Expert: James Michael Roan - 8/1/2008

Question
QUESTION: Hi James,
I have a six month old daughter.  After watching some videos on firstsign.org on autism, I started to have some concerns about my daughter.  Developmentally, all of her caregivers except for me think she is on track.  I'm not sure if I am being an overly paranoid mom.  My concerns are with her smile.  She does have "big" smiles - it's just that they are not that frequent.  Sometimes, she will smile when she sees me in response to my smile (especially after waking up in the morning or after a nap) but there are times when she may be hungry, tired, bored, etc that she does not response.  We have an impossible time getting her to "smile" for the camera.  Other than the smiling, she makes fairly good eye contact, follows objects, looks up and occasionally smiles when playing with toys, smiles spontaneously (such as at our dog), does some babbling (a bit less now as she has a cold), and responds to her name around 60% of the time.  She is a bit limited in the "response" babbling, but does reciprocate some noises on occasion.  Really, it is the smile thing that haunts me.  I brought my concerns up to my pediatrician - she had the nerve to tell me that if I was so worried that she could refer me to someone for help for my worrying.  Maybe I am being overly paranoid - I don't know too many other babies (except a really smiley one) to compare her to.  I also don't know how much of a baby's "personality" comes into play.

Any help would be greatly appreciated - sorry for the long question.  I will be bringing this topic up at her six month appointment in a few days, but am wondering what to do if I get brushed off again (i.e. to ask for a referral).

Thanks,
Heather

ANSWER: Hi Heather;

You have just cause to be "paranoid," autism is nearly epidemic. At this age, the only research-based criterion for predicting autism is "failure to orient to name." It sounds like she is doing pretty well in this department. As far as her smiles are concerned, I don't hear any problems there either. It's the social quality of the smiles we are looking for here. As long as she smiles in response to some people she's probably fine. Remember all children are different and have different personalities. Some are very social, while others are not. Stimulate her positive experiences with social interactions through interactive games such as peek-a-boo and Itsy Bitsy Spider. Here is a list of red flags for different ages. Let me know of other behaviors which may concern you.

6-12 Month Markers:

·   Infrequent eye contact
·   Failure to orient to name
·   Does not smile in response to smiles from others
·   Social and emotional passivity
·   Fixation on objects

By 12 Months:

·   Poor or no eye contact
·   Failure to orient to name
·   Poor imitation
·   No babbling by 12 months
·   No gesturing by 12 months

By 16 Months:

·   No single words by 16 months
·   No pointing to objects or events of interest in an effort to share

By 24 Months:

·   No spontaneous two-word phrases
·   Loss of any language or social skills at any age

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: Hi James,

I have some additional questions - I hope you don't mind.  Your responses have been so helpful.  My daughter is now nearly 8 months.  From the markers, I believe she has good eye contact, smiles to those people who she knows (has improved on this in the past few months - much more smiley), isn't socially / emotionally passive (very upset if I leave the room, grasps when I return, and doesn't have fixation on objects - she is just curious.

My only question is on the orienting to name.  I have read the research study that was done where the child was held by the mom with a small toy and the researcher said the child's name.  Now, if I do this with Avery, she will turn and respond to her name nearly 100% of the time.  But, if my husband or I are playing with her, and saying something like "Oh Avery, you are so funny" or something like that, she really doesn't make eye contact with us unless we are interacting.  

What do you think?

Heather

ANSWER: Hi Heather;

That's when you looking for eye contact, when you are interacting. As she develops what Simon Baron-Cohen calls "theory of mind," her social thinking will develop to the point where she will be making more eye contact and under a variety of circumstances. She coming along fine.

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: Hi James,
I hope you don't mind but I have another question.  I've found you to have great answers.  My daughter, who is now 13 months (14 months in a few days) has a weird behavior.  She will, typically once every day or two, just cover up her ears with her hands.  It doesn't seem to be related to any loud noises or anything that I can hear that would be annoying - she just seems to do it.  Most of the time it is in her outdoor swing.  She doesn't seem bothered - it actually bothers me much more.  I'm wondering if it could be a sensory thing?  She has none of markers for 12 or 16 month autism (has good eye contact, orients to name, imitates a lot, babbles, and points/waves/claps, etc, also can say around 10 words and points at objects to get our attention (mostly food).  I asked my pediatrician; she wasn't sure but asked if she was bothered by tags in clothes or socks not on straight (she isn't bothered by these things).  What do you think?  Is this something to worry about or am I just an overly paranoid mom?

Thanks!!
Heather

Answer
Hi Heather;

Ask as many questions as you like. It may be sensory related or she may be fascinated about the change in sounds when she covers up her ears. Sounds associated with but not limited to an autism spectrum disorder include: vacuum cleaners (hoovers), hair dryers, hand air dryers, noisy places like McDonalds, unexpected sounds, etc. You can have sensory delays independent of autism. Many children I've known with over sensitivity to sound have often become excellent musicians at very early ages.

Kind regards,
James