Expert: Valerie Herskowitz - 5/17/2011

Question
QUESTION: Hello there.  I have a 34 month old little boy and I have just come to the realization that he has ALOT of the red flags for autism and/or apraxia of speech.  I have typed out literally pages of the things he does/doesn't do but I will try to only touch on those that are most significant in my head right now.

The first big thing is that he doesn't talk very much.  This sounds crazy that I just noticed this I know but he has always 'talked' along with familiar shows on tv.  He can say/repeat (intelligable) almost anything on one of his favorite shows (we watch the same ones most of the time).  He can repeat these same things he hears on tv when not watching tv as well.  And actually it seems he will try to use them in speech to represent something.  For example when watching The Land Before Time, he will always say 'uh oh dinosaur' (dropping consonant on end of dinosaur) and every morning when he wakes up he will almost always say 'uh oh dinosaur'.  I assume that he is using that phrase as some sort of communication device but I still haven't figured out what he WANTS to say.  Moving forward, he does not hold, initiate or participate in any conversations.  He will not answer questions unless they are 'yes or no' questions and even then will only answer if it will benefit him somehow (ex: "do you want some chex?" when standing at the pantry door)  If you ask him any random questions he will not even attempt to answer - it is like he is ignoring you.  He knows all of his letters, numbers & colors by sight (will speak them) yet he can't say his ABCs.  He does use some words/phrases in context but this is very limited.  Examples:
-He will come up to me or his father and say 'up dada'.  He never calls me mama even if I ask him to or model 'up mama' for him.
-He will say 'basketball court' (intellible) and point down the driveway if he wants to go play there
-He will run to the door when daddy gets home and say 'Hey it's you' (copied from a phrase he heard sometime)
-He will also say 'thank you, bye bye' when leaving or when someone else is leaving (again a copied response from something he hears us say)

As far as communicating his needs...
-He will go to pantry/fridge and point until someone helps him
and sometimes will attempt to get things himself
-He is still breastfeeding (thankfully or I am not sure he would eat much - very picky) and will come up to me and pull on me and say 'boo'
-He seems to have no recognition that his diaper is soaked and doesn't seem to care
-He DOES know when he has to poop and will do so and then his actions will indicate that he needs a diaper but he doesn't normally come up to anyone to let them know

Now for the other things that I feel indicate some form of autism spectrum disorder:
-90+% of the time he does not respond when you call his name (even multiple times, including making noises)
-He used to know his body parts but now either doesn't care or doesn't remember them (seems to ignore any requests/inquiries)
-He pretty much has no self help skills (he can put on slide-on type shoes and they are about 50/50 on the wrong feet)
-He doesn't seem to have issue with gross motor things but does have issue with fine motor skills (no recognizable crayoning, not able to properly hold scissors)
-He attempts to feed himself with a spoon but isn't very good at it
-He will push around a batman truck with batman and robin inside but not indicate that he is actually pretending anything
-He is insistent on things being 'just so' exmaple: how he wants a toy situated before we can walk away
-He can't stand to wear clothes and mostly fights when we try to dress him (we have been working on ways to make this easier)
-He has really bad tantrums which I assume come along with not being able to effectively communicate his needs -OR- when he doesn't want something like a shirt
-He seems to be in his own world most of the time
-He can't sit down to listen to a story or to eat at the table
-He can't settle himself or calm himself
-He has been caught spinning wheels on the stroller when it is inside
-He was notorious for stacking blocks, knocking them over and repeat and would get upset if you tried to make him stop
-He seems to have a thing about carrying something around like dvd cases.  He will bring these random objects up to me and hand them to me (no communication) and walk away.
-He does have problems with certain textures of foods - refuses them - like beans for example
-He has always had gastro issues and reflux since birth but we have been able to get this mostly under control with his diet
-He has always had difficulty falling asleep and is known to wake frequently
-He seems to have no fear of danger

Anyway, these are some of the things I have noticed.  What is your input?  We have a full evaluation scheduled with a neuropsychologist very soon.

ANSWER: Hi Amber

I'm glad you are going to see the neurologist as it does appear that your son is showing a lot of red flags for a developmental disorder. From the lack of speech, the sensory issues, the social issues, he is really demonstrating a lot of signs. Take the list you made to the doctor when you see him, and then get back to me after the evaluation so I can help you start making some plans to get him some help.

He's young and can make a lot of progress. I know it's a scary thing, but you should be very proud of yourself for figuring this out.

Good luck and don't forget to get back to me when you get the evaluation

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

QUESTION: Do you think there is the potential for Apraxia there?  I haven't had any luck finding anyone locally who can/will diagnose that.  Is that something the neuropsychologist can diagnose?

I appreciate your quick response and I am SO anxious to get started with him.

Answer
He may have apraxia or dyspraxia as part of the bigger picture, but you wouldn't treat him or label him apraxic as that would be missing the point. He does need lots of language-based therapy, but we wouldn't work with him as if he was a child that solely had a apraxia diagnosis. A child that solely has an apraxia diagnosis wouldn't have the other issues that you describe. His apraxia would come from a different reason and therefore we would treat it differently. For you son, I recommend setting up a broad range communication program that would start by focusing on the "communication" part as we teach him to speak. So we would use alternative communication methods to start.

I can help you set this up when you are ready as I work with families all around the globe. Just let me know when you are ready.

If you are online now-and want to chat with me for about 15 minutes-you can call me at:
954-980-0134