Expert: Valerie Herskowitz - 1/1/2011

Question
QUESTION: I am concerned about my 19 month old toddler but i don't know if i am overanalizing things. He opens and closes his fists, both hands for a couple of seconds, a couple of times a day, seems to be when he is tired or really excited.He also intermittently walks on his toes.He has about 20 words but he doesnt use them every day, he may say a new word and then i may not hear it for a week or so.However he does babble when he is playing with his cars and toys and makes driving noises with his cars.
He has met all his milestones on time,he has excellent eye contact, he is affectionate..play fights with his brother, lots of hugs  for us and extended family, he expresses joint attention,comes up to you with toys, takes you to his playroom, wants you to play pat-a-cake and peek-a-boo, points to things in books, will point to the light/pictures if you ask him,and spontaneously will point to things such as the bath running/badges on jumpers etc.He interacts well with others and children.He says "hi" to his cousins when they come to visit and runs off to hang out with them.He plays appropriately with his toys. He laughs at funny things. He eats an excellent healthy diet.If he wants a drink or food he'l smack hes lips or take you to the fridge, he tries to say milk and if you open the fridge, he will reach over get the milk and say"that"..
I am so worried about the sterotypie that i feel like i am going crazy,every time he does it i feel so anxious.. my g.p told me to ignore it and my family think i am overreacting. Please help..what do you think???
Thanks
valerie

ANSWER: Hi Valerie

Let's see what happens in about 3 months. If his language doesn't pick up a bit or if he continues to not use the words he has previously used, then I would be concerned. Since he is talking and seems to have good social skills, I think you should just wait a few more months before getting too worried. But... I wouldn't ignore anything. You are doing a great job by being aware of your child's development. Kudos to you for picking up on some of these behaviors. Hopefully, they will all even themselves out, but contact me when he is just a little less than 2 yrs. By then, he should have lots of words and be using them regularly. If that doesn't happen, then it will be time to start a process of evaluation. But let's just wait a bit-ok?

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

QUESTION: Thanks Valerie for your prompt reply. When you say you would be concerned if this speech didnt pick up do you think hes displaying autistic traits or that he may need speech therapy? Would you be concerned about the sterotypie?
Thanks again
Valerie

ANSWER: Kids do weird things sometimes and then the behavior goes away and everything is fine. But if his hand thing doesn't stop and he doesn't start to speak a lot of words, then I wouldn't necessarily say autism, but I would still say there are "red flags."

But his social skills as you described seem really good, so I am hoping that the hand thing just goes away and he starts talking a lot. Then you can relax.

Does he pull you to what he wants because he can't say it?  That's an important question I should have asked you originally

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

QUESTION: Hi valerie, Yeah i suppose he does..e.g if he wants to come up in your arms he will pull at your clothes and babble with his hands up and makes eye contact.If he wants to go out he will take you to the door and verbalize.I think he does understand what im saying because most of the time he will obey commands, such as open the door for me, close the stair gate, lift up your arms etc. To be perfectly honest at this point im so tired from watching hes every move if dont know what hes doing... Im going to get a paed to look at him and also visit my public health nurse because i cant keep doing this each day.Thanks again.
Hope you have a happy new year.
Valerie.

Answer
It seems he wants to communicate a little more than he can. When a child needs to pull his mom or caregiver to something he wants but can't communicate it, then he is slightly expressively delayed. You could try to bridge some communication skills for him until the words come by making a few picture cards of the items he wants and having him show you or point to what he wants rather than having him pull you to the item. Another predictor is if he can imitate what the word is that you are saying. Not perfectly, of course,he is only a little toddler, but if he tries.

You seem so worried that it would probably be a good thing to get an evaluation. But not by a public health nurse-call the public schools and ask where you can get an Early Intervention screening. They will set it up for you. Then qualified professionals will screen him in different areas. If they see anything that is worrisome, they will recommend a more complete assessment in that area.