Expert: Valerie Herskowitz - 1/22/2012

Question
Hi,

I have written to you before regarding my daughter in regards to my concerns about her development. At that stage you advised me she was showing quite a few "red flags" for autism.
Since then we have seen our Paed & had a speech assessment done & a general assessment through our early intervention provider. Her speech assessment showed she had severe delays with both receptive & expressive language and she was diagnosed with an expressive language disorder.
Her general assessment showed she was delayed in all other areas (gross motor, fine motor, social, play etc) except that her pincer grip was that of a 4 year old..  
She is now almost 25 months old and we went to our Pead with the reports he ordered & he informed us that although she has these problems as well as some "quirky" behaviors such as spinning, flapping, licking things, her complete obsession with pens & pencils just to name a few, that he wasn't convinced that she had ASD due to the fact that her eye contact is reasonable & she called me while we were in his office as if she wanted me to look at a toy she was playing with. He also only skimmed over the reports we took him & really gave us no advice as to where to go from here, only told us that she would be "difficult".
I have booked her in for a formal assessment in a few weeks as I'm not happy with how we were treated by our Dr.
I guess what I want to really know is do you think he is right in saying it's not Autism because she makes some eye contact & showed me something?  Do you think it's worth my while to get the formal assessment done?
I just want to do what is best for my daughter but just don't know where to go from here.
Thank you in advance
Georgina

Answer
Hi Georgina

I know that it can be quite confusing to have a doctor not give you an autism diagnosis while she is clearing showing many of the signs.

The truth is that no two children with autism demonstrate the exact set of characteristics. She may have something called PDD-Nos, which is basically the same as autism however, not every characteristic is there. But it is still considered to be part of the autism spectrum. Presently, they are revamping the criteria for diagnosis of autism. It will be this:

Autism is characterized by an individual evidencing at least six of the
following twelve features from the following subparts 1 and 2, with at least
one feature from subpart 2:
1. Severe communication disorders, which may include:
i. A delay in, or total lack of, the development of spoken language (not
accompanied by an attempt to compensate through alternative modes of
communication such as gesture or mime);
ii. Stereotyped and repetitive use of language or idiosyncratic language;
iii. For those applicants with speech, marked impairment in the use of
multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction;
iv. Failure to develop peer relationships appropriate to developmental
level;
v. A lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (e.g., by a lack of showing, bringing, pointing
out
objects of interest, or achievements to others);
vi. Lack of social or emotional reciprocity;
vii. Marked impairment in the ability to initiate or sustain a
conversation with others in individuals with adequate speech; or
viii. Impaired imaginative ability evidenced by a lack of varied,
spontaneous make-believe play or social imitative play appropriate to
developmental
level.
2. Severe behavior disorders, which are restricted, repetitive and
stereotyped patterns of behavior, interests, and activities which may include:
ix. Encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus;
x. Apparently inflexible adherence to specific, nonfunctional routines or
rituals;
xi. Stereotyped and repetitive motor mannerisms (e.g., hand or finger
flapping or twisting, or complex whole-body movements); or
xii. Persistent preoccupation with parts of objects.

Take this to another doctor, and get another opinion.