Expert: Jene Aviram - 2/26/2010

Question
"I have been worried about my son since he was born in May. He seems to display some red flags of autism but my pediatrician is not concerned at this point. I just wanted to give you some information and see if you think I should be worried or not.


Cons....
-He will make good eye contact but for very limited amounts of time. He makes better eye contact when I am at a distance than when I am up close. He was never one to gaze into my eyes while nursing--I still nurse him and he does not look at me.
-Head circumference at birth was in the 25% (cone head), at 2-6 months it stayed in the 50%, and then at his 9 month appointment it jumped to the 90% and my pediatrician wasn't concerned. After I told him how worried I was, he has asked me to come back in 4 weeks for a recheck.
-He doesn't wave, clap, or point.
-No back and forth giving and taking of toys, food, etc.
-No mimicking or back and forth "talking" to one another. Does not try to mimic sounds at all.
-He doesn't babble. He can make a couple of consonant sounds ga and ka but he doesn't string them together or use them often .
-Very stubborn and very fussy when he doesn't get his way. He had bad colic as a newborn.

Pros....
-He seeks me out with a smile when I enter a room
-He loves to be held
-Very social---he loves getting attention from people
-Will bang an object on his high chair but he does not bang objects together.
-He is starting to try to clap--he will hold both hands together and move his right hand back and forth against his left hand. He does not move his left hand. He only does this whenever he wants to---never when I clap in an effort to mimic me.
-Makes vowel sounds and loves to laugh
-Responds to facial expressions---if I smile, he will smile back
-Beginning to understand the word no. He can tell by the tone of my voice. He doesn't always listen but he does stop and think about it and sometime sticks his bottom lip out.
-Has some joint attention and eye contact
-Wants me to sit with him while he plays....loves peek a boo
-Can sit unassisted, crawl, pull up, stand for short moments, and take a few steps.
-Can feed himself with his pincer grasp
-Pass objects from one hand to another
-Responds to his name 80-90% of the time

Do you think I should be worried at this point? The main things I am worried about are the jump in his HC and the fact that he hasn't said any words yet. Thanks for your help!"

Answer
Hi Kristy,

As parents we worry about everything.  It all comes with the territory.  Nine months is way too early to detect autism.  But I will say that at this point, it sounds like you have nothing to worry about.  Your baby is right on track and doing everything he is supposed to.  He should only start to point some time around 12 months.  He is too young to want to bring and show you toys.  That starts in a few months.  He should only be clapping by 12 months and it sounds like he's already getting there.

Not only that but this fine motor skills seem right on track too and these are typically delayed in most kids on the spectrum.  And you've said the most important thing which is responding to name and joint attention.  At this age we don't expect an infant to respond to their name all the time.  And it's great how you weren't on the fence about it.  Not only that but he seems to understand the word "NO" and seeks you out when you enter the room. All these are simply wonderful signs of typical development.  I wouldn't be concerned that he hasn't said any words yet.  He's not expected to.  He is making sounds and the rest will come.  Also keep in mind that all toddlers develop at different rates and as a total picture your baby sounds just fine.

A big increase in head circumference can be due to a number of factors and none of them have to equal autism.  Especially when the rest of the picture looks so good!  Has your son grown accordingly in weight and height along with the head circumference?  Your pediatrician is clearly not concerned and he is able to see the big picture. The study is really about disproportionate growth.  There are also many opinions that believe the study is not valid due to the number of kids they've tested and a whole host of other reasons.  So I definitely wouldn't panic about it.

I do think it's great that you expressed your concern and your pediatrician will follow up on it.  As a mom, you're doing a terrific job in advocating for your child.  Enjoy your baby.  I have a feeling that everything will be just fine.

I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com