Expert: Valerie Herskowitz - 4/18/2010

Question
Hi Valerie

My daughter is almost 29 months old and I have concerns about her development and her possibly being on the autism spectrum.  

Just to give you some background our first concerns arose last year at about 18 months, our daughter wasn't pointing or talking and seemed ina  world of her own.  She would spend long periods of time (if you let her) outside in the garden picking up stones and throwing them over her shoulder.  We were very concerned and started speech therapy, saw a developmental paediatrician and started occupational therapy for some of her sensory issues.  Everyone said she was too young to diagnose with autism and that there wasn't enough there for them to make a diagnosis.

Fast forward one year, our daughter is completely different to last year.  She exhibits no obsessive behaviour at all, she has over 200 words, can string a few words together like 'more milk', 'let's go outside', 'pretty dress' etc, she can count to 20 forwards and backwards and knows and recognises the whole alphabet.  She likes books and playing with her dolls and toys and is happy to play by herself.  She plays with other kids at playgroups and always has a smile and hello for everyone.  She also loves to share stuff with us and play 'back and forth' games with us.  We are happy beyond belief at the progress she's made.  

However, I still cannot get rid of my gut feeling something is still not right.  I do not know if this is just a remnant of the fear we felt last year or whether its justified but I still feel that on a social interactive level something is missing.  If you ask her a direct question or use a simple command like 'pick up the cup' she won't do it.  Occasionally she will get a doll if you ask her 'where' the doll is (like a game) but if you ask her to just get the doll she won't.  If I ask her to pass me the cup it feels like the request just isn't registering inside her head. She also does not imitate often.  Physically she loves to climb and use slides and swings but her upper body strength is very weak and she cannot do something like pull her trousers up, not even partially.  The occupational therapist said she did well in her Peabody assessment but did mark very low on auditory and receptive information and did mention about trying to get her to learn to dress/undress more but we are struggling with getting her to use her hands to undress.  

She's recently been diagnosed with lactose intolerance and the change in diet has been very helpful. She had a hearing test last week and we saw an ear, nose and throat consultant who said she had a bit of liquid in both ears and reduced hearing in one ear but not enough to account for the issues I mentioned above. They will see her again in 2 months to see if there is any difference caused by the change in diet, otherwise they will look at putting in grommets.  

I don't know if this would really be relevant to what we see as her social and imitation delays but I thought i'd mention it.

I hope i've given you enough info and that its been useful.  What red flags should we be looking for in relation to aspergers/autism?  Am I just nitpicking now about my social and imitative concerns? I would really appreciate your input and opinion, thanks.

Eloise

Answer
Hi Eloise

I agree with you. She is still having issues as noted by your OT. It seems like the speech is coming along with the help of your Speech therapist, but there does seem to be an issue with the processing.

You need to keep going with the therapies. There is something going on or else she wouldn't have needed all the treatment. I'm glad you are doing the diet. Many children improve when dairy is removed from the diet. Gluten as well

I'm thrilled with all the progress. But I do agree that you are dealing with a child who has something going on. It's not Aspergers as these kids do not have speech delays. It does sound like something in the developmental spectrum.

Don't focus on a diagnosis right now. That may be inconclusive anyway. I would just keep up with what is working for her. She is really very young and the fact that she made so much progress is quite promising.

Make sure your speech therapist focuses on the language PROCESSING as well as the expressive component. I can help with that if you need it.

Take care and keep in touch!