Expert: Dr. Sharon A. Mitchell - 10/24/2011

Question
Dear Dr. Mitchell

I was so glad to have come across this service because I have been extremely worried about my 18 month old son.  In some ways he seems like a beautiful, bright, intelligent boy.  In other ways, he seems 'different' to his peers.  I might add that he appears to be left-handed.

He loves to spin wheels, particularly big wheels.  He will chase prams to spin their wheels.  He is not interested in spinning the wheels of smaller cars.  I think it is because they don't go fast enough.  He will spin for ten or fifteen minutes before moving on to something else.  If I interrupt him while he is spinning he will sometimes protest and throw a small tantrum.

He loves to spin objects that look circular in shape.  He used to spin his gears on the fridge a lot but he has lost interest in them these days.  He also spins his stacking frogs, and his peg board puzzles.  He likes to throw objects on the floor and see how they move (like a play egg or his egg marraccas etc.)  He still will not play with a car correctly.  He loves spinning them on the ground though or if I spin them on the ground.

He used to flap items such as foam cut out shapes and animals.  He liked to have one in each hand and walk around flapping them.  He doesn't flap items so much anymore.  These days he just seems to move around a lot.  He is always wiggling and moving some part of his body unless he is reading a book or watching a DVD.  He seems to have very high energy.  

He has quite a few spoken words.   He can say - mum, dada, moon (moo), cog (cog), duck (duck), star (tar), ball (ba), car (ka), clock (gock), nah, cookie (coo coo).  I think he is trying to say give and go but I can't be sure.  He speaks in a lot of continuous jargon and has done so for a long time.

He is having trouble developing the right grasp.  When I give him pens to draw with he holds them at the end.  When he grasps them on the stem he inverts his forearm so his thumb is pointing down not up.  He mainly uses his left hand.

He is a picky eater.  He used to eat crunchy food only but as progressed on to a variety of food.  He loves crunching on corn, and spaghetti, rice, meatloaf, chicken.  He still will not eat fruit by himself.  I have to hold his fruit for him while he bites it.  He chews on apple but then spits it out.   He eats oranges but then again he spits them out if there is too much 'texture'.  

When he wants his milk or water he tries to reach for them on top of the counter and makes whining and upset noises.  He does not point.  Sometimes he brings me his container of snacks so  I can open the box and give him a snack.  He won't sit down with other children when we go to playgroup to eat anything.  He pretty much won't sit still if he is in an exciting environment.  

Now onto the positives.  

He learned sign language as a baby.  He signed milk at 10 months old.  He still signs for more.  He has also signed - monkey, bath, water, flower, hat, eat, shoes, boat.  He tries to join in if we are singing 'eensy weensy spider.'

He has a large vocabulary - I'd say hundreds of words by this stage.  He can point to many objects in books but he particularly loves to point to flowers.  He loves looking at books with illustrations of flowers and he can identify many different kinds of flowers (rose, tulip, sunflower).  He will not walk past a flower without going to look at it or to touch it.  He notices when there are flowers on tissue boxes, in paintings etc. However, while he points willingly to objects in books he will only point if he can touch the item he is referring to.  I can't get him to point to the clock on the wall or to the light.  If I ask him where the clock is (and he loves clocks) then he will look at the clock. If I ask him where the flag is, he will look up at the flag.  He will look wherever I point regardless of if I name the object to look at.  

He knows most of the letters of the alphabet.  I gave him letters for his bath then he ran around pointing at all the letters on signs etc.  He developed an odd reaction to the letter W and the letter M.  He would do a little dance to the letter W.  He doesn't do it so much anymore.

He constantly brings things to me.  He needs my attention all the time.  If he picks a flower he will bring it over and give it to me.  If I sit on the lounge, he will start piling toys and books on my lap.  

He loves to read.  Reading books would probably be his most favourite activity.  He can find pictures in books if I just mention the word.  Like if I say star, he will bring me a book with a star in it.  He will look at books by himself.

He loves shapes and he can identify most of them.  He can bring us a triangle, a circle, an oval and sometimes a square and a rectangle.  He likes to do puzzle sorters but he gets cross if he can't get the shape in quick enough.

He loves music.  He will sit on his couch an listen to his CD.  He often tries to put CDs into the CD player.  When he was a baby and could sit up (around six months), he used to dance to music.  He still dances to music.  

He loves to draw and paint.  Although he has trouble maintaining a grasp on the pens and the paintbrush.  His favourite colour is red and he can identify many red things.  He tries to draw zig zags and loops and circles.

From about fifteen months old he invented complex games for us to play with him.  For example, he has a car that moves on battery (he doesn't try to spin the wheels because they don't go very fast).  He will bring the car to us, and then he will go into another room, and we are to put the car down.  He can hear when it stops and then he comes in and picks it up and brings it back to us.  He does the same thing with balls.  He also invented a game where he would give us his push and pull monkey and then hide in his couch while we pushed the monkey near him.

He is very affectionate.  He loves cuddles.  Give me lots of kisses.  He kisses his sleepy and some of his stuffed toys.  He used to get his toys to watch TV with him but he hasn't been doing that lately.  He has a talking cookie monster and he often moves his mouth up and down while babbling (presumably pretending cookie monster is talking).  I do that a lot so I'm not sure if he is just imitating me.  

He follows my instructions/suggestions such as go and get your hat.  Go and play in the sandpit.  Don't touch.  Although he won't help me put away his toys.

I am not searching for a diagnosis but an indication of whether I need to be concerned.  I will also be mentioning this to my family GP (we are not allowed to see specialists here without a referral).  

Thank you in advance for your advice.  

Kim

Answer
Good evening Kim,

Let's start with the positives:

- he's affectionate and cuddly
- his receptive language seems good when he follows instructions, points to object on demand
- he picked up signs and uses them appropriately
- although active, he can sit through a book reading, listen to a CD, do activities like drawing
- he has developed some spoken language
- he did not skip the babbling stage, which is a normal part of developing language
- he enjoys showing you things and sharing with you, seeking your attention
- he demonstrates joint attention when you read him books
- he shows pretend play with his cookie monster toy
- he already knows some alphabet letters

I wouldn't worry about his pencil grasp nor his hand preference at the age of 18 months. Hand dominance is often not determined until a number of years later. Proper pencil grasp is also a later developing skill. At a year and a half of age, many children are still grasping drawing tools with a fist.

The things that seem to be bothering you center around his spinning and the way he plays with objects with wheels. You have no doubt heard that some children with autism spectrum disorders like to spin.

I'm not sure what to say about this. It would depend on the frequency and intensity of this activity. Does he play with any toys in a typical manner? Does he just spin a small bit of the time or does he try to seek out objects to spin much of his waking hours? When he is spinning, are you able to distract him or otherwise move him on to another activity? Will he go willingly or does your attempt at redirection result in a tantrum?

The same thing holds true of the flapping you describe that he used to do. Again, it's a matter of intensity and frequency.

At eighteen months, kids are still in the parallel play stage where they may engage in a play activity in the vicinity of other children, but play alongside them rather than WITH them. It's great that he is willing to play with the adults in his family. You might see if you can expand that to include extended family. Is it possible for you to arrange play dates or put him in contact with other toddlers? His lack of interest in other kids may be partly due to lack of exposure. Watching him with a group of other children his age may provide further comparisons of how he is developing, while keeping in mind the typical variations.

You might be interested in the brief list of red flags for autism at this following link. Based on what you've said, he does not have a preponderance of these symptoms: http://www.firstsigns.org/concerns/flags.htm.

But, if he seems obsessed with spinning, there may be concern. It would be worth mentioning to his doctor, especially if you had anecdotal notes on when/where/how long, etc. Even a brief video clip taken with your camera may give the physician more information.

At this next link you can see brief videos of children with autism or Asperger's then children of the same age who do not have an autism spectrum disorder. http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm. To access the videos, you must register, but it's free and carries not obligation.

There are many positive aspects about how your little guy is developing. There are also a few points of concern. It is worth mentioning your worry to the doctor and keeping an eye on his further development. Pay particular attention to his language, which should increase at a good pace during the toddler years. Here's a website that describes the type of language skills typical of children in their second year of life: http://www.asha.org/public/speech/development/12.htm. If your son continues to grow in his expressive and receptive language, wonderful. If you feel that his rate of language acquisition slows or if he starts to lose the words that he has now, talk further to your doctor and to a speech therapist.

Best wishes,

Dr. Sharon A. Mitchell