Expert: James Michael Roan - 7/26/2006

Question
Thanks James,

I apologize about my rambling.  What I was trying to say was could he have had an autism regression last month but already start showing signs of improvement(not playing with sister last month and now taking an interest again)? I ask that because EI said I had to watch him closely for social withdrawl, loss of words, et at around 15 months and 18 months. I am also glad to hear that the motor imitation is not necessarily indicative of autism and could be something else.
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Followup To

Question -
Hi James,

I just wanted to give you the progress on my 14 month old question I posted back in June. My son is now 15 1/2 months old. Last month he seemed to be doing very poorly and we were extremely concerned. He seemed to be withdrawing socially, ignoring his name alot by strangers and it was noted by professionals in EI that he was increasingly self directed. He also seemed to have very low energy and did not smile much at all. However, we started a vitamin and have increased his food intake. At the same time we vacationed with family and while he was very guared the first 5 days, by the last 5 days he was actively looking for people during hide and seek, lauging smiling, clapping his hands and saying "yea" at the dinner table several times repeating this geature after others performed it as if he did not want it to stop. He also looked at every single person (8 total) to see if they were participating. During that time he started babbling more even adding two words to his existing 2 or 3. Last month he withdrew from playing with his sister and only last night he was following 8 children around and very interested in their activity. On the negative side, he did flap frequently while vactioning with the extra stimulation, he loves to dance esp when other people are dancing with him but it seems to be on his toes, he still is self directed if the activity is presented as work. If it is fun he will gladly join in, but if you ask or demand that he point or touch something in a book he will show obvious frustration and maybe throw it, tantrums really don't exist though. A large area of concern for me is still the ability to imitate. It seems very difficult for him. He does point, maybe once a day to something of interest but rarely when he wants something. It takes him a few seconds to get the clapping motion down, and if he does wave which is infrequent it is only moving the fingers and he'll usually look down at his hand. He also tries to play peekaboo but it is on his ears not eyes. He can verbally imitate fairly easily and imitate a clicking noise with his mouth. It's the motor imitation that seems so difficult. Does this sound like it could be apraxia? Also, he is still a bit shy and if he does not know the person he might run when they call his name but answers by the first, second, sometimes third time to familiar people. He just the other day repeated an activity that I lauged at several times and is smiling again. Could this have been a regression? I was told they don't usually work like this with improvement so quickly! Also, his receptive language is increasing and he has begun to follow one step commands like pick up your cup but has understood where's this questions for a few months. He was tested for Fragile X and it was negative. Finally, I check the M-CHAT regularly and the questions he fails are 5. pretend play ( has brought phone to his ear briefly)6. pointing to ask for something 12. smiling in response to a smile (sometimes only) and 13. Imitation (again only sometimes). Please let me know what you think esp about the imitation and regression question.

Best Regards, Kate

Answer -
Hi Kate;

It sounds like your little guy is coming along quite nicely! I am not sure if I understand your regression question. As I understand/interpret it, your son repeated an activity several times in order to produce a pleasurable response from you? If I have it right, that is an excellent example of social thinking, rarely if ever seen in children on the spectrum. Most children on the spectrum never quite realize that what they do, say, etc., affects how others feel or what they do.

Imitation difficulty can come from apraxia, and like you I suspect this is more a motor planning problem than autism. He is very young. He'll get it.

The VERY good news is he has social interest, emerging social thinking, a desire to imitate(albeit with difficulty), and joy in being with others. I think he will be fine. Let me know of his progress as he reaches new developmental milestones.

Kind Regards,
James

Answer
Hi Kate;

Here's the deal on the subject of regression. When teachers etc. use the word regression, it has two different implications. Classic regression occurs when a child has developed perfectly normally until around the age of 3 to 3 1/2, when all of a sudden they lose speech, social interest, and develop sudden stereotypies or repetitive behaviors. With all due respect, it does not happen at 15-18 months. This is fairly rare and I have only actually experienced it directly a few times.

The term regression is also used by teachers and educators of the autistic to, in my opinion, poorly describe what appears to be a frequent loss of skills. For example, a child develops a certain skill, and then the next day is unable to demonstrate that skill. This phenomena is common in most children, not just children with autism. Autistic children are known to have concrete thinking styles, and as such have difficulty with abstract thinking and thus the ability to understand "concepts." For example, when a child learns that a dark green is green, then when asked what color some light green object is they will be unable to name it because it is not the identical color of the dark green they previously learned. In other words, they learned a direct correspondence between the word green and the dark green. They didn't get the concept of "greeness," where light, medium, and dark greens belong to a family of Green. To many educators it appears that the child has lost skills, when in fact, they have not. I'm sure I have made myself as clear as mud!

The toe walking and hand flapping behavior can also be signs of developmental delay-not a big deal. In any case, keep an eye on his social development relative to others his age. If you still have concerns when he goes to school make sure you have the teachers, etc. judge or rate his social competence and look for any social withdrawal.

Kind Regards,
James