Expert: James Michael Roan - 1/11/2006

Question
Dear James,
In reply to your questions:

Does he play with his toys as he should...other than line them up or just spin their wheels? I'm not sure how to answer this.  He doesn't seem incredibly interested in toys...at least not at Christmas.

Does he turn around and look at you when you enter a room he able to play pretend games?  He does turn around and look at you when you enter a room.  I haven't seen him play "pretend games".  He didn't interact much with his younger cousin who is 16 months old and INTO EVERYTHING!  Alan took an observer's position.

Does he point at things of interest in an attempt to share them with you?
Not really...unless he wants it.  Like his favorite food, his blanket or something to drink.  He knows some sign language also and he still uses that to communicate "more" and things like that.

As far as I know, we don't have any family members with Autism, but I am a bit of a perfectionist, which is why neither of my children are!  I guess I pushed organization too much on them as children!  

If this is only a "perfectionist" cognitive style, how can I help him...interact better with him, etc.  I want my grandson to be as comfortable as possible with me and his environment.  Is there anything I can do to soothe him?

Thank you very much for your time and information!
Gayle Asbury

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Followup To
Question -
My oldest grandson will be 3 in February.  He has severe separation anxiety, and becomes highly upset when separated from his father.  He's a great cuddler with his father and eventually warms up to others in the family to some extent.  He places all his toys in order, (they must be touching!) and at Christmas, he wouldn't open his packages...he didn't want to tear the paper or disrupt it in any way.  He frequently has screaming tantrums when he doesn't want to do something or eat something or when he doesn't have his blanket at nap time.

Are these symptoms of autism?  From the descriptions on the web site, he doesn't fit into any of those categories.  Something is wrong... I just don't know what.  Can you help?
Answer -
Hi Gayle;

These sound like personality idiosyncrasies that are also tied to his cognitive level of development. Separation anxiety is normal but ranges from the simple to extreme. Lining up toys and not tearing the wrapping paper sound to me more like a "perfectionist" cognitive style than behavior that might be considered on the "obsessive-compulsive disorder (OCD)" continuum. Although it could be the latter, especially if a close relative has that condition. Typically, in my opinion, I see this sort of thing in individuals at this age who are very bright, but who are, due to their age, still in the concrete thinking stage. I worked with a young lad that would throw incredible fits when his Hershey chocolate bar broke into sections. The parents were unable to reason with him that it was because that was the way the bar was designed, that it was supposed to do that. This little guy was convinced that because the bar was "broken" it was unusable because at his concrete stage of thinking AND reasoning he mistranslated "broken into pieces" as "broken and unusable," which frustrated him. I asked the parents to change to another chocolate bar until he was older.

Perfectionism and concrete thinking are closely related. As far as autism, you are looking at significant impairments in communication (verbal and nonverbal), impairments in social interaction, and very narrow range of interests.

Does he play with his toys as he should...other than line them up or just spin their wheels? Does he turn around and look at you when you enter a room he able to play pretend games? Does he point at things of interest in an attempt to share them with you?


Kind Regards,
James

Answer
Hi Gayle;

Keep your eye open for behaviors like pointing, sharing, and interacting. If they don't emerge or begin to occur less frequently, then let me know.

It's difficult to deal with a rigid cognitive style. It's the thinking style that causes the behaviors. You could of course give him exactly what he wants when he wants, but this would only be beneficial to you in the short run. You have to to slowly and in a sensitive way introduce flexibility. The first place to start is with discussing his "expectations." For example, when you anticipate a problem with him, like when Dad is going to leave him with you I suggest the following:

1. Have Dad, before they leave their house, consistently and at predictable points in the process remind his son that he's going to Grandma's soon and Dad has to leave him to go to work and that he will pick up on time as usual. Have Dad in his schedule allow for a 5-7 minute transition before leaving from your house to work. Have him give several reminders, a count-down so to speak, of the fact he will be leaving. Do not respond at all to behavioral outbursts just work to ignore them and distract him with an activity you know he enjoys. If this transition isn't working well. I suggest you buy a special clock called a Time-Timer. You set it for a time which is displayed in red. As the time diminishes, so does the red. This important at your grandson's age since they don't understand the abstract concept of time. I use it with my grandchildren and it works wonders! I have additional suggestions related to the subject of autism listed below:

In autism, we are most concerned about social awareness, social development, and social interactions. I suggest you download off the internet the Checklist for Autism in Toddlers (CHAT). It was normed on 18,000 children in the UK and provides a risk estimate for autism. 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 grandchild 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.

2. In addition to the special education referral, take the 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.

It's absolutely essential to get the right diagnosis and appropriate services going right away.

Stay in touch if you have additional observations or concerns.

Kind Regards,
James