Expert: Valerie Herskowitz - 3/30/2011

Question
My son has been developing normally (he turned four in November). Recently, however, I have noticed odd behaviors and some loss of vocabulary. I should add that he is bilingual, and sometimes finds it difficult to go from one language to the next (but so do I).

He enjoys playing with a few children, but becomes totally overwhelmed in large groups of children, like big birthday parties with lots of kids he doesn't know. He also can't stand the sound of the balloons popping or loud/screaming games. He basically stays glued to my side, or wants me to go participate with him.

He seems to be in his own world when he is alone sometimes. I have to call his name several times, or ask him a question repeatedly, to get an answer. He doesn't seem to have trouble answering me once he engages, though.

He likes to play with others, and if there are no playmates around (he's an only child) then he will often invite me to play. He does use his own imagination in play and likes to "pretend" with others as well. I'm seeing a bit less of this lately, though.

He's very precise about certain things- but I wouldn't say obsessed. He is a rather picky eater- he especially hates mixed textures in his food. Also, if he can feel a clothes tag against his bare skin, he will cut it off. For a while, he had a certain routine about getting out of the shower, but he's gotten over that.

I've recently noticed little songs he sings to himself while doing ordinary things. He likes to make up his own words to songs, and he is very good at this. He has begun a new game where he jumps around the apartment. When I ask him what he is doing, he says he made up a new game where he has to jump over obstacles and not touch any objects. Sometimes, he pats his head or claps his hands when he is moving about. I've always just thought he had a lot of energy that needed expression, but now I'm not sure.

The most worrying thing for me is that every morning, he says that he doesn't feel like going to preschool, that he will miss me and that he's afraid I'll leave him there. This hurts my heart because I don't know why he has these feelings, or what to do about his school anxiety. He seems fine once he's there, however.

He's always had good progress checks with his pediatrician and the teachers at his preschool have never indicated that they see a problem in his behavior or learning.

Am I overthinking this? Or is it possible for a four year old to suddenly demonstrate signs of autism/autistic regression?


Thanks in advance for your help

Answer
Hi Jeni

Your son really reminds me of my oldest son (who is now 21 and graduating college cum laude.) The reason that I say this is that he had similar issues that your son is displaying.

I do recommend that you get a speech and language evaluation in order to determine what is going on with the language regression. He may have being having trouble processing both languages at the same time, therefore, it may be recommended by the speech pathologist that you stick with one language until he is a bit older. I do notice that you live in Italy, so the language choice (unless he is going to an English pre-school) would probably be Italian.

So there may be a slight language processing issue going on.

But mostly notably, your son is having distinct sensory processing issues. Most of the issues that you mentioned fall in that area. You need to get him started on occupational therapy to help with these issues so they don't develop into more of a behavioral disorder.

It would be unlikely that a child would start regressing at 4 years old. So either he was already showing signs of autism and you didn't notice or he doesn't have autism, but just a mild language processing issue and sensory processing problems. My guess is the latter. But I am not a doctor, so you may want to take him for an evaluation with someone who specializes in developmental delays.

But the picky eating, sensitivities to things like tags on his clothes, his fear of going to school, becoming overwhelmed in a large group of people, sensitivities to certain sounds. These are all signs of a sensory processing issue. So get him to the occupational therapist for sensory integration therapy.

My son got therapy at an early age and he is doing great!