Expert: Jene Aviram - 3/19/2010

Question
QUESTION: Forgive me for the long, rambling question.  When I'm nervous I tend to do that.

My son I almost 21 months old born June 29, 2008.  I am a little concerned about him.  He doesn't seem to be talking much. I've counted about 20-30 words he uses, but not all the time. He is very vocal and always babbling, but his actually words are not very many.  He tends to point at everything all day long and say "this" or "that".  He uses "go" a lot to mean "go out", or "do it again" or if he wants his cars to "go".  Those are his three most common, but he does have others (bubble, book, bath, ball, thank you, dada, mama, baba (bottle), tickle, uh oh, no, bye bye (sounds like da da or dy dy though), amen, yay, banana (nana))those ar the words he uses most often, though their are some more he says occasionally. What got me worried was that he is always pointing and saying "this" or "that" I didn't think anyting of it till I saw a video on Autism Speaks with a boy saying "what's that" constantly.  
Anyway, aside from that I worry about his imagintive play...he will play with cars appropriately  (never spins wheels) just pushes them and makes vroom noises, the same with his toy train.  He used to hug his dolls, not so much anymore, he'll pretend to feed them if I initiate and only for a minute.  He does like to pretend everything is a phone.  He loves to play with our house phone.  
He seems to have good eye contact at least with me (and the pediatrician and others have never been concerened about this), my husband doesn't think as much with him.  He never wants to be alone.  He'll play by himself for a bit, but prefers us and pulls us by the hand (not to get us to get him something), just so we'll be with him - if we are both home he'll take one of each of our hands. He likes to throw the ball back and forth, he loves to be chased. He'll sit and read with you and point at pictures he knows if we name them or point and ask "this" or "that".  He seems to understand.  If I tell him go get the ball, he will leave the livingroom go into his bedroom and open a drawer to find it.  He does reference us if there is a stranger, always happy to see us after picking him up from sunday school.  He takes a few minutes to warm up but has been fine with babysitters.  He loves to listen to music and dance.  He will check to see if we are looking when he is playing and usually won't go to far from us (if I'm in the bathroom he will usually play right outside the door till I come out).  He is always laughing and smiling.  He is very adaptable, we've moved states since he was born and been on 5 trips and still always slept pretty well even in different time zones.  He does do this stomping feet arm flapping thing when excited and says "ooooo".  But it's not all the time.  So I guess I'm mostly concerned about speech and lack of imaginitive play. He doesn't seem to answer yes/no questions, if you ask him this or that he'll point to whichever one he wants.  Do you think I have anything to worry about?  I did call early intervention, but it will be a week or two before I hear anything.  Thanks for your time!

ANSWER: Hi Anna,

I'm not going to keep you in suspense.  One can never diagnose over the Internet and only a comprehensive evaluation can tell you the real story.  But I will say that by what you've said in your post, you do NOT have to worry about autism.

Let me explain that a little bit.  The hallmark of autism is really a social disorder.  You have described so many social characteristics in your son that are typically absent in children with autism.  For example, he's pointing at everything.  He like reciprocal play such as throwing the ball back and forth.  He plays right outside the bathroom because he's waiting for you.  He references you if there is a stranger.  He checks to see if you are looking at him and doesn't venture far away.  That's a lot of stuff!  

I would just like to ease your concern about the Autism Speaks video.  I did not see the video you're referring to but many children with autism repeatedly ask "What's that?" when they KNOW the answer.  And often when you tell them, they'll ask you right back again "What's that?"  The function of this behavior is very different to your child pointing and saying "this" or "that."

I'm really glad that you called Early Intervention because your son might need some help with moving his speech forward.  He might qualify for speech therapy which will help in this department.  But I don't think it's anything to stress over.

To ease your concerns even more, you can take the MCHAT which you'll find over here http://www.nlconcepts.com/autism-mchat.htm
You can also download this article called "How do you know if your child has autism?"  My guess is you won't be able to relate to it.  You can get it here http://www.nlconcepts.com/autism-howdoyouknow.htm

You're doing all the right things.  Your son is very young and you're getting him evaluated early.  I know it's hard not to worry, but I truly don't think you have much cause for concern.  I wish you great success and I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com

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

QUESTION: Hi, sorry to bother you again, but we had a disturbing visit from early intervention.  The speech therapist was quite fine with his language development, however the other early intervention coordinator said she was "on the fence" about wanting to do an assessment.  In the end she decided to do one next week - she said while he has some good skills, he's missing some.  She said he seemed to have poor problem solving skills, not that good joint attention, and not good at imitating.  I'm just confused because I never really noticed these issues.  He's always seemed quite good to me on these things. And she wouldn't speculate on what could be the cause or what it means.  The few things she seemed concerned about were him wanting something and looking at it in her hand and not at her.  He wouldn't turn a container upside down to get a cheerio out...not copying her with stacking blocks.  However, after she left he wanted a ball and looked at me and pointed at the ball for it.  He looked at light that was making noise in the hallway pointed at it and then at us...is that not joint attention?    I stacked 3 blocks on his tray and then he stacked 4.  I put a ball on my head, then he put a ball on his head...so he seemed to imitate me just fine. He wanted a music box on his dresser and opened the bottom drawer stood in it to reach it...I thought that was pretty good problem solving.  But who knows.
So, I'm wondering, if he is delayed in these areas...are these autistic characteristics or could it just be he is a little behind...and is it possible that he was simply tired and wary of a new person.  He doesn't always take to new people right away and we woke him up about an hour earlier because they were coming early - so all this was happening shortly after his normal wake up time and he definitely did not want to get up this morning.  Also, my husband and I have wondered if he has an iron deficiency.  We looked at what he eats typically and due to his lack of veggies and very little meat we know he doesn't get nearly what he needs.  Could an iron deficiency cause things like this?  I'm just shocked because when he was 12 months they were here and said he had great joint attention...so I don't understand how a few months later he doesn't...the only thing that changed is he is off of iron fortified formula.  Anyway, not asking for a diagnosis or anything.  We are also seeing his pediatrician next week...I'm just wondering your opinion. Thanks so much!

Answer
Hi,

I know this freaked you out but you're actually very lucky.  She could have ended the evaluation right there or decided to extend it.  Instead, she's coming back on a different day.  This will totally rule out your concerns about how your child's mood affected the evaluator's opinion.

Not having joint attention and not imitating is often associated with autism.  Even though he didn't do the activities when she was there, it's great how he did it with you.  Also, an iron deficiency will NOT produce the behaviors you are concerned about.

I know you're afraid to get a diagnosis.  But I can't stress this enough - it's NOT about the diagnosis.  Who cares if she gives your son a diagnosis or not. I've seen countless children get a diagnosis because the evaluator was on the fence only to lose the diagnosis later on.  Even IF you got a diagnosis, that's just a license to get services for your child.  You don't have to tell anyone about it.  But if your child needs help the services will push him forward.  Any by everything else you've said, I'm pretty sure your son will learn fast and not need them for long.

Only a comprehensive evaluation can tell the full story. But from what you've said about your son I think you have a pretty good chance that all will be OK.
Good luck and let me know how it goes.

Jene Aviram
http://www.nlconcepts.com