Expert: James Michael Roan - 2/3/2006

Question
I have a 3-yr old nephew who I believe is autistic.  His mother has not sought any help for him, and believes his problem is simply that they have babied him for too long.  She made an appointment for an evaluation but then cancelled it.  Can you tell me if you think he may be autistic based on the following behaviors?:

Extreme speech delay - he barely puts two words together.  He'll repeat a lot of things, though, and he babbles a lot.  When he gets upset he does not express why he is angry/sad, he just cries.  He doesn't even mention one word as to why he is upset; for example "ouch" if he is hurt.  He loves to watch previews on movies, but not movies.  He is entertained literally for an hour by pouring water or dirt from one cup to another.  He runs back and forth from one end of their living room to another repeatedly.  He will walk along the back of the couch and then the side of the couch, follow the same path back, and will repeat for a while, however he can be distracted and will stop if you say his name.  He likes to stare at the wheels on cars.  He has no interest in playground equipment at the playground, he likes to lie down and stare at the wheels on cars instead.  He used to rock back and forth and bang is head on the back of his high-chair, but I think he stopped doing that.  He just recently started putting his hands in front of his face and moving his fingers back and forth rapidly.  He doesn't seem to have a problem with eye contact, and he is affectionate to his parents, but not really anyone else.  When he plays with blocks he will put them all in a pile and then sit in the middle of them.  He doesn't pretend play.  He is very uncomfortable outside of his own environment.  

Answer
Dear Anguished Aunt;

I'm with you. You're detailed observation has me very concerned. I suggest you download off the internet the Modified Checklist for Autism in Toddlers (M-CHAT) http://www.firstsigns.org/downloads/m-chat.PDF It  provides a risk estimate for autism. Also download the scoring instructions at http://www.firstsigns.org/downloads/m-chat_scoring.PDF
I suggest you ask the child's parents to allow you to fill out the M-CHAT in their presence and to even debate the answers. Remember this is a screening tool, although a very valid screening tool. If there is any risk noted then do two things:

1. If your nephew lives in the U.S., make a special education referral to the school district in which your nephew lives. They are responsible for the assessment of children 0-21 years of age, and if they qualify for special education, responsible for education and related therapies.

2. In addition to the special education referral, have the parents take the M-CHAT to the child's pediatrician and ask for a referral to a multidisciplinary team expert in this area. Again, if you live in the U.S., you can go to the autism unit at a university near you, or a Children's Hospital.

It's absolutely essential to get the right diagnosis and appropriate services going right away. You have done the right thing. Every day that goes by without appropriate and intensive interventions, the less bright your nephew's future becomes.

Kind Regards,
James