Expert: Valerie Herskowitz - 9/2/2009

Question
I am concerned about my 20-month-old daughter. I will try to include as much information as possible. She once had a vocabulary of at least 10 words that she no longer says. She does babble but her sounds often sound repetitive. She seems to understand a lot and will usually follow commands. She does not usually seek out contact with others unless it is for basic needs. She screams, high pitch, to indicate that she wants or needs something, but then it is a guessing game to figure out what she wants. She used to gesture for these things, but has stopped. She does point, but not usually to indicate want. It is normally just random and she is not looking in the same direction she is pointing. She will just grunt and look at the object she's requesting. She is content to be by herself and will often ignore others when they attempt social interaction with her. She does not actively play with other children. She does not play appropriately with toys, unless they have buttons to push. She does not "pretend play" but will share her cup and food with me (feed me). Seems disinterested in others, pretends they are not there. Has NEVER acknowledged her baby sister. She makes selective eye contact. Often doesn't respond to her name. She does not seem to enjoy and rarely reciprocates affection such as just being held, kissed, hugged or comforted. Does not seek to share enjoyment, interests or achievements with other people. Does not share joint attention, if I point to something, she will look at my hand. Stares off into space. Repetitively flaps her arms and hands, paces, claps, shrugs her shoulders, twists her body back and forth, rocks, taps her foot/feet, stands on tip toes and hums. Enjoys being rocked, bounced, "danced", being tickled, chased, and held upside down. Refuses to wear shoes. Mouths objects. Has began licking and smelling objects and rubbing them on her lips. Eats non-food items. Does not seem to feel pain or be affected by temperature changes. Seems to have difficulty with depth perception or where her body is in relation to objects. Has no concept of danger. She likes to collect things into a pile. Will empty objects from a container and put them back repeatedly for long periods of time. Is often preoccupied with parts of objects instead of the entire object.  The same with people, she focuses on and shows extreme interest in people's jewelry and their mouths/tongues instead of the person. Appears to see people as objects. Likes to flick light switches on and off. Will get upset if unable to do so. Enjoys objects with buttons she can push, including belly buttons, electronics, and clothing. Has become increasingly attached to her security objects. Doesn’t like when objects do not stay where she puts them. Engages in self-injurious behavior such as biting her hand or arm, pulling her hair, shaking her head rapidly. There are 3 boys ages 4-6 in my family with varying degrees of ASD. She saw a Ped. Neuro. today who said that he doesn't think she has autism and even if she does, no one would diagnose her this early. I don't understand why there is an emphasis on early intervention, but no one will diagnose until later. The Neuro. has ordered an EEG for concern of her staring and a hearing test. He told me that her behaviors were typical for her age. He said this while she spent 10 mins licking her baby sister's car seat. I am also taking her for a speech eval. I have started trying to teach her sign language but she will rarely look at me to see the signs I am making. I know that you cannot diagnose, but I am wondering what you think. Should I take her to someone else for a diagnostic eval?

Answer
Hi Julie

Did you share all this information with the doctor? I would certainly recommend that you not only seek out another doctor, but begin early intervention services immediately. She not only displays many characteristics of autism, but it runs in the family. I personally know several children who were diagnosed at a very young age. You seem like a wonderful mother-instead of going into denial, you are ready to take on this situation aggressively. I applaud you for that. Let me know if you need any help setting up a home program or if you need something else. Good luck!