Expert: Valerie Herskowitz - 8/29/2011

Question
I have written before regarding my little boy who is now 32  months old. At present he has no diagnosis of autism although he has been flagged up three times now by speech therapist, doctor at the child development centre and also the audiologist who assessed his hearing. The doctor feels that he has autism but just wants some more information from his nursery regarding how he interacts with other children. She wants us to go back later in the year for diagnosis.
I have spoken to the nursery and they have said he has never interacted with another child but does with adults although it is always on his terms.
I feel confused as whilst it is obvious that there is more going on than just a language delay I do not know if he fits the criteria for a diagnosis of autism.
When he goes to appointments he completly ignores anyone in the room, does not respond to his name,has rages over things like a toy dropping on the floor , lines toys up and gives very little eye contact. He does behave like this at home also but we also see another side to him.
Firstly the concerns;  no words until 2years. now has around 60 words and just beginning to make a few sentences,where is dummy,wos sat, wheres gone ,get out, etc He uses alot of jargon and has an unusual tone when he speaks almost song like and will repeat words over and over, sometimes he stops if we repeat the word or he just carries on.His receptive language skills are very poor. He would not understand go and get your shoes or can you find me a book for example.
He flaps his hands alot when excited, scared or overwhelmed or sometimes just randomly.
He often walks on tiptoes.
He shakes his head alot
If I let go of his hand outside he just runs and does not respond when called.
He has sensory issues regarding sounds and textures and has food aversions.
He has an unusual posture that does not look  or move as you would expect from a child his age.
He often repeats the same action/sequence of events over and over. for example I took him to the doctors and whilst in the waiting room he stood by the door checking his feet were on the line, ran to the other side of the room,touched the door and said mummy, ran to me and said hello mummy, then to my husband and said hello daddy, then he ran to the door and said tree, then he repeated over and over 20 plus times whilst doing lots of hand flapping and walking on his toes. In his play he often arranges toy cars and studies them or he will act out small snippets from his thomas dvd with his trains and repeat over and over and will not let us join in or open and close doors repeatedly.He seems to get stuck on one particular sort of play at a time.
He has frequent severe rages during the day which are often disproportionate to the situation or often there appears to be no obvious cause.
He does not always give good eye contact unless he initiates interaction then it appears normal.
He does not consistantly respond to his name.
The one thing I am unsure about however is his interactions. I have read that autistic children do not like to interact, however my son thrives constant interaction to the point that he dominates every situation. If we do not do what he wants he will have a huge blow up. He tries to force us to interact by grabbing our hands and he will often interact through song. He will go up to people and sing eieio or we will we will rock you, and if you don't sing he will grab your lips and make your mouth move. It is very difficult to gain his attention and keep it and also to get eye contact, but he certainly isn't in a world of his own and he does not always want to play alone.He also loves rough and tumble play, tickling, chasing games, bubbles and sand or water play.He laughs if we do something silly like putting something on our head and pretending to sneeze and making it fall off and wants the action to be repeated over and over and understands slapstick comedy.
When he has interacted with younger children he generally will grab them, cuddle and not let go, keep kissing them etc and does not seem to recognise when they are upset.He is fascinated by his baby sisters hand and foot movements and will find it very funny.
He enjoys cuddles when he wants, but if we try to cuddle him he will push us away.
I feel so confused as it has been hard for me to except that he could have autism and just when I begin to except it I start to have doubts because of his level of interaction. sometimes I look at him and think no theres definately something not right with him and then other times I am unsure.
Do you think it sounds like he has autism or do you feel that he may not meet the criteria.I just need an answer as the uncertainty is causing me alot of stress. I know you can't diagnose but please what are your thought on my son?

Answer
Hi Sharon

Thanks for writing back.

I do feel that your son has a lot of red flags that would lead me to be concerned about him having autism or a developmental delay. You are right that I am not allowed to diagnose, but you do state so many different things in your letter regarding his behaviors that I don't think you can deny the fact that he has developmental issues that you need to address beyond the language delay. I think you know in your heart of hearts that there is a problem. It is just so hard for you to accept it-I know that is difficult to think about. But be it as it may, it is your job now to accept what is going on and get your son the help that he needs so he can be the best he is able to be. Please don't wait any longer. The earlier that you get him help, the better the outcome.

So be strong. See if you can find a group in your area or on the Internet of parents who have children on the autism spectrum. They will be there for you as well as give you direction. And feel free to write me anytime