Expert: Valerie Herskowitz - 6/1/2010

Question
Hi Valerie,

I am confused about some developments/lack of in my daughter. She will be 18 months in a couple of weeks. At times I have a strong sense that there is something relating to autism there and at others she seems perfect "normal". I have raised some of my questions with her pediatrician but was always told to wait and I never seemed to get a clear answer as to whether some of the things she is doing or not doing are red flags. I will describe my daughter, I will try to keep it brief. I should mention at this point that she was born with a malformation in one of her arms, which is not related to any syndrome.

Physically she developed well, crawled at 9 months, walked at 13, could sit on her own at 7, despite her physical limitations. She can go up the stair if she is holding on to the railing now. She started babbling as in infant and could say dada, mama and other one syllable words early on, although I am sure that she only recently (about 2 months ago) figured out that I am mama and my husband is dada. She can point to all body parts (on myself and also on herself) and knows to point to all our family members when asked. She can also imitate animals when asked (dog, chick, cow etc.) and can also imitate facial expressions (when asked "how does mama smile" or "how does daddy look angry"). She does point to things she is interested in or things that she wants, but I had to struggle to teach her to say "give" (or something sounding similar to it) when she is pointing at what she wants. My concern with her pointing is a) that she sometimes points with her entire hand, sometimes with a few fingers and sometimes with index finger; and b) that she usually does not look at us when she points at these things. Actually one of my major concerns is the fact that she does not like to look at people form a close distance (when being held) unless they are singing a song that she likes or playing pekaboo with her; but she will usually have good eye contact from a distance. She does not have any obsessive behaviors and does not seem to mind a change in routine. I did see her a few times walking on tiptoes and there was a time a few months back when I saw her spinning, but this is not something that is consistent. She likes to be around people and does not mind physical contact, in fact she is very aware of people and of what they are doing, she will sometimes track the conversation of other people (look at them while they are talking to each other). She is shy with new people and usually hides behind my legs or in lap when somebody approaches her. I say she is moderately social with other kids, although not crazy about them. When playing, I have seen her play pretend, she would pretend that her doll is walking or would try to feed her doll chereos or from her sippy cup, she kisses and hugs dolls and even made dolls kiss each other a few times. She understands basic instructions (close the door, give me a hug, give me a kiss, let's throw this in the garbage etc.) although she does not always do what she is asked. As for her language, she is very vocal that's for sure, she is always making sounds saying a few words that she can say and talking gibberish, however she does say only about a handful of words and seems to like to speak in one syllables. I have noticed that she is at the stage where she whines a lot and gets frustrated (although she rarely has major tantrums) and I think it's because she does not know how to communicate what she wants, because sometimes she will just get upset and won't be able to tell me what is wrong.

I guess my major concern is with the not so great eyecontact and the lack of speech. As I had mentioned, there are so many positive signs with her and I am just so confused. Can there be something else that can be the cause of lack of eye contact and communication problems that is not related to autism.

I also wanted to ask you, for your personal opinion on something: I hear that children or people who have high functioning autism can go through life relatively well and other people might never know that there is something "odd". I am sometimes very torn between pushing for a diagnosis and just letting things take their course because sometimes I believe that I will be creating more problems by putting yet another label on my daughter (given that she already has a physical disability) and that if she is able to go through life relatively normally (maybe a bit "odder" than others), maybe I should just let it be and not chase after a diagnosis.

Thank you so much for your answer in advance, I am so happy that there are some resources out there for us parents who are not getting answers from our pediatricians.

Thank you!

Less

Answer
HI Less,

Thank you for the very informative letter. There is no doubt that your daughter has a language delay. But the question is whether it is just a language delay with frustration because she isn't communicating well, or if she has a developmental delay. I do see some of the "slow to warm up: issues, but even so, that doesn't necessarily mean autism. I would have her checked out by a developmental pediatrician so see. And meanwhile, she needs communication skill training. There are many ways in which you can go about that: traditional speech therapy, home programs (I help create these if you are interested), or school-based therapy.

It is true that there are people with high functioning autism that do mix in the mainstream of society. They do seem a bit "odd" as you mention the word, though-usually that is. But in a world with lots of autism, I guess eventually, the society will get really used to people like that and it won't be considered "odd" anymore. (Maybe I'm being a bit optimistic).

Anyway, I am here if you would like to work on her communication skills. That is what you should be doing now. You can email me at anytime at: info@valerieherskowitz.com