Expert: James Michael Roan - 9/18/2007

Question
Hi there,
I am a home daycare provider with a few concerns regarding  one of my kids.
I have been working with children for years and have never had such difficulty with a child. I have worked one on one with an autistic girl but a group setting is very  different. I also know several moms with autistic kids, and have quite a bit of information on the matter. Also my father and brother both have aspergers. The similarities "L" (child I mind) has to my friends son who has high functioning autism are alarming. It is quite disruptive to the other children...
"L" was very slow to talk and walk, he was only really talking after age 3, which was just 6 months ago. He hardly makes eye contact and it's as if he doesn't hear me when I say his name or need to talk with him about something. He often throws temper tantrums, which involve relentless whining and crying. He has VERY strong attachments to certain toys, his shoes, his blanket, even things that don't belong to him. MINE is his favorite word! When angry he often hits himself or rocks back and forth or hits his head against the floor. He rarely will use words when he is upset, just whine and cry. "L" is very sound sensitive and gets upset when things are loud. He also plays alone mostly doing things like lining cars in a row, building with blocks or just watching TV. I am not a fan of TV but he still asks for it constantly...
His mom (my close friend) has told me he was developmentally delayed and when his old Pediatrician mentioned autism she never took him back to see him. "L" has many allergies as well and no regular doctor for the past 1.5 years. I don't agree with him not having a regular doctor, but my hands are tied. His mom is a good mom to be sure, but she is busy working a lot because she is raising "L" on her own. I am concerned about "L" but afraid to mention autism for obvious reasons (I am not a doctor for one). But I know in the case of my brother (aspergers) it helped immensely that we found out early. He is very high functioning whereas my dad was not diagnosed until later in life and is unable to work and lives on disability. I am worried my friend would be angry if I mention my concerns but I am also struggling with the disruptive situation and it's affects on the other children...
What do you think? Any advice on how a childcare provider should broach such a subject with parents? Advice would be greatly appreciated!

Thanks,
Rory

Answer
Bravo Rory;

Early intervention means everything to these children in terms of communication and social development and future independent functioning in general. He will not "grow out of it" or get better and adjust on his own without intervention. If you live in the U.S. school districts are responsible for assessing children suspected of disabilities and providing intervention services if those disabilities are severe enough.

Although I do not diagnose over the internet, your description alarms me enough to recommend that this boy needs an evaluation immediately. His behaviors are not a constellation of behaviors that are typical of developmental delay.

You can go to my website at: www.autismspectrumdisorderfoundation.org and take the M-CHAT and score it and share the results with your friend over coffee along with what I have said about early intervention. You can also have her or you can print off the "Early Signs" info from the the American Academy of Pediatrics and the Center for Disease Control to support your case. Although the M-CHAT is designed for children 18-30 months, it has been proven useful for assessing risk for autism up to 4 years.

For this boy's sake I hope your attempts are successful. My experience has shown that great care must be taken with parents when first discussing the possibility of autism. Autism has terrible connotations and can be extremely upsetting to parents. You will need to slowly bring her into this, which it sounds like you have already started to do. Please remember, early intervention will not "fix" a child but it will significantly reduce the impact of an autism spectrum disorder on their lives and the lives of their family. Your father's situation is a good example of that.

Let me know of your progress.

Kind regards,
James