Expert: Valerie Herskowitz - 4/28/2010

Question
QUESTION: Hi Valerie

I have had concerns for my 22 month old daughters development from an early age of 11 months. Her first unusual behaviours that was most obvious were: resisted cuddles, refused to be consoled when upset/hurt, no babbling and repetitive flapping/twirling hands. I seek a behavioural paediatrician at 12 months and was advised to wait and see for 6 months. At her 18 month review with the behavioural paediatrician, he advised that she needed to be assessed for Autism mainly due to her lack of language development, sensory issues, inappropriate age play development and her hyperactivity.

We booked into an Assessment Centre where she had the ADOS/ADI-R assessments at 21 months. The outcome is: she does present some peripheral features of Autism (such as reduced directing of vocalisation to others, limited nonverbal behaviours such as gesturing and pointing, lack of social reciprocation during non-physical play tasks), she demonstrated good distal eye contact however has limited proximal eye contact. She initiated and responded in physical play on several occasions (tickling and jumping games).

The primary concerns at present is her significant receptive and expressive language delay, reduced attention for cognitive tasks, multiple sensory issues and her repetitive toe walking. At present she is sub threshold for a diagnosis but at the conclusion of 6 months of Speech Therapy and Early Intervention and 2 days per week of childcare, she will be reassessed to conclude whether a diagnosis is still warranted.

She has made some progress in some areas such as engages in cuddles occasionally, she is learning a couple of signs, her receptive skills is starting to emerge and she is attempting to say two words (is-this/sh-shoe). She is on the GF/CF diet due to her major GI issues and has now ceased flapping her hands repetitively. It has also come to my attention that she lacks emotional empathy when someone is crying or upset. She also demonstrates sensitivety by covering her ears and tantruming when another child is crying or screaming.

What do you think? In your opinion, should she have received the diagnosis. She has not had any other assessments besides the ADOS and me the ADI-R questionnaire. She will be having a language assessment within the next two weeks. Do you think she requires a more thorough assessments. I do apologise my letter is extremely lengthy however I felt the need to try to explain as much as possible.

I truly appreciate your time and effort.
Thank you and kind regards
Julie

ANSWER: Hi Julie

Thanks for writing and for all the information.

From your letter, it appears that your daughter does have all the requirements for a diagnosis of autism. She has the language and sensory issues. I think you are on the right track with that diagnosis.

My concern lies more with the language therapy that you are receiving. I think she could be doing a whole lot more than what she is doing. That would be my issue to be honest. How many words does she speak at this point. Let's start there. Feel free to write me back with that answer.

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

QUESTION: Hi Valerie

Thank you so much for your very speedy response, I truly appreciate your advise and validation. I also have concerns regarding her non diagnosis and her language delays for a couple of reasons. Firstly I would like to advise that I live in Australia and from all the research I have done over the past year, I have learnt that the services and resources are somewhat different. Here in Australia, until my daughter receives the official diagnosis, she is only eligible for fortnightly half hour ST sessions and fortnightly hour Early Intervention (child psychology) sessions through our Government funded programs. If she is diagnosed at any time now or in 6 months time, she will then be eligible for the 2 year ($12,000 grant) for intensive therapies and treatments.

I have to admit I am very concerned that her fortnightly ST will not be sufficient for her significant delays. At present she is only babbling (sounds more like under 12 month old), she is babbling Mama but isn't directing it at me. She does however understand when someone says to her "where's Mummy" because she looks in my direction and has only began to occasionally point to me but she does not say it to address me. She isn't saying any other words although she attempts to say this and shoe.
Her receptive skills are emerging but still isn't at her appropriate age level.

I have also noticed over the past week that she has finally got the "dog" (woof) sound and gets extremely excited when she sees a dog. I'm very surprised how well she is doing with the sign language, she demonstrates one sign consistently and two other signs are emerging in a matter of 2 months. I'm kind of getting the feeling she prefers to sign rather then speak but in any case she is finally beginning to communicate her needs.

I have just recently learnt of an organisation (not to far from me) that will assess her language skills and other areas too. I'm not sure if they will implement the diagnosis immediately but they have a team of different special educators and therapists.

Another issue I failed to mention previously is with her ADOS assessment, I have been advised that she is very clumsy and it is due to gross motor delays. I did suspect that she had gross motor delays as she trips and bumps into things a lot and isn't efficient with using a fork/spoon as yet. I have also noticed that she doesn't seem to move her tongue around in her mouth properly when she is vocalising her speech sounds and attempts. I had to teach her how to blow just recently with a musical recorder.

I definately would like to point out that the GF/CF diet has helped her immensly, not only with some of her repetitive behaviours but also with her sensory issues. She still does have her sensory issues and the occasional unusual behaviours but not like how it was before the GF/CF diet.

Thank you and again I apologise for the lengthy letter, as you can tell I try to be a very thorough parent.

I sincerely appreciate your time.
Kindest regards
Julie

Answer
HI Julie

Yes you really are a very through parent!

I do think you are going down the right path in terms of getting her services and the diet. Hopefully your speech therapist is doing the right things as well by providing augmentative communication paths for her to communicate. I see you are doing sign language which is wonderful-you may want to check out my web class on sign language and I have several others on increasing verbal productions and communication strategies for low verbal children. You can email me if you want the specifics at info@valerieherskowitz.com

Keep in touch!