Expert: James Michael Roan - 6/6/2006

Question
Hi! I have a question about my 14 month old son. He is in early intervention but they have taken the wait and see approach although the psychologist said "definitley not" to autism while the speech pathologist said poss signs. Between the ages of 8-11 months he had reoccuring ear infections and stopped responding completely. Not turning to his name, engaging etc. After some recovery and time without illness he began to bounce back, albiet slowly. He now turns to his name 70% of the time, plays with his sister, loves books and will show and bring them to me to read to him, knows how to play with cars, other toys, has strong attachment to me (mother), looks at us for our reaction when doing something he knows is wrong and smiles, initiates hide and seek behind a curtain, drinks from a cup, eye contact is steadily improving. He understands several commands but seems to do them only on his terms not every time like our daughter to seek approval. For example if I say show me round and round, he will roll his arms 20% of the time, but if I say do you want to read a book he will get a book almost everytime. Some of my concerns are that his pragmatic language skills seem to be coming very slowly. I taught him to put his arms up to be picked up by saying "up". He sometimes will point to things of interest but does not use his finger to show what he wants, he will still reach. He does not wave goodbye or shake head no. He recently started to say words , I think! He was on  the fireplace brick and said "NA NA NA" for no because I always tell him no there. It think he's also saying hi, thank, and his sister's name but not with the ususal enthusiam. He also started sleeping from 10-1 at daycare and can not be woken up until He hears my voice and then he pops right up. They said it's like tryin to wake up a teenager. He also refused a bottle and had to be exclusively breast fed until 10 1/2 months. He will spin and hold his hands flexed backwars but not for long periods of time. Any thoughts on this would be greatly appreciated! Thank you.

Answer
Hi Kate;

It sounds like your son has some real social strengths such as bringing things to show you, desiring to be read to, and looking at your face for your reaction (emerging theory of mind skills). It is also a very good sign that he is initiating "hide-and-seek," which is has a social interactive component to it.

Overall, I would agree with you that his social development is lacking a bit in some areas. Remember, there are many of us who are socially low, but who are not autistic. 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 was normed on 1,293 children in the US and provides a risk estimate for autism. Also download the scoring instructions at http://www.firstsigns.org/downloads/m-chat_scoring.PDF If there is any risk noted then write me back with the score and we can discuss it further. Please remember that all children develop at different rates in different areas. Your son may be slow to develop socially due to his ear infections. Ear infections correlate with slower developing verbal skills and verbal abilities are highly correlated with social skills. Use the M-CHAT as a guide and a way of keeping track of your son's social development.

Kind Regards,
James