Expert: Jene Aviram - 7/2/2010

Question
My nephew turned 3 in April.  He was born prematurely so we contributed a lot of his behaviors to that.  However, I am seeing things that are more and more concerning.  When he gets excited or very happy he tends to flap his hands or clap rapidly.   He has always has a "temper" but lately they have almost become rage like and are accompanied by his running in a circle while screaming.  He runs in circles any time he is upset which includes just the mention of a diaper change (although he is in the process of potty training).  He walks on his toes a lot - especially when not wearing shoes.  He has suddenly become afraid of everything - even when asked to do things he's done many times before he will cry and say "I'm scared".  At times he has great eye contact (usually on his terms) but if asked to look at you he only maintains eye contact for a few seconds.  He has also become self-abusive by either slapping himself in the face or biting himself.  He becomes obsessed with certain movies or toys - lately it has been Thomas the Tank Engine....he will not go anywhere without it and talks about him constantly.  He is very particular about what he eats - no vegetables or fruits...won't even try them and never has - even as an infant.  He has also had many major changes in his life over the past year so I don't know whether to contribute his behavior to that or if we should be concerned about something else.  What are your thoughts?

Answer
Hi Michele,

What a great aunt you are.  It's wonderful how you've taken the time to figure out how to help your nephew.  A lot, if not all the behaviors you mentioned are synonymous with sensory processing disorder.  Toe walking, inability to self calm, picky eating, flapping etc.  While the majority of people with autism tend to have sensory challenges, autism is really the hallmark of a social disorder.  I'm not sure if your nephew has any of these red flags as you didn't mention much.  Lack of eye contact is certainly one red flag, so is the inability to converse appropriately, lack of interest in peers, poor play skills etc.  Since you didn't mention these characteristics I'm not sure if they are present in your nephew.

I'd like you to do is download this article called "How do you know if your child has autism?"  This will explain exactly what you're likely to see with examples, and no technical language.  I think this might help make things a lot clearer. http://www.nlconcepts.com/autism-howdoyouknow.htm

Another good thing to do is the MChat.  This should really be done by the parents.  After you do the test and click "Should I be concerned?" it will tell you which questions were the most important.  http://www.nlconcepts.com/autism-mchat.htm

You are in a difficult predicament.  As much as you love your nephew, and as close as you are to his parents, it can place a real strain on your relationship if you are the bearer of bad news.  Tread really carefully here.  After reading the article, if you find a lot of commonalities, I would print it out and casually say to the mom that you were surfing the Internet and found this.  That it reminded you of your nephew a bit but are not sure.  And what does she think?

If your nephew simply has some sensory integration problems then a little bit of OT (occupational therapy) goes a long way.  The parents have to be the one's who want to take action.

When they are ready, the best thing for them to do is the following:
They should make an immediate appointment with the pediatrician and express their concerns.  They should write them down on paper so they don't forget to mention anything.  It's a good idea to take videos of any behaviors such as arm flapping etc.  They could take the article as well as the MCHAT along if it rings true.  They should ask the pediatrician for a referral to a developmental pediatrician, neurologist or child psychologist who specializes in childhood disorders.  The waiting lists are often long, so the sooner they do this, the better.  If your nephew does qualify for services they will be provided for him. Typically this is no cost to the parents.  Your nephew will also get all the help he needs when he goes to school as he will have an IEP (Individualized education Plan.)

I think you are an amazing aunt and your nephew is lucky to have you in his life.  Going through this process is not going to be easy for the parents.  It's emotionally draining and very scary to think that your child might not be perfect and something could be wrong.  They're going to need a lot of support, and I know they'll have that with you by their side.

I wish you and your entire family lots of happiness and success.

Jene Aviram
http://www.nlconcepts.com