Expert: James Michael Roan - 4/21/2006

Question
My 21 month-old daughter has extreme separation anxiety from me.  I stay at home with her, but at Bible school and mothers morning out (2 days a week) she almost hyperventilates when I leave and I sometimes come back to get her or stay in Bible class with her. (She like grips me)What mainly concerns me is that she does not like people that she first meets in her personal space it seems.  Like, If I see an old friend at the store, and they say Hi and rub her back or something, she will kick her legs a little and make a noise indicating "Back off".  Also, she is speech delayed.  She has actually tried to mimic most of our words lately so I would say that she has mimicked close to 40 words.  She is very cuddly with people she knows.  She points and says "that" so that we will tell her what it is. (Constantly)  She does have a lot of major temper tantrums, which I think could be from her inability to form the words.  She seems very smart, can point to the shape I say and any animal or body part and some numbers, letters and colors.  I think she is just slow to warm up and very stubborn but would like some input please. Also, when I ask her a question that requires a yes or no answer, she will shake her head no if the answer is no usually, but has yet to nod her head yes and will just proceed to do whatever it is I asked her.  She also does follow directions pretty well.  Thanks for your input.  Jennifer  

Answer
Hi Jennifer;

I do not diagnose over the internet, however, based on the limited information you have been able to provide me it sounds more like an expressive language delay. To get a better idea, however, I recommend that you download off the internet the Modified Checklist for Autism in Toddlers (M-CHAT) http://www.firstsigns.org/downloads/m-chat.PDF It was normed on 18,000 children in the UK and provides a risk estimate for autism. Also download the scoring instructions at http://www.firstsigns.org/downloads/m-chat_scoring.PDF If there is any risk noted then do two things:

1. If you live in the U.S., make a special education referral to the school district in which your child lives. They are responsible for the assessment of children 0-21 years of age, and if they qualify for special education, responsible for education and related therapies. I suggest you do this anyway since there may be a language delay.

2. In addition to the special education referral, take the M-CHAT to the child's pediatrician and ask for a referral to a multidisciplinary team expert in this area. Again, if you live in the U.S., you can go to the autism unit at a university near you, or a Children's Hospital.

Remember, Jennifer, you can always discuss the results with me before taking any other actions.

Good luck!

Kind Regards,
James