Expert: Valerie Herskowitz - 10/1/2010

Question
My son is going to be 19 months in a week.  He crawled at 10 months and walked at the end of 13 months.  It was hard to teach him the gestures like waving bye-bye etc but it came around 15 months.  We live in a bilingual environment and my husband and I were talking to him in different languages.  When he turned a year or so, we found that his receptive language is not so good and we referred to some websites and thought we would change to unilingual environment and within 2 months he showed a lot of improvement.  He started to understand more and more of what we said and was responding to "hey, look here", "here you go" etc.  He started to respond to his name around 8 months or so and is consistent on that.  He gives a good eye contact and loves to play with us.  He also plays by himself many times.  These are my concerns about his development at this point.

1. He is not pointing to distant objects yet.  He can point to pictures in a book and can identify few basic shapes.  He can point to 2 facial parts of anyone (not his own face though) and also in pictures.  His this kind of pointing came in about 18 months and he did point to a distant object with his index finger only twice in the last 1.5 months.

2. He does not show any of autistic characteristics.  But of late, he is afraid of kids of his age (he had 2-3 experiences with kids pulling his hair, pushing him down etc) when they come very close to him or touch him.  If they are around he does not worry about it though.  He developed stranger anxiety around 17 months and was very social before then.

3.  One thing that bothers me is - when he gets up in the morning or after a nap, he does not smile at me or come to me for a hug.  He looks over my shoulder to get out of the room and goes straight to his toy box.  I have seen kids giving a smile and a hug and expecting the parents to cuddle them after a sleep.  This behaviour of his is very weird for me.

4. He was not having any single word by 15 months.  But now he has about 12 - 14 words.  He identifies his dad in a photo and can say "daddy" and can also identify his grandparents.  But he does not call me "mama" yet and also does not say that word when I show my photo.  Neither does he really call his dad as daddy but says the word when I ask him who is that in the picture.

5.  He follows simple commands like "shut the door", "vacuum the house" but it is tough to get his focus on one thing generally.  

6. He does not pretend play yet.  He does play with his vacuum toy but I do not think he pretends as though he is cleaning the house.  He says "hello" when he sees a phone but he does not pretend to talk with it.  

7.  My watchdog mind says that he is not always to looking at what I show him.  He does that sometimes and not always.


He was evaluated by ECI at 16 months and he had more that 25% delay in both expressive and receptive language then.  His evaluation of cognitive, motor skills were good.  My husband strongly believes that he has only a few months delay but he does not seem to have any disorder.  We need to note here that he has an autistic cousin.

The positive aspects of him are:

He has a good eye contact
Responds to his name
Has few words and use them consistently
Understanding is gradually improving
He loves music and can say few ending words of rhymes and songs.  
He imitates a lot.  He also tries to repeat a few words that we talk to someone else over the phone.

My question is - Does it mean that a kid is having a disorder if he/she does not point?  Do normal toddlers also sometimes miss to point or do it a little late?

Answer
HI

Great letter-very informative. The delays in speech need to be addressed at this point. I wouldn't deal with taking it to the next level until he is 24 months. If you still see the social issues, then have him re-evaluated. From your list of behaviors, there isn't anything that is screaming out AUTISM, so I wouldn't really be too worried. And some children never point. They just start talking.

So address the language delays for now and write me back when he turns 2.