Expert: Catherine Ridenour - 7/10/2006

Question
Hello, I have a question about my daughter.  She turned four years old this month.  I question autism in her from time to time and I dont know where to start getting her help or if she really needs any at all.  If she is autistic, she would be very high functioning.

She seems just like a lot of other kids her age.  When I read about development for age, she seems to be on track.  However, she has "other things" that I notice, such as the "finger wiggling" she does whenever she is excited.

My question about autism is, can a high functioning child be social and have the ability to use imagination?  My daughter is very social.  She has never had a problem with eye contact, playing with other kids and she has never seemed "aloof."  She loves to be in the company of other kids and her family.  She is very attached to me and bonds well with everyone in her life.  She also engages in pretend play.  She likes dress up, playing with her pretend kitchen and at the moment she loves barbie.  

The problem I see is the hand movement and her speech.  She wiggles her fingers whenever she is excited or playing with her toys.  She has done this since she was an infant.  When she does this, she will grind her teeth and make a facial grimace.  Before she turned three, she would make a humming sound at the same time but this has stopped.  She seemed to peak with her movements at two - three as well.  She is not doing it much anymore but it is still happening every day, just much less obvious.  

Her speech is another issue.  It is hard to explain.  She is on target with her developmental age as well but there are problems.  She said her first word on time, mama.  She did put two words together at two and started using sentences at three.  But, during her development she did echo a lot, mostly at two.  She used a lot of preservation, mostly at two and three.  She did not use a single pronoun until three and a half, when she did, she would reverse them.  She had issues with mixing up he & she, and she called herself "you."  She went through a phase when it seemed as if she memorized phrases.  Over time, she has come along way.  She talks a lot now and asks a lot of questions.  She is using more spontanious speech and she uses the correct pronouns.  She still has trouble with words like yesterday, tomorrow, lastnight etc.  It seems like she has a hard time getting the meaning of words but once she gets them, she is ok.  

Aside from that, she is your typical kid.  She is active, loving and fun to be around.  I dont see any other problems in her such as needing any routine or being lost in her own world.  

What advise can you give me?  Should I think autism?  Should I be considering anything else?  Thank you so much.

Answer
Hi Jon,

Mixing pronouns, at first, is a common thing for all children. However, you describe a group of symptoms that make me suspect an auditory processing disorder. This can be part of an autistic spectrum disorder or a separate learning disability.

As she gets older, social problems may appear. Many autistic children do well until about age 5 when the other kids get their own ideas and won't go along. Then, the spectrum child has trouble adopting the ideas of others and joining the games.

Autistics ARE able to use imagination perhaps even better than others. They do tend to isolate more as the social issues crop up and imagination can become an escape.

I would recommend a good evaluation by someone who specializes in autistic and developmental disorders. He/she can help weed out the important facets of your daughters symptoms. It does sound like she is on the high-functioning end of the spectrum. At the very least, speech therapy would be helpful for her.

Best wishes,
Catherine