Expert: Valerie Herskowitz - 9/26/2011

Question
QUESTION: Hi!
My son is 3.3 year old and I am writing because he displays some symptoms that I find abnormal:
-not responding to his name, unless I change my voice or tone (if it is something unusual, or if I say it’s a surprise, he responds well)
-not participating in structured group activities (he does not seem focused on what the adult does, and definitely he does not want to do what other kids are doing, although he likes to observe)
-not great eye-contact, unless he is doing something he is not supposed to do and then, he checks my reaction smiling
-he does not like to be told what to do and tries to avoid being in that situation (if forced, he gets really angry)
-some hand flapping when running and when happy
-not joint attention (I don't remember him checking my reaction to something new, since he was a baby)
-not responding to my questions, he wants to be the one that starts the communication, give directions, calls for me, etc

He has great pretend play, he likes to pretend he is a daddy, or a doctor or a fireman, he likes to put me or his stuffed animals to sleep and also he plays very appropriately with toys. He likes imagining social scenes inspired from cartoons, but without following the lines or actions of characters. He would imagine that a stick is Jack and the tree in our yard is the beanstalk and recreates the scene from Jack and the beanstalk.  He follows instructions well, if he likes the outcome (like making a cake). He almost never responds to my questions and he sometimes tries to avoid responding to them by asking another question instead or diverting the discussion (I ask: Where is the circle? He points to the rectangle and says: This is a rectangle or he points to the triangle and  asks: Where is the triangle?). He rather likes to be given choices (do you want to go in the park or at the pet store?) and he never responds Yes  to a question(sometimes he says ‘’I do’’ instead of Yes, but most of the time he would just rephrase: I ask: Do you want to go home? He answers:  I want to go home.  He says No without any difficulty.
He has several friends whom company he enjoys and wants to go see them all the time. They would race cars or even take turns for a simple game without an adult supervision. My son would try to have the other kid do whatever he wants, sometimes by forcing him.
He seems to enjoy having around kids at play areas, although he doesn't really play with them directly.  He loves babies and he likes to play with them and even to pretend I am a baby and he gives me the bottle, changes my diaper, puts me to sleep :)
He has a good vocabulary, he knows how to ask for help, but he is not very conversational (not answering or asking questions), just telling me what he wants or what he is doing, or what his imaginary characters or real friends are doing. He seems to have a good grasp of ''I'' and some minor difficulties with using ''me''. He talks about me as ''she'' sometimes, even when I am there. He likes to play with me and seems to be very attached to me.
He is half potty trained (independent in using restroom to urinate), can dress/undress himself with little help and a lot of encouragement and/or threats, can put his shoes on all by himself.
We attempted to integrate him for the first time in pre-k this year and he cried a lot for me and even after 3 weeks, he does not want to do anything the teacher asks him to do. He likes to observe the other kids, but does not want to participate. He is not focused at all on the teacher. He gets upset when the routines are changed, even that at home he does not care about routines. He works well with me in the class if there are just the two of us there and I give him one-on-one attention. He would also follow directions from persons that he is familiar with. He does not like watching TV a lot, so we don't insist that he should.

He does not have favorite textures for food; he likes to walk barefoot, to play with the sand or mud. Sometimes if I watch a movie on TV, he gets scared of a commercial or a dark forest and turns off the TV, explaining that he is scared. About once per month he gets a sudden scare of a weird noise such as a haunted house or a toy. He throws a bad tantrum, and wants to get out immediately but once I turn off the noise, he is fine and explains to himself: It's nothing to be scared of.  He would not let his friends watch any cartoons because he is scared that something unexpected might scare him.

He had some traumatic events this year. His daddy left, and even that we talk to him on Skype every day, he is very upset about that. His two best friends and even his favorite neighbor left this summer. He is still asking about them and wants to go see them.  About 3 months ago he got a persistent cough that might be due to allergies. No medication worked so far and we do not have a diagnostic yet.
At 18-20 months, following a traumatic half year in day-care (first year of his life I was at home with him),  we questioned why he had just several words in his vocabulary and why he would ignore us when calling him or trying to get his attention and he was evaluated and diagnosed as following: developmental delays in social interaction and language acquisition (by psychologist), temporary autism (by psychologist), normal (by psychiatrist specialized in autism),  speech delay 77/100 with normal development ( by developmental pediatrician), normal (by  MD  in Genetics), hearing loss (by hearing specialist-MD). His hearing was/is fine.  My son received speech therapy for one year, until 2 and a half. I also became a stay at home mom again.  His speech improved very much and he seemed to be just a happy normal little guy until this fall when he started pre-k and he suddenly seems just so different than the other kids (not participating in any group activities, not listening to the teacher, crying for me, not communicating to the teachers or classmates at all, having accidents with potty training, trying to get at the toddler/baby area and interacting just with the toddlers). I understand that the kids find him very weird and bothering them and even the teachers mentioned that he refuses to do anything, no eye contact, no listening. I understand that they think my son has a disabling condition.
My husband has ADD and he receives medication for that. He also thinks he has some traits of Asperberger’s. We both had speech delays and a difficult integration in school. I had difficulties paying attention to the teacher and staying focused/not interrupting, but these symptoms solved without any intervention around 7 years old. They persisted for my husband and he still struggles with them.

Thank you so much!

ANSWER: Hi RJ

Though I enjoyed reading your very comprehensive letter, I didn't see a question for me. Please feel free to write me back and let me know how I can be of help to you.



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

QUESTION: Hi, Valerie!
Thank you for reading my letter. The questions are: Do you think my son's behaviors are normal for a three year old? Looking at the whole picture, do you think he might be on the autism spectrum?

Answer
Hi RJ
I do think that your son is displaying some questionable behaviors for his age. With his history of delays and diagnoses, it is prudent that you continue with the services that you were getting for him when he was younger. I am really happy that his speech and language has come along with therapy, but it doesn't sound like you are out of the woods yet. His social skills seem quite behind as do his listening and comprehension skills. And he appears to be having difficulty adjusting to the environment as well. Though I am not allowed to diagnose, it seems that he was diagnosed before by some professionals, and because he is really showing signs of continued problems, you would most likely assume that he is certainly still somewhere on the spectrum. But to be sure, it's time to take him back to a qualified developmental pediatrician, pediatric neurologist and/or psychologist. And more importantly, to get him some therapy for his social skills, listening and comprehension skills and sensory-based issues. That would mean seeking out speech therapy for social skills and the listening and comprehension and occupational therapy for the sensory.

Let me know if I can be of any further help. Good luck and keep me in the loop. He seems to make a lot of progress with treatment, so keep it up!