Expert: Jene Aviram - 5/24/2010

Question
Keep on worrying about autism, in particular regressive autism, my 2 twins (ID boys).  Now 18 months old, consistently say 6-7 words each (mama, dada, dog, uh-oh,  ball (incorrectly), down) and about 5-8 other words- very inconsistently.



I want to refer them to EI for speech referral and evaluation but am getting strong disagreement from my spouse.  I tend to be anxious/worry a lot, and since we had a developmental pediatrician observe them at 15 months who said their behavior was normal, who told us ‘not to worry about it until they’re 2’ my spouse refuses to even entertain the idea that they might need help until they’re 2. For speech or any other concerns. Our regular pediatrician is also not worried because they have the minimum 6 words and they passed her ‘screening’ questions at 18 month appointment.    I'm asking because I wonder if it is just me worrying to much, or if there is concern that might be worth an all-out fight w/the spouse.  My spouse is convinced my concern is just anxiety.



Reason I am asking you is I am so worried about regressive autism, and worried about some things the boys (in particular twin A) has been doing recently.  I hope you can give me an opinion on if you think they sound fine and maybe it is just me being over-anxious (and put my mind at ease) or if I should go against my spouse and 2 pediatricians and push for evaluation through EI anyway.



One question 1st is  I’ve heard is people rarely develop autism after they develop pointing.  Is this true?  Is this true for regressive autism, as well?



Anyway, find below concerns.

Twin A-I caught him arm-flapping while he was relaxing having a bottle two weeks ago.  I’ve only seen this once, I haven’t seen it again and neither has spouse or daycare, but his weekend he hit his head against the wall a few times while he was playing, and sometimes he’ll spin himself around in a circle when playing (not all day or anything, while running round for a few seconds, etc.). He lines up his toy trains together in a chain, but I don’t know if this is concerning or not because these are ALL magnetic trains that are SUPPOSED to be linked up together (and his dad has shown him how to do this repeatedly) and after he’ll push them back/forth, but sometimes he will study them for a while 1st.  This is the only thing I’ve seen him do lining up for (I haven’t seen him line things up that aren’t supposed to be linked together).  He doesn’t do this for hours or anything, either, just while playing with his trains. He used to be very responsive and almost always turn around and look and smile when I called his name, he hasn’t been doing this consistently the last few weeks, especially if he is playing he will ignore me if I call his name.  He will seek out eye contact for other things? When he's crying, wants something (pointing) and not giving it to him right away, etc.  Twin A has only a few times waved bye-bye not at all recently.



Both twins clap but not really like copying what we do….  Sometimes if I do, or if I ask them to clap  or if they’re happy. But not like I do than they do.. they have to be in the mood to copy.  I don’t know if he copies facial expressions anymore.. he always used to smile if I smiled at him, but not the last week or so.  They sometimes will ‘give us 5’ if we ask them to…  but sometimes we have to remind them/show them how to do this 1st.



Twin B is very similar but will wave bye-bye- sometimes.  His eye contact is still been great.  However, he does arm flap when he gets a stimulus to something exciting…  seeing a dog, etc.  Only time he does it.  Daycare says he does it often.  Developmental pediatrician (but again, the one who said not to worry about anything until they’re 2) isn’t concerned as with him it is always a trigger for something exciting.



One thing both of the twins have been doing which, I don’t know why it worries me which concerns me on gut level I can’t explain, is if they want us to do something (put a track together for the trains, fix a broken toy,etc., or want us to read them a book) they will come up and put the toys in our hands and grunt. If we don’t take it they’ve grabbed my hand and shoved the item in my hand. They also hand us toys they want to share or show us. I don’t know if this is concerning or normal?



So here are what I think is good/positive… They do both point but they don’t usually look at us when they point, but they do sometimes.  They point both for things they want (a dropped toy, spoon, etc. anything out of reach, food they want) and when they are interested in something they’ll point at it and make this odd giggle or grunt until we say what it is.  Lately, twin A has been doing this a lot again recently.  He’ll point at everything he’s interested at above eye level, and sometimes will point again to the objects after he’s gone through the room.  He gets really excited if I bring him up so he can touch the object he’s pointed at.  They will both look at objects that I point at.  They can both feed themselves well with spoons.  They will try to feed eachother and other people with spoons, try to share food and share toys (they toys with adults, not eachother…. Lol).  The only ‘pretend play’ I’ve seen is moving trains and cars and saying ‘brrrr’ or ‘chugchugchug’, they pretend to talk on a phone (hold toy phone, or something of a similar shape up to their ear, sometimes babble with this, sometimes not) and pretend to eat/feed out of empty containers, complete with ‘mmmm’ sounds. They are both very affectionate.  Twin A give hugs often, Twin B gives hugs rarely, but they both climb on laps and like to cuddle, etc. They have recently been having lap-climbing fights… one will climb on my (or another adult’s ) lap, and the other one will want to sit on that same person’s lap, too.   They do have stranger shyness (not anxiety) and don’t like to be alone in a room. If I move from the kitchen/livingroom,etc… I am often followed.Daycare says they show interest in the other children.  Both are walking, climbing, etc. Both usually seem to understand what we say, but I wonder about twin A a little bit recently.  Twin B shakes his head 'no' but doesn't say it, Twin A says 'nonono' when really upset but doesn't shake his head no.  Neither say 'yes'.


I also read that "Uses one catch-all sound or syllable to name most things" is a sign a child needs speech therapy, or saying a word once and then saying it rarely after this.  Do you know what this is a sign of/could be a sign of?  The last week, twin A has been saying SOME of his 6 words, (mama, oh-oh, dog, down ball (incorrectly)) but is saying 'dooow' for almost everything, including things he knows what they are.  ALso, Both boys will say a word correctly and then not use it again for weeks or longer.   I read it could be echolacia to repeat a word....  if I ask Twin B if he wants milk or juice, he'll tell me 'juice', or if I ask if he wants to go see Miss Stacy (daycare) he'll repeat 'Stacy' then put down his drink, and walk over to where we get ready to leave and lift up his arms....  is this concerning/echolacia or potentially normal?


Thanks so much in advance

Answer
Hi Josephine,

I'm impressed by your detailed post.  You are clearly a very thorough person - and a wonderful advocate for your children.  It's tough being concerned about our children's development and if spouses have differing opinions it makes it that much more challenging.  Your husband cannot make you relaxed as much as you cannot make him anxious.  In my opinion, peace of mind is a wonderful thing and if you can get that taken care of by an evaluation, then so be it.

Let's discuss your concerns for a minute.  In answer to your first question, yes - children who point can have autism.  BUT that does not mean I'm suggesting your children are on the spectrum.

Autism is hallmarked by a social disorder and these are the things we really need to look at when we are concerned a child might be on the spectrum.  The pointing in itself is not so important as the reason behind it.  Toddlers point because they want others to see what they are looking at.  It's a form of communication where they are sharing.  Your children seem to do this quite regularly.  They also bring toys for you to see which is another form of sharing.  They make eye contact for the same reason - to see your expressions, and what you're thinking which is great.  When you leave a room they often follow you which is also wonderful.  You said a lot of other great things too.  They share their toys, the do have some form of pretend play, they use gestures and they use utensils appropriately.  You have many reasons to feel good.

That being said I do think that your children would qualify for some services such as speech.  They should be using their words and increasing their vocabulary at this point.  Some of the grunting that you're seeing could be related to this.  I would certainly start modeling the desired behavior.  If they shove a book in your hand, look them in the eye and say "Read."  If they don't repeat it, catch their attention and repeat "read."  Once they say it (or give it their best shot) lavish the praise, pop them on your lap and start reading right away.  They've already shown that they're fast learners and I think they'll pick up on this right away.

I'd like to mention the flapping behaviors for a minute.  I was surprised to hear that the developmental ped said he's not concerned about flapping because your child only does that when excited.  I wonder if you understood him correctly?  Most children who flap only do this when excited, autism or not.  Again, I don't think your child has autism - flapping is a sensory behavior.  So is spinning, sensitivity to noise, aversion to textures etc.  Some kids grow out of these behaviors and some need a bit of OT (occupational therapy) to help them along.

Have you ever done the MChat?  Please go to this site and answer the questions.  Once you're done it will tell you if you should be concerned or not.   http://www.nlconcepts.com/autism-mchat.htm

Another article you will find helpful is called "How do you know if your child has autism?" It explains exactly what you're likely to see without any jargon. http://www.nlconcepts.com/autism-howdoyouknow.htm

Lastly, if I were in your shoes I would seek an evaluation.  However, I don't think it would matter too much if you waited a couple of months before you scheduled it if that's what will give you peace in your home!  But if you let your husband know that he's probably right but you would feel so much better to have some peace of mind, then perhaps he wouldn't mind too much.  Just to reiterate, your post does not strike me as two children with autism, but rather as two delightful kids with some mild delays that can easily be helped.

I think it's great that you're so on top of things.  What a proactive mom!  I wish you great luck and success.

Jene Aviram
http://www.nlconcepts.com