Expert: Ettina - 9/19/2009

Question
Hi
I am just starting to look into various behaviours that I can't ignore in my 5 yr old daughter, one being stereotypy behavior.  She has a habit of holding some little animal or toy and keeping it out  straight in front of her twirling it while she presses her other fist against the side of her nose, and does a little dance while she does it too. Five gallops left, 4 skips right, or some var. of that.  Back and forth.   She says her nose itches, that she can't help it.  She doesn't normally do it at school, or on the bus; only when left to her own devices, and had presented no issues thus far.  BUT, she is a very bright, very sensitive middle child.  She has trouble socially sometimes with inappropiate responses and reactions, and last year she did exhibit the behavior at her pre-school.  A playmate rejected her resoundedly, and none of the other children would play with her as they were already paired off.  She retreated and began to display stereotypy at school then too. Disorders run my family; boderline pd(m.father), OCD(m.father), manic depression (half-sister), dyslexia(cousin), paranoid schizophrenia (half-brother)and Aspergers (undiagnosed officially in my niece because the mother won't label her but she's receiving ABA, and I'm suspicious of my brother who at 46 is a social failure)
Should I be concerned enough to have the pediatrician look further into this? I mentioned it a few times at physicals when she was younger but he didn't seem alarmed since she had no issues in any other area.  I don't want to be a worry wart, but i also don't want to miss something just because her doctor is so blaise.  Thank you
jen

Answer
Certainly, the family history suggests a high chance of autism. OCD, manic depression, dyslexia and schizophrenia, and of course autism spectrum conditions, are often seen in families of autistic kids.
For a child to be considered autistic, they have to have both social abnormalities (reduced interest in and/or lack of understanding of social interaction) and repetitive behavior. Since your daughter seems to have both of those, chances are good that she's mildly autistic.
However, there are some alternate explanations I can see for her stereotypies, particularly since her claim that her nose itches isn't really consistent with autistic stereotypies (which usually just feel good, without any discomfort prompting them). It would be a good idea to get her nose checked out by the doctor, because she could have allergies or something.
Alternatively, all her stereotypic behavior could be explained by a tic disorder, basically a milder version of Tourette's Syndrome. People with tics often say that they feel some sort of discomfort, such as itching, that prompts the tics - either that or an OCD-like sense that things are not 'right' until they do it. Tics can be suppressed somewhat, especially in milder cases, but then rebound later, so if a child is avoiding ticcing at school or on the bus, then they'd tic more right after they get home.