Expert: James Michael Roan - 12/28/2007

Question
One of my twin boys born at 28 weeks (currently chronologically 19 mon. & adjusted 16 mo.) is not pointing using index finger to communicate needs or interests nor brings objects to show interests. He mouths everything, but knows how to pretend play with a car & some other toys & kisses baby, but not care for baby.He loves to spin wheels on cars, but not fixated.  He had silent ear infections for apparently months which resulted in tubes & is slowly progressing each day. He walks with walker toys, cruises, taken about 2 steps, climbs, but is fearful of letting go. He maintains eye contact, plays with his brother, loves attention,imitates, responds to name, is social,& understands simple commands with seemingly good receptive skills. I'm concerned about the lack of nonverbal gestures, expressive language (only imitates about a dozen words- not saying spontaneously consistently). Should I be concerned about autism or is this just preemie developmental delays with further delay because of ear infections & hearing issues? He hears well now. We will be beginning OT & ST soon. PT eval. suggest just developmental preemie delay. He did fail the M-CHAT, but I know he is not quite at 18 mo. adjusted yet. I will redo in 2 months. Constantly worried! Please answer soon. Thank You!

Answer
Hi Adrienne;

Of course, I DO NOT diagnose over the Internet, but I'll help direct you as much as possible.

Speech delays are most likely due to ear infections and developmental delay. In autism, we are looking for social delays, which can affect verbal and nonverbal communicative development. In autism, receptive or understanding of language is almost always seriously impaired. I'll need you to experiment with his understanding by giving him first one-step instructions, then two-step instructions, etc. These instructions should be new and not routine activities. Use simple language. Let me know what you find.

Kind regards,
James