Expert: Jene Aviram - 1/7/2010

Question
QUESTION: Hi,

I know that 12 months is young to diagnose anything in terms of autism, but I am really worried about my daughter.  She definitely has some form of language delay, but I am worried that it goes further. We are bringing this all up to our pediatrician during her year well visit next week, but I am looking for more info.

She barely ever responds to her name, particularly if she is playing. She responds to sounds, most of the time, so we do not think it is her hearing.  My husband seems to think that she has good eye contact up close, but I think that she looks more at my mouth than my eyes when I talk to her. She does not seem to have "stranger danger."  She may sometimes cry if I give her to someone, but it is not often.  She reaches for what she wants or crawls to it and looks back at us, but doesn't point.  She constantly pulls at her right ear. Or puts her hand to the right side of her head, but it doesn't look like a compulsion.  She babbles constantly, but doesn't have any words and does not seem to understand when we talk to her.

On the positive side, if I take her pacifier and hide it, she will go after it.  She is very lovey with stuffed animals and dolls.  She holds her stuffed duck for me to kiss, shares food, and her pacifier.  She loves hide and seek or peek a boo, but we usually initiate it. She crawls to us to be picked up.  She loves other babies and will kiss her face in the mirror.  

I am terrified that I have to sit and watch as my child develops more and more symptoms.

I am trying to get her attention when I speak and to get her to point, but am not sure how.


ANSWER: Hi Lisa,

I can feel your anxiety in your post and my heart goes out to you.  It's not easy when we fear that something is wrong with our child.  You are a wonderful mom and are doing all the right things.  You're on top of things when most parents wouldn't yet even be aware, you already have a plan to speak to your pediatrician and you've reached out to me.  That's what I call proactive!

You are right that it's very hard to diagnose at 12 months of age.  And the reason is simple - a lot of these behaviors may fade with maturity.  I have seen so many 12 month old's with concerning behavior.  So many things they do constitute as a red flag.  And 6 months later the picture is entirely different.  It would simply be awful to label a child inaccurately, and that's why development is a lot more set between 18 to 24 months.

But that doesn't mean you have to do nothing.  I do think that some of the things you've mentioned warrant concern.  The first one is eye contact and how your daughter focuses on your mouth when you speak rather than your eyes.  The lack of stranger danger and poor response to her name is also a concern.  But I'm also aware that you're worried and you've only told me your concerns.  If you had to write a list of all her assets and good points I know there would be many.  

If I were in your shoes I would make a list of all your concerns.  I would take small videos of behaviors that are harder to explain such as your daughter putting her hand on the right side of her head.  This way you are totally prepared when you speak to a professional and you don't leave anything out.  I would take your list and video to your next pediatrician appt.  (Take the video camera so you can play it while you're there.) Regardless of what your pediatrician says, I would ask for a referral to Early Intervention.  This is a full evaluation that's covered by your state.  Sometimes it takes some time to set up so it's good to book it sooner than later.  If she's not talking, she'll certainly qualify for speech therapy.  Having a professional's guidance on a regular basis will also help put things in perspective.  While you're at your pediatrician, ask him for a referral to a developmental pediatrician as well.  The waiting list is usually quite long but Dev Ped's are experienced in childhood disorders and if your daughter needs any services, they can be instrumental in helping her get whatever she needs to progress.

While your daughter is still young, I think it's worth going to this site and downloading an article called "How do you know if your child has autism?"  It's meant for 18 months and up but keep it on hand as that will give you an idea of what to look out for as your daughter develops.  You can find the article at this link http://www.nlconcepts.com

Try not to worry too much - OK, I know that's impossible.  Do all the steps to get an evaluation and then try and put it out of your mind and enjoy your daughter.  Play lots of peek-a-boo, hide and seek, and anything else where she enjoys interacting.

I wish you great luck and success.

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: Thank you for your response.  Unfortunately, worrying is all I seem to be doing right now.  I read the article you sent and it sent me into a panic.  I seem to have found more things to worry about - she flaps her arms and rubs her hands together when she is upset.  My husband insists it is normal behavior, but I don't think so.

Are there any ways that I can work with her to point?  At her age, is there a difference between pointing and reaching in terms of communication?  

Also, (and I am not sure if you can answer this over email) how can I tell when she is interacting with me to interact, not just repetitive play - like when she feeds me or gives me her stuffed toy to kiss?

ANSWER: Hi Lisa,

It's not really the physical action of pointing that's important, it's the intention behind it.  Toddlers point at things because they want to show others what they're looking at.  They want to share their interest.  That's what we look for.  Some toddlers don't point a whole lot and use words instead.  That's fine too.

Any interaction your daughter does with you is great.  Peek-a-boo, feeding her stuffed toys, hide and seek ... it's all good.  You can try adding a few elements to the play.  For example let's say she wants you to feed her animals, do so and then exclaim that the stuffed toy is tired and needs to go to sleep.  Tuck it under a blanket and pat it to sleep.  See if she'll join in with you.  Gradually you can expand her play.  The more she interacts with you, the more fun she'll realize it is.

It's a little beyond the scope of cyberspace to explain how to get her to point.  Only because it's so much easier to watch it being done and then you can copy it.  A common way is to start with flash cards. Use real photo cards of objects.  Put two of them on the table for example a chair and a bed.  Have something on hand that she loves for example cheerios.  Sit in a quiet space - a small room preferably where there are few distractions. Make sure you are both sitting at a table. Put the 2 photo cards on the table and say "Point to the chair."  When she does nothing, take her index finger and put it on the picture of the chair.  Then say "Good job" and give her a cheerio to eat.  Then repeat this process.  Instead of using something like cheerios you could also play peek-a-boo every time she gets it right.  Since she'll be motivated to play she'll be keen to point to the right thing.  Don't put more than 2 cards on the table in the beginning and make sure she masters the first object before moving onto the next.  This is usually therapist work so I'm not sure if you would want to do this.  Remember it takes time and patience but once she's got the concept it starts moving fast.  The key is to show no frustration with her and lots of praise and encouragement.

I know you are really nervous and worried but don't panic just yet.  Your daughter has some very encouraging points, doesn't have a diagnosis and in fact, you don't even know if she actually qualifies for services in any way. But I do understand mommy fears and I know you like to be proactive so I hope that some of this helps.

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: Thank you for being so helpful. I am seeking therapy for myself and EI testing for my daughter.  

I have more more question about something that was drawn to my attention yesterday.  My Daughter puts everthing in her mouth and has become more strongly atached to her pacifier.  I always thought that it was because she is constantly teething, but is it possible that this too is a sign of autism?  

Answer
Hi,

I would not take that as a sign of autism.  Toddlers put things in their mouths to explore and learn.  They might do so for sensory input as well.  And yes, they do so for teething as well.  Pacifiers and nail biting etc are habit forming.  So, please don't worry about this as being a sign of autism :-)

Jene Aviram
http://www.nlconcepts.com