Expert: Dr. Sharon A. Mitchell - 8/20/2007

Question
MY 20 MONTH OLD GRANDDAUGHTER SPINS AROUND ALOT, AND AT TIMES SHE WALKS WITH HER HEAD TILTED BACK LOOKING AT THE CEILING, SHE ALSO WALKS WITH HER EYES CLOSED. SHE IS ALMOST NEVER STILL AND MOST IMPORTANTLY SHE SELDOM LOOKS AT US WHEN WE TALK TO HER. SHE TURNS HER HEAD SIDEWAYS OR JUST HER EYES. MY QUESTION IS THIS SHOULD THERE BE CAUSE FOR CONCERN? MY DAUGHTER THINKS ITS ALL NORMAL,BUT SHE IS A FIRST TIME MOM. MY DAUGHTER DOESN'T THINK HER DAUGHTER SHOULD BE EVALUATED. ANY ADVICE WOULD BE HELPFUL.

Answer
I'm afraid it's not possible to give you a good opinion about whether or not this might be autism without seeing the child.

But Maggie, you're in a difficult position. You suspect that something may be developmentally wrong with your granddaughter but her mom may not want to look at or admit to that possibility right now. As parents, we hope against hope that all will be well with our child.

Perhaps mentioning all your concerns would overwhelm your daughter right now. She may react defensively or dismiss your concerns because the difficulties you're suggestion seem just too enormous or threatening. She may even become angry because you are saying things she does not want to hear or consider.

Instead, you may find a better reception if you focus in on just one or two things - preferably less threatening aspects of what this little girl is or is not doing.

Your eventual goal is to be as helpful as possible. Ideally through your suggestions, your granddaughter would visit a health care professional who would either find that this toddler's development is within the normal range or if not, then he or she would take it from there and begin the process of getting the needed help.

As a starting point for you, here are some sights that talk about normal physical developmental milestones for toddlers that you can use to compare with what your granddaughter does:

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

A general physical is another good place to start. Most doctors do a developmental screen with young children to see if the child is meeting expected developmental milestones at typical times. Also, this child is likely due soon for some immunizations. At such times, the public health nurse or doctor may take notice of the behaviors your describe and begin further investigations on their own.

It would not hurt to ensure that the doctor or nurse take a look at how this child uses her eyes to see if there is any physical reason she turns her head or looks out the corner of her eyes. Some young children with vision difficulties also show these behaviors. A screen on her hearing would also be useful in ruling out other factors.

You don't mention if this child is speaking. Below are a few websites that can help you sort out what is within the normal speech/language parameters for a child your granddaughter'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, there is a lot parents can do to help their child's developing language skills. This is a way you could broach the subject with the parents or try some of these ideas with your granddaughter yourself. 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 still concerned, and the mother is ready to seek some guidance, I think you should speak to a Speech/Language Pathologist (SLP) to developmental language advice. These professionals don't just deal with how a child talks, but also with how well a child processes what she hears and the social skills she uses for communication and interaction.

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.

Below are two versions of a Checklist for Autism in Toddlers that a physician might use. 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

Your granddaughter is lucky to have such a concerned grandma.

Best of luck,

Sharon A. Mitchell
www.autismsite.ca