Expert: Catherine Ridenour - 8/5/2007

Question
QUESTION: My daughter in law is the parent of a 2 1/2 year old boy who has been biting and inappropriately expressing anger when he doesn't get what he wants. On a recent car trip when Jack was in the back seat with my husband and his mother on either side of him, out of the blue he hit my husband who said, "stop that Jack, it's not o.k."   Jack hit him again at which point my husband hit him back setting off a crying spell you would not believe. He has kicked me (then minutes later been affectionate) and often, if i'm holding him, he pulls my hair or the loose skin on my neck, etc.  We parents have expressed dismay and I've suggested my daughter in law take Jack to a developmental specialist to be sure there is nothing wrong, but the response is anger toward me, "He's a sweet boy most of the time," and "I've read about this and beleive it's a stage he's going through. I discipline and give him a time out when he does this."  Do you have any suggestions?  I'm at wits end as I continue to watch this acting out, suspecting the 'out of the blue' hitting, biting, screaming (more pronounced when he doesn'tget what he wants)are warning signs that the child may be autistic or headed to more serious problems--especially since they are expecting a second child (girl) in September. Everyone in the family (and friends) are pretending this isn't a big deal--they talk about it when we're not with the mother/child, but do nothing.  I guess what i'm eager to know is could this behavior be autism?

ANSWER: Hi R.J.

It can be difficult to tell whether such behavior is the "terrible twos" or something more serious.

I would like to ask a few questions to help me unravel this.

Does Jack play with his toys in a "normal" way, make car sounds and drive them around or just line them up?

Does he point to things he wants and look toward things that are pointed out to him?

How is his speech? Does he repeat things that are said to him or answer questions directly?

How are his motor skills? Is his balance good, does he run and hop like others his age?

Does he get fascinated with spinning things or "zone out" often?

Tell me how he behaves when he does not think you are watching. Will he play with other children sometimes? No two year old shares well, but does the get the idea of give and take?

I look forward to hearing from you again.

Catherine


---------- FOLLOW-UP ----------

QUESTION: thankyou for your prompt and very helpful reply.   The answers to your questions (for clarity) are mixed.  The play is mostly normal...no "lining" things up that I'm aware of but the next time they visit (or I visit) I'll be more watchful.  There's no "zoning" out--something I was watching for. The "pointing" is variable....his language skills developed late (IMHO) and so there was lots of pointing that seemed unrelated to anything.  It was pointing that led us to say, "what do you want?" then go through a lot of words "is it this or that?"  He becomes very frustrated, screams and Sara then comforts and holds him.
His speech is not as well developed as others his age (he'll be 3 in September) but it's better than it was a year ago including that (some of the time) he seems to answer (nod for yes or scream for no) when directly asked questions. Haven't seen any hopping. His balance seems good. He runs well. will watch re the fascination with spinning things. I wouldn't say he zones out the way I see other autistic children zone out. But when he's angry/frustrated it's as tho he's in his own world. As for playing with others when he thinks we're not watching...he's much worse. My other daughter in law who has a five year old (Lee) no longer wants to leave the boys alone -- in fact Lee (very masculine but sensitive child) often stays with us or his other grandmother and he's told his mother and us that he doesn't want to go over to play with Jack because "he doesn't know how to play."  
Mostly you've given me some very specific and helpful questions to ponder (and watch).  I asked my hubby last night about one or two of them and his response was "I don't know."  I cannot tell you how appreciative I am for your help. Let me know if this triggers other thoughts. Meantime,  I'll write again if I have further questions.
thanks

Tell me how he behaves when he does not think you are watching. Will he play with other children sometimes? No two year old shares well, but does the get the idea of give and take?

I look forward to hearing from you again.


Answer
Hello again,

The "he does not know how to play" is a key item. There is something going on. Maybe autism, maybe some other disorder.

I know it's hard when the parents don't want to hear it. I tell grandparents, friends, etc. that as tough as it is to tell the truth now, think of how they would feel if, a few years down the road, the child is finally diagnosed and they knew all along but kept silent.

His parents may take notice after the new baby comes along and they see his reactions to her. In my experience, firstborn autistic children have very strong reactions to be "dethroned."

Hang in there.
Catherine