Expert: James Michael Roan - 8/18/2007

Question
QUESTION: Good morning,
I e-mailed you previously on my young baby boy regarding some of the concerns we had with his behaviors.
Our son is now 16 month old:
He positively does the following:
-walks/run
-Says about 15 words (not very clear as yet but still specific for an object or purpose)
-Reasonnable eye contact (i mean good as he will not look at us all the time if he is doing something).
-Good pointing and sharing of objects although does not always look at us in the eye when pointing at something or gives us a book toread for example.
-Look where i point.
-Scribbles.
-Pretend to drink out of our coffee mug, imitate etc...

But recently (last couple of weeks) some patterns have appeared:
-when playing with blocks if not with him he will kinda line them up, he will be trying to arrange them in some kind of order, so last night we removed the blocks he then out of the blue, came to his mum with the ball of shapes asking her to get all the shapes out grabbed his little shapes, lay them on the ground and once again kinda line them up!!!! (my heart sunk).
-He gazes at time for short period (2-3 min not even).
-He still doesn't interact well with other kids his age (i.e. he will not stay at playgroup and scream until we leave the room and then be happy, although he loves swimming and kinder music).

Here are my questions (sorry for the preambule):
1- Does lining necessary means your child is autistic or does lining up objects is a primary sign/factor for autism?
2- We went to see all doctors, nurses, pediatricians but no straight answers ("he is fine"), can we ask for a test to be done, we want to be sure!!!
3- In general at what age does regression occurs and how heavy will it be (i gather that different child, different level)?
4- although no "cure" is available how successful are the help methods & when can we sart them?
5- DO all children gaze?
6- We have never encounter another child which hates playgroup like ours is it common?
7- Would those patterns be enough to get some tests done?

Thanks a lot for your time and i do apologize for the length of the letter, i am very worried and my wife is absolutely shattered especially after last night experience, she believes 100% that he is autistic (and we say to usually believe their gutfeel)as for me i am an analyst so i need data and fact and i do not like to give up hope without facts...
The internet and media are sending a lot of wrong messages and the list of things to watch out for is very long...
Your help is vital as it will enable us to focus our effort.

Thanks a lot for your answer in advance,
T&D


ANSWER: Hi Timm;

Sorry for the delay. Just before I was to hit the "send" button yesterday, my computer crashed. So I'll try this again!

Generally, I trust a mother's intuition, however, there is an epidemic of autism spectrum disorders and a lot of media hype on the subject. Your son sounds like he's developing normally, however, if he has a very high functioning form of autism it could go undetected unless he is observed by a very experienced clinician such as a psychologist who specializes in autism spectrum disorders.

Here are my answers to your questions below:

1- Does lining necessary means your child is autistic or does lining up objects is a primary sign/factor for autism?

Many typically developing children line up toys. In autism it is called "systematizing" (coined by Simon Baron-Cohen), but is found in many, many children.

2- We went to see all doctors, nurses, pediatricians but no straight answers ("he is fine"), can we ask for a test to be done, we want to be sure!!!

Please visit my website at: www.autismspectrumdisorderfoundation.org  and take the M-CHAT and score it then email me the results if you like. If there is any risk noted, then take the M-CHAT to your child's pediatrician ASAP and demand a referral to a Children's Hospital or nearby university with an autism assessment team. Then make a special education referral to your school district. It's free and if he qualifies, he receive Early Intervention services.

3- In general at what age does regression occurs and how heavy will it be (i gather that different child, different level)?

Regression, which is somewhat rare, occurs around 2 1/2 to 3 years. It is most often correlated with a birth head circumference in the 97  percentile. I wouldn't stress over this at all.

4- although no "cure" is available how successful are the help methods.

Early Intervention is everything and makes a huge difference.

Take care,
James

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

QUESTION: Hi james,
Thanks a lot for the answers...
Could you please answer the last 3 questions from my previous letter.
does head circonference in the 97 percentile mean "having a big head" within th spread of the population?
Please find below my answer for the M chat:

M-CHAT
Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g.,
you've seen it once or twice), please answer as if the child does not do it.
1. Does your child enjoy being swung, bounced on your knee, etc.? Yes
2. Does your child take an interest in other children? Yes but not his age group yet he likes older kids (i.e : he is 16 months he likes ~3Y.O ONWARDS)
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, Yes
or pretend other things?
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? Yes
8. Can your child play properly with small toys (e.g. cars or bricks) without just Yes
mouthing, fiddling, or dropping them?
9. Does your child ever bring objects over to you (parent) to show you something? Yes
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)  No
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 but not all the time if he is playing or watching tv he might not answer staight away
15. If you point at a toy across the room, does your child look at it? Yes
16. Does your child walk? Yes
17. Does your child look at things you are looking at? Yes
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? Yes
20. Have you ever wondered if your child is deaf?  No
21. Does your child understand what people say? Yes
22. Does your child sometimes stare at nothing or wander with no purpose? Yes but not for long period of time.
23. Does your child look at your face to check your reaction when faced with Yes
something unfamiliar?

HOpe you can help out, as per your scoring on your website he has a couple of failed answer: not interested in children (half failed i hope), Staring at nothing sometimes
HOpe to hear from you soon...
I am going to see the pediatrician today!!!
Thanks alot in advance,
T &D
ANSWER: Hi Timm;

Yes, children born with big heads are often due to an inflammatory response to stress and may react negatively to infection or antibiotics in a way that causes regression. There is nothing more known on the topic.

Congratulations, your son passed the M-CHAT! Doesn't sound at all like autism. Watch his social development just in case.

5- DO all children gaze?-Not sure what you mean by "gaze."
6- We have never encounter another child which hates playgroup like ours is it common? I mentioned before that social aversion or alienation can have many causes such as to much social information to process, sensory sensitivity, etc.
7- Would those patterns be enough to get some tests done?-No those patterns would not be enough.

Kind regards,
James

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

QUESTION: Thanks a lot James,
THe gazing means staring at nothing and/or focussing at something in particular for a period( hope you know what i mean, it is an australian term: that's where i live!!just in case).
As for the social behavior what do you mean by "sensory sensitivity"?
Thanks again those question should be the last one

Answer
Hi Timm;

Australia...lucky guy! Gazing is generally harmless unless it comes on while you engaged with him, then I would suggest checking for seizures. Sensory theory, according to Winnie Dunn, states that many children are born with underdeveloped sensory/neural pathways. In some cases they may seek out certain sensory stimulation and/or may avoid other sensory stimuli. Although common in autism, it is also somewhat common in typically developing children. The sensory information falls into the following general categories:

1. Visual
2. Auditory
3. Tactile
4. Vestibular
5. Oral motor
6. Kinesthetic
7. Muscle tone plays a role

Take care,

James