Expert: Catherine Ridenour - 8/28/2011

Question
Hi Catherine.My son does not have a diagnosis of autism, however he does have a delay in both expressive and receptive speech and language skills. I first became concerned about him due to communication difficulties,[no words until 18 months] and the fact that he never responded to his name until he was 2years. He is now coming up to three and does not respond consistantly now. He has around 60 words and has just started to join a few sentences together, for example'where is Daddy?, wos that? come on,lets go, wheres gone? he has good eye contact when he interacts but very little if we try to interact with him. In fact he will often completely ignore us. He has other red flags associated with autism, flapping hands when excited,scared or overwhelmed, walking on toes, shaking head, spinning in circles,repetative behaviour [repeating sequences over and over or acting out snippets from his thomas dvd and just repeating them and not adding to them, food aversions, sensory difficulties regarding sound and textures. He also has an unusual posture and seems kind of jerky and clumsy. its hard to describe but he just doesn,t seem to move normally.He also has severe rages that can be triggered by something very small, dropping his dummy, his milk finishing, being told no, or often there seems to be no obvious cause. He will scream, bang his head,bite,throw things, kick etc and shove his hand into his mouth.He has been seen by speech therapist who said he had a significant delay in his speech and language and social skills and that she felt that it was pointing strongly to him being on the autistic spectrum. He was seen by doctor at the child development centre and the doctor agreed with the speech therapist and wants us to go back later in the year for a diagnosis. She just needs more information regarding how he interacts.He attends a specialist centre for pre school children with autism or who have been flagged up. The teacher there said to me that he has never interacted with another child, but does with adults although it is always on his terms. At home he demands constant attention which I find confusing because I have read about autism and they say that children on the spectrum avoid social interaction.I agree with the nursery that interaction is always on his terms. It can be very hard to gain his attention and if we do he often shows little interest and just walks off. If he wants us to play his game he will try to force you by grabbing your hand and if you refuse he will go into a rage. He often interacts with people by singing bits of songs like, eieio or, we will we will rock you.   He will repeat this over and over up to 30 times until you do it and even grab your top and bottom lip and force your mouth to move.He has interacted with his 15 month old cousin but does so inapropriately by constantly grabbing, cuddling her and not letting go, kissing and stroking etc and does not seem to recognise when she is getting angry, even when she pushes him away he thinks its funny and laughs. He has a baby sister and seem very interested in her hands and feet when they move and laughs.He does enjoy rough and tumble play, chase and bubbles and enjoys it when poeple act silly and will laugh and want the action repeated over and over. I feel so confused at the moment as some days I convince myself that he has autism and the next I am unsure,sometimes I think he interacts too much to be on the spectrum.He is certainly not in a world of his own and has lots of personality. I find myself constantly observing him . Do you think he sounds like he could have autism even though he does want to interact or that he could just have a higher functioning form. I know there is more going on than a speech delay but feel confused at the criteria for an autism diagnosis. I believe I will feel better once I have an answer, the not knowing is the worst.

Answer
Hi Sharon,

I understand your confusion. One reason it is called a "spectrum" is that each child seems to have a different combination and severity of the symptoms. Your son seems, to me, to be clearly on spectrum.

Many autistic individual interact with others quite a bit, they just don't do it appropriately. This is an indication of the lack of "theory of mind." That means that he has no idea that people are not objects. He does not understand others have thoughts and feelings. At his age, he does not even know HE has thoughts and feelings, he just does what his mind/body prompt him to do. This is why he will move your mouth for you or over-cuddle the baby. Everything is on his terms because he is the only "active" entity involved, as far as he is concerned. You need to supervise him around your younger child. He does not know he can hurt her.

It is common for an autistic child to be very clingy and demanding of the primary parent. He depends on you to interpret the world for him.

His rage episodes are a very common thing with autistic children. Because he cannot communicate verbally, he expresses his frustration in the only way he can. He is unaware he is becoming angry until it overwhelms him. As much as possible, handle these by ignoring them. What gets attention is reinforced. Remind him to use words to get what he wants. Model the correct response, "I want more milk, please."

It can be very difficult to assess the intelligence of a child like this because you can't tell how much information is getting in and the output is not always consistent with ability. I think it is important to assume he has a good mind and continue to teach him as if it was all sinking it. It just might be.

I urge you to go for the diagnostic assessment. Your son needs help to learn well and reach his full potential.