Expert: James Michael Roan - 9/13/2005

Question
When is the right time to reach out?
My wife and I share the same concern about my brother (“Dave”) and his wife's son, Anthony.
Anthony is a healthy 27 month-old who is exhibiting what we feel are some of the behaviors associated with Autism.  His speech is very delayed.  He doesn't generate any words on his own—the few words he does use usually come in response to rehearsed questions from his mother or father (“What does a clock say?,” “Count the blocks, Anthony.”)  He fails to sustain eye contact with anyone other than his parents, and will only acknowledge others for a fraction of a second, and then only when raising our voice.  He comes to life when “chased” or tickled or some other exaggerated gross-motor play, but as soon as it ends he will gaze off into empty space.  In almost every environment he is in, he will amuse himself by spinning something—a plate, a bowl, the wheels on a toy car turned upside down.  When we attempt to play with him one-on-one it is though we aren't even in the room.  When we try to gently direct his gaze toward us by holding his face, he will look at us for less than a second and then resume looking into space and staring at the lights and ceiling fans.  Although we have never broached the topic with my brother's wife “Sue” (who we dearly love), we desperately want to see Anthony get the help we feel he really needs.  Sue seems to feel that Anthony is just coming along a little slowly (information she told us unprompted).  She told us that at his Pediatrician visits, nothing of note was ever said by the doctor.  She said she had concerns with his lack of speech, but Dave said the doctor told them Anthony was “perfectly healthy,” and “what are you worried about?”
My wife and I went through a similar experience with our own son (now 10), who had socializing issues of his own (he would bite other children at day care) when he was three years old.  Althoguh his needs were just barely on the fringe of the Autism spectrum, we used the label he was given to get the services he needed.  We want Anthony to get help, but we're very concerned that my brother and his wife are in denial.  They've seen many other children very close to Anthony's age who have much more vocabulary, and display much more typical social behavior.  Sue stays at home with Anthony and thusly doesn't expose him to other children his age, which might be helpful.
Our relationship with Dave and Sue is very close—we love them both and want their son to be able to enjoy a rich, full life no matter what that may be.  MY QUESTION IS THIS:  When (if ever) is the right time to discuss what we see in Anthony?  How do we reach out and share our concerns?  Now (before he is of pre-school age) is the time he can benefit from a proper evaluation.  We know how hard it is.  We can help.  How and when (if ever) do we broach the subject?


Answer
Hi Pete;

You have made some very good observations and you have personal experience as well. I also, have been in your shoes and it is very difficult to ascertain "when." Having made big mistakes in this arena I suggest that you wait for(or arrange)a quiet moment when they are least likely to be defensive, which it sounds like they already are to some degree. Let them know how much you love them and their son, and for these reasons you need to speak up. Cite your personal experience and the fact that, if your suspicions are correct, that their son is missing out on a "narrow window of opportunity," which lasts between the ages of 2 1/2 and 6. The longer they delay, the less likely their son will develop functional communication, much less the more complicated social cogniton/communication skills he will need at school and as an adult. Let them know that the population of autistic children is growing more diverse every year and that pediatricians may or may not be aware of this diversity. Even now I work with pediatricians and some psychologists who believe (erroneously) that if a child has good eye contact and good social smiles, that they must not be autistic. Nothing could be further from the truth. The only way that you can know for sure is to have a psychologist who is a specialist in this area and who uses a variety of tests and observations in making a diagnosis.

I sincerely hopes this helps. I've always found it better to plant a few seeds and hope they take root. You are a good uncle! Good luck.

Kind Regards,
James