Expert: Dr. Sharon A. Mitchell - 5/22/2007

Question
I am concerned that my son may have ASD but I know I might be overreacting to all the reading I've been doing.  He has some of the symptoms that I've read are related to ASD but not to a severe degree. The ones that do concern me are that he often tunes us out - we will call his name and he appears to be completely ignoring us.  Other times though, he interacts and responds typically.  His language is delayed and I am going to get him assessed for this.  He mostly uses 1-2 word (understandable) sentences, but babbles alot and is hard to understand, so he may be using more complex sentences than that. Often the "conversations" he has are repeating lines from his favourite TV shows (which are multi-worded sentences).  He also does not engage in imaginiative play very much - he sometimes pretends to talk on the phone, but usually plays with cars, blocks or trains. He doesn't just line them up, but basically just connects them and drives them etc.

He has a twin sister and so we can't help but compare their behaviours.  He does enjoy playing with her and our nanny's daughter, but engages in more physical play with them.

Are these behaviours normal, or should we be concerned? Should I have him assessed by an autism specialist, or should we wait to see what the speech pathologist says after his assessment (this will likely not be for another 4 months).

Thanks.

Answer
I definitely think you are taking the right first step by having a speech pathologist see your son.

Some of the the things you describe are also found in kids with autism; but they could also occur in typical kids or kids with more language-related delays.

Being a twin also complicates things. Girls frequently have more advanced language skills than boys. Some twins communicate with each other more effectively than with their parents or other people.

It's also not unusual for a boy to engage in more physical play than would his sister or your nanny's daughter.

The type of language delays your describe could suggest that your son may have some hearing difficulties. Does he have a history of ear infections or upper respiratory infections? If he hears better some times than at others that could account for why his speech production is uneven. Some children who have had ear infections that affect their hearing have more articulation trouble as they have not always been hearing the speech sounds correctly, making reproducing them more difficult.

A speech pathologist while assessing your son's language skills will be able to detect the likelihood of hearing difficulties and would then make a referral to have his hearing assessed.

Speech paths do far more than just look at a child's articulation (pronunciation of sounds and words) but assess also how the child uses language and responds to language compared to others of his age. They also can look at pragmatics, sort of the social niceties of our language that involve turn-taking, voice inflections, conversation openers and enders, etc. Receptive, expressive and language pragmatics can be areas of weakness for kids with autism. But children without autistic tendencies may also experience weaknesses in these areas.

Your speech pathologist, after assessing your son will be in a good position to recommend whether or not further investigation into the possibility of autism may be warranted. She may also be able to give you suggestions that your family can work on to help develop your son's language skills.

I've written to a few other parents with concerns similar to yours. Perhaps there are checklists or further information in these links that might help you:

http://en.allexperts.com/q/Autism-1010/2-year-old.htm

http://en.allexperts.com/q/Autism-1010/sound-son-autism.htm

Sharon A. Mitchell
www.autismsite.ca