Expert: James Michael Roan - 9/6/2007

Question
QUESTION: I have 9 month that is showing some early symptoms...hand flapping, attractions to fans, lights, poor motor skills and moderate to low eye contact. He likes being held but not cuddled and he has started banging he head, he is always moving.

He still engages, babbles and smiles but I am very worried. He can roll over both directions and sit independently, but is unable to transition from one position to the next and he still is not crawling. Is there anything I can do to help prevent autism from developing?

I notice similarities in my sons' movements from the studies conducted by Dr. Teitelbaum. I have seen a developmental pediatrician he has a wait and see attitude.

I am trying to as proactive as early as possible. I have also look into studies conducted by The Mind Institute and early intervention seems to make a profound difference. I was going try a read up on the floortime technique, but it seems to be geared by an older toddler. Please Help

ANSWER: Hi Dawn;

How brave you are. Your pediatrician is wrong. DO NOT "wait and see" under any circumstances. I have just a few questions:

1. If you walk into a room where he is playing and you call out his name, how often does he turn and look at you (This is the most important red flag)?

2. Does he orient and look at you when he hears your voice?

3. Does he lift his arms to be picked up?


Here are some early developmental markers that are generally absent in autism (From the Autism Spectrum Disorder Foundation):

Is there a cure for autism?

There are no cures in the foreseeable future, a plethora or research indicates that early intervention is key to a positive outcome for a child with ASD. The earlier, the better. Some early developmental markers that indicate a child should be referred for a full autism evaluation are listed below:

6-12 Month Markers:

·   Passivity and decreased activity
·   Extreme distress reactions
·   Fixation on objects

By 12 Months:

·   Decreased positive affect and social smiling
·   Delayed gesture and language
·   Poor or no eye contact
·   Poor disengagement of attention
·   Inability to shift attention back and forth between different stimuli
·   Failure to orient to name
·   Poor imitation
·   No babbling by 12 months
·   No gesturing by 12 months

By 16 Months:

·   No single words by 16 months
·   No pointing to objects or interesting events in an attempt to share them with another

By 24 Months:

·   No spontaneous two-word phrases
·   Loss of any language or social skills at any age

Finally, you are absolutely correct: Early intervention is everything...the earlier the better. You want your son to be in a program that offers a strong social communication curriculum. You want around 10 hours per week upwards to 20 hours per week as his attention and tolerance warrants.

Remember: DO NOT "wait and see." Get right on this now.

Kind regards,
James


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

QUESTION: 1. yes, about 95% of the time
2. yes
3. yes

Answer
Hi Dawn;

Are able yet to establish joint attention? That is, can you and he interact by referencing an object or activity? Does he look back and forth at you while you are doing this? This can include story time, or any interactive game involving an object or extraneous activity. The key is, does he reference your eyes and face while doing this? Actually, this begins to develop in very simple ways at 6 months and should be present between 9-12 months of age.

It may be next to impossible to get a diagnosis at this age but you can do a number of things in case it is found out later he is on the spectrum, he will have had the necessary early intervention from you.

Key points for addressing social deficits in children on the spectrum at this age:

1. Engage in joint attention activities regularly such as peek-a-boo, story-time, Itsy Bitsy Spider, etc. Use exaggerated vocal inflection and prosody, facial and eye expression, and body language. By doing this you are teaching him the additional information carried with social communication and interaction. If it is difficult to get him to engage in activities of your choice, then observe what he seems to like and join in activities that he seems to enjoy, then wait for any eye contact and reward with hugs and kisses. Eventually, after you have established a pattern of joint attention, you can slowly steer the activities to more functional ones.

2. Augment your speech with simple sign language or gestures as a precursor to engaging in simple pretend games.

Finally, remember that almost 20 percent of typically developing children show some stereotypies such as hand flapping or lining up of toys, spinning, etc. Flapping is a relatively common method for regulating arousal level.

I hope this helps. Stay on top of it and don't let anyone dismiss you instincts.

Kind regards,
James