Expert: Valerie Herskowitz - 8/25/2010

Question
QUESTION: My 25 month old daughter since she first started walking has had this habit of holding on to something (i.e. our coffee table) and putting her knees together, going up on her tiptoes and bouncing or jumping up and down. Now she seems to do it when she hears music but also when someone she knows (i.e. grandparents, aunts, uncles) come over to our home - it's like she gets excited to see them but maybe because she can't express herself she does this?! She also used to squeeze her knees,legs together as well when on the floor. Spoke to the doctor a while ago about it he thought both things could be "masturbation"...then he thought she was bouncing because she had a diaper rash. She stopped doing this thing for a short period of time and has now started it again. Seems like she bounces when shes bored as well. Also, since a baby she has rocked back and forth in the highchair (which she seems to have stopped) but still when she sits on the couch, she will rock back and forth...the last thing she does is she rocks from side to side, one foot to the other at times - that is how she dances but sometimes i will see her walking like that. I don't know what to think? Is it just a habit or can it be a sign of autism? On the other hand, she plays appropriately with her toys, seems to understand everything that we say, is starting to put words together, does not have crazy temper tantrums, eats pretty much everything, sleeps well (since about 2 months old, has not woken up at night unless sick), i think her eye contact is good, she loves other children...maybe she has sensory issues? or anxiety? She is terrified of doctors and sometimes when I take her to her grandparents, she will cling to me and not want to look at them until she is ready - but she only really does this with the grandparents. She doesn't seem to like her father - whenever he tries to interact with her, she turns away, hits him, etc. as well with her brother (but then he is always bugging her)...I need some advice. I'm thinking of going to her pediatrician again because I am driving myself insane researching this on the internet and not finding anything or reading too much about autism...also, when autistic children stim, is it easy for them to snap out of it? or is it like they're in another world? We can tell her to stop and she does most of the time.

ANSWER: HI Sonia

I know that you are really worried. Whenever our children display quirky behavior that doesn't go away, we should check it out. The problem that you are going to have is that there are no medical tests to determine if a child has autism. Don't bother going back to your pediatrician who already gave you a stupid answer (masterbation? diaper rash? I don't think so...)This time, research to find either a developmental pediatrician or psychologist in your area that has a LOT of experience with developmental issues.

I'm a little confused. You mention she can't express herself in the beginning of your letter, but then later on you mention she is putting words together. So my question is: does she speak a lot. She should have approximately 250 words that she is using now (and starting to put words together). Please clarify.

The good news is that she understands what you tell her, plays appropriately with other children, and has good eye contact.

The concerning issues are the obsessive need for rocking, jumping, etc and her extreme behavior with her father, grandparents,borther, and doctor. There does seem to be a sensory issue there-whether it is related to autism or not is not certain as she seems to have decent language (please write to clarify.)She seems to need proprioceptive input (look that up on the Internet and then we can discuss it)demonstrated by her behaviors.

You do need to look into this. but I think more importantly than worrying about a label, you need to give her Occupational Therapy which will help her with the issues she is having. There are also lots of things you can do at home to help give her proprioceptive input. I can help you with that.

So clarify the questions and we can go from there.

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QUESTION: Well I probably have to go back to my pediatrician to refer to me to someone else - it will probably be a neurologist that he refers his patients to with these types of concerns. I guess at the time that's what he thought it was (masturbation/diaper rash). In terms of language, she is starting to put words together...compared to others, I guess she speaks less. I don't know how many words she knows...I took her to a speech and language class for 6 weeks over the summer to give me some tips how to speak to her and I noticed when I actually tried, she seemed to pick up a lot more. However my son was the same way and he seems to be fine - but all kids are different. When she does talk though, she sometimes repeats what she says a couple of times. i.e. "What's that noise mommy?" "more milk"...I've looked that up on the internet as well and other parents say that their children repeat words over and over like a broken record...but my son never did that so I worry about that too. I looked up proprioceptive input but am a little confused about it...would she be considered under or over responsive or just sensory seeking? Hopefully some of this helps?!

ANSWER: It's not uncommon for 2 children in the family to display similar issues but one grows out of it and one needs therapy to learn. It sounds like you need to continue with what you are doing with your daughter in terms of the speech help as you say it is working. But that said, if she is language delayed, that adds something into the pot, so go ahead and have her checked out by the neurologist. Repeating over and over again certain phrases adds another dimension. Be aware that if you take each characteristic all by itself it may not mean a lot, but if you put them all together, there is more of an issue. So if you are on the Internet and researching just one behavior, it may say that it isn't uncommon, but if you add it to a list of several things, we begin to see patterns and that is when we are concerned. In your daughter's case, you describe several behaviors that seem unusual so that is why I think it is prudent that you visit the neurologist.

I understand your confusion about the sensory stuff. Children with sensory dysfunction are under responsive and over responsive at the same time. Certain things may cause her sensory system to go into overdrive, but then she may be sensory seeking other times.That is why the sensory system is out of whack. The rocking, jumping is sensory seeking behavior while the fear of certain people could be attributed to an over response to sensory stimuli. Perhaps your husbands voice bothers for example. Often children with sensory issues have difficulty transitioning to new things, new environments or new people which would explain why she has too "warm up" to being at her grandparents.

Let me know how it goes. If you want to do a private phone consult with me, just let me know

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QUESTION: Could the bouncing not be a habit though or something that she does to soothe herself? She seems to do it more at home but when we're out or with other people she doesn't do it at all or does it very little. I ask because I know that some kids rock themselves as a way to self soothe...I was reading that if these behaviours don't stop by age three, then it becomes a concern...apparently my sister in law used to rock when she was a baby/toddler and then all of sudden just stopped. Also, should I be telling her to stop or does that just make the problem worse. Sometimes it seems like a game with her. I will say stop and she will stop , look at me and laugh. I don't know...tomorrow my husband is going to talk to his doctor about the problem to see what he suggests.  Are you an SLP? If so, where should she be at in terms of language/speech? I see so many 2 year olds but hardly hear them speaking...maybe they just don't speak in front of others?! Based on my observations, her receptive skills are fine, it's just the expressive.

Answer
Hi Sonia

Children display behaviors that we consider typical, but when something is done in excess or in combination with other behaviors that are concerning, we start to put patterns together. Since you have described several concerning behaviors, you probably want to check things out with a specialist and then  keep your eye on things for the next couple of months to see how she progresses. If your daughter was just rocking occasionally, I would tell you to just wait and see if she outgrows it, but since you are telling me several things, my response is that you should have her checked out by an expert.

I wouldn't tell her to stop rocking or jumping. What we do is provide opportunities for more proprioceptive input and over time, the excessive jumping will hopefully stop on its own.

Yes, I am an SLP. A quick answer is that she should have approx. 250 words and be putting different kind of words together(which she seems to be doing from what you describe). But I don't know how large her vocabulary is. I do have a speech and language checklist that I can do with you to determine exactly where she is for speech and language if you want to do a private consult with me on the phone, or you can take her to see an SLP that specializes in young children. If I do a consult with you, we can also talk about proprioceptive exercises you can do with her.

Just let me know.