Expert: Ettina - 1/24/2010

Question
QUESTION: I have a 22 months old son. he was born at term and normal. I am really worried that he could be autistic. he doesn't take direction or instruction. he doesn't seem to understand tone of voice. when I want to discipline him he doesn't seem to get it. sometimes he thinks I am playing with him and starts to laugh. he doesn't point to anything at all. the only words he says since he was 15 months were mama and dada. we have been trying repeating simple words but no luck. it took me 2 months to teach him how to wave his hand and how to clap. he knows his name. he has been going to daycare since he was 15 months. he started self feeding when he was 18 months old and he does not chew yet but eats table food and just puts it on his tongue to melt or swallows straight down. he has been assessed by infant development counselor as 9 to 12 mon baby. he has had about 8 ear infections since he was 6 months old. last December he had 2 in a row. I am really worried and don't know what to do.  please help

ANSWER: It doesn't seem to me like he shows any signs particularly suggestive of autism, but he does seem to be delayed somewhat, particularly in speech. Does he show repetitive behavior and lack of interest in other people, or is he just behind in development?
Frequent ear infections can slow language development, for two reasons. Firstly, the kid is basically hard-of-hearing some of the time, and therefore gets less practice, and secondly, there's a chance that the child's brain will decide that processing sound isn't that important, resulting in an auditory processing disorder.
My suggestion is to find a speech-language pathologist, who can assess him and figure out how to help him.

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

QUESTION: Thank you for your quick response. I hired a private speech therapist and she worked with the infant development counselor and she also assessed him as 9 to 12 months old baby who is just babbling. and the answer to your question, he does show repetitive behavior but is really social and likes people. most of the time he prefers to play alone. He didn't know how to play with his toys up to few months ago. at 16 months he learned how to play the toy designed for a 6 months old. recently he shows some aggressive behavior such as hitting his head against the wall or the floor. sometimes when he is playing in the middle of his play he throws himself on the floor banging back of his head and throws his toys very aggressively here and there. this is worrying me. it is for sure that he is behind in development. just a little bit of our background, we do not have any history of autism in  our family. one thing to mention is that i have a 45 yr old uncle (my mother's brother) who is mentally challenged since he was born with more than normal numbers of chromosomes. I also had a neural screening at 13 weeks and it came back normal. I don't know if this information helps. could these behavior be signs of autism? thanks

Answer
Well, it's not clear if he's autistic or not, since he is developmentally delayed, and there is a great deal of overlap. I'm not certain it matters, though, since the treatment is the same regardless. If he is autistic, the only difference is that you'd be less able to predict his future development, because both regressions and developmental spurts are fairly common in autism. But since he's fairly social, my guess is that he's probably not autistic.