Autism/Asperger's Concern

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Question
I am starting to be really concerned that my daughter has Asperger's. She shows some definite signs but I am not sure how pervasive. She is two years and nine months. I am not sure if some of her behaviors are typical of a 2 (almost 3 year old) or should be explored further.

My main concern is that she has a lot of repetitive speech that seems out of context. Sometimes she will say something like "I'm 2 years old" when we are talking about going outside. It's like sometimes the context does not match the conversation. She was talking in full sentences around the age of 2 and now speaks very well with good grammar. She was mixing up pronouns and does refer to herself in third person. Additionally, many times I have to call her name several times for her to answer me. I am not sure if she is engrossed in whatever she is doing and ignoring me or she is just not responding. A lot of times I am not sure she really understands what I am saying to her. We constantly have to tell her to say please and thank you and she does when we ask her to but you would think after telling her to do so numerous times she would do it on her own.

Additionally, she sometimes seem to understand feelings. Lately she will say, "Mom, I am happy." Or when her brother (15 mos) is crying she will say, "He is sad." But if she is playing with me and pinches me and I fake cry she looks at me awkwardly like she doesn't understand.

Sometimes she will laugh awkwardly out no where and I am not sure if she saw something funny or is thinking of something but it will be out of thin air.

She doesn't have any obsessive interests but she is an intense learner and will study something until she knows it. She knows her letters and the sound each letter makes. She learned it by watching a video over and over. She also knows her shapes, numbers, and colors. She does love her books and sesame street and will read the same books and watch the same videos over and over again.

She seems to do well around other kids. Her daycare teachers tells me she is social but I am not sure how social she should be at this point. When we go to her cousins house she loves playing with them and sitting on their laps. We were at the playground the other day and there was a girl on the adjacent slide and she looked at her then looked at me and said I want to say hi. I told her to say hi and she did but I am not sure if her normal reaction should be just to say hello instead of asking to say hello.

She loves to chew on her shirt and rip the threads of of it. I notice she does do it more as a comfort thing but she does do that often.

She is a picky eater and doesn't like to try very many new foods. She will try new things outside of the home, at daycare. She will say let me try and opens her mouth and turns her head.

I have noticed that she does spin in circles. Not for long but she does do it.

She pretend plays a lot with different toys.

She does make good eye contact and points and brings thing to show me. She just seems a little off from other kids and I have read many people explain their kids that way when describing Aspergers.

Thank you very much for any help.

Answer
Hi Pam,

I can hear how concerned you are.

At your daughter's age, it is not easy tell if she may be on the autism spectrum unless the signs are fairly significant. From your descriptions, some of what she is doing might be found in kids who do have autism or Asperger's, but most of these things might also be seen in typically developing children of this age.

There are some real positives that you mention:

- makes good eye contact
- points
- shares her interest in objects with you
- she demonstrates pretend play and with a variety of toys
- she enjoys playing with her cousins
- you are not noticing obsessive interests
- she has already developed pre-reading readiness skills
- she expresses feelings about herself and will tell you how her brother may be feeling
- she has good language skills
- her day care providers say she is social and are not raising concerns with you

Most of the above items would not be well developed in a child who has an autism spectrum disorder. Two year olds with Asperger's might share your daughter's good language skills, but would likely have difficulty in these other areas.

Children in the late toddler stage still believe that the world revolves around them. They may be learning about their own emotions, but will still have difficulty putting labels to how they feel and may be just beginning to realize that other people have thoughts and feelings that may not mirror their own.

At times, most parents question if their child has a hearing problem, are too engrossed in their own activities or are ignoring their parents. If you are worried, it would hurt to have her hearing checked, just to rule out any potential difficulties. Although, kids who have some degree of hearing loss or who have hearing weaknesses due to recurring ear infections generally do not have such well developed spoken language.

Many children, much to the dismay of their parents, are picky eaters. Some kids are this way due to sensory sensitivities, where they dislike certain textures or temperatures in their mouth. The fact that your little girl is more adventurous in her eating at day care suggests that her pickiness with food is likely not due to sensory issues.

Most children enjoy the sensations they get from spinning and rocking. Like with many other things when we are looking at autism, it is the degree, frequency and intensity of these activities that can set them apart from what is common with most children.

It is not uncommon for two years olds to still refer to themselves in the third person. Part of that stems from the way we speak to small children - we don't always address them in second person tense as "you" but sometimes speak to them in third tense. At this link, you will be able to read what is concerned "normal" with expressive (speaking) and receptive (listening) language for a child of this age: http://www.asha.org/public/speech/development/23.htm. If after reading this, you have concerns, please speak to a speech/language therapist. If you're not sure how to locate one, this link will help you find one in your vicinity: http://www.asha.org/proserv/.

This next website lists markers we look for when we're wondering about the possibility of autism. Check through how you saw your daughter at various ages: http://firstsigns.org/healthydev/milestones.htm. The First Signs website also offers an excellent video glossary where you can watch short video clips of a typically developing child of a certain age and a child who is on the autism spectrum: http://firstsigns.org/asd_video_glossary/asdvg_about.htm. You must register to look at the videos but there is no cost and you will not be plagued with advertisements.

If after looking at these websites, you still have concerns, here is information on how to talk about your worries and who to go to: http://firstsigns.org/concerns/if.htm.

In your question, you mention Asperger's. Asperger's differs from high functioning autism by just a couple things. To be diagnosed with Asperger's instead of autism, the child must have intellectual ability (IQ) within the average to above range and to have developed spoken language at a typical time or earlier. There are many bright children who an autism or PDD label rather than Asperger's because they were older when they started to speak.

In North America, children are generally diagnosed using criteria from a manual called the DSM. The DSM-IV included different categories of autism, including Asperger's. In May of 2013, the new version, the DSM-V was released. In this version, the different categories that make up autism spectrum disorders have been removed. Asperger's does not appear in it. Instead, kids will now be diagnosed with Autism, and Levels One, Two, Three or Four. The levels refer to the amount of support the child will likely require, with four indicating the highest level needed.

It sounds like you have a delightful, bright, little girl. While it is impossible to diagnose over the internet, based solely on your descriptions, I don't think I would worry about your daughter being on the autism spectrum. But, if you continue to have concerns, definitely seek help.

Best wishes,

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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