Expert: James Michael Roan - 6/25/2005

Question
I'm hoping you can help clarify some things for me.  

As an infant, my son was very social, smiled, great eye contact, babbled, loved to be held and actually demanded to be held and was most happy in the Baby Bjorn which he was in until he was about a year.  He didn't want to play with conventional baby toys, rather preferred to play with remote controllers, computer keyboards, DVD players and door handles.  The only toy that he did really seem to enjoy was his Leap Pad table.  He would also spend a lot of time bouncing shoes up and down by their shoe laces.  

Fast forward a little...He has never pointed and joint attention seems to be very difficult for him.  He has a primitive gesture in that he'll reach out for something and cry or grunt and as last resort, he will glance at me.  He does reach out to be picked up or held and he does come to me if he's hurt, lonely, needs to be held.  He is still breast feeding and to initiate this he'll take my hand and put it on my shirt.  

He has been dx with expressive and receptive language delays by our school district.  He has just begun to use 2 different sounds together.  He can say a few words but he doesn't say them in a manner to communicate with me.  He knows the cat's name and uses it.  And he'll use lots of sounds and babble when "talking" to the cat. He still does not point at objects of interest.  

Eye contact is variable.  Its usually on his time and terms.  He has a giant ball that he will throw at me and makes great eye contact when I'm playing with him and its something that is very fun for him.  His preferred toys now are pushing a toy vacuum and other push toys, Cozy Coupe toy, LOVES puzzles.  LOVES Baby Einstein videos, loves to stack nesting cups and climb.  

We recently went on a camping trip and he was impossible to take on short hiking trips because he kept getting hooked on going up and down different surfaces and he can do this for quite a long time...he likes to go up and down steps.  And once he is engaged in something like this, its very hard to get him to want to do anything else.  

He is VERY bonded to me almost to an extreme.  He will go to his dad, but if I'm in the room he'll cry for me.  

He understands simple commands like "sit down, come here, lets eat, lets go bye bye, lets go outside, lets go downstairs, do you want to nurse?"  He also understands "no" and if I'm upset with him he's clear that I'm not happy and will cry in response to my unhappy facial expression.  

He can eat with a fork and a spoon and actually prefers that to eating with his fingers, though he will eat with his fingers.  He eats a wide variety of foods too.  He will drink from a cup and a straw too.

As far as imitating...he will imitate a cough, different breathing patterns, kisses and some sounds...

He does not say "momma" or "daddy" with purpose.  He does not say his siblings names or respond to "where's Ryan or where's Rachael" by lookng at them.  

He also does not point to body parts although we talk about them every day and watch videos on body parts.  He will not clap his hands.  He will imitate his sibs dancing tho.  

So....my concerns with him are the lack of joint attention, lack of proto-declarative pointing and the expressive/receptive language delay.  From what I've described, does he sound like he's on the autism spectrum?  

I've had him evaluated by a developmental pedi at 15 mos who said he had "features of PDD-NOS" but wouldn't dx him with PDD or autism.  We were recommended ST, OT and early childhood specialist and they come to our home once a week.

I'm desperate for some insight or answers.  

Thanks
JOyce

Answer
Hi Joyce;

You are very knowledgeable about autism. If on the spectrum, your son needs immediate and intensive (24 hours per week) services. He appears to be high functioning, however like you, I'm concerned about the lack of social development. Social development in most cases dictates language development.

Getting an accurate diagnosis these days is difficult to say the least. It became clear to most professionals a few years ago that strict and rigid criteria for inclusion into the autism category was impractical. Children are now presenting with a great deal of diversity in development. It is important to get an accurate diagnosis so your son receives "appropriate" services and interventions. This is difficult to obtain at your son's age. He may look much different in six months.

What is most important for right now, in my opinion, is that he makes the conection with the social world around him. With his good imitation skills, I suggest playing games like peek-a-boo, that require intensive interpersonal social interaction and that are fun for the two of you. Be sure to use exaggerated voice inflection and facial expression.

If you email me at roanpsych@gmail.com I can send you some more information.

Kind Regards,
James