Expert: James Michael Roan - 10/9/2007

Question
Hello, and let me say thank you so much for this wonderful service. I hope I am not going into too much detail, but we are just so concerned.   

I have recently become concerned about my son's development. He's a healthy 29 month old, referred by our family doctor at 25 months because of concern about the lack of clarity in his speech. He had some history of ear infections, but nothing chronic. Had a 2/3 ear infections by 15 months, but nothing I can recall after that. Has had a few other colds that required nebulizing but that a while ago. He had been scheduled for a hearing test, but he had an accident the day of and missed it. He is being rescheduled, but we don't suspect a hearing problem.    

We had a screening in our home by a Speech Pathologist and Child Psychologist at almost 27 months. BDI-2: Cognitive, Personal-Social, Motor Domains all normal. Adaptive skills below normal. Rosetti Scale: Interaction/attachment:15-18 months Pragmatic:15-21 months; Play 15-21 months. Language Comprehension: 15-21 months. Language Expression 18-24 months.  He didn't qualify for special ed services at this time, but suggested a reevaluation at 3.   

He had been cared for by a nice woman who had little/no structure in her home. She also watched 5 other children. Typically, we think he watched TV all day. We have switched to a preschool that is more structured. He is more stimulated, but has started suffering from separation anxiety in the morning, and has stopped eating lunch there most of the time. They say he does not seek the companionship of other children there and has difficulty with transitions. They say he does much better in the afternoon after a nap, however. The staff is working with us.   

Some concerns in particular that we have are that he doesn't consistently respond to his name. He gets very focused on something and will sometimes ignore us when we call him. It's hard to tell if he is ignoring us or if he is not making the connection it's his name. If we add something like "Sam...want a banana" or something that interests him, he will usually direct his attention to us. Other times he responds normally. He maintains good eye contact during play and other times.   

At about 24/25 months he would put a couple of 2 word things together like "More Juice" or "All Done" or "Tickle Sam" but nothing much more complicated than that. In the past few months, he has become better, connecting more words like "Mommy go upstairs" or "this is my toy" "Take a bath". After some prompting, we can get him to say "I want some milk please" or "Give me Milk Daddy", but only does it spontaneously 10-20% or so.    

He didn't use pronouns really, so we started pushing him. We have seen some progress in the past week, but it is hard for us to gauge. It doesn't seem like he's making a connection that me/I are really him.    

What still concerns us the most is his inability to answer "what's your name." If I say "Who's that?" and point to myself or his mom, he will say our names. If I ask "Who's this" and point to him, he will say "Sam". But "what's your name?" elicits "What's your name" in response or "My name's daddy", or sometimes the name of a toy he likes. We play games where my wife and I shake hands with each other and say "Hi - My name is Daddy. What's your name?" He would usually do what we did and then say "Hi my name is Daddy" or Mommy. He will see himself in the mirror or pictures and say "That's Sam" and seems excited about that. He will even phsyically point to himself if he has been pointing to things in a book and I then ask "Where is Sam" - but has only answered his name correctly once or twice.  

He would say "Pick you up" when he wants up because we would ask him "Want me to pick you up?" but has changed it to consistently saying "pick me up."    

To encourage him to start using my/etc I started taking his toy and saying "That's my toy" He would copy me and take it and say the same. I have heard him say that around other kids that take a toy from him, or when we try to take his milk he might say "Mine!" if he’s not finished. He might put the toy in my hands to initiate our game and he will tell me "that's my toy" as he puts it in my hands - knowing that's what I say when we play it.   Just recently he has used "yours" appropriately - "your cheeks, daddy" while pointing to different body parts. This is not consistent, but is becoming more so.   

We are concerned about echolalia. He repeats a lot of what we say. His speech development has been delayed, so we don't know if this is him having fun copying us, i.e. going through a normal but delayed stage of copying, or something else. If we ask him a question he will often repeat the last 3-5 words. Not all the time, though, and if there is something he wants or doesn't want, he'll answer the question with a yes or no without hesitation.   

When we turn the page in his favorite books, he usually knows all the words, and will say them as we turn the page. Great memory.    He has known about 10-12 body parts for a while and can identify them if I point to mine, or his. He can count to 20. Identifies and greets people by name in person and in photos. He can identify colors. Sings the ABC song, Twinkle Twinkle and some others. Saw six coins on the table and he said "Oh coins! 1,2,3,4,5,6" while moving each coin with his finger. I didn't even know he knew the word coin! He sometimes surprises me with vocabulary I didn't know he knew. He can follow 2,sometimes 3 step instructions (when he wants to!) Knows many words, and has good receptive language (despite the test results- he easily understand a great deal of what say and ask of him). He can answer his age when asked somtimes. He asks "Where" and "who" (in books only - not live people) questions a lot.   He does not point to much. If we are reading a book, it can be very difficult to get him to point to things. If I point and say "What's this" he knows all common items, and many unusal items (igloo) - even in a new book. But to get him to point, I have to take his finger and point the first few times if I ask "Where is the cat?" If it's a page I have worked on with him before, it is easier to get him to point to things. Sometimes he takes our fingers and points to things in books.    

He does occasionally generate spontaneous statements - just the other night with a new bath toy he said "Ducky swimming in bathtub" totally unprompted/ unlike other things we say in the bath. In the week or so since we have been pushing him, we have made some progress with pronouns. Some days he seems to have more clarity than others and will actually apply "I want" statements to things we have never mentioned - suddenly say "I want applesauce please" but still not consistent or often. He will spontaneously ask for things he wants done - "Turn on the light Daddy" "Turn off the Fan mommy" "Go to the Bathroom Mommy" (i.e. you go back in the bathroom, mommy) "I/me Go outside" "Take off my shoes/shirt" "Open it". "It's dark in there" etc. His pronunciation is fair. Still mixes a lot of jumble sounds into his speech when playing by himself.    

He is very affectionate, energetic and loving with us, grandparents, neighbors, pets. He laughs and plays with us a lot. He has a few "friends" he gets excited to see at first, but then goes and plays by himself, usually. Sometimes he will bring a train (his obsession) over to another child like a gift while playing. We make play dates and he interacts marginally with the other kids, if at all.   

He does have imaginative play, pretending that he was me leaving for work with his little bag (like me), closing the door, then opening it and saying "I'm Back!" Sweeping the floor with us. Pretending to go to sleep and waking us up. Pretending to be a lion and roaring and chasing. "Eating" plastic look-alike toys. etc. He is very sweet and loving. Copies us sometimes in what we do (facial expressions, sweeping, etc)  

We have never noticed any sensory things, no flapping, rocking, tip toes, rubbing, etc. He is very flexible at home - we travel and he can adapt to most anything. Does not throw fits or tantrums if we diverge from much. We don't have a rigid routine for him, and he seems fine with it. At his new school, he has struggled with transitions, and they say he doesn't like to be part of circle time or usually seek out the companionship of other kids. (I am shy and never did well in big groups either, if that means anything) They do say he does much better in the afternoon after a nap, like I said. Last week had very positive remarks from teachers that he was adjusting better and ate lunch a couple of times.   

Stacked over 6 blocks no problem, but seems less interested in blocks now.   We have seen improvement in his speech since we became aware of the delays, and try to work with him, but we always fear he is plateau-ing and the changes have not been too dramatic.   

Again, thank you so much for taking the time to help me and all of these other parents out here. I sincerely appreciate all of your efforts to help - it really helps relieve so much of the strain of uncertainty.

Answer
Hi Bill;

It sounds like you have a very bright little boy! I see absolutely no signs of an autism spectrum disorder whatsoever! Many boys are either shy or have low social interest, it's perfectly normal. You have nothing to worry about at all. Echolalia is a normal stage of speech development. He clearly has no speech delays, either receptive or expressive.

Kind regards,
James