Expert: Valerie Herskowitz - 7/27/2011

Question
QUESTION: My daughter just turned 11 months old a couple days ago. For a few months I have been growing increasingly concerned that she might be beginning to display behaviors indicating she might be on the spectrum. I know you can't diagnose anything online but I would really appreciate your thoughts on the below 'symptoms' as well as ideas regarding next steps.

The most troubling behaviors are listed first. I have also included some positive behaviors she is displaying.

Troubling:
-She started babbling late (9.5 months old, although she did have several colds/ ear infections and got tubes for a possible mild hearing issue.) Anyway she babbled for a month or so after getting the tubes (mostly "bo bo bo", "ba ba", "da da" or "ya ya ya"... but now, for the past week or so, all she has been saying is "ba"-- as the response to any noise at all.

-She speaks no words. She did do a little sign language (the milk sign) for a couple months but also recently stopped. Not sure if this indicates loss of skills? We also sign 'all done' and 'more' with her but she has yet to do those back to us.

-She is not yet pointing consistently. Over the past couple days she has started to point, sometimes with her index finger, sometimes with her whole hand. She doesn't look at me when pointing though, to see if I am paying attention... it's almost as though she is going through the motions of pointing (copying me, because I do it often) but she doesn't understand the concept of joint attention?

-I worry sometimes she doesn't play with toys appropriately/ relationally. She stacks her stacker and blocks as a positive, but mostly wants to play with my car keys, put lids on containers in the kitchen or steal the remote control and bang it on the floor.

-she doesn't often 'show' me toys while she is playing (to show me how neat something is, etc. Again, the joint attention concern.)

-She sometimes is described as quiet/ undemanding/ easygoing.

-She hates when I wipe her face or brush her teeth, or aspirate her nose (she had a lot of colds, so this one was unfortunately common recently.)

-Sometimes gets a spaced out look but 'snaps' out of it if you say her name or wave your hand in front of her face

On the other hand, here are the good things she is doing

Pros:
-Her receptive language seems pretty good. She knows what 'nursey', 'up' and 'eat' mean (and she even smacks her lips together when I say the word eat.) She also knows what no means. If my husband or I say 'no' or 'don't', she shakes her head no. She knows who mama and dada are, as well as the doggies in our family (she will look at us/them if asked but not necessarily point.)

-She understands simple commands like 'Come to mama', 'Where is dada', or 'Show that to mama' (where she will then hand me an object.)

-She is starting to share. She will sometimes put food in my mouth or my husband's.

-She waves and claps and also is starting to blow kisses

-Her fine and gross motor are great-- she feeds herself, she crawled early at 6 months, pulled to stand at 7.5, cruised at 8.5. She has recently taken first steps and is standing unassisted for longer periods of time now.

-Very good eye contact

-Very smiley and social; smiles and waves at strangers, likes to watch people. She follows conversations with her head, looking back and forth at the faces of people speaking. Described as "the friendliest baby" by strangers often.

-Seems interested in other children, most of the time anyway

-Follows a point pretty well, most of the time

-Responds to her name about 95% of the time (the other 5% of the time, she is distracted and you have to say it a few times for her to look.)

-No sleeping issues; sleeps through the night regularly

I just don't know how concerned to be and what my next steps should be. I encourage as much language as possible; I narrate everything, label everything, point, do lots of floor time, sing songs, even do silly babble/ faces. So far, it's hard to say how much impact these things are having.

Do the above symptoms sound like ASD? Is it possible to have an innocuous speech delay without being on the spectrum and is a speech delay issue typically easily dealt with? Other ideas for next steps? I am sorry this mail is so long but I am very worried and want to ensure I am being thorough.

ANSWER: Hi Andrea

Yes-it is possible that someone can have a speech delay and not be on the spectrum. Right now, she is showing a delay in expressive language, since you are not seeing babbling. I wouldn't say that autism is screaming out, but definitely a expressive delay.

Please start by getting her hearing checked. I don't think this is the issue as she responds to her name, but you need to rule that out.

She does need to go to see a speech pathologist who can work with her to begin expressive language. We don't see words yet at 11 months, but we do see a lot of vocalization which she is not doing.

The fact that she has good receptive language is a good sign. And she seems interested in others. Right now, I would just focus on increasing her expressive skills.


I can always do a consultation with you via phone to give you some exercises to do at home. There is a small charge, but I would be happy to work with you. If that is something that you would like to do, you can email me at info@valerieherskowitz.com

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

QUESTION: Thank you Valerie. I am a little confused what you mean by "we are not seeing babbling." Doesn't 'bo bo bo', 'ba ba', 'da da' and 'ya ya ya' count as (duplicative) babbling?

I wanted to clarify my earlier mail here as I re-read it and thought perhaps I was not being clear. She has done those things. It's only the past week that her babbling has gone from greater variability (the above noises) to just 'ba ba ba'. She seems rather stuck on that sound at the moment. I have heard from others that this *can* be normal (they get fixated on a sound but eventually move on). Thoughts?

Either way I am happy to take her to a speech pathologist; I have contacted one and they indicated they'd be happy to see her at 12 months old.

Also since she has gotten ear tubes, she has had her hearing checked. As I mentioned in my mail, she did have a mild hearing issue at around 8-9 months, after several ear infections. We are doing a follow up audiology exam tomorrow to ensure it has improved. I am confident it has, as she responds to whispering, etc.

Answer
Hi Andrea,

Actually, you said in your first note: "but now, for the past week or so, all she has been saying is "ba." And the sounds you mentioned that she was making before were not very complex in nature.

But that aside, a child of 11 months should be on the cusp of saying words. They are usually in the stage we call, jargon. During jargon, the vocalizations sound like real language with inflections and intonations, however, the actual sounds are still "baby talk." And there is a huge variety of different sounds that the child says. From your reports, I don't see this yet.

The hearing issue that she had could have definitely caused a language delay. So I am happy that you are going to see a speech pathologist and not waiting until there is a more definitive gap. The pathologist will decide if she needs therapy or if she can give you some things to do at home. Hopefully, both.

But the good news, from what you have reported, is that her understanding of language is good-that's more important than anything else. She will most likely make a ton of progress with early intervention.

Good luck and keep me in the loop.