Expert: Dr. Sharon A. Mitchell - 1/15/2010

Question
My 5 month old just started flapping his left arm up and down- sometimes with a lot of force! At first it was just at naptime. I would start rocking him (he just recently-about 2 or 3 weeks ago started sleeping without the swaddle) and that left arm would start going. I would try to hold it down and he'll pull his hand away and continue until he falls asleep. This week he started doing it during his bottle as well. Is this something I should be concerned about? With all of the talk about autism, I'm starting to get really scared! Thank you in advance for your input.

Answer
Yes, there is a lot of talk about autism everywhere now. This is a good thing because as awareness grows, more kids are being recognized as being on the autism spectrum at an early age and interventions can begin.

But the arm flapping you describe in your is not a great cause for concern if that is the only sign that makes you think of autism. Most definitely you should mention this and any other concerns to your physician or health nurse the next time they see your son. Most likely they will reassure you that things are fine if there are no other signs. Arm swinging is not a strange phenomena in babies.

How is his development generally?

Although no two children gain skills at exactly the same time, there are certain milestones that most kids pass at around the same time. The American Speech Language Hearing Association states that around your son's age, most kids can show these receptive language skills:

   * Moves eyes in direction of sounds
   * Responds to changes in tone of your voice
   * Notices toys that make sounds
   * Pays attention to music

Although we don't expect five month olds to talk, they are developing pre-language skills such as:

   * Babbling sounds more speech-like with many different sounds, including p, b and m
   * Chuckles and laughs
   * Vocalizes excitement and displeasure
   * Makes gurgling sounds when left alone and when playing with you

Kids who do have autism show differences in the ways in which they communicate and relate to others.

First Signs is a website devoted to dispensing information at early detection of autism. For a child your son's age, here is what they consider typical development (http://www.firstsigns.org/healthydev/milestones.htm)

At 4 Months:

   * Follow and react to bright colors, movement, and objects?
   * Turn toward sounds?
   * Show interest in watching people’s faces?
   * Smile back when you smile?

At 6 Months:

   * Relate to you with real joy?
   * Smile often while playing with you?
   * Coo or babble when happy?
   * Cry when unhappy?

Red Flags that may indicate something amiss are listed at http://www.firstsigns.org/concerns/flags.htm

If your baby shows two or more of these signs, please ask your pediatric healthcare provider for an immediate evaluation.

Impairment in Social Interaction:

   * Lack of appropriate eye gaze
   * Lack of warm, joyful expressions
   * Lack of sharing interest or enjoyment
   * Lack of response to name

Impairment in Communication:

   * Lack of showing gestures
   * Lack of coordination of nonverbal communication
   * Unusual prosody (little variation in pitch, odd intonation, irregular rhythm,
     unusual voice quality)

Repetitive Behaviors & Restricted Interests:

   * Repetitive movements with objects
   * Repetitive movements or posturing of body, arms, hands, or fingers


One of the nice things about the First Signs website is the video glossary where you can watch short video clips of kids of varying ages who are developing typically and those with a diagnosis of autism. You must register with the site to gain access to the video glossary but registration is free at http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD candidate
www.autismsite.ca