Expert: Valerie Herskowitz - 9/2/2009

Question
I have a question for you regarding my 2 year old daughter (almost 27 months) and signs of aspergers/autism.  I tend to worry just by nature – so I’m not sure if I’m being an overly worried parent or there is actually legitimacy to my concerns.

I have a couple of things that I’ve noted that are potentially concerning:

•   Routine oriented – but isn’t upset if we change it.  Really, my husband and I really are routine oriented anyway but for example in the morning, she will always play with this baby stroller and play with her babies after we come downstairs from her bedroom.  If the stroller isn’t there, she is asking and looking for it but at times does do other things if there is something new in the environment.  
•   She has ok eye contact, not great but certainly doesn’t avoid eye contact.
•   Lately, she has started “licking” stuff – really only when we are distracted to I believe elicit attention but nevertheless kind of weird.  Maybe once or twice a week.
•   She mixes up pronouns more than other kids I’ve noticed – the most prevalent example usually being something like “pick you up” when she wants to be picked up.  However – we have noted improvement lately and she is using “I” more often but still uses you and Avery (her name) 50% of the time.
•   She has pretend play – but mostly focused on being a “mommy” and playing with one of her 15+ dolls and associated stuff.  I attribute much of this to the fact she has a 6 month old brother and basically spends her days imitating things that we do.  She does play with other toys though, in multiple different ways and other pretend play, but plays with dolls the most
•   Socially, she is an “observer”.  She likes being around other kids but is shy in social group settings.  She does, however, interact with kid once she warms up and seems “normal” but still shy.  She is usually one of the shyest kids at play time and such.   I’ve noticed lately she tends to “mother” the younger kids – telling them – “here, you have this toy and sit down and play” or other stuff that she does with her brother.   She used to take a long time (45 minutes) to warm up but now its down to 5-10 minutes (still shy though but willing to participate, etc).  At times, she will cry when other kids approach her at the park, but generally only in the evening after she has had a long day and is tired.
•   At times, with strangers/less familiar, they will say  hi to her and she at times responds something like “andrew is at home sleeping” – if she says anything its always about her brother.
•   When I get home from work, instead of being excited she usually whines, cries, or crawls around like a baby  - for a minute or so.  I’m usually stressed when I get home so I think that’s part of it.
•   Spins around on occasion, but it is either a ring around the rosie game or she imitates our dog that does the “bucking bronco”.  I noticed she will do this sometimes as a way to deal with stress (potentially someone new coming to our house – doesn’t do it always or very long)
•   Rarely, when mad, she will “shake” (or flap?) her hands – it seems very controlled to the situation and even more rarely walks on her toes (it seems to me all kids do this – I frequently see this at the groups we go to).
•   When she pushes the stroller, it seems like she will look at the stroller wheels at times to watch them going around (while pushing).  Mostly this is done with her baby stroller. I asked her what she was doing, and she said “looking at the wheels”.  She plays with other toys with wheels appropriately (pushes little trucks around on “roads” and stuff like that) – she isn’t spinning wheels and watching but she tends to look at stroller wheels at times when she is pushing these things around.
•   Talks about a variety of things all day long and does use original phrases (I want a treat, wanna go outside and play, what’s this called, etc)
•   She is not overly affectionate but does hug/kiss, etc.  She understands facial expressions and can tell if a baby is “happy” or “sad”.

On the positive end, she tends to always respond to her name, points to things, shows us things (although doesn’t do this real often – maybe once or twice a day.  I attribute this to the fact that she can speak well and just tells us stuff instead – like “want to show mommy my PJs or something).  She has an extensive vocabulary that is slightly advanced for her age based on the other kids we are around, and good receptive language (understands everything we tell her.  Can follow multiple step directions when she feels like it).  She does have echolalia at times – she will rarely repeat something we say immediately (only if it is something new she has heard – she’s starting to say “ok” or something like that too) but she will use echolalia at times.  It is always in content, but it might be something we told her before.  Like, for example, I’ll tell her “we’re going to the park” and she might say “don’t be shy”, which is something we told her but then she will say other things like “wanna play on the swings, is Daddy coming with, etc”.   

She has hit all of her milestones along the way – wasn’t a really smiley baby and isn’t an overly physical toddler (still can’t jump and walked at 15 months) but is within the normal ranges of development.

Oh, and I’ve done the m-chat multiple times through our pediatrician and on my own once a month or so and she has passed each time.  She was recently evaluated by an occupational therapist – she saw no sensory or other social issues.  Our pediatrician has recommended that she maybe see a child psychiatrist to be assessed for autism after we talked about some of these things (this was after her two year that he did not have any concerns with her) – I’m really not sure if this is something we should do or not.  My husband and I do not agree – he thinks there is nothing wrong with her (along with everyone else that sees her on a regular basis.)  Maybe it’s just me then!   

Sorry for the long list!  Please let me know if you think there is anything in here of concern.  


Regards – Heather

Answer
Hi Heather

You really are a very observant mom. From your list, there are a few troubling behaviors. I would tend to agree with your doctor and have her evaluated, so you will have piece of mind. I wouldn't listen to your husband or friends-they mean well, I'm sure, but have a vested interest in your daughter (especially your husband). If you are worried, and the doctor wants you to have her checked out, I would. If she does turn out to be on the spectrum, she would be quite mild anyway. And if she doesn't come out on the spectrum, then you will feel better.

Just a note-it may not be that black and white. I think a lot of people have autism or Asperger characteristics without being fully on the spectrum. I think there is a little autism in us all. So the professional you take her to may not be totally definitive at this time, but may just want you to watch her a bit. I do think she is having a little bit of a language processing issue-hence the echolia.Echolia is a sign of language processing issues-I can always help you to work with her on that-just let me know if you want me to help you with that area of development.

Good luck and let me know how it goes.