Expert: Dr. Sharon A. Mitchell - 12/27/2007

Question
How can I help a 3 yr old boy with HFA or PDD (not sure yet), how can I teach him at home, what are some great books/videos available.
He has the folowing symptoms
My son Tim is 38 months and I have appointment with a specialist .
Here are all details :

Started to be concerned about him at 15 months when he wasn't walking yet. He walked at 17 months.
18 months he had a good vocabulary-12 words
2 yr old - 2 words sentence
Until last month his eye contact was good , although kind of starring at people (blank) then I just noticed he avoids eye contact with strangers and becomes nervous , touching his eyelashes . Repet: that just started about a month ago.


Social
Shy with strangers, doesn't talk to them or say his name

At the library doesn't participate in games with other kids but likes watching them .
Sometimes he withdrawns from me and his siblings (4 yr old boy / 20 month girl) , goes in another room and reads books or plays music or just lays down in the bed . When I go there , he says "Sad mommy" .
At inapproppiate times he says "scared mommy" .

Communication
Doesn't always answer questions properly (how old are you - Luke) , doesn't communicate much but has
4-6 words sentence sometimes words are unclear
Sometimes gibberish words
Sometimes talks to imaginary people

Behavior
Lines up cars/animal toys but doesn't get upset if I remove any of them and this is not consistenly
Throws up ripped paper towel or newspapers (also leafs,light toys,any small parts)
Sings same song over and over , sometimes humms
Little imaginary / pretend play
Not excited about opening gifts for special occasions and not interested in new toys , but later he may play with them.
Touches his eyelashes when stressed or tired
Takes off running in stores,parks
Plays a lot numbers and ABC puzzles
Plays a lot musical toys
Fascinated with musical notes from songbooks


In the past used to:
Be fascinated by number plates, switches and a moving ball hanging from the ceiling in the garage
bang his head on me when I said NO .
Open/close doors / light switches
Cry when praised (it happened only 2 times)



Positive Signs
Good academical skills--average or above average for his age
Knows almost all letters, shapes, numbers to 10 ,can count to 10 in two languages , sings nursery rhymes
Doesn't flap hands
no spinning ( only when there is music )
no rocking
no echolalia
no sensitive to noise
Responds to name
He is ok if we change his routine
Plays well with siblings
Tells me about his achievements ,interests
very affectionate
likes touch

Answer
When you arrive at your specialist's office, the doctor is going to be a happy person. I doubt that few mothers ever show up on the doorstep so well prepared with a list of her son's strengths and challenges. The list you've included with this question is excellent.

It sounds like you have a reasonable grasp of what autism might look like across the spectrum. There area a couple things I particularly like about what you have written:

- autism is not static - symptoms may come and go
- children develop skills over time and things that were once a pressing concern recede into the background
- being a spectrum disorder with a wide range of abilities and characteristics, there is no one autism picture
- not everyone with autism flaps and not everyone who flaps has autism
- although many people with autism also have an intellectual disability, some have average or above average intelligence
- you can most definitely help your son at home
- the exact label (or even no label at all) is not the crucial point, but rather which things you can do to help

There is a lot you can do for Luke at home. Actually, no matter what the diagnosis may be and no matter which specialists may ever be involved, what you do at home has the most significance.

It's at home with you that Luke will learn love and trust and develop his positive self-concept. He already has a great start with a mom who is so in tune to his needs.

Also, you know your son best. While professionals have training and experience, you are the expert on your child. Their advice can be invaluable but you can do a lot by relying on your instincts.

Pick some area to begin with, rather than tackling many areas at once. What one thing, if it was different, might have the biggest impact on your son's life and that of your family? Based on what you've written, might if be something like:

- not running off in stores or parks
- responds appropriately to strangers
- engages in imaginative play
- communicates his feelings and wants more reliably

These are all things you can work on right now, whether or not your son has a formal diagnosis.

Let's look at communication, as that is so closely related to play, emotions and how we interact with others.

Most people with autism have difficulties with auditory processing. By that I mean that although their hearing may be just fine, they have trouble taking in what they hear, making sense of it and in responding to what they've heard. (If you have not yet had your son's hearing checked, that is a good first step).

Most people with autism find it easier to take in information that they see, rather than what they hear. This is true even for high functioning autistics who may have a good speaking vocabulary. Dr. Temple Grandin, a professor at the University of Colorado and probably the most famous adult with autism has written an interesting book called, "Thinking in Pictures".

When you think about the auditory processing weaknesses inherent in autism, then that may explain some of why your child does not always respond to what is said to him or responds in inappropriate or repetitive ways.

It sometimes helps to think of autism as a processing disorder where the person has trouble taking in information from more than one sensory modality at a time. That's why your son may not appear to look at you or make good eye contact, but he's listening all the same. While for most kids we specify that they "look at me when I'm talking", for a child with autism, this may actually hinder rather than help. Luke may find that he can either look or listen but not do both at the same time well.

This could be in evidence also at the library where he'd rather sit back and watch rather than become actively involved. Begin overwhelmed by sensory input may contribute to him running when shopping or in a park.

You can help Luke feel more comfortable by presenting more information visually, rather than orally. It helps to make instructions and expectations as visual as possible. An easy way to do this is through schedules. For instance, in his bedroom you could have on the wall a picture poster showing him the order in which you'd like him to put on his clothes. Pictures on drawers and containers help him know where to put things away. In the bathroom, pictures could flushing the toilet, washing his hands, brushing his teeth, etc.

You can learn more about how and why to use visuals at this site: http://www.do2learn.com There are also free pictures there for you to use as well and grids and templates to use for visual schedules. A book I really like on this topic is Linda Hodgdin's "Visual Strategies for Improving Communication : Practical Supports for School & Home" You can take a look at it at http://www.amazon.com/dp/0961678615?tag=autismhelpf0e-20&camp=14573&creative=327...

Another tool you may find handy now and over the next dozen years or so is social stories. Social stories are a way of explaining to your son what's going to happen, how it will look/feel/sound and what is expected of him. Social stories are also a good way of rehearsing how he should respond to strangers, what to do instead of running away if he feel overwhelmed and even how to play with toys. I've listed some books on social stories that I like here: http://www.autismsite.ca/html/using_social_stories.html

Here are some examples of social stories: http://www.autisminspiration.com/public/department47.cfm

Luke has some real positives going for him. He is
- talking
- responds to his name
- plays with siblings
- accepts changes in routine
- is affectionate and likes touch
- shares his achievements and interests
- has some early academic skills
- tells you when he's sad or scared

You mention that he may say the latter two inappropriately. Social stories would be a method of teaching him other responses.

It's not uncommon for people with autism to have difficulty deciphering the emotions of other people, explaining their own feelings or reading facial expressions. If you go to the games section of www.do2learn.com you'll find a Feelings game and an Emotions game you can try with Luke.

Before your specialist appointment, you might want to take a look at sites such as the following.

Here are a few websites that can help you sort out what is within the normal speech/language parameters for a child of this age.

http://www.asha.org/public/speech/development/child_hear_talk.htm

http://www.comeunity.com/disability/speech/milestones.html

http://www.ldonline.org/article/6313

Below are two versions of a Checklist for Autism in Toddlers that a physician might use. It may be helpful for you to look them over to get an idea of what sorts of things a diagnostician may look for. The first link explains a bit more about the CHAT:

http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=128&a=2226

http://depts.washington.edu/dataproj/chat.html

http://www.utmem.edu/pediatrics/general/clinical/m-chat.pdf

You're most certainly on the right track. You've set up an appointment with a specialist. You're realistic about your son's challenges and his strengths. You're proactive and wanted to learn and do all you can for Luke.

I know it's a scary time and you'll be anxious to hear the specialist's verdict. If he does not feel your son has HFA or PDD, that's great. But your son still has the characteristics you describe and you will continue to help him grow and learn. If he does have an autism spectrum disorder, it's not the end of the world. It might help if you read Luke Jackson's book. Luke has Asperger's Syndrome (also in the autism spectrum) and wrote "Freaks, Geeks and Asperger Syndrome" when he was 13 years old. You can take a peek inside his book by going to: http://www.amazon.com/Freaks-Geeks-Asperger-Syndrome-Adolescence/dp/1843100983/r...

Please feel free to write again if I may be of some help.

Sharon A. Mitchell, B.A., B.Ed., M.A.
http://www.autismsite.ca