Expert: James Michael Roan - 6/20/2005

Question
Just wanted to give you some of the additional info.  First, when I walk into the room he does immediately turn and look at me, even when I just walk by the doorway I catch his eye.  His hearing is good and yes has been tested.  He does respond to me calling his name.  Now there are times when he is caught up in watching maybe an animal, another child or something on TV where I have to repeat myself to get his attention.  I have a 4yo neice and 16 mo nephew, and he will play with the 4 yo to some extent.  Mostly he just follows her around.  But she seems to scare him a lot, like if she yells or jumps at him.  I noticed the other day, both my neice and nephew came over to they could swim in our kiddie pool, and he wouldn't have anything to do with it, and normally he loves to be in his pool.  He just wanted to sit on my mother-in-laws and my lap.  It may have been because the 4yo was very hyper jumping in and out of the pool, screaming, running around.  Every time we tried to put him in the pool, he just cried.  He is speaking in single words, he of course says a lot of words that have no meaning to anyone except himself.  As far as pointing out objects, he doesn't really point out objects.  If he wants something like his bottle for example, he lunges for it and starts crying.  When he has something like food on the tray of his high chair, he does give others bites.  He has good eye contact, especially when he is tired, but most of the time he is so active that he doesn't sit still long enough to look you in the eyes.  If your talking to him about something that sparks his interest he will look you in the eyes.  I hope this information is what you were looking for.  Thank you again for responding and not making me feel like a total hypochondriac.-------------------------
Followup To
Question -
My son is 13 months old and has some tendencies that may or may not be unusual.  When he is in his high chair or stroller, actually anything where he is sitting, he rocks back and forth quite a bit.  He gets very aggitated when he can't get his toys to "cooperate" with him, immediatly.  He has extremely sensitive hearing, which is probably not a concern.  He also is obsessed with spinning things.  He is constantly moving, he cannot sit still.  Even if he is watching a show on TV, he has to be standing and moving, sometimes only a few steps back and forth.  This is probably just a 1st time mother over reacting, or it may be something like ADHD.  I thank you for your time.
Answer -
Hi Melissa;

The rate of autism is now 1 in 166 children, so it pays to be on top of it! You are being a good mother by investigating. Remember, I am NOT diagnosing your son. With enough information, however, I can point you in the right direction.

I guess I need more information, which you can email directly to me for privacy reasons if you choose at roanpsych@gmail.com

Here goes:

1. When you enter into the room does he turn around to look at you? Does he look into your eyes? How frequently?
2. Does he respond to you when you come up behind him and call his name? Has his hearing been tested?
3. When you observe him playing with other children is his play interactive or does he play alongside rather than with them. Is his play social?
4. Is he speaking with single words yet?
5. If he sees something of interest does he point it out to you in a genuine effort to "share" it with you?
6. What is the quality of his eye contact?

Most of the behaviors you reported sound like, if anything, sensory issues and/or delays, although children with autism do display the characteristics you described. There are usually other, more disconcerting, behaviors as in the type I have queried here. My list is certainly not exhaustive, nor do negative answers indicate autism.

If you live in the U.S., public schools in the district in which you reside are responsible for the assessment and service provision for children from birth to 21 years of age, if the assessment meets state eligibility requirements for special education. A thorough psychoeducational evaluation of your child should address all areas of concern such as cognitive (thinking);  behavioral (social and emotional), motor (fine and gross muscle skills), and a speech and language evaluation. Sometimes the public schools subcontract their services to an outside organization when the child is under the age of three. Services, specific to this age group, is also referred to as "Early Intervention Services."

I am happly to help you and your son as much as I can.
Kind Regards,
James  

Answer
Hi Melissa;

You certainly are NOT a hypochondriac! I trust a mother's knowledge and sensitivities more than anything else! I rely on it. It does seem like your son has some sensory sensitivities himself. Do you live in the U.S.? If you do, you can have a multidisciplinary team assess your son in your school district. The occupational therapist can also assess your son's sensory processing with the Sensory Profile. I would not rule out autism, not that I think your son has autism. I really don't have enough information. The fact that he has low sociality could indicate autism, but it is not clear to me. The idiosyncratic language worries me a little, as does the lack of protodeclarative communication (pointing to items or events of interest to him in an attempt to share them with others). If your son does have autism, then early intervention is the answer. A good screener for decision-making purposes is the Checklist for Autism in Toddlers. It was developed in the UK and is a good predictor. It was normed on children at the age of 18 months. The psychologist at school district in which you reside should have access to it. Call up your school district's special services department and tell them you want to make a referral. They will handle it from there.

If you have an independent assessment indicate that you want a thorough speech and language evaluation that includes a thorough oral motor assessment. You want a cognitive assessment and you want the psychologist to use the Autism Diagnostic Interview-Revised (ADI-R). It is essential that no stone be left unturned in the evaluation.

I will be out of town the next few days, but if you require more assistance you can email me directly (if you have email yourself)and I can send you some stuff as attachments if you are not in the U.S.

I will be in Ireland from July 13 through August 10.

Kind Regards,
James
roanpsych@gmail.com