Expert: James Michael Roan - 6/14/2007

Question
My son just turned 3 years old about a week ago, and was recently diagnosed with "Passive-type autism with mental retardation".
I`m finding it hard to believe that this diagnosis applies to my son. I am nowhere near an expert, but I did spend a year on a research project dealing with language development in which I ended up doing a lot of reading. I am wondering whether I should pursue a second opinion, or just accept the diagnosis.

Due to his age (past 2) his medical history has been disregarded in his diagnosis - I believe this is entirely unfair. My son was born after suffering a major stroke in the left hemisphere, at 25 weeks gestation weighing 14 oz. He will not be 3 adjusted until the end of September.  An MRI has lead the doctor to also suspect mild (non-cystic) PVL throughout the left hemisphere. He was hospitalized for 5 months after birth, and then fairly isolated from other children (And really anyone outside the family) due to immune system concerns until around 2. He has also undergone two operations requiring extended hospital stays.
We were told to expect delays with movement and muscular control, as that is where the damage is most prominent. We were also advised that he would most likely be unable to walk. He showed no physical progress until around (adjusted)10 months - when he finally began rolling over, etc. However, he was able to walk by 1 year 3 months.
Because he is showing no significant delay in his gross motor milestones at this time, the doctor has discounted any physical cause for his delay. (Which is quite strange in my eyes, as he wasn`t able to so much as stick his tongue out on command until around 4 months ago, and is still entirely unable to exhale at will. Try as he may, he can`t blow bubbles.)

He did not begin pointing until two, which is about the same time that he really began to show comprehension when I spoke to him. His comprehension is still about a year behind his peers, but he does listen to me and will follow commands, etc. His eye contact is good and he is quite affectionate. He consistently responds to his name, and will raise his hand when called. He points constantly at anything of interest, and will call my attention to it.
He uses "Ah ah", "Gai gai" or other repeated syllables to get my attention and will use simple gestures to convey what he wants me to do. He is very vocal and has a lot of variety to his babbling, but nothing yet that has meaning.
He does not have any strange behaviors - he is just generally delayed. I would say he behaves like a mix between an 18 month old and a 2 year old.
He will imitate sounds I make only when they are sounds he makes on a regular basis, otherwise he will appear to attempt to make the sound then grow frustrated and give up.

I have always understood that autism generally shows itself as a lack of desire for communication. My son is constantly trying to communicate with us and with others...

Answer
Hi Krista;

I'm sorry for the delay. My internet is out at home!

I'm not entirely clear what your question is. You are right that a stroke could have damaged the language portion of the left hemisphere. It sounds like he has some oral motor problems with speech production, i.e. not blowing bubbles. You should get an oral motor evaluation to determine if this is due to low muscle tone/strength or apraxia. Apraxia refers to a difficulty with the fluent execution of a sequence of motor actions. You are right, autism is generally about low social interest, low social awareness. It manifests itself in low eye contact, low sharing, and low social development.

I will be abroad for 3 weeks beginning this Thursday and away from a computer.

Kind regards,
James