Expert: Dr. Sharon A. Mitchell - 6/9/2010

Question
I have a 21 month old niece in my care, and I'm concerned about little things that just don't seem right.  She will stand in the middle of the floor and scream for no reason.  If you tell her to sit down, she'll say "No".  And if you make her sit down, she throws a temper tantrum.  She has very little interest in playing with other children.  Now at 21 months, my son was well advanced with his vocabulary.  So I'm not sure how many words, or sentences, she should be saying at 21 months.  her vocabulary isn't very high.  She can say maybe 10 or 20 words with prompting.  When you ask her if she has an ouchy, or try to communicate with her, she will just stand there as if she hasn't heard you.  Yet at other times she seems perfectly fine.  We can get her to bring us things, say please and thank you, and even interact with other children.  Could these odd behaviours be an early sign for autism, or am I just being an over protective guardian?  thank you in advance for your time with this matter.

Loretta

Answer
Hello Loretta,

She's a lucky little girl to have you as her guardian.

Let's start with the language questions you ask. According to the American Speech/Language/Hearing Association, between the ages of one and two a child should be expressing herself in these ways:

   * Says more words every month.
   * Uses some one- or two- word questions ("Where kitty?" "Go bye-bye?" "What's that?").
   * Puts two words together ("more cookie," "no juice," "mommy book").
   * Uses many different consonant sounds at the beginning of words.

Her receptive language also should be growing with skills such as:

   * Points to a few body parts when asked.
   * Follows simple commands and understands simple questions ("Roll the ball," "Kiss the   baby," "Where's your shoe?").
   * Listens to simple stories, songs, and rhymes.
   * Points to pictures in a book when named.

At this website link they go on to explain some of the things you can do to help develop your niece's language skills (http://www.asha.org/public/speech/development/12.htm).

Here is another view of what is considered typical speech and language development in a toddler, taken from the Child Development Institute's website (http://www.childdevelopmentinfo.com/development/language_development.shtml):

18 Months     

   * Has vocabulary of approximately 5-20 words
   * Vocabulary made up chiefly of nouns
   * Some echolalia (repeating a word or phrase over and over)
   * Much jargon with emotional content
   * Is able to follow simple commands

24 Months    

   * Can name a number of objects common to his surroundings
   * Is able to use at least two prepositions, usually chosen from the following: in, on, under
   * Combines words into a short sentence-largely noun-verb combinations (mean) length of sentences is given as 1.2 words
   * Approximately 2/3 of what child says should be intelligible
     Vocabulary of approximately 150-300 words
   * Rhythm and fluency often poor
   * Volume and pitch of voice not yet well-controlled
   * Can use two pronouns correctly: I, me, you, although me and I are often confused
   * My and mine are beginning to emerge
   * Responds to such commands as "show me your eyes (nose, mouth, hair)"

Kids Health has some more information on this at http://kidshealth.org/parent/emotions/behavior/not_talk.html

If you look at these descriptors and feel that your little girl is not where you think she should be, then speak to a speech/language therapists. Your doctor or public health nurse can tell you how to get in touch with you. Your local school district or hospital also could steer you in the right direction. In the United States you can search for a local speech therapist through this site's search engine: http://www.asha.org/proserv/ In Canada, try http://www.speechandhearing.ca/en/find-a-professional/find-a-professional-search...

It definitely does not hurt to start with a general physical to make sure that there are no health concerns getting in the way of your niece's development. At the same time you could have her hearing assessed. Sometimes young children have recurring ear infections the adults around them may be unaware of. An ear infection decreases the child's ability to hear. Without adequate hearing a child does not properly acquire the speech sounds of a language, hindering their ability to communicate.

Speech Therapists not only look at the way a child speaks but at communication as a whole. They have knowledge of child development including play as part of socialization. Many, if not most two year olds still engage in solitary or parallel play, playing alongside another child rather than interacting. That skill often comes in the three year old range.

First Signs is a website dedicated to spreading information about the early signs of autism (http://www.firstsigns.org/concerns/flags.htm). You might want to spend some time browsing the information available here. Their website includes an excellent video glossary where they show short snippets of typically developing children and kids with autism. You need to register in order to watch these informative videos but it's free and there is no obligation. You can take a look here: http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

This next link is to a quick, free, online screener you could do. The results will not indicate the your niece has or does not have autism; it's results are simply more information that you could take to your doctor. http://www.childbrain.com/pddassess.html

Since you have experience with other children in the "terrible two" stages, you are familiar with the burgeoning independence streak and the "No!" and the tantrums that can erupt. Yet, you are feeling that something is different about your niece.

I would suggest that you go with your gut instincts and check this out. What is the worst that could happen? You could talk with some professionals who see this little girl, assess her skills then reassure that her development is on par with others her age. You'll be relieved. On the other hand, they could see a problem. In that case, then you will have done your part in helping this child by seeking help quickly. Intervention at this young age can pay big dividends in helping bring along her skills over the next few years.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD candidate