Expert: Jene Aviram - 8/11/2010

Question
QUESTION: My son is 22 months old but his language development seems
far behind in comparison with other kids I know his age.  He
does have a number of words (maybe 35 or 40), but he mostly
babbles excessively and often.  He does use a few words such
as juice, milk and up to get what he wants.  He is almost
always able to communicate his needs through physical means
and crying. He understands a number of basic simple
commands.  He is very affectionate, but only in the past two
months has he come out of his shell with new people.  He now
behaves in what I would consider to be a typical fashion for
kids his age with new people.  Beginning at as young as 3
weeks of age he would not let anyone hold him except his
parents and the Parenting Center diagnosed him with acute
stranger anxiety.  He suffered with colic and moderately
severe acid reflux.  It seemed as though he never slept.  
Today, he is over those afflictions but I am concerned about
the lack of language development.  We read daily and try to
coach him with language.  He has never taken to waving and
very rarely says "hi" or "bye", but he does laugh and smile
a lot and enjoys being tickled, playing chase and peek-a-
boo.  He is very physically active.  People have always
remarked that he seems to be observant/acutely aware of his
environment.  He is very curious and he typically has good
eye contact but when he becomes engrossed in activity he can
be very hard to reach.  He is very intense and throws
tremendous long lasting tantrums - usually numerous times in
a single day.  This usually happens when he doesn't get what
he wants or when he is tired.  I've read things in the past
about a connection between head circumference and autism.  
His head has always been in the 99th percentile, but the
rest of his body is in the 95th percentile.  He will be two
in five weeks and I can't imagine that he'll meet the
language milestones set forth by his pediatrician.  Nor do I
think he will meet the "two phase command" milestone in five
weeks, although we have never worked on that before.  He
frequently lines up his toys but he also creates big messes
and seems ok with the messes and he actually seems to enjoy
changes in his routine and likes very much to get out.  He
prefers to always have a toy in each hand no matter what he
is doing.  He is fascinated by trains nearly to the point of
obsession.  Should I be concerned?

ANSWER: Hello there,

You mentioned a lot of wonderful things about your son and he sounds delightful.  It's great how he loves to play peek-a-boo and he clearly has a great bond with you.  

You did mention some red flags.  That's not to say that your son has autism, but I always err on the side of caution.  That being said, it's worth getting a comprehensive evaluation as this is the only true way of giving you a clear picture.

Let me tell you my thoughts.  I'm not too concerned about his speech.  He has some words, he can ask for what he wants and he is able to express himself.  My bet is that his words will come in due course.  If he qualifies for some speech therapy, well that will be wonderful and will certainly speed things up.

A couple of the red flags you mentioned include not participating in greetings such as waving, and saying hi and bye.  Another one is the way he gets engrossed in an activity and it's hard to break his attention from it.  The same holds true for his "fascination with trains nearly to the point of obsession."  Tantrums and not being able to self calm is another concern.  Lining up toys is another one.  Children with autism don't line up toys all the time, but they often enjoy doing it frequently, or with a few specific items.  Granted, children with sensory processing challenges do the same thing.  That's why I recommend getting a full evaluation.

If I were in  your shoes, this is what I would do:

1.  Go to this link and do the MCHAT.  After you've done all the answers click "should I be concerned?  Show me now"
http://www.nlconcepts.com/autism-mchat.htm

2.  Go to this link and download "How do you know if your child has autism?"  It will explain a whole lot of behaviors you're likely to see without any technical words.  You'll either feel relieved when you read it or want to make an appointment for an evaluation.
http://www.nlconcepts.com/autism-howdoyouknow.htm

3.  Your son still qualifies for early intervention.  Getting services (which are typically free) are a lot easier if you start now.  Call you pediatrician and ask him who you can call for Early intervention.  Tell him you want an evaluation because you have concerns.  

4. Make an appointment for an evaluation.  Write down a list of all your concerns.  Video tape your son doing specific things that are hard to explain.  Trust me, once you get that evaluation, you forget all the things you wanted to mention.  And a list of your concerns is the best way to get an accurate picture of what is going on.

5.  Keep doing what you are doing.  You sound like a phenomenal mom.  You read to your son, you play with him and love him deeply.  You're a great advocate too and he's lucky to have you.

I wish you only the best, with great success and happiness.
I hope this has been of some help.

Jene Aviram
http://www.nlconcepts.com

---------- FOLLOW-UP ----------

QUESTION: Thank you.  We did the "should I be concerned?" evaluation and he came through fine with no indicators.  But...we also did the "How do you know if your child has autism" behaviours link and it was as if the author had spent a day with my son for the majority of the behaviours listed.  We are scheduling an evaluation.  My hope is that, if there is a problem, that it is on the minor end of the spectrum and very treatable at this early age -- especially since he did so well on the first test?   I know you can't diagnose him online but I am just sick with worry.

Answer
Firstly, thank you for such nice feedback :-)

Secondly... my heart is with you now.  I know what you're going through.  And you're not alone.  You wouldn't believe how many parents at this very minute feel the same anguish and uncertainty that you do right now.  Raising kids makes our world complete, but when when we're facing a possible development delay, it tears us apart.

You are correct.  There is no way one can make a diagnosis on line.  But let me assure you, even if your son does get a diagnosis, and please take note of the "IF" because I don't want you to think that I'm suggesting he will, there is no way your son would qualify as having severe autism.  He has some great strengths.  He is interactive, he can request his needs, he comprehends etc.  

Please don't lose sight of the fact that your son today is exactly the same delightful kid as he was a month ago, and as he'll be in a year from now.  A label can never define the beautiful person that he is.  It's possible that he has no developmental issues, but even if it's a speech delay, sensory processing challenges or the mild end of the spectrum, YES... it is very treatable.  And the sooner you begin, the sooner early habits are changed.  So keep your faith.  You'll be amazed how your son will grow and blossom as he matures, and if he qualifies for services, well that will just speed up the process.

Sending you strength and lots of good vibes.

Jene Aviram
http://www.nlconcepts.com