Expert: Catherine Ridenour - 8/31/2007

Question
I worked in the mental health field for about 8 years, I have a BS in psychology and really, just need a 2nd opinion. Most of my work is with severe MRDD or CMI with MR I have worked with a few autistic clients but they were adults and severe. I have since retired to another field but Psychology is always my passion. OK now about Nate.....
My friends son is almost 4. He is the size of a 2 year old and acts like a 2 year old. He was born premature and has been in programs on and off all his life. He doesn't see any specialists. His biggest problem is biting. He has been suspended from preschool twice in the last 6 months and kicked out of 2 day care centers. He isn't usually angry when he bites, but its a constant behavior, occasionally he will hit, push or pinch as well. He bites other kids, adults, his parents, himself... and so on. When you redirect him he seems to not understand what your talking about. You can punish him with time out, his mom has spanked him, bit him back, nothing phases him. He screams like a banshee if he has to go to time out, but he has no concept of why he was put there.
He doesn't play per say. He likes cars and trains, and yes, he lines them all up. He doesn't always know who is who, sometimes I'm mom and my husband is dad, and his parents are right there. He doesn't make alot of eye contact but I think he has a few times. He can't dress himself, he is not yet potty trained, another thing he seems to be confused about. If you give him a drink in an "open" cup he just pours it on the floor, he will steal food off others plates. I know its not lack of discipline and him just being a brat because his mom tries so hard. I have tried to help her but as I said before, he seems to have no concept that what he did is wrong or even that he did anything. His father is rarely around. He works away an when he is there he is no help, he let's Nate do what he wants and really doesn't try to correct him. Not that I think that would matter.
I have seen him show emotion, mainly anger and frustration. Happiness is rarely seen. They have another baby that is 3 months old, I'm scared to death he will hurt her. He has already tried to bite her and he has hit her 2 times. Usually she is kept out of his reach.
Any thoughts? Are my suspicions correct? Does this sound like it could be ASD? What do you suggest my friend do for help, the pediatrician just says "its a phase, he'll grow out of it"? Thanks so much!

Answer
Hi Crystal,

His mother needs to get him to a child psychiatrist as soon as possible. The pediatrician is wrong to ignore this. Hopefully, they have insurance. If the doctor will not give a referral, she needs to change doctors. If she does not need a referral, have her call the insurance company for a list of qualified child psychiatrists. If they do not have insurance, call the school district and find out about early intervention and where he can be tested.

This description contains all the signs of an ASD. Waiting is not the right thing. And, yes, he can hurt the baby because he has no concept he/she has feelings. Mom must never leave them alone.

I'm sorry, I don't have better news but thank you for writing. You are a good friend.

Best wishes,
Catherine