Expert: James Michael Roan - 11/7/2007

Question
QUESTION: Hi there - I am writing for some clarification on whether or not my 22 month old's behaviour is 'normal' or bordering on something else? My son is 22 months old and only saying a few words (not including Mum & Dad) although he used to say these, he leads me around the house by the hand letting me know what he wants. He doesn't point to things, but puts his arm out and wiggles his hand back and forth when he wants something desperately. Sometimes he answers to his name straight away, other times I can say it 15 times with no response (often when I add 'look' to his name, he turns straight away). He is 50/50 with eye contact. He turns his head away from strangers and grunts, but smiles and makes eye contact after a while. He plays with toys, but loves cars and lines a couple of them up and lies on the floor pushing them back and forward. Does lots of his playing lying on the floor, pushing things in twos together. He loves taking them outside and covering them with dirt. He brings me books to read him and occasionally things of interest. His gross motor skills are excellent and he feeds himself with a spoon every meal. He walks on his toes a few times a day for a 10 seconds at a go. He hasn't had much social contact as we live in the country. He has had alot of TV when younger and still has a dummy (I contribute his non speaking to these things). He does most things that I ask, sometimes it takes a few asks. He hates it when 'Happy Birthday' is sung. He kisses me at least once a day, but isn't affectionate. He loves being tickled and rough-housed. I'm beside myself. I can't see a paediatrician for a month. Your thoughts would be appreciated. Lisa

ANSWER: Hi Lisa;

I'm hearing both good things and behaviors that are worrisome. The best approach is for you to go to my website: www.myasdf.org and download both the M-CHAT and the scoring instructions. I'lm be happy to discuss the results with you. You can also take the completed M-CHAT with you on your visit to your pediatrician. It is well respected by the health care community. If your son fails the M-CHAT your pediatrician is more likely to provide you with a referral for a formal assessment.

Kind regards,
James

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

QUESTION: Hi James, thank you for your answer. I have done the M-Chat. Most answers we passed. On questions 6 & 7 - he doesn't point with his index finger, but he holds his hand out towards something he wants (ie drink) and flips his hand back and forward grunting. Doesn't really point things out, but likes certain pages to be read to him in books, etc. Picks his own books and brings them to me, or brings me things to open or things I have to do for him. Number 14 & 15 are 50/50. But it definately happens sometimes. He often ignores me. Number 19 - he likes to play alone, but doesn't mind at all when I join in. Brings me books to read him, etc or a game we played earlier. He does understand what people says, especially 'No', etc. He stares into space for maybe 5 seconds, very occassionally. I notice it's mainly at breakfast he looks out the window and stares for a few seconds. I can bring him back asap and he smiles at me. How do we fare? He used to wave good bye and point to birds in the sky. These skills have disappeared. Is this normal?

Answer
Hi Lisa;

These behaviors are borderline in terms of failing the M-CHAT. If you provide examples for each question, I'll be happy to review more thoroughly, otherwise you should review these with your pediatrician further. I suggest you ask them if they are familiar with the M-CHAT and can help you review it. I also find many children whose social development is behind somewhat, but who are clearly NOT on the autism spectrum. You can also wait 2 months and give your child the M-CHAT again and compare results. If he loses any more skills take him in for an autism evaluation.

Kind regards,
James