Expert: James Michael Roan - 8/21/2007

Question
QUESTION: Hello..I have a 7 yr. old son with Aspergers, so I am somewhat knowledgeable in the ASD arena, however I am not sure how to read my 2 yr. old daughter.  She has been diagnosed with a developmental and speech delay.  She has no hearing problems, and recieves developmental and speech therapy, at 1 time she also recieved OT for some sensory issues.  At 28 months my daughter only says the following words on a regular basis: hi, daddy, momma, Nanny (for Grandma, and here.  She can say but hardly ever uses the following: apple, all done, and bye.  to comunicate with us she uses sign or points and grunts.  She enjoys the company of other kids, trys to play with them, has great eye contact, immitates us (at times).  However, she also seems to be in her own world most of the time, keeps to herself, loves to put things in bags and take them out, over and over again she will do this, she opens and closes doors.  To entertain herself this weekend she spent the whole day with doors or walking up and down stairs.  She has huge meltdowns when people sing, if she hears cars drive down the street, or getting into an elevator.  She also seems to forget and become afarid of people she hasn't seen in a few days, even her grandparents.  She goes in for testing next month, but I am looking for advice.  Does this seem like PDD?  Thanks

ANSWER: Hi Tina;

This is a tough one. Something is going on and it may not be autism related. I'm concerned about the repetitive behavior and memory problems. She will require a thorough evaluation.

I suggest you download the M-CHAT at: http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf  and the scoring instructions at: http://www.firstsigns.org/downloads/m-chat_scoring.PDF

After you have scored it you can write me back with the scores and I can provide further interpretation. I just do not have enough information about her social development to comment.

Kind regards,
James

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

QUESTION: James, Thanks so much for your quick response.  I copied the following for you to look at my answers.  As far as her social develoment, I can tell you that she LOVES babies, she loves to hug and kiss them, but doesn't try to play with them, she does try to interact with older (3-4 yr olds) kids, by "talking" to them, she "plays" with them by letting them chase her, and she likes to hand them things.  She says hi and waves bye to almost all adults after she has gotten comfortable with them, but she is painfully shy.  The forgetting is much more recent, like just in the past few weeks.  We recently went out of town for 2 days, after returning home her grandmother (whom she is very close to) came to visit, she became terrified, refused to look at her, and was grasping me so hard she was digging into my arm.  She has done this with every person she comes in contact with that she has not seen in a couple days.  She does this with close family, and even her therapists each of whom she has been seeing for over a year.  This has been my biggest worry recently.  She just seems extremely fearful of her close family and friends so suddenly.  Her therapist are very worried about this as well.  Thanks again James

1. Does your child enjoy being swung, bounced on your knee, etc.? No

2. Does your child take an interest in other children? Yes

3. Does your child like climbing on things, such as up stairs? Yes

4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes
5. Does your child ever pretend, for example, to talk on the phone or take care of dolls,  
or pretend other things? Yes

6. Does your child ever use his/her index finger to point, to ask for something? Yes

7. Does your child ever use his/her index finger to point, to indicate interest in something? Not sure how to answer this one.  She does point out things she wants me to get for her, but not for me to look at.

8. Can your child play properly with small toys (e.g. cars or bricks) without just
mouthing, fiddling, or dropping them? Yes

9. Does your child ever bring objects over to you (parent) to show you something? She brings them to me if she needs me to work the for her.

10. Does your child look you in the eye for more than a second or two? Yes

11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes

12. Does your child smile in response to your face or your smile? Yes

13. Does your child imitate you? (e.g., you make a face-will your child imitate it?) Yes

14. Does your child respond to his/her name when you call? Yes

15. If you point at a toy across the room, does your child look at it? Yes, she will look in that direction.

16. Does your child walk? Yes

17. Does your child look at things you are looking at? Yes if I point them out she will look in the general direction.
18. Does your child make unusual finger movements near his/her face? No

19. Does your child try to attract your attention to his/her own activity?  No

20. Have you ever wondered if your child is deaf? Yes only because she wasn't speaking..this was ruled out.

21. Does your child understand what people say? Yes

22. Does your child sometimes stare at nothing or wander with no purpose? Yes

23. Does your child look at your face to check your reaction when faced with
something unfamiliar?  Yes


Answer
Hi Tina;

I'm happy to help. The criteria for failing the M-Chat, which means making a referral for "possible" ASD), is failing any 2 critical items OR any 3 or more items. Your daughter failed 3 critical items plus 4 noncritical items. These does not necessarily mean that she has an ASD. The CHAT and M-CHAT were developed to slightly over-identify children who may be at risk for ASD, with the thought that it's better to be on the safe side and not screen out children when they may have an ASD. Although she is pretty young, she may have high functioning autism/Asperger's, which as you know, really doesn't show itself to psychologists and/or educators until around the age of 4. My guess is that evaluation team at this point would write her behavior off to obsessive-compulsive behavior along with social anxiety or shyness. Girls with Asperger's frequently go completely undetected because, by nature, they are more social than boys. That means they interact with others and really don't stand out much. Keep your eyes on her looking for low social cognition (Michelle Garcia-Winner: www.socialthinking.com), low theory-of-mind (Simon Baron-Cohen), and poor social competency. Girl bullies are much worse and more concealed than boy bullies, so be on the watch fro this beginning around the first grade.

Kind regards,
James