Expert: James Michael Roan - 10/27/2005

Question
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Followup To
Question -
Ihave a 22 month old son, Luke. He was born at 31 weeks gestation.  He has been followed by our local early intervention service since he was 2 months old.  When we did his 12 month screening it showed possible delays in social and communication skills and fine motor skills.  They did an evaluation at that time and he showed a marked delay in fine motor skills, but tested ok in social and communication skills.  At the time I was not sure that I agreed because I was starting to have some concerns in that area, but not having a whole lot of experience with this I took their word for it.  He received services for his fine motor delay by a developmental therapist and things went fine.  However, I began to have concerns about his speech.  He showed absolutley no progress in that area so I pursued an evaluation for speech.  He did show a delay and therefore began speech therapy at that time. He has been receiving 1 hour of speech once a week for 4 months and I really haven't seen much progress.  He babbles more than he used to but still does not have many words that he uses on a regular basis. He has started saying mama almost constantly but it's mostly not to call me.  He seemed to be saying a primitive form of the word juice but that only lasted for a few days.  He mostly points and grunts to communicate his wants and needs.  Recently, I had him evaluated by OT and a developmental behavioralist because fo his behavior.  He has become increasingly difficult to handle.  He now receives 1.25 hours each of OT and behavior therapy every other week.  I also had him evaluated by a developmental pediatrician at Children's Hospital of Pittsburgh.  So far everyone is saying that he is not autistic but I have my doubts.  He seems to be sociable with adults but has no interest in children his own age.  I took to the mall today to play in their play area. There was a little girl (15 months) that was trying to interact with him.  She was trying to hug him and touch him and he wanted absolutely nothing to do with her.  I have also seen him do some odd finger posturing, not alot but I'm wondering if it's not the start of something.  I am at a total loss as to what to do.  I guess my question is do you think I have something to be concerned about? I know it's difficult for you to say for sure in this venue but does this sound like something that I need to investigate further? Also, I'm concerned that the amount of therapy he's receiving isn't enough.  What do you think?
Answer -
Hi Ellen;

First, I think the amount of service you are getting is probably enough, assuming your son only suffers from a speech and motor delay. It is common for children with a speech delay to prefer more language-competent partners such as adults. His rejection of the peer in the mall could be due to sensory delays or a preference for the activities he was involved in when the other child approached.

I need more information on your son's social behavior:

1. How old is he now?

2. Does he bring objects to others in an attempt to share his interest in the object(s) with them?

3. Does he ever point to planes in the sky or something of interest in an attempt to share rather than as a sign that he wants the object?

4. When you walk into a room and call his name, does he turn around and look at you?

5. Does he avoid physcial contact with others, including parents?

6. Does he return social smiles?

Let me know about your son's social behavior in more depth please.

Kind Regards,
James
Hi James! Thank you for your reply! Luke wil be 2 on December 7th.  He does bring objects to me and others but he mainly sits them on my lap and plays with the object himself.  He does point to planes and things and looks at me as if to say Look! An airplane! It often tkes several attempts to get his attention when you walk into aroom, but he eventually will acknowledge you most of the time.  Sometimes he's a little squirmy when you try to hug him but other times if you ask for a hug he will run over for hugs.  he does return social smiles.  As for why he's getting OT an behavior therapy, he does have some pretty horrendous tantrums at times.  He has periods when his activity level is very high, running around aimlessly, climbing the furniture, going from one toy to the next until I feel as though I have a wild monkey loose in my house!  I have also had a very difficult time taking him shopping.  Doesn't want to sit in the cart and has tantrums if I make him.I've had to leave stores frequently because I just can't get him settled.  The OT and behavioralist are working with us on these things and we seem to be making progress.  They have me providing lots of physical activity for him and it does seem to help.  Another area we've had a lot of difficulty in is his sleep.  He never really got onto any kind of schedule when he was a baby and naps have always been an issue.  He seems to need a nap but then when I tried to put him down for one he would fight me with every ounce of enregy he had.  We have now started letting him take naps on the sofa. I call it quiet time.  I close the blinds and put Baby Mozart in the DVD player and we've had some success but he still gives me a hard time about sitting on the sofa but usually within 15 minutes he's asleep and sleeps for 2 hours.  A few months ago we had to switch him to a toddler bed because he was climbing out of the crib and that has been a disaster!  We have started letting him stay up until he runs out of juice because when I would try to put him down for bed he would cry hysterically when I would try to make him stay in bed.  When he finally would fall asleep, he usually would wake up around 3 or 4 in the morning and come into my bed and then it was play time!  I am now just letting him fall asleep in the living romm and I take him to bed with me.  It's not the ideal situation, but at least we're all getting a decent night's sleep.  There have been a few nights when he wakes up and wants to get out of bed but I don't let him. Last night he woke up at 4 am and tried to get out of bed.  I wouldn't let him and he carried on for about 15 minutes but then went back to sleep.  I hope this isn't the start of something!  He also has alot of separation anxiety. He started this when he was about 7 months old and has never really gotten over it.  I read that sometimes kids who have this often have sleep problems because they know it's a separtaion from you.  I think this is very true of my son.  One other thing that I wanted to mention are his staring spells.  I used to call it zoning out.  He just looks as if he's staring off into space and lasts up to 20-30 seconds.  I told the dev ped. about it so we're doing an overnight EEG in november.  Sometimes he doesn't come out of it when you speak to him.  At times you have to shake him by the arm a little to get him to come out of it and then he'll look at you and smile as if to say What's your problem?  Well, that's about it.  Sorry this is so long. I really appreciate your time!  Thanks! Ellen

Answer
Hi Ellen;

Your little guy sounds like a god deal of work! I had one just like him and now he's ready for college! I'm glad about the EEG follow-through. I was going to suggest that.

The Baby Einstein movies are ideal for putting them to sleep. Remember, routine is everything when it comes to falling to sleep quickly; it works for children and adults alike.

Take care and keep me informed.

Kind Regards,
Jim