Expert: James Michael Roan - 12/14/2007

Question
My daughter is three years old, will be turning four in July.  She was evaluated by a ped. neuro. recently and although he did not feel she was autistic, I am still worried.  

I took my daughter to see the ped. neuro. because I am concerned about a repetitive hand movement she makes.  The movement started when she was about 6-7 months old.  When my daughter is excited or happy she will rub her thumb over the other fingers really fast.  This movement is accompained by a facial grimace and her teeth clench.  Sometimes it also appears she crosses her eyes.  This movement lasts about 10-15 seconds.  It happens through out her day, every day.  She can be called out of it and redirected without any problems.  

During the evaluation, the doctor looked at her and talked with her.  He spent about 20 minutes with her and they took a little walk where he had her run, jump, stand on one foot, etc.  She followed all his instructions and she was having a lot of fun with him.  He looked at me and said some kids develop "stereotypical movements" and that not all kids that make these movements are autistic.  He said she was "defiantly not autistic."  I questioned the fact she reversed pronouns and had a language delay.  He said the movements where probably related to a "language disorder."  Is this possible?  Can a nonautistic child reverse pronouns and have stereotypical movements?  I am so confused.

Reasons I am concerned about autism...mainly the movements and her language.  My daughter said her first words on time and did speak in two word phrases by two years however, there was something different.  She only talked when she wanted something.  She didn't chit chat.  She was quiet but she was not shy, she laughed a lot and she smiled a lot.  She did echo a lot at two.  She has mostly outgrown this.  She stopped most of the echoing after she turned three.  At this time she began to reverse pronouns.  This was also outgrown about six months after it started.  At this time she is very chatty but when she talks the conversations are mostly one sided.  Also, these conversations seem the same daily.  She is talking in sentences with 6-7 words.  She can say "I am thirsty, I need some water mom."  Also when she talks she repeats herself a lot.  An example, she was playing in my room with her Thomas the Train set the other day and she said "look mom, Thomas is pushing Percy" about 10 times in a row.  

She is also pretty active.  She never established a nap schedule as a baby.  Sometimes she would nap, some days she would not.  She does not nap as of now.   She is very distractible.  She does want to sit still for very long.  There is family history of ADHD on her fathers side of the family.

She is also constipated a lot.  She doesn't complain about it but I can tell she is.  I heard autistic children are constipated a lot.  I must say however, when I have her drink more juice she gets better.  She is fully potty trained and training was not an issue, it was very easy.

Reasons that I think she is not autistic...
She is very loving.  She has attachments to myself, her step-dad (her natural father has never been in her life) and all her grandparents, aunts & uncles and cousins.  She can tell when other children are sad and tries to comfort them.  She seems 'normal" in the social area of her life.  She does not have a need for any routines in her life.  She also has good eye contact and I haven't noticed any sensory issues.

The area of play is 50/50.  She loves toys and has many.  She loves stuffed animals and she will dress them up and make the eat and drink.  Her play seems rather purposeful though.  She has them drink when a toy cup is around.  She has them eat whatever she is eating.  Another example, she loves dress up.  She will spend sometime putting outfits together but once she is dressed she doesn't play the part of a princess.  She has a toy kitchen sitting in her room but she doesn't spend much time there.  She has doll houses that she plays with a lot and I have seen her put the toy people in the car and they "drive to McDonalds" so the idea of pretend is there but it seems pretty limited.  She prefers to play outside on the slide or swing.  She likes play-dough and painting.  She seems ok when playing but like I said, she does not use a lot of imagination.

With all this said, do you feel she should be seen for a second opinion?  Do you feel this child could fit on the spectrum?  Any help would be very appreciated.  I am very, very concerned.


 VERY CONCERNED FATHER !!!!!!


I'm very interested in this story, as my seven year old shows a lot of familiar traits.         
 Especially contorting her face, crossing of the eyes. In my daughters case this reaction seems to be brought on my excitement.
 I WOULD BE THANKFUL FOR ANY HELP.. OR IF THIS PERSON HAS HAD ANY LUCK IN DIAGNOSING THE DISORDER

Answer
Hi Don;

Please be aware that I do not diagnose over the internet. I simply provide an informational service.

Three quarters of the behaviors you described are frequently seen in children with Asperger's syndrome. You should get a second opinion by someone or a team very experienced with Asperger's syndrome both at this very early age and with girls. This will take some time to do. Girls often are overlooked because they are naturally more social than boys. There is wide fluctuation in the severity of Asperger's syndrome among those who have it. If your daughter does have it, it sounds to be quite mild.

Let me know if I can answer any other questions.

Kind regards,
James