Expert: Dr. Sharon A. Mitchell - 4/9/2007

Question
QUESTION: I have been concerned that my son, Luke, could be autistic. However, he has only two things that seem to fit that bill.  He does not point w/ his index finger at all.  He will "point" with his hand.  How important is the "index" finger?  He also has some regression of speech at 17 mths old he was saying "go outside" and another 7 or 8 words.  He seemed like he did not want to say much after that.  Maybe "uh, oh" or "daddy".  After 4 months of hardly any words other than, uh, oh and daddy, he now says, "Bye Daddy", "ma,ma", "uh-oh", "oooh", "go", and "Hey dad".  He does seem to be babbling in sentences now.  My brother is a principal and his wife is a young Sp. Ed teacher.  They think I am crazy to thing my son, Luke, has autism.  He is happy, affectionate, loves peek-a-boo and expresses his wishes in his own way and he clearly understands everything that is said to him and follows 2 step directions.  He is not a gregarious child by any means, he plays next to other kids but if the kids get rough or if there is too many of them, he will wander into a different room some of the time. I always assumed that his is normal due to my husband's personality.I could let this whole "autism" thing go but noone seems to be able to explain to me the "regression" of language, there has been "absolutely nothing" different in his enviorment.  I stay at home w/ him, we haven't moved, nothing.  He does absolutely love to be outside and w/ the cold weather he obviously did not get to go outside...that is all I can come up with.  The index finger is another thing I cannot account for.  When I type "lack of pointing" on internet searches, the only thing that comes up is "autism", nothing else.  Maybe you could enlighten me?
ANSWER: It can be hard not to worry when you're a parent.

Much of what you describe sounds to be within the norm for a two year old. It's encouraging that your son is happy, affectionate and communicates. Playing next to rather than with other kids is expected of children your son's age.

Within the normal spectrum, kids develop different skills at different ages. Included in the variation are physical skills such as fine motor coordination. There is a chance that your son is pointing with his hand because he is not developmentally able to easily separate the appropriate finger to point as we would. Also, pointing in his method seems to be getting him what he wants, so from his point of view, would there be a need to change and work at refining his pointing technique?

I'm not sure the expressive language differences that you describe actually constitute a regression, especially when you feel that he's still communicating, both expressively and receptively well.

But to be sure, you might want to check with a Speech/Language Pathologist (SLP). SLP's are expert at assessing a child's communicative development. They can either give you pointers to encourage your child's progress, put your mind at rest as to your son's normal development or provide therapy for your child is needed.

Below are a few websites that can help you sort out what is within the normal speech/language parameters for a child your son's age. Armed with this information, you can then speak to a public health nurse, pediatrician or speech/language specialist.

http://www.asha.org/public/speech/development/child_hear_talk.htm

http://www.comeunity.com/disability/speech/milestones.html

http://www.ldonline.org/article/6313

Even without professional guidance, there is a lot parents can do to help their child's developing language skills. You'll find some suggestions here:  

http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm

http://www.hsdc.org/News/Speech/encourage.htm

If you're concerned, I think you should speak to a Speech/Language Pathologist (SLP) to get the best advice.If you live in the United States, you can find a local Speech/Language Pathologist through this site:

http://www.asha.org/proserv/

In Canada, try here: http://www.caslpa.ca/english/profession/find.asp

For other countries and general information on finding SLP help, check out this site:  http://members.tripod.com/Caroline_Bowen/find-slp.htm

Sharon A. Mitchell
www.autismsite.ca

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

QUESTION: I appreciate you responding so quickly.  It is encouraging to hear that he may be within the normal development of a 2 year old.  I stay at home with him and feel like I read to him, play with him and do all the things you "should" do with your child.  My son attends a couple of playgroups so it is hard to see the other children, in the last six months, really develop their language skills, and to see my son reverting back to "Da, da", and "uh, oh".  I took him to Help Me Grow a couple of months ago.  They said his language was that of a 13-15 month old.  They said he qualified for free Early Intervention Services. Have met w/ his teacher, aide, speech therapist and really feel pretty good about taking him there.  I figure it can't hurt anything and seems like it would be enjoyable to my son.  I am waiting to hear back from the SP about an assessment, she is on vacation now. Even though Luke's hearing appears to be fine I am having him get a "hearing test" at an Ear, Nose and Throat specialist this week.  When my son was born, I thought he may be my only child, so I have documented every milestone or interesting development since he was a newborn in a journal and updating it about every 2 weeks.  At that time, I didn't want to forget anything.  I feel now that this will help me have some information to give the SP and the Early Intervention Specialists to help them see what other new things he was learning during his times w/ no speech advancement.  I definitely feel because he is my only child that I worry alot.  It is just hard to have some people say "He is fine" and others saying "Whoa, he needs Early Intervention".  It is hard to have such differing opinions.  I just want to be a responsible parent and not miss anything that needs addressed.  So would you say its within the realms of normalcy to have a child really take off in language around 17 months, saying some words that he has never repeated again and asking a version of "What's that" to stop doing that?  I hope that is the case.  However, we do play this game where he puts his hands on an item and I tell him the name of the item. Then he goes around the room and touches different things and I tell him the name for other items.  Do you think I am enabling him to not speak? Should I be teaching him sign language at this point? I have tried in the past and he seems totally uninterested.  My pediatrician says at this point, he just needs to talk and not necessarily with sign language. It just seems to me that Luke has no motivation or interest in talking at all.  Does that seem normal?  I kindof thought that once children started to talk it would just take off.  I am not sure why my son wouldn't do the same...I praised him and did all the things you would do when your child says a new word. The thing that makes me sad is not knowing what kind of things go on in his mind because he can't/won't tell me.  I am sorry for the long novel.  

Answer
You most definitely can't go wrong taking your son for early intervention. Especially when he's enjoying his time there.

Conflicting opinions from well-meaning friends and relatives can be hard. These people mean to help and reassure but it's still hard to hear.

Many developmental physicians long to have a detailed history at their disposal; your thorough documentation of your son's milestones will certainly help, especially if there has been some loss of skills.

No, I don't think your naming game is enabling your son not to speak. If believe he can say the name for an item, yet you give it to him without him speaking, that could be a cause for concern but that does not sound like the case. Most SLP's believe that augmentative communication encourages a child's oral language, rather than being a hindrance or giving the child "an easy way out" where he does not need to speak.

Sign language, PECS (Picture Exchange System), Amer-Ind, etc. are all examples of low-tech augmented communication systems that can be used with young children. I'd suggest though that rather than beginning one of these one your own, talk to your son's teachers and SP. They may have a preferred system or one already in place in the Early Intervention program. It'll be more effective if you are all using the same strategy.

Most kids of your son's age are interested in communicating verbally and you're right that generally kids' spoken vocabulary continues to increase. It requires more of a guessing game on your part too, when your child does not tell you what's going on. But your SP will be able to determine the stage at which your son is currently at and direct you best in ways to assist in his development. If your son has a history of ear infections, this will be useful information for your SP.

It really is hard when you see your child not doing things or responding in the same way as other children his age. It hurts. I know.

But different is not necessarily wrong or bad - it's just different. And right now, you don't know for sure that your son is experiencing anything more than a lag that can be aided greatly by early intervention. It happens - not so often in autism, but I have seen kids benefit sufficiently from early intervention that when they begin school they perform close to their age peers.

Best of luck in your appointment next week,

Sharon A. Mitchell
www.autismsite.ca