Expert: Catherine Ridenour - 10/5/2010

Question
I've been worried about some of my son's behaviors for quite some time now. He is now 2 yrs, 11 mos old. When he was an infant, noise and crowds seemed make him fuss and cry. As soon as we would leave, he would stop. Today, it remains much the same, except that he now fusses and acts up until we leave. He also has issues with haircuts, to the point that I give them at home now with assistance from my husband to hold him down. I give him a bath immediately to wash the hair off him. Most of the time, he closes his eyes at the beginning of a haircut and doesnt open them until after the bath is over. He also cries the entire time. Recently, after his flu shot, he began closing his eyes while going to potty, so that he would not see the "boo-boo" on his leg from the shot. A week later, he is still doing this. I thought he could possibly have a sensory problem, but lately other things have me worried. He can talk very well, has known and recognized upper and lower case aphabet for a while, recognizes numbers to 20, and knows his colors well. He's very loving towards me and a few close family members, but isnt very social. He attends mothers day out twice a week, and I've noticed that he follows the other children around and imitates them in what seems like an infantile way to me. He seems to be facinated my his letters and numbers and usually notices them first when seeing anything new. He likes to "count" the numbers on clocks, but on watches where the 3 is replaced with a date...he seems to get annoyed that the number is missing. Another thing bothering me is that he refers to some people by the color of their shirts, even when he knows their name. Something else bothering me is that he only eats about 6 things and will NOT try anything new. He just refuses to eat. These are just some of the things concerning me. Please let me know if these are behaviors are normal for toddlers of if I need to have him evaluated. Thanks.

Answer
Hi Tara,

It is really hard to untangle what is "normal" toddler behavior and what is more likely autistic. Any one or two of these things could be passing phases. Taken together, however, I do think it's worth more investigation.

If he is on the autistic spectrum, his sensory input and processing is just different from ours. Getting his hair cut is traumatic because either the sound of the clippers and scissors or the prickling of the hair creates intense irritation or even pain. It's the same reaction he's having to noise and crowds.

If I had to guess, he's probably in the "Asperger's Syndrome" area of the spectrum. These children are usually very bright, talk early, learn letters and numbers easily and become fascinated with the details of particular subjects. They are easily thrown off by sudden change, new situations, load noises and/or bright lights. Their nervous system is just more sensitive. They can't filter out the things we label just annoying.

His social behavior can stem from the lack of "theory of mind". Basically, this means that he does not realize that other people have thoughts and feelings like he does. Calling people by the color of their shirt is one indication that they are objects, not persons, to him. Nor can he understand the physical sensations that emotions cause in him. He can learn both of these, over time, but it will take direct teaching.

Read about "social stories". These are simple books that address one topic and use your child's name in the story. Once you read a couple, you can write your own. "Tommy Shares His Truck" would be one of those ideas. This link lets you print out a free one: http://www.sandbox-learning.com .

One thing you need to try to get a handle on right now is the food thing. Try to identify the qualities that his favorite foods have in common. Are they the same color, similar shape, flavor, or texture? Many fussy eaters have a negative reaction to the feel of foods in the mouth. Some hate slick textures, some hate crunchy. Figuring this out can help you broaden his menu.

Start by modifying his favorites just a little. For instance, cut his toast in triangles instead of squares. Let him help you do it, even ask him what shape he wants. If he says circles, use a cookie cutter.

Talk about the food in fun ways. Make up stories or songs. I know this sounds silly but it works. Let him play with food (I know this turns some people off). Let him help make cookies and hope he licks his fingers. Feeling the textures with his hands lets his brain accept it more readily.

If he eats anything like oatmeal, cream of wheat or mashed potatoes, start stirring TINY amounts of a pureed vegetable (like green beans) into it. You can use baby food to make this easy. Over the course of a week or two work up to the point he can taste the new flavor. (Don't let him see you doing this.)

Unless he is severely underweight, missing a meal won't hurt him. Don't cave in to his "I just won't eat" tactics. Letting him win this power struggle is a sure way to more trouble later. Put out good food using the above ideas, eat together and have a nice meal. Don't beg him or threaten him. If he does not eat much, clean up the table and feed him at the next regular time. And NOT only with his favorites. Making a big deal out of his not eating just reinforces the behavior.

I know I've thrown a lot at you. The upshot is that I agree he's showing some signs that may indicate a problem. Whether testing him, at this point, will give you an answer or not can depend on who administers the tests. If you get hold of a really good child specialist, you might get some answers. Most pediatricians are going to just nod and tell you he'll grow out of it.

Don't despair. He's clearly intelligent and engaged with you. You have great opportunity to teach him what he needs that he does not pick up on his own. Talk about feeling mad, sad, glad. Draw simple pictures of faces, and make faces in the mirror. Learning to read faces is one of the hardest things for these kids


Check out these links to read more about Asperger's and autism:

http://www.autismasperger.net/intro.htm (a helpful diagram of the spectrum)

http://www.ninds.nih.gov/disorders/asperger/asperger.htm
The government website explaining the diagnosis

http://www.patientcenters.com/autism/news/resources.html (many links to other resources)

Write to me again if you have more questions.

Best wishes,
Catherine