Expert: Dr. Sharon A. Mitchell - 12/24/2007

Question
I think I have been in denial for the past three years about my son.  My family members and a few friends have been trying to tell that there is something a little different about my son, he doesn't point to anything and when he wants something he just takes my hand and pulls me to what he wants to eat or drink but never speaks even when I try to get me to say juice or cookie he just won't.  Also one thing I never really paid attention until recently he rarely responds when his name is called as if he is completely ignoring every person who calls his name. I had his hearing checked out and they said no problem.  The pediatrician has said to have him checked out for development delay and possible autism then it was as if I was slapped in the face and woke up that there might be a problem and looking on the Internet and checking out asd I strongly feel he has this disorder so my question is what do I do to better help my son?  He makes eye contact with me and the people he knows but with strangers he completely avoids 100% sometimes I feel embarrassed because they are trying to talk to him and he never shows any response and as if he doesn't even understand. He does make noises as if he is playing with his voice and once in a while when I tell him to say "hi" he will.  What are the chances he will grow out of this? My main concern he doesn't respond to his name!  How do I get him to respond?

Answer
Yes, you may have been in denial but please don't feel badly about that. What parent has not had similar thoughts? We all hope and wish for our children to be as "normal" as possible so that they can have an easy and happy life.

But sometime, despite our best efforts, some of our children develop differently than others.

Autism is a spectrum disorder, meaning that there is a wide variation in the degree of autistic symptoms a child shows and also a wide variation in intellectual ability.

To be honest, if your son has autism, I do not think he will ever outgrow it. That's not the way autism works. But what will happen is that your son will grow and change, developing new skills and learn better to cope with his world.

Your son is not using language now. It might help if you read about some intelligent, capable autistic adults who also did not speak until they were older. Dr. Temple Grandin is probably the most famous person with autism. She's a university professor in Colorado, is well-known in her academic field, speaks world-wide on autism and has written several books. One of her books I'd suggest is called, "Emergence: Labelled Autistic". Take a look at it here:

http://www.amazon.com/Emergence-Labeled-Autistic-Temple-Grandin/dp/0446671827/re...

You've taken a great first step by having your son's hearing checked. Now that you've ruled out a hearing impairment, you know that that is not why he does not respond to his name.

You've also taken a good step by picking out a main concern - getting him to respond to his name. It would not be realistic to attempt to tackle everything at once, but what you've chosen is realistic and meaningful in his life.

Many people with autism find it much easier to take in information through their eyes rather than through their ears. That's why visuals are such an excellent way to communicate and to help bridge the world to spoken language.

Do you think your son is at the stage where he can relate to pictures or photographs of objects? If you show him a picture of your car and tell him to get his coat, will he understand that you are going somewhere? There are a couple books I like that show ways of using visuals to support communication - Visual Strategies for Improving Communication (http://www.amazon.com/dp/0961678615?tag=autismhelpf0e-20&camp=14573&creative=327...) and Making Visual Supports Work in the Home and Community (http://www.amazon.com/dp/096725146X?tag=autismhelpf0e-20&camp=14573&creative=327...).

You can learn more about why you should use visuals and how to use them at this site: http://www.do2learn.com

There are other things you can do to encourage your son's language development. Most of them you are likely doing instinctively but you may get some more ideas from The American Speech Language Hearing Association
http://www.asha.org/public/speech/development/Parent-Stim-Activities.htm

Some people feel that a child's language skills have been enhanced when taught sign language. These are simple signs a baby or toddler can learn to make in order to get what he wants. It's a ways of teaching him that he can use communication to control his world. Using sign language, picture cards or other types of facilitated language will not discourage your son from speaking. Rather, it reinforces his learning that communicating gets you what you want. You'll find information on how baby signing here: http://www.signingbaby.com/main/

I agree with your pediatrician - have your son checked. What is the worst that could happen? Perhaps you'll learn that your fears are unfounded and your son if just a bit delayed. Or perhaps you will learn that he has autism. It's not the end of the world.

As a starting point for you to get ready for the assessment, here are some sites that talk about normal physical developmental milestones for toddlers:

http://www.med.umich.edu/1libr/yourchild/devmile.htm

http://parentcenter.babycenter.com/refcap/preschooler/pdevelopment/1496593.html

http://parenting.ivillage.com/tp/tpdevelopment/topics/0,,4rwc,00.html

Below are a few websites that can help you sort out what is within the normal speech/language parameters for a child your nephew's age.

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, or while you wait for an appointment, 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 after looking at this developmental information, you're ready to seek some guidance, I think you should speak to a Speech/Language Pathologist (SLP) to get the best advice on your child's communication skills. 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

While an SLP might be one of the first professionals you want to see, a developmental pediatrician or child psychologist might also be helpful, as your pediatrician has suggested.

Below are two versions of a Checklist for Autism in Toddlers that a physician might use when your child is seen. It may be helpful for you to look them over to get an idea of what sorts of things a diagnostician may look for. The first link explains a bit more about the CHAT:

http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=128&a=2226

http://depts.washington.edu/dataproj/chat.html

http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

Best of luck,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca