstSigns.org offers a series of free videos that on recognizing autism: http://www.firstsigns.org/

Whether or not this appointment results in a diagnosis of an autism spectrum disorder your local school district would be a good resource and planning help to your family.

Best wishes on your appointment,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD Candidate
www.autismsite.ca