Expert: James Michael Roan - 9/27/2009

Question
QUESTION: Hi James,
I recently adopted a baby from Korea. He is now 14 months old and has been home for 6 months. We are noticing some very minor red flags, however, these are making me extremely anxious and I am hoping to share my experience. Any response will be helpful. Many of my concern seem to mirror attachment issues, however, I am wondering where the fine line crosses over to a mild autism diagnosis. I have a nephew with autism which has made me hypersensitive to the issue as well.
My concerns are as follows, he does not wave, will not clap, does not point. We have worked on these for 6 months. He is content playing alone, his speech is delayed and he is very very quiet (currently getting speech twice a month), and most  times, I feel eye contact is lacking (unless he is in high chair). He will not do "soooo big" with his own arms, but instead will gently pull my hands up, this is similar with peekaboo, as he wont cover his own face but he will cover and uncover mine once I initiate. Finally, he has a high pitched squeal which he uses when he is excited. Oh, and he mouths toys excessively. His imitation abilities are somewhat poor.
The positives are that he has great receptive language skills and follows simple commands, including "Give mommy the _________" No food or texture aversions, he laughs alot and is very smiley, he responds to his name 80% of the time. he is playing with toys appropriately for the most part except for occasionally spinning car wheels, which does not seem to be something he fixates on. he seems interested in other kids and adults for the most part.
Any interpretation of the above would be helpful. I understand completely that no diagnosis can be made.
Thanks,
L-

ANSWER: Hi Lynn;

Please keep in mind that at no time am I diagnosing anything nor am I ruling out any potential condition, just providing guidance and direction.

The positives you mentioned seem very positive and are generally missing in autism at this age. I am a bit concerned about the lack of nonverbal communication, the high-pitched squeal, and using your hands as a tool, which is often observed in autism. I would carefully watch his development while also reading what you can about attachment disorder and the father of attachment theory: John Bowlby. Download the M-CHAT and scoring key and use it as a way of ticking off his developmental milestones against autistic behaviors. It is really not valid until around 18 months.

http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf
http://www.firstsigns.org/downloads/Downloads_archive/m-chat_scoring.PDF


Kind regards,
James


Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting assessment professional responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.


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

QUESTION: Thanks James for the quick reply,
In your experience, do you feel that some attachment disorder behaviors and autistic behaviors mimic one another or overlap? I.e. Lack of eye contact, verbal delays, motor delays, poor imitation.
Since I have wrote the above question, my husband took the baby on an overnight visit. The baby miraculously waved (just once), covered his face with a blanket and played peek-a-boo (10-15 times), and even gave good eye contact and affection with the in-laws. And....identified some body parts on his self and others. All of which is making me more concerned about attachment. (thoughts?)
Also, can you please expand more on using the parents hands for play and why that is associated with autism.  I havent read that and I am interested.
Thanks you very much for your time and response. You must be a really great and caring person to take your personal time to answer all these questions.
Lynn

Answer
Hi Lynn;

Thank you for your kind comments :-) To be honest with you, I am no expert on attachment disorders. What I know and have seen of it, yes there is some overlap. Both conditions result in some degree of social impairment. Your baby may be showing mild signs of attachment difficulty but does not necessarily mean that he has an attachment disorder. Keep a close eye on his social development.

"Using another's body to communicate" comes primarily from the authors of the Autism Diagnostic Interview-Revised (ADI-R. These authors (Rutter, Le Couteur, and Lord) developed the ADI-R as a parent/caregiver interview based on observations of hundreds of individuals with autism. According to the authors, the emphasis is on the abnormal use of another person as a kind of extension of their own arm or body. Typically a behavior that meets this criterion is a child will place a parents hand on the door knob while twisting their parent's hand. It is considered nonsocial and that's why it is in here.

Please let me know if I can help further. Have fun with your baby! They grow up so, so fast.

Kind regards,
Jim

Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting assessment professional responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.