Expert: Dr. Sharon A. Mitchell - 8/2/2011

Question
Hi there

My sisters daughter is 33 months old, and can only say about 5 words. She also yells when another child or adult attempts to approach or talk to her. For example, if you say hello to her and smile, she will just yell or scream at you (no words, just sound) she also has frequent tantrums. All this to be said, her receptive language is quite good, and she does sign.

I'm concerned my sister might be in denial, but I dont want to broach the subject of autism if it is not warranted. I have done a lot of research myself, but I'm just not sure. Can you offer your opinion?

Many thanks for your time and effort.

Answer
Kaylee, I understand your concern about a child who is almost three saying only a few words. You mention that she signs, so I presume that she sees a speech therapist. Some parents teach signing on their own, which is fine, but with this degree of expressive language delay and the other characteristics you mention, I'd strongly suggest close involvement with a speech therapist.

It's not possible to offer an opinion about autism without seeing the child. But, from what you describe, there is cause for concern. Autism may not be the only explanation, though. Has the child seen an Occupational Therapist? Some kids (not just kids with autism) has sensory sensitivities that show similar symptoms.

Here is a quick, online, free screener that you or your sister could do to get a rough idea if any of what you're seeing may fall within the autism spectrum: http://www.childbrain.com/pddassess.html. This is by no means a definitive test of autism - it just might give you an idea.

The First Signs website has a nice video glossary where you can watch a child with autism along with a typical child of the same age. You need to register at the site to gain access to the videos, but it's free and there is no obligation: http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm.

You wonder if your sister may be in denial. It's possible; she is most likely overwhelmed. When we have a baby, we expect all good things for that child and being "normal" is part of our ideal. When we begin to realize that that child may not be just like others her age, it's scary. Obviously your sister has already looked into the language delay and that is a first step.

It's hard enough to contemplate the possibility that your little girl might be a late talker, let alone thinking that there may be something else also going on. There is always hope that the screaming and different behaviors are all due to the child's frustrations at being unable to communicate her wants and needs. That happens often. But, learning augmented communication systems, such as signing, often results in a decrease in these unwanted behaviors (such as tantrums) as the child learns that she does have the power to get what she wants through signs. No matter what the reason behind her delayed expressive language, learning signing is a good thing.

What does the speech therapist say? Does she feel that it is more than just a language delay? Does she know about the screaming and tantrums? What does the child's physician think? Again, is the doctor aware of all the symptoms that you describe? Not all parents are forthcoming with such details. It might not necessarily mean that they are in denial or are hiding information; it may be that they have become so used to this as a way of life and don't realize how atypical it might be.

When a child screams and tantrums often, life gets tiring for the adults, as well as the child. It's hard to see your child in distress and be unable to fix things. Often such parents become trapped in their house, unwilling to or unable to go places for fear of a public scene. Your sister may be just hanging on by her nails, trying to get through each day. In such circumstances, it's hard to think ahead, to plan and to look into other possibilities.

If that's the case with your sister, having someone suggest that something ELSE is "wrong" with her little girl may seem more than she can handle. On the other hand, she may be grateful that someone else is able to take the time and look into possibilities that could make life easier for this child and her parents.

If your sister is interested in pursuing what else may be bothering her daughter, the M-Chat may be a safe, anonymous place to start. You can take a look online here: https://www.m-chat.org/.

This is a sensitive issue. Your niece is lucky to have you in her life.

Dr. Sharon A. Mitchell