Autism/30 month old son

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Question
Hello Dr. Mitchell,
I am a 42 year old happily married wife to Matthew and stay-at-home mom to Jordan, our 30 month old son and only child.  We are very worried about his communication development and hope to gain your insight.

In the past 6 months or so, Jordan has displayed several behaviours that have us concerned about autism:  he doesn't often respond when he's being called, his vocabulary growth has been very slow and he seems to have "forgotten" a few words that he once used, he doesn't answer yes or no questions and he will not/cannot point out objects when asked.  He is also drawn to light switches and doors, although his "obsession" is intermittent and rarely takes up more than a few minutes a day.  To confuse matters, there are times when Jordan seems to hear perfectly well and not others, times when he will follow directions and not others.  He also likes to takes us by the hand for play/help rather than asking.  Finally, he walks on his toes a fair bit.

In contrast to these behaviours, Jordan is a happy, gentle, mild mannered little boy who smiles and makes good eye contact.  He enjoys his toys and plays with them appropriately.  He also loves other children.  He will watch them, laugh at them and play alongside them.  Despite his limited vocabulary, he can communicate his wants and needs much of the time through gestures such as reaching, grunting, batting away, shaking his head and verbalizing "no-no-no".  He also loves to explore, has a curious nature and has no difficulty with variations in routine.  I take him everywhere with me.  He certainly seems to be a bright little boy, with a sharp memory and a knack for figuring things out on his own, especially gadgets.  Medically, he has no health problems, has a healthy diet and excellent sleep habits.

Although we are awaiting a hearing test, an evaluation from a speech language pathologist and an appointment with a specialist at the Alberta Autism Centre in Edmonton, my gut tells me that Jordan does in fact fall somewhere on the autism spectrum, perhaps the high functioning end.  I am anxious to help him in every way I can until we can get him treatment.  In addition to 1:1 play at home, my husband and I take him to the pool once a week, tumble tots once a week and a drop in play group at least twice.  My question is this: are my instincts correct and if so, what particular exercises can you recommend for overcoming Jordan's challenges?

Thank you kindly for your consideration,

Tina

Answer
Hi Tina,

As I read through your first few paragraphs, the first things that came to my mind were:

- have his hearing checked
- have a medical check-up
- make an appointment with a speech/language pathologist
- see someone for a developmental assessment

As I read on, I see that you have already set each of these things in place.

Now, for the positives:
- he has you for parents and you are on top of things
- his health, sleeping and eating are fine
- he responds well to changes in routine
- tolerates many different environments that you are wisely exposing him to
- he's found ways to communicate despite some challenges in verbalizing his thoughts
- shakes his head no
- he's happy
- he smiles and makes eye contact
- he enjoys interacting with other children

You have identified some of the concerning points:
- lack of development in his expressive language skills
- receptive language difficulties, although this may be sporadic (possibly related to ear infections)
- possible loss in some of his language
- toe-walking
- guiding you by the hand to get what he wants (using hand as tool)

I think you are on the right track with all the things you are doing and have arranged for your son. The first issue I would address is the possibility of ear infections; some children do not give outward signs of distress so it is possible to miss the fact that recurring infections may be interfering with the child's ability to hear. Without adequate hearing, it is very difficult for a child to develop language.

The American Speech/Language/Hearing Association gives some good information on the development of children's production of speech and understanding of speech. This link talks about what is typical for a child of your son's age, then at the bottom are some suggestions you can try for enhancing his language development: http://www.asha.org/public/speech/development/23.htm.

I am not an advocate of any one particular treatment approach for kids who have an autism spectrum disorder. I believe that the approach must be tailored to the individual needs of that child and of his family.

Plus, you do not know that your little boy has autism. There are some possible signs, but without meeting your son, it is hard to give an opinion. Still, there are some things you could do that may help and certainly will not hurt whether he has autism or not.

Likely your most pressing concern is his language. You are already doing much by exposing him to different situations and people. I would suggest limiting the amount of time he spends watching television and stress more interactive games with people. Do not be too quick to jump to meet his needs; give him time to come up with the way to ask for what he wants, whether that be through words, gestures or pictures. It's all right to have him struggle a bit, although you don't want to create undo frustration.

Kids with autism, as well as many other children, take in information that they see far easier than that which they hear. You might consider having a set up pictures on your fridge or somewhere readily available - pictures of things he might commonly request. If he can't find the words to use, he could bring you the appropriate picture. This strategy can actually enhance language development; you need not fear that the child will prefer showing pictures to speaking. Rather, pictures can form a bridge to spoken communication. There is a website that offers many free, ready-made pictures you could use: www.do2learn.com. You could also do an internet search for baby sign, another tool that might help. Hopefully your appointment with the SLP will come soon as he or she will have lots of suggestions for you.

I wrote a book about a nonverbal little boy and the strategies his family uses to help. It's available on Amazon for about a dollar right now at http://www.amazon.ca/Autism-Goes-School-Book-Daze-ebook/dp/B0085HN9HQ/ref=sr_1_1. While it's offered in paperback, the ebook version is cheaper and can be read on a Kindle, tablet, smart phone or computer with the free app (http://www.amazon.ca/gp/feature.html/ref=sv_kinc_1?ie=UTF8&docId=1000817631). I believe the book is also available for Kobo readers. You will find suggestions and further explanations in the book.

You are definitely on the right track for helping your little guy and you are going to a good facility in Edmonton.

Best wishes to you and your family.

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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