Expert: Trey McGowan - 9/9/2009

Question
Hi There,
I recently opened up a home Day Care and I currently care for 2 boys, one is 1 month shy of turning 3, and the other little boy is 14 months old. My question is regarding the almost 3 yr old.
When I first took on the responsibility of caring for this little boy, I noticed right away that he does not respond to me calling his name, after a about a week of observing all his different behavioral traits and I will list them off to you shortly, I am hoping that you could possibly offer me some advice as to how I can help this little guy out with the aid of communicating in an easier fashion.
Here is a list of what Daniel does and does not do:

-As mentioned, does not respond to his name, even if I yell it out at the park to get him to stop running away from me.
-Periodically walks on his tippy-toes
-He cannot say any words, not even Mama or Dada, when he does attempt to make sounds, he will repeat the same sounds continuously ( Wa, Wa, Ma Ma-those are the only semi-words he knows how to say)
-Rarely makes eye contact
-He likes to repetitively open and shut doors, or open and close my blinds
-Will not play with other children, and if a child is playing with a toy he wants, he will push them forcefully down so he can take over playing with it
-He is a relatively good eater, but I noticed he will place food on his lips and will rub that item over and over again before he places it in his mouth
-He will take me by the hand if he wants something,( sometimes quite forcefully) but if I say "No", he tries to slap my mouth, he has also pinched me when I try to help him put his pants on.
-He is not potty trained either, and when he does have a bowel movement, he does not seemed to be bothered by it.
-I have a swing set, and all he really likes to do is be pushed in the swing, he would love it if I pushed him for hours.

I had a talk with Daniel's Parents that I was concerned about his behavior and asked if they had brought him to their pediatrician to be tested for a form of Autism, their response was that they were concerned about the same thing and they informed me that the Dr. said there was no concerns at the present time ( I beg to differ) I also asked them if they had his hearing tested, they informed me that he has had it tested twice, and that he hears perfectly fine ( according to the Dr's), I was also informed that he has been in speech therapy for about 1 yr now, but what I do not understand is if he has been in it for over a year, why hasn't the Dr. suggested that he have further testing done to rule out some form of Autism?

I really enjoy caring for this little guy, but how can I get him to express what he would like using words rather than taking me by the hand and getting upset when I say no? and should I ask his parents to have Daniel be seen by a different Dr. to rule out Autism? so at least if he has some form of it, he can get help from different resources?

Thank you for listening to my story,
Yours truly
Samantha

Answer
hello, Samantha!

I hope you will forgive the extended period of time it took to answer this. It's really not usual for me. Life's been keeping me on my toes and a week hospital stay didn't do me any favors!

The first answer I will give you, unusually enough for me, is to your last question: you can't really *ask* his parents do that, as in the end, as his parents, it's their decision what gets done. However, if you genuinely feel uncomfortable about the situation, or concerned, then by all means you can *suggest* it to them. This may seem like semantics, but not only is it an important distinction on paper, but bringing it up to the parents themselves in that way will make them feel more in control of the situation, thus making them feel more at-ease if they are scared of the whole situation.

Now, for the question about the child expressing himself, I may not be able to help as much here. For one thing, without a diagnosis on anything, I can't begin to guess why he doesn't express himself. It may well be that he has physical or mental speech difficulties, and thus taking you by the hand is the only way he genuinely *can* ask for something. Telling him 'I want you to use words' may well get frustrating in that case, as it may very well be that *he* wants to use words as well, and for whatever reason can not.

It might help me a bit if I know how much of an advance the speech therapist has made with him, and if he has any diagnosis of his speech difficulties. You mention he's been in therapy for a year now. Do you know if he has advanced any, or if the therapist has identified some of the issue?

Also, have you asked the parents about slapping you when you say 'no'? Does he do the same with them? Do they slap him if he says no? Knowing if that reaction is coming with people other than you might help out with figuring how to at least mend part of the issue.

Hoping to hear back from you on those things, now that things are straightened out! Questions, comments, feedback, and follow-ups are welcome as well!

Trey