Expert: James Michael Roan - 10/18/2006

Question
My baby boy is 20 months old, profoundly deaf and diagnosed with global developmental delay (due to seizures that he had at about 1 year old which are now in control). Recently he is being assessed for a cochlear implant and although his surgeon and speech therapist have given the go ahead for him the audiologists feel that he may not be suitable for a cochlear implant since he may have learning disabilities due to autism.

I do not believe that he has autism since he does initiate social contact with others when he chooses to, uses different cries for when he is hungry, sleepy, angry etc. He is able to laugh n smile n play with us when we mange to get his attention. With toys he does not display pretend play, but I do believe he is yet too little for this. He does tend to focus on toys quite intently but he does it with most things not just one particular toy. Since he is deaf he loves looking at colours and lights and anything that moves. He is slow at learning and has just recently learnt to containerize objects. He is happy being cuddled, loves tickles, and often is very determined about what he wants to play with. He is not easily distracted once he is focused on a particular object or toy, but when he is ready to move on in a few minutes he willl happily let go and move to another object of interest. He often comes up and holds onto our leg expecting us to pick him up and makes noises when looking around for us.

Inspite of all this his audiologist feels he may have learning difficulties and possible autism because he hasn't learnt a certain conditioning response in the last 2 sessions that we have had. Basically a tiny vibrator is put on his knee while he is looking at toys and each time the vibrator goes on he is expected to turn sideways n look for a reward (toy). He hasn't learnt this and so she thinks he has a learning disability, but I believe it is only because he is a very well focused little boy and independent minded and likes to choose what he plays with on his own. I believe he is just not easily distracted like most kids. Do you think he might have autism??? It is very important for me to find out as this might affect the decision to give him an cochlear implant.

Also would you know or recommend anyone that I can approach privately to do a full diagnostic assessment for my boy?? Advice would be greatly appreciated as I have been through a lot of material on autism n I think he is not autistic. the only thing that concerns me is his lack of pretend play, but then again considering he is only 20 months and has global developmental delay wouldn't it be unrealistic for him to display pretend play skills??  

Answer
Hi Frian;

I am very glad to hear that the seizures are under control. Social development and communication development are reciprocal in nature:  delay in one automatic creates an "observed" delay in the other. Pretend play begins in typically developing children between the ages of 12-15 months. It reflects the cognitive ability to think symbolically. You are right, his global developmental delay probably includes some level cognitive delay. Please keep in mind that most developmental delay is, by definition, a temporary delay in development and rarely is it a life sentence or permanent condition.

I need more information regarding the circumstances around and the quality of his eye contact.

Does he like and/or is he able to play some form of peek-a-boo with you? Can/does he physically imitate actions like clapping?

When you walk into a room after he has been left alone for a few seconds or minutes, does he look at you? Does he smile at your approach and look you in the eye?

Does he reach is arms up for you to pick him up?


Do you live in the U.S.? If so, the best source for a quality autism assessment is by a Children's Hospital or an autism unit at a nearby university is your best bet.

Kind regards,
James