Expert: James Michael Roan - 1/5/2007

Question
My son is 14 month old. He is our only child. I am Chinese, his father is Dutch; we live in The Netherlands. He is a really lovable baby, and he smiles and everyone enjoys him.  

The day before yesterday he had his 14th month check-up, the doctor thinks he is perfectly normal, while she was a bit in a hurry, she almost didn’t let me finish any of my questions, then started to reassure me everything was OK... I am still a little bit worried  -- maybe to me, parenting is just a profession of being worried. However maybe it is smart to seek an real expert’s opinion, so I am asking now…

It started with spinning; after I read an article about “autism”, I started to associate the scary word with him. He loves spinning objects – it started when we visited my parents in China: we tried to spin anything that could be spun. He was just fascinated by it, and then he started to spin anything he could get his hands on too; his most favorite toys are two discs from a toy-set. He plays with one or the other, or both, for a long time. Not for hours, but they can occupy his attention way longer than any other toy can, and even when he finishes the spinning, he holds one of the discs while exploring other toys. (The doctor said that was normal for his age, and it would be a problem if he would still be doing so when he is 5 or 6 – will that be too late for early intervention? Below, all comments in parentheses are from the doctor.)

Thinking back, other little things also started to alert me:
He hardly reacts to his name. Actually he started to respond quite well when he was really young, and we all called him by his pet name. However, after we sent to him to a day care center when he was three and half months old, we started to call him in all kinds of different ways, and then he just ignored all of them. One or two months later, I banned the use of any other name than his real name, and things seemed to go better. However he still doesn’t respond all the time, far less than half the time. My mother suspected his hearing, however his hearing is really outstanding, he is sensitive to noise and loves music.  (Some children just don’t react to their name, as long as he reacts to noise, then it is fine!)

He did yet not wave when he was seven months. When we held his hand to wave, he just retrieved his hand vigorously. Anyway, he started to wave when he was 11 months, however he stopped doing that recently again. But he can clap his hands now; for instance when we sing a “clap your hands” song. (Some children just don’t wave, so not a problem.)


He is never afraid of strangers. Actually he enjoys strangers. He opens his arm for stranger, and he never complains that when I hold another baby, though it doesn’t occur often enough to be sure. (But he interacts with me normally, and he goes to you and sees you as mom. Autistic children don’t make difference between strangers and parents.)

He never points at things for me – his father disagrees with me. Recently we taught him very hard to point at the animal when we “read” his favorite book. I pointed to the animal repeatedly and made some “tick tick” noise. He learned it immediately, but he seems not to point to things to share them with us; rather it seems to be just for the fun of doing it. However, it probably is a good start anyway. He enjoys it so much and some times he does look at us with a big smile. And we can say again and again the names of the animals. (Some children don’t point. No problem.)

He hasn’t shown much progress in understanding languages – but we are a tri-lingual family, my husband and I talk to him in our own mother languages (Dutch and Mandarin), and we speak English between us. He seems to understand my way of saying “breastfeeding”, and both our words for clapping hands. He bubbles a lot different sounds now, but he only seems say “mama” in a more appropriate way, but it seems also he say “mama” just for fun. (Too early to say.)

He plays a lot on his own. I keep blaming his father that he doesn’t interact with his son enough. But even myself, most of time I just watch him playing. Though he does check if we are around, and if we pay attention to him. He seems like to play under our watchful eye, not with us. But sometimes we can read books together, or play with a ball together.  (– We didn’t continue the talk with doctor, because she really thought he had no problem…)

He also pulls his ears often.

However if those are early signs of worrying, there are also many for re-assuring.
The eye contact is so wonderful; he looks straight sweetly at me, usually smiles when I smile. And he laughs when we laugh. But sometimes it can be a little bit difficult to catch his attention though.
He loves to play peek-a-boo. When we hide, he looks concerned, and when we jumped out, he laughs.
He seems imitating us very well. He feeds us food, and when we went to a nearby petting zoo with him, he even fed some bread to a goat. He also brush his teeth – teeth-to-be, yet only gum.
Also, he plays a lot by himself, but he cannot be left alone for even a very short moment. He keeps checking if I pay full attention to him, if not he will certainly crawl to me though he doesn’t play much with me. .
He is friendly to everyone, he smiles to visitors, and nearly everyone that meets him enjoys him very much.  Actually he likes to be the center of the attention, esp. with a big audience, he behaves like a little star. He shows his sweet smile to everyone, he is very friendly and happy.
He doesn’t point, but when we walk outside in a nice environment, e.g. birds sing or children play, he some times look at me gratefully, as if thank me to bring him to the place.
He also never stands on his toes.
In day care, people say he is fine; he acts properly for his age. He pays attention to other young kids, crawls with them, and goes to younger babies.
He likes different environments; he likes doing different things and is never bothered by us doing things differently. He likes animals and as mentioned above, even tries to feed them. He is not stubborn (yet?), if he cannot get what he wants, he will be satisfy by an alternative.
Except for the spinning discs, he doesn’t seem to bind to any other things specially
He hasn’t walked or stood without any support, but he makes steady progress – he has pulled up for many months already, and walks along furniture, or even pushing a chair around, as if learning how to ice-skate.


What should we do?
I am concerned, no matter if he is autistic or not, it will take at least a few months to diagnose; what should we do in the mean time? Shall we start with early intervention or just treat him as a normal kid? We were planning to wean him totally, and let him sleep in his own room; now I am afraid that we would be closing the door to his heart by doing that. And should we continue his vaccinations? He’s had a few extra ones before we visited my parents. Some people link the preservatives used in vaccinations to autism, especially mercury-compounds; but then again, Dutch vaccinations don’t contain these.

Also, are there any parenting techniques that would be very good for autistic kids, and wouldn’t harm normal kids?  

Thank you!


Answer
Hi hh;

I doesn't sound to me like he has autism, although he may have a very high functioning form. In autism we are primarily concerned with social behavior and social interest. It sounds like he is just fine in that area.

The sensory (spinning) may be limited to sensory delay at this age. He's probably too young for anyone to attempt to diagnose him.

He does show good imitation and joint attention behaviors. A little low on the "showing" social behavior and orienting to his name. He is high on the social interest and naturally occurring ability to take interest in, and more importantly, take pleasure in being around others.

My advice is to keep your eye on him. Download the M-CHAT and scoring instructions off the internet at:
http://www.firstsigns.org/downloads/m-chat.PDF Also download the scoring instructions at http://www.firstsigns.org/downloads/m-chat_scoring.PDF If there is any risk noted then send me full results and we can discuss this further. Your son is really too young to take this screening tool, but it will inform you as to what to look for to be developing over the next few months.

Kind Regards,
James