Expert: Dr. Judy Horrocks - 12/5/2011

Question
Dr. Judy,

I have been worrying the past couple of months that my 13 month old might be delayed in development.  She answers to her name, but you have to really work to get her attention. She smiled at 6 weeks, laughed at 2 months, and crawled and stood within what is considered normal range. She has started to take several steps on her own, though normally when shes not thinking about it.  My biggest concern is with her language and communication. She has always been a calm and easygoing baby, and still is, apart from when shes hungry, tired, hurt, or frustrated at not getting her way or not being able to do something, like she loves to mess with the dvd player and we tell her no, and she cries a little. She doesn't indicate her wants or needs by pointing or verbalizing, though she will reach for it and lean forward if shes interested.  She seems to understand certain directions, like turn off the light, stand up, hold out your arms, give me a hug, walk, get the ball.  She doesnt initiate games, but she will respond to games like peek a boo and enjoys getting scared and roughousing, and will laugh hysterically at that.  She is starting to discover different foods (thank god!)and mastered the pincer grip at around 12 months.  I read to her every night.  She has also started screaming when shes excited and has been flapping her hands since around 7 months.  She shakes her head no, but I dont think its in response to anything.  Should I be concerned?  I know that I just gave you a whole lot of information, but I want to give you a clear picture.  Thank you!

Jessica

Answer
Parents all worry about their children meeting developmental milestones.  We are always comparing our children to other children to be sure everything is fine.  Today more parents are worried about autism since there is so much on the news.  I can understand your concern about communication if your child is not pointing or verbalizing at 13 months, however that does not necessarily point to autism.  Regardless, you are enhancing your child’s language skills as well as future reading skills by reading to them regularly.  Spending a few minutes every day to simply read a small children’s book is a great sharing experience.  Children love to hear the same stories over and over and eventually begin to memorize the words.  Singing songs and repeating nursery rhymes also builds language.  

I would also recommend you contact your local school district and ask about Early Intervention Services.  Your child can qualify for free services by demonstrating a delay in any area, they do not need a diagnosis.  IF your child is delayed in communication, then you can receive free speech therapy services. The therapist can also guide you on lots of great activities to do with your child to help develop more language.  If your child catches up.....then great, they may never need any diagnosis.  There is no down side to getting these services and the services can be delivered at your home or at a local preschool or daycare.  

You may also want to make an appointment with a developmental pediatrician.  This is the specialist in child development and the best to provide you with a diagnosis if necessary.  Most major hospitals have one on staff, but it can be difficult to get an appointment (sometimes a 6-8 month wait), so schedule one early and cancel if you feel you do not need it.  


In the meantime, I would also suggest that you begin to build social routines.  Practice greetings when appropriate including a wave or even look toward the other person.  Reinforcing this interaction, however slight is great, then build on it.  If you participate in pretend play with your child, you may give preschool social skills a boost.  Don't dictate the game or let your child dictate the game, demonstrate how to be cooperative. Peek a boo is a great game, also playing together over a toy.  Since you mentioned a interest in the DVD, develop a game for ON and Off, having your child request the ON with "yes" or "more."

In the area of behavior, parents need to have simple rules that can be consistently followed.  It is difficult for any parent to say “no,” to their child, but parents need to stay in charge.  Children who don’t always get what makes them happy immediately learn to emotionally calm down, wait, and realize that they cannot dictate every situation.  To take charge, parents need to be calm and consistent.  If the rules are consistent, then children understand your expectations and live up to them, which also helps them feel competent.  Do not be concerned about the flapping behavior unless it becomes obsessive, many children with normal development flap their hands when excited.  Typically, the flapping lessens when speech increases.

I have a blog if you want more information about autism and the typical characteristics.  You can find it at: www.drjudyautismblog.com.  

Have fun with your daughter!
Dr Judy Horrocks