Expert: Valerie Herskowitz - 12/5/2011

Question
My son is a happy 15 month old.  However, he is delayed in gesturing.  He still does not wave, clap or point, despite us doing it non-stop for the past 6 months.  He has no real first word yet, though he babbles a lot and says mama and dada - but don't think it is to us.  He knows who mama and dada are as well as some other labeled items.  He is very independent, rarely asking for help if he is struggling with a toy.  He does smile and laugh from interaction with us and toys.  He likes peek-a-boo games and will come up to request more if we stop.  He knows his name.  He is very happy to see mommy and/or daddy as well as both sets of grandparents.  He does bring me/show me toys sometimes.  He doesn't always follow our gaze or point.  This concerns me as well.

He started army crawling at 9.5 months and real crawling at 11 months and pulling up at 11 months.  He started walking at 14 months and is doing it more, but prefers to crawl and crab crawl.  He was late in imitation skills but is getting better at imitating now - imitating sounds and some actions.  His eye contact is great and always has been --will look you right in the eye and examine what you are doing. His favorite "toy" is anything he can open and close - toy box, trashcan...he can do this for 10-15 minutes straight.  He never liked us taking his hands to clap them...he would get mad and pull them out of our hands.  He is getting a little better with this.  He does do high 5 - on command though.  His receptive language seems ok, but slightly delayed.  He understands some commands but not all. He still sometimes uses his mouth to explore objects.  He doesn't parallel play with other kids, but is not upset to be around them.

He is a very picky eater and always has been.  He won't eat table food -- he will eat cheerios, crackers, kix cereal and anything of the like.  He gags on some food still.  He won't eat cut up cooked carrots, chicken nuggets, etc.  He is still on the bottle and is a challenge to get him to use a sippy cup - though he has gotten better with a straw sippy cup.  
 
My question is, in your experience, can limited to no gesturing at 15 months, late talking, and lack of requesting for help (independence) be something other than ASD?  I have been worried for MONTHS and feel better when he learns something new and continues to develop something new each month, but the lack of gesturing and communication worries me.  Also, his lack of requesting for help and sharing our point or gaze.  

He has been in early intervention since 11 months old for his delayed gesturing and imitation.  An OT is coming out this week from early intervention for the first time.  I also have appointments this month with an external OT and an external speech therapist (he has not been seen by a speech therapist yet).  Next month, I have an appointment with a pediatric neurologist.  I am on a 6 month waiting list for a developmental pediatrician - should be seen in February. Any help/advice from your experience is greatly appreciated from this very worried mother.

Answer
Sorry for not answering sooner. I just received the email.

Hi Flo

First of all, I am very glad that you are in Early Intervention, because regardless what your son's eventual diagnosis is, you are getting him the help he needs.

To answer your question: My question is, in your experience, can limited to no gesturing at 15 months, late talking, and lack of requesting for help (independence) be something other than ASD?  

The answer is yes. His delays do not definitively point to autism. However, he is delayed. But regardless of what the label is that the developmental pediatrician gives him, he can and is able to make progress.

I am concerned about the lack of communication. I am glad his imitation skills are improving, however, I would highly recommend that you begin another form of communication with him such as picture exchange communication system (PECS). It will make learning speech easier for him and also give a means to communicate until he learns to speak.

Please let me know how it goes