Expert: Valerie Herskowitz - 1/23/2011

Question
QUESTION: Hello,
My son is 3.5 years old and has attended preschool since he was 15 months. He used to have frequent tantrums but it is much less now.  Seems to subside when we show we won't put up with it for too long. HE responds well to time-outs. Excellent gross and fine motor skills. Developed normally.  Speech is his only delay. Learned words well and always had a good vocabulary for his age, but the expressive speech is lacking - on the bad days only.  On his good days he speaks in complex sentences. Speech prosody and volume are normal. Easily distracted on good and bad days. He has seen a developmental pediatrician, who recommended more specialized person to study his behavior. He is sure my son has frontal lobe issues with attention and showed autistic behavior such as humming while he eats and poor eye contact etc, though he is not sure what to label it. So the Dev. Ped. referred us to a Developmental psychologist, because he does have speech delay, about 6 months to a year delay.  Not toilet trained, is hard to "reach" some days.  I agreed with the dr.'s concerns but the doctor saw him on a bad day.  He was hyperfocused on certain things in detail in the office, not attending to things I pointed out to my son until I said, "hey not over here, over here!" then he acknowledge what I was asking him and answer.  Some days he is so "present" when we think our concerns are overblown and he is engaged, speaks at his age level, goes to the bathroom (just pee), and other days he is inattentive, hyperfocused on something and we cannot get his attention, he has a blank look on his face, he does not want to play with the other kids in his class, but only on days like those.  Even his teachers don't know what to make of him. They make the some excellent engaged days when his eye contact is great and he is playing with the others, and the not so good days. He is like TWO different KIDS! He is always usually pretty flexible, meaning I can change plans and he will eat pretty much anything and try new ethnic foods. But he also likes to look at objects closely, and he is difficult to reach when he is in a trance like state.  No stereotypical stuff like hand flapping, perseveration or spinning, just quirky stuff and glassy-eyed look, and poor eye contact, when he does not hear us.  His formal evaluation is in a couple of months and he has a meeting with the speech pathologist tomorrow, but how she will interpret his behavior will depend on whether he is having and "engaged day" or a "disengaged day" he is otherwise a sweet boy and is tender and loving.  Loves affection and books, any cartoon that is on TV, puzzles, music.  Oh and when we are at the park he always seeks to interact with another kids his age and plays really well, up to 45 minutes with the kid sometimes, until when the child begins to demonstrate his better mastery of words, then my son starts to put his attentions elsewhere on the playground.  Just today we were at the Dr.'s office and he did not look at any of the other people or babies in waiting room but just looked up and stared at objects on the wall the whole hour we were waiting. And would not respond when I called him over and over, now would he look at me when I asked him to so that he could get his treat.  Needless to say this was a bad day where he preferred to read books than interact with his peers at daycare.   Help! Can you make any sense of this? Have you ever heard of this type of autism?  He definitely has autistic traits, just not every day.  Thanks you so much!

ANSWER: Hi Lyane

I know it can be really frustrating to have a child who has such drastic different behaviors. One day, you are sure there is a big problem only to change your mind when he has a good day. So-listen carefully to what I am going to tell you now. It is very important that you understand it and know that it is coming from a person that truly understands your feelings.Also, I am very objective and have no other reason to tell you this other than to help you.

Here it is...

It is not typical for a child to have such drastic changes in behavior from one day to the next. That alone would have me suspect that there is a problem other than just a language delay going on.

That said, you did express several major red flags:
1. used to have temper tantrums-needed intervention for this
2. has language delays both expressively and receptively
3. hyperfocuses
4. hard to get his attention
5. not responding when his name is called over and over again
6. has times when he prefers to read books rather than interact with other children
7. excellent gross and fine motor skills
8. humming when he eats
9. poor eye contact

Well, that's a lot of red flags. I also want to let you know that it is not uncommon for children with developmental delays to have good days and bad days.

Meanwhile, I don't want to diagnose your son. But he does seem to be exhibiting enough characteristics that would lead me to recommend that you pursue a formal diagnosis with someone. This way you can start the process of getting him so really good intervention to help him.

BTW-good job on helping him with his temper tantrums. You can see that with help, your son could go a long way. But he really needs help at this point.

You can feel free to write me back at anytime. I'm sorry to have to answer your question this way-but it's time for you to really get busy and get your son the help he needs

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

QUESTION: Hello,
I just wanted to update you. My little 3.5 year old guy has been diagnosed by three specialists (Developmental Pediatrician, Devel. Psychologist, Speech Pathologist) as being high functioning autistic disorder.  He will need an aid in preschool during free-play to help him learn how to integrate in groups. But i just wanted other readers to know that if I had been a stay-at-home-mom i would have never had noticed a problem.  It was only in the daycare setting that these issues became obvious.  He was great with other kids at the park, but not good at joining groups (AWKWARD Behavior) made eye contact But only when he wants something and not to share an idea or experience or to show something for the sake of showing it to you).  The symptoms were subtle and required and expert eye, but now that they explained the issues to me, and that they GET WORSE if they are not treated, with social rejection often leading to depression in later childhood/adolescence, if this sounds like you child too, get him or her help ASAP Please! Btw, his regular pediatrician did not any problems with him but refered us to specialists anyway. THANK GOD!

Answer
Thanks so much for the update. I admire that you really got on the stick. Early intervention really is the key. And I do have the problem with many pediatricians which is why I always recommend that you take your child to a developmental pediatrician if you have any concerns.

Again, thanks for writing back and for the inspiration for other parents