Expert: James Michael Roan - 12/16/2005

Question
I am the mother of 3..15yold boy, 4 1/2 yold boy & 18month old girl,  she did physical developmental goals early..crawling at 5 months, sitting up at 6months, pulling up & cruising at 7-8months, etc. However she does not talk...much..very different from my othe two who were early talkers, she never babbled or cooed, she just recently has said "dada" a few times but can't be prompted to say anything...she only says moma when fussing, tired...she sometimes says ball; she loves books & when we point at things like "wheres the dog" - she points to it & is able to identify parts of her face when asked "where is your nose""....but she doesn't say the words...I am a pediatric & family nurse practitioner & feel that in lots of ways she is "ok" and that all children are different but the not talking bothers me more, she is affectionate, maintains eye contact but she will not & has never laid down with me in my bed to fall asleep / cuddle for a nap like my other children would do...she has to be in her own bed, doesn't do well when traveling/overnight visits; she is even more reserved/quite when around others even family members, also she does not smile on demand like for pictures but she does smile when playing with brother, when being tickled, etc. Since she is my onhly girl at first just thought it was the difference in sexes, also my 4yold is SO very talkative ...I am starting to get a bit uncomfortable at family gathersings b/c my neice is 2 months older than my daughter (this is my brothers first & only child thus far) & although physically my daughter did things sooner than she did, my neice talks so much more/more interactive with others .... my sister makes comments like "whats wrong with her...why doesn't she ever smile....does she EVER say anything..???? It is starting to bother me...perhaps I need to go ahead with Early Intervention..?? Thanks for taking the time to read this & any advice Wanted to add another big difference with her & my others - she has experienced severe pain with teething,  so much more than my others which were uncomfortable but she was miserable for weeks at t atime, crying, fussy, no ap[petite, not sleeping...absolutely terrible with teething - has all of her teeth now thank God,....

Answer
Hi Beth;

As far as autism is concerned, I'll need to have more iformation about her social development before I can direct you:

1. Does she or did she ever turn around in response to you calling her name when you walked into a room where she was playing by herself?

2. Does she or did she ever reach up with her arms in a nonverbal request to be picked up?

3. Does she or did she ever point to objects of interest in a genuine attempt to share them with you, and, did she look back and forth between the object and you to determine if you were enjoying it also?

4. When she approaches you or her brother does she or did she ever smile and make eye contact with you?

5. Does she look into your eyes when you are talking to her?

Keep in mind Beth, that all children have the uncanny ability to guage their social and linguistic (expressive) competence by observing other children for only a few seconds. If they judge their own competence to be even slightly lower than the other child's, they will self-alienate, thus "appearing" to be on the autism spectrum, when they are not.

I suggest you download off the internet the Checklist for Autism in Toddlers (CHAT), which is available on many different sites. It will give a you an estimate for your daughter's risk for autism. The CHAT was normed on over 18,000 children at the age of 18 months. If there is a legitimate risk, then have your daughter assessed by a team of professionals skilled in autism. Early intervention is essential.

If you live in the U.S., you can have your daughter assessed and provided speech therapy by the special education department in the school district in which you live if she qualifies. Let me know how this works out for you and/or if you have thought of more details. In my experience, the central deficit in autism is social and degree of social interest varies significantly within that population.

Kind Regards,
James