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Autism/Sensory concerns about my son

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Question
Hi,
Thank you for taking the time to answer my question.  I should preface my question by saying I am the only one with concerns and the rest of my family thinks J is developing typically!  I work in pediatrics so I seem to be overly concerned with a lot of things related to my kids health.  
J will be 3 next month and I have some concerns about a few of his behaviors.  On a positive note: He communicates well and had a lot of words from an early age.  His speech is very advanced for his age.  He asks for help when he needs it, makes good eye contact, points and follows our points, shares and seeks out our attention when he is playing.  He is very affectionate and give lots of hugs and tells us he loves us.  He has a very active imagination and loves to play restaurant,blocks,  super hero, etc.  He plays well with his 3 year old cousin.  I am a stay at home mom (I work occasional evenings and Dad watches the kids)  so he does not go to a formal pre school or have a lot of interaction with other kids his age.  He seems to be developing well physically although he was a little slow with stairs and jumping/gross motor (he does ok now). All of his well checks/standard developmental screens at the Dr have been normal.  He is pretty easy going and we do not adhere to a strict routine. If someone is crying he will try to comfort them by saying "it's ok", although sometimes he ignores or screams at his 7 month old baby brother when he is crying.
My concerns:  he has some odd repetitive movements and twists/ crosses his fingers, occasionally flaps his hands, jumps in place, and walks on his tip toes. He seems to do these randomly when he is playing etc.,  He will stop doing it if asked and does not get upset.  If it matters, my Mom said I was a toe walker when I was little too.  The finger twisting/crossing has appeared in the last few months and he sometimes does it when he is stressed/anxious- again he will stop easily when asked.  
He asks the same questions over and over even when he knows the answer.  When we ask him what he thinks, he will answer correctly.
He has a good appetite but will sometimes gag when we ask him to try new foods.  He has a very sensitive sense of smell and will smell things before trying them. If he doesn't like the smell then he will gag.  
He has some pretty dramatic tantrums (screaming, yelling, etc, )buts usually  calms himself within 15 minutes. These do not occur every day and are more frequent when he tired or hungry.    They seem to be triggered by not getting what he wants or waking up from a nap.
He wakes up well in the morning but almost always cries when he wakes up from his afternoon nap. Lately he has been waking up screaming and crying once a night too.  He goes back to sleep with comforting.  
He is sometimes very shy in new settings (clinging to us) and other times seems overly friendly (talking to strangers etc.).
He is not potty trained and has no interest.  He gets upset when we try to push the issue.

Am I being overly concerned or should I bring up these behaviors at his next well check up?  My family seems to think he will just grow out of it. Overall he is a very happy child, I just don't want to miss something like Aspergers or a sensory issue that he would need treatment for.  
Thank you!

Answer
Hi Ashley,

I'm not sure anyone can be "overly concerned" about their child and any nagging worries you have are worth mentioning at the next well check-up.

But, as for an autism spectrum disorder, so much of what you describe does NOT fit the profile, such as:

- good eye contact
- pointing
- following your point
- good communication
- seeks out and shares attention
- is affectionate
- imaginative play
- easy-going
- tolerates changes in routine

Now, for your concerns. His tantrums don't seem out of keeping for a three year old, but discuss with your health care provider the frequency and duration of these upsets if you're unsure. His reactions to his sibling also sound typical.

It is not only kids with autism who toe-walk; there are many other reasons behind this type of gait. Toe-walking is something to mention to at your next appointment. They will likely check his neurological responses and possibly recommend a physiotherapist. Some simple exercises might remedy the problem.

Some children (and adults) express their thoughts aloud as a way to process information. Your son may be doing this when he seems to ask questions that he knows the answer to. Or, this may be a way to engage you in a conversation or capture your attention.

Some of what you describe may be sensory issues. Again, kids with autism are not the only ones to experience sensory sensitivities. There are some quick oral motor exercises you can do with your son before he begins to eat to help lessen his gag or other reflexes. An Occupational Therapist is the best person to give you advice in this area. An OT would also check out any other possible sensory issues and give you suggestions on how to help calm his nervous system. Sometimes this is a matter of maturity and over time over-sensitivities will settle down. But, I'd suggest you talk to an OT.

Unless there are other factors you have not mentioned, no, I do not think you are describing a child who is on the autism spectrum, although it is not possible to rule in or out any diagnosis over the internet.

If you still have concerns, there are some easy things you can do that would not be harmful to ANY child, but would help a child who is upset. You can read about some of these, especially the sensory strategies, in the short novel http://www.amazon.ca/School-Daze-Autism-Goes-ebook/dp/B0085HN9HQ.

Best wishes,

Sharon

Autism

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Dr. Sharon A. Mitchell

Expertise

Sharon can help with parenting and educational concerns. She has worked in teaching, special education, counseling and consulting for over thirty years and gives workshops to educators and parents on working with kids with autism spectrum disorders. Sharon speaks from both the education and parent points of view, having an adult son with Asperger's.

Experience

Sharon has spent decades as a special education consultant with a school district and autism consult for the province's Department of Education, giving workshops and individual consults. Currently she works as regional autism consultant for a health district in between teaching university classes. She is an Amazon bestselling author or a series of novels, each depicting a child who has an autism spectrum disorder. Sharon's Master's thesis looked at the long-term outlook for persons with high functioning autism and Asperger's. Her Doctorate focused on strategies to help those with autism spectrum disorders.

Organizations
Website at http://www.drsharonmitchell.org and sits on Autism Today's Panel of Experts (www.autismtoday.com)

Publications
Author of "Autism Goes to School" - a novel about autism that that became an Amazon bestseller. Get this Amazon bestseller free at http://www.drsharonmitchell.org. In the next book, Autism Runs Away, Ethan is only in grade one and already has been kicked out of one school due to his tantrums and pattern of running away when in a panic. Now in a new school his mom remains glued to her phone, waiting for the call to tell her that they don’t know what to do with a child who has autism. Sara is about to learn if this new school is up to the challenge. (https://www.amazon.ca/Autism-Runs-Away-Book-School-ebook/dp/B01FCYQ7DC). Autism Belongs is the 3rd book. Manny's life has shrank to the confines of their house. His parents are desperate not to rock his world because the aggression has gotten to much worse. Where will this lead? Is there a chance that Manny could actually belong out in the world? You bet! Get a free sample at https://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6. Book four, Autism Talks and Talks, is about a 12 year old girl who has Asperger's. She's bright, inquisitive, highly verbal, but lacks social skills. Try a free sample at https://www.amazon.ca/Autism-Talks-Book-School-Daze-ebook/dp/B01IIUZH3S Book five, Autism Grows Up features Suzie, a bright, twenty-one year old whose life collapsed after she finished high school. Now, she lives in her mother's basement, spending nights on her computer, afraid to broach the world outside their door. Autism Grows Up is found at https://www.amazon.com/Autism-Grows-School-Daze-Book-ebook/dp/B01JB8QW3U. Prefer a boxed set? Get the first 3 books bundled together at https://www.amazon.com/Autism-Box-Set-School-Books-ebook/dp/B01KBEHJ08. Co-author of Amazon.com bestseller, The Official Autism 101 Manual (http://autism101manual.com/).

Education/Credentials
B.A. in Psychology, B.Ed. in Special Education, M.A. in Educational Leadership PhD. in Psychology Management, specializing in autism.

Awards and Honors
B.R.A.G. Medallion for the novel Autism Goes to School - Book 1 in the School Daze Series. (http://www.bragmedallion.com/medallion-honorees/2013/school-daze-autism-goes-to-school). Like Autism Goes to School, the third book in the series, Autism Belongs, also ranked #1 on Amazon (http://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6). Manny is not like other children. He doesn’t talk. He doesn’t leave the house. His parents desperately try to arrange their world so that Manny does not get upset. Because, when he does, well, the aggression was getting worse. At ten, Manny was becoming difficult to handle.

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