Autism/Now a 16 month old


QUESTION: Dear Sharon,

You have been very kind to respond to my questions and your opinion has been very helpful to me.

My son is now 16 months old. He has very well established joint attention, such as if presented with new toys, he will gaze shift 20-50 times. Also, he often engages in "conversation" with us, such as if I tell him no, he will turn, and "protest" by saying something as an obvious dislike, I will talk, he talks back in baby language with great eye contact. He often "talks" and looks at people on the streets, explains something to them, points towards the fountain, and there is no doubt that he is trying to engage them in conversation. He likes kids and tries to look/copy what they do in the park. He has 6-7 real words, and he has 10 consonant in his inventory fo baby babble.

My son was seen by DIR Advanced Lead Psychologist, and she doesn't see ASD. She said "he is capable of prolonged eye gaze shifts, is very engaged, vocalizes age-appropriately, and has good joint attention". He also can brush his hair, and put sunglasses. He will copy "jumping", will imitate if I put a toy on my head, or will try to put lego together if I show him how. he understands 60-70 words, few simple commands,etc

So far so problem son is pointing with his whole hand only. He points all day long, but rarely with index finger. Hence, he is failing the MCHAT, because it specifically asks for index-finger point. He will fail the two questions for index finger pointing plus pretend play (feeding a doll).

In your experience, is 16 months ok to take the MCHAT? Are the above skills enough to worry less about this whole hand pointing?

ANSWER: Hi again Julileta,

I'm so please to hear all the progress that your son has made and I would agree with the DIR Psychologist.

Out of the M-CHAT's 20 questions, from what you describe, your son would have not received passing scores on questions 6 and 7. But, with further probing, I think he would then receive a pass for question 6. So, out of 20 questions, there is really only one indicating difficulty.

Take a look here at the M-CHAT questions: If you continue scrolling down past the end of the questionairre, you will see guided questions the interviewer can ask to elicit more information, such as for questions 6 and 7.

The M-CHAT is for kids between ages 16 and 30 months, so your son is just at the early stages of M-CHAT applicability. Since he has come along so well in all the other areas, I'd wonder if pointing with his whole hand rather than just his index finger is a physical maturation aspect that he has not yet mastered. Think about how small children hold a crayon in a fist - they have not yet acquired the fine motor control to separate out their fingers.

The hallmarks of autism are difficulties in communication, socialization and intense preoccupations. From your descriptions, your son's communication and socialization seem age appropriate and you don't mention intense preoccupations and extreme behavior difficulties.

Other than the discrete movement of pointing with one finger, it sounds like your son is developing typically and is a delightful child. It never hurts to keep an eye on development, but I think it is safe for you to follow the advice of the DIR Advanced Lead Psychologist and enjoy your child.

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

QUESTION: Thank you! Yes, we have seen him point with index finger about 20-30 times for the last two months. So if the question is Does he EVER use index finger...I would say yes but it is not his preferred way.

Otherwise, he uses his whole hand to truly point...not only to request items, but mostly to show items in the environment  (with and without eye contact), and also in response to Where is xxx questions. Probably just gesture immaturity as you suggest, because the intent is present.

At the same time, my son would struggle with a 3rd question on the MCHAT too (I think i mentioned it in the previous post). The two index-finger ones PLUS the pretend play based on the examples in the MCHAT. He does brush his hair, and puts his glasses on, and puts his hat on, and puts a plastic duck top on his head as a hat...but he doesn't ride a car on pretend road, or talk on the phone, or feed a doll (these example sare only listed on the MCHAT)...we have also seen him trying to wash himself with an empty cup...can I count the above as pretend play enough to satisfy the "Does your child ever pretend" question on the MCHAT?

Julieta, I think you should relax. The opinion of the psychologist you visited seems sound and you could keep the door open with her by asking if you can return to see her is a year or so if you have further concersn. Other than that, it sounds like your son is developing typically.

None of us are perfectly typical; we all have strengths and weaknesses and none of us develop  exactly in a text book fashion. "Normal" is not a single line. Think of typical as being a range above and below so fictional "normal" line. Most of us are somewhere to the left or right of that line, depending on which skill areas you're looking at. The same is true of children. While that range of being typical is within certain parameters, there then are those of us who in some areas might be a bit outside those lines. Generally, the person would still operate fine for the most part.

Where I think it's important to seek a possible diagnosis is when those bits that are outside of typical interfere enough with day-to-day life to make things difficult for the individual.

Your son is lucky to have such an alert, concerned mom, but I think I'd trust the opinion of the psychologist you saw, relax and possibly check in with her in another year.


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Dr. Sharon A. Mitchell


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.


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.

Website at and sits on Autism Today's Panel of Experts (

Author of "Autism Goes to School" - a novel about autism that that became an Amazon bestseller. Get this Amazon bestseller free at 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 donít know what to do with a child who has autism. Sara is about to learn if this new school is up to the challenge. ( 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 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 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 Prefer a boxed set? Get the first 3 books bundled together at Co-author of bestseller, The Official Autism 101 Manual (

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. ( Like Autism Goes to School, the third book in the series, Autism Belongs, also ranked #1 on Amazon ( Manny is not like other children. He doesnít talk. He doesnít 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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