Expert: Dr. Judy Horrocks - 1/5/2012

Question
Hello, I have been very concerned about my toddler since he was a baby. He is now twenty one months old and I'm a wreck from constantly worrying about his behavior(s) and sensitivities. I have an appt to have him assessed by a dev ped. But being in Canada we have been put on a year and half long wait (by then he will be3yrs old). As a baby he would constantly cry (inconsolable crying) in crowded loud places and even in his car seat. He had lots of feeding difficulties so starting at three months he was put on mess for acid reflux. Eventually the feeding issues tapered off but he still is a poor eater. He did not seem to have any significant delay in development as a baby, however he would spin all his toys (such as nesting cups) and household items from a very early age(8/9) months. Now at 21 months he doesn't spin anything but he is fascinated by fans and wheels. The strange thing is that as much as he seems excited over fans (and things that spin) he doesn't really spend a lot of time watching it.  Lately he has become very fascinated with clocks and shapes in general (circle has always been a favorite though). As I mentioned above he is sensitive to textures and loud sounds. Terrified of Certain sounds  to such as music played on radio (not all but some) hand dryer toys that are too loud (this has imProved). Hates rough textures as well as sticky messy things (paint grass sand Christmas tree ornaments bubbles/foam diaper clothes socks) to name a few. These are my main concerns in addition to the fact he is a very poor sleeper. Wakes up every half hr and wants to be held/rocked. If I even sit down after he's fallen asleep hell wake up right away. I'm stRting to wonder ifthis more of a sensory issue. He has on occasion flapped his hand, twirled, and rocked but I thing he picked up some of the behaviors from from watching other kids(watching kids dance on YouTube). Otherwise he has a vocabulary of over 150 words. Strings two words together (not a lot 5/6 maybe, for example give apple, take apple, where is duck, yellow bus). Always asking where questions; not sure if this is normal:) plays with us, talks to us constantly, sometimes will throw intense tantrums (usually when he wakes up in the middle of the night), very active, social with relatives ( not extremely but he has his favorites), not social with kids though. Sometimes does not show much interest in other children. He seems pretty normal otherwise. Dances to musics, can identify and name several body parts, animals, letters, numbers, shapes etc... Please let me know your thoughts ... We have seen a psychiatrist when he was 17 months old and she didn't thing he was on the spectrum. Thanks in advance!!!

Answer
I am happy to provide you with some information about autism and the characteristics of the diagnosis.  I am glad you have scheduled an appointment with a developmental ped, it is difficult to get appointments in the states as well, usually a 6-8 month wait.  An evaluation with a doctor will help steer you in the right direction if any services are needed.  To get a diagnosis of autism, your son would need to demonstrate 6 characteristics.

As far as these characteristics, your son seems to be developing verbal language and is social with relatives, both very good signs!  Asking "where" questions is another skill that is both communication and social in nature.  The deficit areas in autism are social skills, communication and behavior.  Your son seems to be doing fine socially from your description, he may be shy with other children, but that is not uncommon for a twenty one month old.  You may want to encourage parallel play as he gets more comfortable with peers before attempting interactive games.  He may also need to have several play dates to get more comfortable.  I would encourage, but don't push.  As he gains confidence, he may advance on his own, but you don't want to put any anxiety to the situation.  It is great that he is interactive with relatives, keep encouraging this interaction.  You did not mention if he has any imaginative play, that would also be a good sign.

You also described very normal verbal language development.  It sounds like he is developing a good vocabulary and putting sentences together.  Continue to work on the readiness skills such as colors, body parts, animals, letters, shapes, numbers, and simple reading.  You may also want to encourage greeting other people, waving and saying hello to both adults and children as well as asking questions and answering simple questions from others. This encourages both language and social skill development.  Begin to introduce figurative language and help him interpret the meaning.  For example: "The early bird gets the worm."  This phrase is about getting there first, to be first in line, etc.  Children's rhymes and stories also have some morals, can he relate the meaning?  These are excellent activities to explore as you wait for your appointment.  Again, no pressure just have fun exploring his understanding!

The final area, the behavioral area is the only area that your son demonstrated one characteristic.  Your son is demonstrating an intensive interest in objects, the spinning things you referred.  Many children do this, actually an intense focus can be more beneficial than a lack of focus!  The hand flapping is typical of this age and nothing to worry about. I would not conclude from these simple activities any concern about autism.   To get this diagnosis we would be looking for 6 characteristics.

I can understand your concerns related to sensory problems, you have identified several sensory sensitivities. Some children have sensitivity that disappears as they develop and mature.  Others can be provided therapy by an occupational therapist (OT) and improve dramatically.  If Early Intervention services are available in your area, you may want to see if your child can be evaluated by an OT. Otherwise wait for your appointment and see what the doctor suggests.  In the meantime, expose him to various sensory activities but again, encourage but do not push.  Playground activities and art activities are great sensory activities.

I would not be overly concerned about autism, your son seems to be doing great.  You may see lots of improvement before your appointment, but follow through to relieve your fears!

Good Luck!
Dr Judy Horrocks