Expert: Jene Aviram - 3/22/2010

Question
I have a 19 month old toddler, who seems to have hit all his milestones more or less on the mark. He started crawling at 8 months, took his first steps at 11 mo. and started walking confidently by 13 months. He has a 50+ word vocabulary (not all could be understood by strangers), recognizes most objects, can finish the last one or two words of every page/line of his books (Sandra Boynton books) or nursery rhymes (he always says "star" after twinkle twinkle little.." , "are", "high", "sky" and so on.)

My concern is that he is not very affectionate. He will not hug or kiss me or his mother but readily hugs and kisses other kids in his playgroup/nanny share. He doesn't point with his index finger but rather points with his thumb and index finger touching. Finally, he makes limited eye contact when we ask him to look at us. But he will look you straight in the eye if you are a stranger, or if he wants your attention. He has just started to "pretend cook" where he gets out some pots and ladles and "cooks" oatmeal, but that is the extent of his pretend play. He prefers to play with puzzles and shape sorters, which he is very good at. Should we be concerned and have him looked at?

Answer
Hi,

If you are concerned then yes, you absolutely should get an evaluation.  It costs nothing since your son qualifies for early intervention.  But even more important, if your son needs help you will get it.  And if he doesn't, well, peace of mind is a wonderful thing.

You haven't given a lot of information which makes it pretty hard to determine what's going on.  It's great to hear that he has a lot of words and it clearly sounds like he has good comprehension.  Even though he is pointing with thumb and index finger, it's more the reason he's pointing that matters.  Is it because he is showing you something?  Is it because he wants something?  This is what we look for in typical development because it shows us social interaction.  

Eye contact is another reason that signifies social connection.  What about when you don't tell him to look at you.  Does he look at you when you speak to him.  Does he look at you when he wants something?  This is what we want to see.

Regarding the pretend play, I wouldn't be too concerned.  There are lots of kids that indulge in endless amounts of pretend play and others that play imaginative games a lot less.  It's important that your son is playing appropriately with toys and he does.  He plays with shape sorters, puzzles and indulges in some pretend play so I don't think this area is a concern at all.

I'd like to recommend a few things that will help you.  Firstly, take the MChat.  You can find it here.   http://www.nlconcepts.com/autism-mchat.htm

You can also download this article called "How do you know if your child has autism?"  This will give you a very good indication of what you're likely to see if your child has autism. You can get it here http://www.nlconcepts.com/autism-howdoyouknow.htm

Contact your pediatrician and tell him you're concerned about your child's development.  Ask him who to contact for an evaluation from early intervention.

This way you'll have all bases covered.  You sound like an incredible parent.  I wish you great luck and success.

Jene Aviram
http://www.nlconcepts.com



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