Could My Toddler Be Autistic? Possible Signs of Autism in Toddlers
With the world-wide epidemic of autism, one of the most common questions I’m asked during an initial speech-language evaluation with a child is, “Could my child be autistic?” Many people assume, incorrectly of course, that because a child isn’t talking by age 2 or 3, he or she must be autistic. There are many reasons for speech-language delays in toddlers, and autism is one of them. Late talking in and of itself usually does not mean autism.
Autism spectrum disorder is a complex disorder that lasts throughout a person’s life. Autism is called a developmental disorder because issues start before age 3, during the critical period of development, and it causes problems in the way a child develops, learns, and grows. Areas affected by autism include delayed or disordered skills in:
1. Social Interaction - the way a child relates to others.
2. Language - the way a child understands and uses words, gestures, and symbols.
3. Cognitive - the way a child thinks and learns.
4. Motor - the way a child moves his body.
5. Sensory - the way a child takes in and processes information through his senses of sight, touch, hearing, smell, taste, and movement.
Autism is a spectrum disorder which means that all children with autism do not share exactly the same difficulties. Severity can range from mild to severe.
Below is list of the other concerns noted during daily routines in young children with autism spectrum disorder. This is not an official diagnostic list, but rather a list of concerns that parents might note. This list was gathered from several sources.
- Does not consistently respond to his/her name.
- Cannot tell you what he/she wants with words or gestures.
- Doesn’t follow directions.
- Seems to be deaf at times.
- Seems to hear sometimes, but not others.
- Doesn’t point or wave bye-bye (past 15 months) or use other gestures such as shaking his head “yes” or “no” appropriately and back and forth in conversation.
- Used to say a few words or babble, but now he/she doesn’t.
- Throws intense or violent tantrums.
- Has odd movement patterns such as flapping arms or shaking body, especially when excited.
- Shows other odd visual behaviors such as staring repeatedly at spinning wheels on a toy or shifting his eyes to the side as he runs.
- Seems hyperactive much of the time; is always “on the go.”
- Is often uncooperative or oppositional during daily routines.
- Doesn’t know how to play with toys. Might spin or line them up excessively.
- Doesn’t smile when smiled at.
- Doesn’t make eye contact. He/she seems to look right through/past you.
- Gets “stuck” on things over and over and can’t move on to other things.
- Seems to prefer to play alone.
- Gets things for him/herself only without asking for help.
- Is very independent for his/her age.
- Seems to be in his/her “own world.”
- Seems to tune people out.
- Shows very little interest in other children.
- Or may interact inappropriately with other children.
- Walks on his/her toes.
- Shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants).
- Spends a lot of time lining things up or putting things in a certain order and gets upset if this is disrupted.
- Has delayed speech-language skills when compared to other children of the same age.
- Memorizes and quotes long scripts of favorite TV shows, sing entire songs, or label lots of objects, but he/she uses very few “real” or meaningful words to ask for things or participate in conversation.
- Repeats what he/she hears rather than using words on his own.
- Learns to read at age 2 or 3 (or has a very strong interest in visual symbols such as letters and numbers), but has difficulty communicating with others in a meaningful way.
- Is a very picky eater. May eat only 3 or 4 different foods.
Let me reiterate that the presence of a few, or even several, of these concerns does not mean that your child could be autistic. Please discuss these signs/symptoms with your pediatrician, and then decide whether a comprehensive developmental assessment is needed for your child.
Research tells us that early identification and treatment for children with these difficulties is essential before these symptoms become severe and chronic patterns are established. Waiting until a child is in preschool or kindergarten before seeking professional and educational assistance NEVER leads to the best outcome for a child with any developmental delay. The earlier a child is diagnosed, the better chance he has of correcting his problems.
Research also tells us that children with autism, regardless of the severity, can make progress with specialized intervention that focuses on facilitating developmentally appropriate skills. The current recommended “best practices guideline” for a child with autism is that he or she be involved in AT LEAST 25 HOURS PER WEEK of engaged time with caring, nurturing adults. This can be a combination of time in therapy, structured and developmentally appropriate preschool (Not mother’s day out), and quality, focused 1:1 play at home with mom and dad or other trained assistants.
Parents with children with autism play a crucial role in determining the ultimate outcome of their child. Success comes when parents make a huge commitment to learning their child’s unique strengths and weakness, become their child’s biggest advocates, and wholeheartedly embrace a comprehensive approach to improving their child’s developmental skills. This means getting a child professionally evaluated as soon as your gut tells you there’s a problem, selecting and following through with appropriate treatments, and pursuing additional education about your child’s needs until you become the best “expert” you can be. It’s not easy, but it will be worth it.
Popularity: 37% [?]
Comment by Kristie on 13 April 2008:
I have been concerned for quite some time about my 2 1/2 y.o. son. He ahs reached all of his physical milestones on time if not early. He does play with other kids when they are around, but it is not really imaginative play or play that requires cooperation with the others. He started babbling early on but there have been times where he would say a word a couple of times and we have never heard that word again. He has maybe 10-15 words he says right now. However much of it doesn’t make sense, he seems to get stuck on phrases and say them over and over again. One of his favorites is “bye-bye daddy car”. He says it at all different times whether he sees my husband or not or sees the car. He says greetings and waves. He can’t link appropriate animal sounds with the animal yet. He will not let me read to him, he rips the book out of my hands every time! If he wants something he gets it himself, if he cant he has a tantrum. If he’s trying to do something and can’t he has a tantrum instead of getting my help. It sems like he ignores me at times, like when he’s got a hold of the cat and is hurting her I’ll tell him to sop and he won’t let her go, sometimes she bites at him to get him to stop and he still goes back and tries to grab her again. My husband says I worry too much adn nothing is wrong with him. I don’t know though something seems off. when he gets excitd he does that arm flapping that they say autistic kids do. The part tht really worries me though is the speech thing. He shouldn’t have e er lost those words he said before. His vocabularly has gotten smaller over time it seems and he just repeats the same phrases, also he does not mimic sounds. If we want him to repeat something we’re saying he won’t do it. I would love a little more info and support, also i woul dlik to hear other stories about delayed children. Thank you - Kristie
Comment by Laura on 14 April 2008:
Kristie - Based on what you’ve said about your son, I would definately have him evaluated through your state’s early intervention program and/or a pediatric speech-language pathologist. Talk to your pediatrician as well, but please pursue an evaluation for him since your gut is telling you that things aren’t right.
According to what you’ve said, his language skills are not age-appropriate, and this is a big deal by age 2 1/2. By this age, children are saying hundreds of words, use original 3-4 word phrases and sentences all day long to talk about everything they see and ask for things they need. They don’t “get stuck” on the same phrases, and they have mastered verbal imitation for words and phrases. Losing words is a big red flag. This does not usually happen in typical language development.
Although I can’t see your son and wouldn’t dream of “diagnosing” him or evaluating him sight unseen, what you’ve said certainly causes me to suspect that he is having developmental issues. Please pursue an assessment earlier rather than later and have a qualified professional evaluate him to either put your mind at ease or give him the special help he needs to make progress with language. This is often a hard step for parents, especially for dads, because it seems like you’re admitting that something is wrong. Try to lovingly persuade your husband that YOU need help for him, and help is not a bad thing.
Research also tells us that children who receive early intervention (that is speech or other developmental therapy before 3), fare much, much better long term than children whose parents wait until kindergarten. By then the delays are so great, that it takes a long, long, long time to catch up, if ever.
If you need help finding your state’s early intervention program, click the post on the home page of our site for assistance.
Please keep us posted and let me know if there’s any other information you need. Laura
EDIT TO ADD - The initial evaluation for state early intervention programs is FREE. If he needs services, many states offer this at no to low cost. The states that charge parents for this service do so at tremendously reduced rates compared to what you would pay an agency or therapist if you contacted them yourself.
Comment by Anonymous on 17 June 2008:
the first question that comes on my mind while reading about autism is weather this is really sickness and disorder or it’s a made up illness that pediatrics are using to get paid some extra money and get new jobs for speech specialists. As a parent naturally i do not like to attach “freak” attribute since the second year of his age like some parents, do but at the same time i would like to do best for my child and if there is a problem help him.
My son is also 2 1/2 years and does not say a word. he is babbling constantly especially after we pick him up from the daycare and sometimes he goes on with hand gestures like he is giving a speech or trying to prove a point. it is all non understandable to us. as 1 year old he was saying few words and then stopped, when my mother started babysitting him and talking to him only in macedonian. so far we were not worried about this, but now this is becoming a problem for us because we started taking him to a daycare a week ago and he has problem communicating with the teachers there. it is difficult for the potty training also. he will tell us when his pants are wet by taking our hand and putting it to the wet area.
i was reading the signs above for autism and honestly lot’s of behavior described above (almost all of it) i can see in him but then talking to other parents i see that he is not the only one doing this. he is flapping his hands everytime he gets excited about something but i think that this is due to the fact that he can’t communicate or say anything to express his feelings. he loves to line up and stack all kinds of objects in the house, but the patterns are changing all the time. sometime the objects are lined up sometimes they are grouped and stacked sometimes lined and stalked. sometimes he makes such amazing compositions that i just have to take a picture of it. he loves puzzles and movements and loves computer learning games. he used to not let me read to him but recently that is changed he likes when i point to the pictures. and yes, he loves pictures and looking at the albums. he is “prancing” a lot also when he gets excited, jumping on his tiptoes and not pay attention to us when we call him.
he is very active and very affectionate boy. loves to cuddle and i think that socially he is very picky. he does love some people from the first sight and does not like others right away. some people he needs more time to get used to.
i really think that this whole deal with autism is just overdone. same exact symptoms can be found in every child and starting treatments like something is wrong with them since beginning i believe might do more damage then good.
Comment by Laura on 17 June 2008:
Dear “Anonymous” - First of all, let me say that I am glad you are concerned enough about your son to seek information. Some parents are so in denial that they can’t bear to even begin to read and explore what might be an explanation for why their child is not talking at 2 1/2.
Let me also say that it is entirely ATYPICAL for any child not be speaking by this age. This in and of itself, not including all of the other red flag behaviors you described, would be reason enough to have him evaluated by a speech-language pathologist, an early intervention program, or a children’s hospital. If a child is not talking by 2 1/2, there IS a developmental problem. By this age most children, even the late talkers, are using many, many words and short phrases that are understood by their parents and other familiar caregivers.
Autism is only one of a number of reasons why children have difficulty learning to talk. I urge you to pursue additional testing for him and information for yourself. Your idea that autism has been “invented” by doctors and SLPs to get additional money is unfortunate. I do hope that you’ll continue to educate yourself so that your son can get the help he deserves. Laura
Comment by Holly on 18 June 2008:
I would be curious as to what his pediatrician says about it all? If you feel comfortable with his doctor and don’t think that he/she’s just out for the money, I would definately start there. My son doesn’t have autism but he does have apraxia and like most mom’s I’m sure, at first I just wanted to deny it all and think of ever excuse I could come up with. I will say however in your defense, I do agree with you to some extent in certain cases. I know with my son and the school district, after all kinds of testing medically and through the district the district wanted to deem him ADHD. I was sooooooo mad and talked to his ped about it and was reassured that he ws a very normal 3 yr old little boy. They also enlightened to the fact that the more ’special needs’ children they get into their program, the more money the program received!!!! That was very upsetting to hear and so I decided at that point he would not enter their program and had the backing of my son’s doctor and slp he didn’t need it. I know it’s scarey to think somethings ‘wrong’ with your son trust me I was there for a long time and still am somedays now but you know to make sure through testing and research that there is nothing going on. The last thing you want for your son is to wait, every precious minute wasted is detrimental to their progress. Hang in there and stay strong
Comment by Sarah on 23 June 2008:
I hope someone can reassure me about my son. When he was 12 months or so, he began to exhibit signs of aggression to other children.Apart from his tantrums, he would just lash out at other children and look at them with very unsure and angry eyes. I have 3 other children and I put this down to terrible twos onset. I did go to the doctor at one stage as it was worrying me, and we were referred to have an assessment but I didn’t keep the appointment, convinvced that it was nothing. As the months went on, his vocabulary is quite advanced, he began walking and talking around 12 months, is very agile and able and the only odd thing I noticed was that some things had to be ‘just so’ but then my 9 year old son never liked getting his hands dirty, so again I just attributed it to ‘toddlerism’. He did once or twice line up the baby kinnex (connecting magentic parts), putting colour to colour, and making long lines. But he doesn’t really do this any longer. The only thing that is distressing me now, is that now at 2 and three quarters, he is no longer hurting other children, and at home is sociable with all of us, however, outside, he seems scared of other adults. He won’t join in whatsoever with a fun activity event i take him to once a week. He won’t even let me shake some bells or do the actions to a song as he seems scared of ‘being noticed’. If anyone talks directly to him, he looks a mixture of scared and angry and burys his face into me or hides behind my legs. I am really trying to keep a routine for him, but it’s getting really hard with him continuously opting out of the fun. I feel like I am achieving nothing by taking him. He will approach older children (very cautiously) to play and interact with him and seems to interact fine with them and also a regular friend of similar age who he’s known since birth. He has the most horrendous (scary) tantrums at home, does not accept ‘no more stories’ at bedtime, won’t eat much at all, doesn’t like new food or anything added to basic food. Will smell it before even trying and then probably won’t try it. During a tantrum we’ve even had to restrain him as he throws chairs and remote controls at us, and has hurt each of us in the family. He lashes out at our faces and is so enraged (over something very small) that he is no longer in control over what he is thinking. My others, of course had tantrums, but never like this. I just want him to trust the outside world and trust the adults he’s beginning to see each week but each week is the same, he just doesn’t want to be noticed by them. His eye contact with us is great, smiles, nods, points, but loses all of this when out with other adults around. He wouldn’t even go on the slide today as a mum was at the top helping her child. Please advice if there may be something wrong, as I feel quite confused now as to what to do and am starting to feel that it is my fault.
Comment by Laura on 23 June 2008:
Sarah - First of all, NONE OF THIS IS YOUR FAULT! This is not your parenting ability, or all of your children would exhibit these issues, so please stop feeling guilty.
Secondly, the behaviors you’re desribing seem more extreme than typical. I would not continue to try to handle this on your own. Many of his behaviors will just become more firmly entrenched the longer they go unaddressed, and it sounds like you’ve tried all you know how to do.
It sounds like your son’s major issues are that he has no frustration tolerance, is very fearful in social situations with adults and peers, and is exhibiting some other sensory issues, particularly with feeding.
I would definately have him evaluated, and you could go one of two ways, and just so you know, I’d probably do both. You could try to get an appointment with an occupational therapist who specializes in sensory and feeding issues. Some of his social issues could also be due to sensory processing differences. However, I’d also see a pediatric psychologist not only to “diagnose” the behavioral challenges, but more importantly, to help you find solutions for dealing with these at home. (And I don’t mean medications for a 2 1/2 year old!)
His issues sound too complex for you to continue to deal with on your own. Although you may find helpful advice from a book or website such as this, you’ll probably not find anything that can produce long lasting change for your son and for your family without sound, professional, specific, one-on-one advice. Get a referral from your pediatrician, or start making calls yourself, but please pursue action for your son soon. He can’t do it on his own. He needs you to help him. Laura
Comment by Sarah on 23 June 2008:
Thank you, Laura, for your informative and reassuring reply. It was such a comfort to read your words. However, I wondered if anyone else could offer another opinion? Of course we are more fully armed with information with as many people that offer it! Are you based in the UK Laura? Do you mind if I ask if you specialise in such conditions, as you certainly sound as if you do…..I do value your opinion (and asked for it!) greatly although as you can imagine, as much as I want to help my son, I don’t want to walk him into being labelled something he may not be, just because some of his behaviours ‘match’ some of those of children suffering ASD. How mildly can autism affect a child? Or is this too difficult to define…?I’m so sorry, I am shooting in the dark, but cautious too. When you mention an appointment with an occupational therapist, would this be privately? Or could my doctor refer me? I know that my doctor would refer me to the pediatric department but usually it would be for all of the above I described - I can’t see them referring me to different consultants for various symptoms. It’s all about cost effective here, and that’s why I am cautious….however, as you say, he can’t help himself and I must do something to ensure his happiness and that for the whole family. Your reply would be much appreciated, many thanks for your help thus far, regards, Sarah xx
Comment by Janet on 23 June 2008:
I have a 33 month old and he doesn’t speak that much but he may a couple words like “no” and “what”. But from that list my baby has allot of familiar characteristics. I mean he doesn’t play other children that well and if he does he wants to fight them. Like today in the hospital he tackled one little boy to the ground for no reason. He also makes allot of noises when he plays, he jumps up and down when he gets excited. But one thing he does is smile at me when I smile at him and he comes to me and he may sit on my lap for a little while but then he gets back up and runs back around. I’m just really worried about him and honestly the program that I just got him involved in isn’t really doing to much to get him evaluated by the right people they just want him to go to preschool and that’s suppose to magically change the way he is. But, I don’t think so I know my child and I know he likes allot of attention and if I do decide to let him go he is going to end up having and nothings going to be able calm him down until he leaves. I just want the best help for my son. What do you think I should do so I can get him properly diagnosed?
Comment by Laura on 23 June 2008:
Sarah - I live in the USA, and our health care system is very different. I am a pediatric speech-language pathologist, so my specialty is speech and language development. I do treat lots of children with autism. Autism, as you know, is a spectrum disorder meaning that the range of severity is from mild to severe. I cannot tell you if your son displays any characteristics of autism because I haven’t seen him. I so understand your dilemna with not wanting him “labeled” or “diagnosed” with ANY disorder or difficulty at a young age. However, if you are worried enough about him to be searching for information, you really should follow up with your doctor and determine what the best professional to help your son would be based on his/her observations from talking with you and actually seeing your child. From your description, it does sound like your son needs to be evaluated by a developmental professional, and your doctor can help you decide who/what profession that should be. Best of luck to you as you search for answers! Laura
Comment by Laura on 23 June 2008:
Janet- Please continue to talk to the teachers in your son’s current program. You didn’t mention if this is a public or private program. Is he there because he’s been identified as having developmental delays, or is it a private preschool program you’ve enrolled him in?
Regardless you should ask his teachers for referrals to other specialists who might be able to give you more information not only about his diagnosis, but also with ways to help him at home.
You also didn’t mention if he’s getting speech therapy. I certainly hope he is because by nearly 3 most children know and say hundreds of words and communicate all day long use short sentences. If he is not in speech therapy, please ask your pediatrician for a referral or contact your local public school system. If you are in the USA, children with developmental delays (such as a language delay) receive early intervention services until they turn 3 in home based programs. At their 3rd birthdays they are then eligible for free preschool and/or therapy services through the public school system. Let me stress again how critical it is for language delays to be identified and treated, and the earlier the better.
Your goal should be to do everything you can to have him caught up to other children his age by kindergarten. Given that he’s not talking very much now at almost 3, that’s probably not going to happen for him without some specialized assistance. I would definately have him evaluated by a speech-language pathologist if you haven’t already. Let me know if you need more specific help. Laura
Comment by Sarah on 24 June 2008:
Thanks Laura, I will do and will let you know what the doctor says. I have had chance to look around the site now and see what you are doing. Good luck with it all, and thank you for sharing your expertise with us!
Comment by Holly on 24 June 2008:
Idon’t know if Sarah will be back but this is for Janet as well. Remember that if your child can’t communicate with people, they do tend to act out from frusteration as well a lot of the times. I’m not a specialist just a mom of a now 4 yr old with speech apraxia and A LOT of experience
My son used to have a lot of tantrums when he was around the age of 2 and looking back now I know most of it was from his lack of language skills. Oh course I thought it was just the terrible two’s as well since I didn’t know at that time he was behind in his speech. He would yell and scream, knock his head on things to the point he almost passed out. Once we got him into early intervention and he was able to ‘talk’ with us better about his needs and wants, his tantrums almost all but disappeared. I know having your child ‘labeled’ is a scarey thing, I didn’t want my son labled either however on the positive side, you can always have that ‘labeled’ removed from your child’s records as well so remember that. I wish you both the best of luck and just remember to keep fighting for your child, follow your instincts as their mom. They wanted to put my son in the preschool as well and I declinded based on my own feeling about my son and now I also have the backing for that decision from his slp’s and his doctor. Good luck.
Comment by Worried on 24 June 2008:
My son will be 3 next month. Since he was 1 yr, he seemed very advanced walked early, recites the alphabet and 1-30, knows animals and their sounds, colors, musical instruments, shapes, does puzzles. Understands phonics, has several words memorized for each letter, and even spells about 30 words both verbally and through typing. I just figured conversation was coming slowly at the expense of these other talents. Taking a step back and being realistic I realize that there might be something else wrong. He typically cannot sting more than 2 words together. He can memorize long lists of objects or dialogs from television, but he cannot explain what he wants or tell me about his day. He also doesn’t listen to a word anyone says unless it pertains to “ice cream” or “park” or “pool” or any other keyword that excites him. He makes his body go limp if you try to move him against his will or put him on the potty. Also fights getting dressed and undressed and going in the bath, and only eats about 10 different things. And when I try to look him in the eye and speak to him, he looks away and talks about completely unrelated things and tries to break gaze and go back to what he was doing. Despite all of his academic aptitudes, do these traits sound like he could have autism?
Comment by Laura on 24 June 2008:
Worried Mom - I cannot say if your son “has autism” since I have not seen him.
However, I would be very concerned about him since he is not meeting his language use milestones. (Referrred to as pragmatic skills by SLPs). Children who are turning 3 are typically USING words combined into short sentences all day long to communicate their wants and needs to their parents, take turns talking back and forth in conversation including asking and anwwering questions, and can follow LOTS of directions and instructions (whether they necessarily want to or not!).
Even though your child is saying lots of words and is verbal, it sounds like he is struggling to truly communicate with you. He is not expressing basic wants and needs by asking for things, and he is not responding to you consistently. I would definately pursue a speech-language assessment for him because although he is talking, it doesn’t sound like he’s communicating very much. He should be using longer phrases and short sentences (4-5 words is typical for this age) to ask for what he wants All DAY, and he should be processing language, even when it’s not his favorite thing.
It also sounds like he has some sensory processing issues regarding bathing, dressing,and feeding, so I’d pursue an occupational therapy assessment as well too.
As a parent it’s so hard to think that something may not quite be right, especially when he is exhibiting some verbal and cognitive strengths. But I’d be concerned if I were you. Trust your instincts and pursue an assessment for him. You can start with talking about these very specific concerns that you’ve outlined with your pediatrician, calling your local school district to have a developmental assessment, and/or pursuing private ST and OT assessments. Let me know if you need any other more specific advice. Laura
Comment by Worried on 24 June 2008:
I’m actually his dad, and I appreciate your reply. I am waiting for the school district to get back to me regarding the assessment. Summer break makes it tough to get a response. Is there anything I could be doing in the mean time to help him? I know how to teach him nouns and songs and adjectives, but have yet to hear him ask or answer a question, other that “what color is the ___?” or “how many ____ are there?”. I would really like him to tell me about his day, or tell me about things he likes or ask a question. Not just listen to him recite songs when he doesn’t seem to understand what the words mean, or tell me what color and animal his toy is, or how to spell different words. He knows how to engage me, is there any way to engage him? I try to speak in full sentences about things he is interested, but he never goes beyond his 2-3 word fragments.
Comment by Laura on 24 June 2008:
Worried Dad - I have lots of specific things you can do at home to target his expressive and receptive language skills. Please click on those categories and read the articles, especially the ones regarding asking questions and Teaching Toddlers the Words They Know To Change Their Worlds. Good luck in your pursuit of how to help your son! Laura
Comment by Jo on 30 June 2008:
Sarah, you might want to read up on Sensory Processing Disorder, food allergies and food intolerances. I don’t know if these would help, but you just might find something that ‘clicks’ there.
Comment by Cameran on 8 July 2008:
Laura:
My son is 22 months old and for some time now I have been worried about his speach and language abilities. At first I chalked it up to being the second child, as I have a 34 month old daugther. His vocabulary consists of about 15-20 words (way below what his sisters was at that age), he has said a couple sentences like - I go get Daddy. But it is very limited. He is a very active child and the best way to describe him is intense! For a couple months we had problems with him having tantrums to the point where he would hold his breathe and pass out! He has done better but still has serious tantrums when told what not to do or if something is taken from him; which I have said is the norm for the terrible twos. But he will not repeat words back to us, and sometimes just acts like he is ignoring us completely. I can sit with a book and point to the object and say the name and then ask him to either point to it or say it but he just doesn’t respond at all. And I also try hard to repeat words (Like - Can you say shoe?) and ask him to say it but to no avail - he just refuses to say it and seems to ignore it all. Any advice would be greatly appreciated! He has his regular checkup in September but I am wondering if I should take him to his pediatricain earlier to get a referral. Both my husband and I are worried. Thanks in advance!
Comment by Laura on 8 July 2008:
Cameran - I would definately be proactive and see your pediatrician to discuss your concerns now. The language issues are not “severe” in that he already has 15-20 words (the minimum is 50 by 24 months and using two-word phrases frequently), but he does have some red flag behaviors such as consistent “ignoring,” limited imitation skills, and then there are those tantrums….
An intense, frustrated almost two-year old is very difficult to live with, and I so applaud your and your husband’s attention to this situation. If you are worried, there is likely a good reason to be, so I would go ahead and pursue the referral for a speech-language assessment so you can have it done at least by his birthday. If you’re using your state’s early intervention program, it’ll take a while (45 days) to get services started, so you could initiate it now to have it done by the time he’s turning 2. I will add that I love to get kids at this age rather than waiting until
2 1/2 or later.
Here you’ll find lots of ideas for things to do at home while you’re waiting for the assessment. Let me know if you need anything else. Laura
Comment by angie on 10 July 2008:
my son is 2 1/2 ,he cant say more than six words at all hes under a speech therapist has been since january ,his behaviour is different ,we have got to have his order where ever he puts his pencils and books its got to stay like that otherwise he will start screaming and hitting himself or booting the furniture ,he refers himself as me .likes to be on his own ,seems to be in his own little world .he points and seems to have his own little sign language.when hes eating if he spills some of his food he wont eat the rest of his meal ,he wont involve us in any of his activities unless he wants us to .but on the flip side of that hes a happy little bunny .
Comment by angie on 10 July 2008:
my son as well wont look you in the eye he will look away and if any one talks to him he looks down to the floor and burys his head,hes also very stubburn.
Comment by Laura on 10 July 2008:
Angie - I know that your health care and educational systems in the UK are very different from ours in the USA, but the behaviors that you are describing are red flags, and do warrant attention from a professional. I am glad he’s seeing a speech-language pathologist, and I hope he continues to make improvements in all areas. Please implement the strategies your speech therapists gives you to use at home. Children with parents who are very committed to their progress to much better than those who aren’t as involved. I wish you all the best as you continue to help him! Laura
Comment by angie on 10 July 2008:
to ,laura thank you very much ,i just needed to tell someone ,i made a appointment with my sons doctor for tomorrow ,i will keep you posted how we get on ,thank you again . angie
Comment by michelle on 12 July 2008:
my son is 3 next month, we are currently waiting to see a paediatrician regarding his development. He is obsessed with numbers and letters and any toy with wheels. Until recently he would only spin wheels on trains and cars but now he pushes them along the floor. He has virtually no imaginative play and will not have anything to do with other children. He will play with other adults eventually but only if it involves something he needs, such as helping him onto a slide. He is very affectionate with myself and my partner and his grandparents, but hasn’t got time for anyone else, even if he sees them regularly. I took him to toddler group during term time and it took him 16 months to be able to get in and out of a little childs car without help and even then he still couldn’t get his feet moving to drive it. His speech is delayed also, he has never asked for anything other than by taking my hand to reach for it, he would repeat whole sentences that he hears and sings whole nursery rhymes but never anything original when he gets excited he flaps his hands and he would also shake his head quite fast with his eyes looking to one side, this usually happens more when he is tired. The first time he ever pointed in his life was 4 weeks ago. Could my son have an ASD or is it possible that I haven’t taught him enough to be at the right stages for his age?
Comment by Laura on 14 July 2008:
Michelle - Although I can’t say definitively if your son has autism because I haven’t seen him, he does have some red flags that indicate that he needs to be evaluated by a developmental pediatrician AND a speech-language pathologist. According to what you’ve said, his language skills are delayed. By the time children are turning 3, they are using LOTS of unique, sentence-length structures to verbally ask for things they need, respond to their parents questions, and talk about things they see and do all day long. These things he’s not doing with language are more alarming to me than the other classic signs of autism in any child. Even if a child is autistic, he should be learning to communicate. I hope that this site can give you some ideas for how to help him learn to do that AND that you continue to seek professional advice for him. Good luck! Laura
Comment by michelle on 14 July 2008:
Thanks for replying Laura. It’s really frustrating just waiting for appointments, i’ve been told I could be waiting 6 months before he see’s a paediatrician. This site is brilliant, i’ve picked up a few tips that i will difinately be trying with my son. Thanks again. Michelle.
Comment by Lisa on 17 July 2008:
I am also a working pediatric speech-language pathologist and mother of young children. The above list of red flags for autistic spectrum disorder is excellent. It is important to remember that most children will not demonstrate everyone of these behaviors, yet concerns still are warranted. Also, there are many typically developing children that may demonstrate some of them, such as picky eater or flapping type movements when excited. It is important to keep frequncy and intensity in mind. Many parents I work with say something like, “Oh, all kids do that sometimes” or “So he’s a little different”. A good motto to keep in mind is “It’s not a problem unless it’s a problem”. If a child prefers to play alone sometimes, maybe it is not a problem. If a child cannot play near others, can’t make needs known, or tantrums excessively, it is a problem. I know this sounds simplistic, but it does help gain perspective.
Autistic spectrum disorders is just that. Most parents want/need black and white answers because there is such uncertainty raising a child who does not present as a ‘textbook child’. Diagnosing ASD can be challenging. Yes, I am sure many ‘typical’ people demonstrate some of the characteristics. (I do believe I hand-flapped as a child.)That is why a complete evaluation by an expert is necessary. I am certain that there are many adults today on the mild end who were never diagnosed and are functioning and happy. With todays advances and early intervention, I am also certain that many more children who fall on the spectrum can grow into happy, successful individuals.
Comment by Laura on 17 July 2008:
Thanks Lisa! I totally agree! I am in the process of posting a couple of other links for parents who are looking for a “tool” to help them with questions about their children who may (or may not) be on the spectrum. These may be useful to you and your clients’ families as well. Thanks again for commenting! I love hearing from other SLPs!!! Laura
Comment by Melissa on 26 July 2008:
My son’s pediatrician said she is 90% positive he has autism, but he doesn’t have the hand-flapping, social avoidance or many other key symptoms of autism. He has therapists for the speech and physical delays. Who can diagnose autism or diagnose him as not having autism, and if it is not autism, who can diagnose a speech disability, like apraxia, if one exists? A department of the local university supposedly does evaluations snd diagnoses, but I have waited several days since I first called and no response. The pediatrician, who has rarely seen my son, says he does little imaginative play. How much imaginative play is a two-and-a-half year old boy supposed to do, especially if he is speech and physically delayed, and what kind of imaginative play is it supposed to be and look like? He seems fairly social and does not do any hand flapping or repetitive movements, but he is very speech delayed and slightly physically delayed. If autism is not the cause, then what is? His cousin has apraxia, but is not physically or speech delayed. She just has a speech impediment and fine motor shaking. Does my son have something worse if he is speech AND physically delayed? Can his therapists help in diagnosis, his pediatrician, or someone else?
Comment by Andrea on 5 September 2008:
Hi Laura, a few days ago I asked you a question on the ‘foreign language and late talkers’ article. It really gave me peace of mind to know that my doughter’s echolalia is normal for her age (20 months old), however, I’m still worried about a couple of things.
One thing is that she started to point at things one week before she turned 18 months old, she she points when we are reading books to show me something in the book and when I ask her to point at something, she also points at things she’s interested in.
Something that really disturbs me is that at the park she’s always picking up sticks or leafs off the floor and needs to have them on her hands, if we try to take them she gets really upset and screams, sometimes she doesn’t care, but the screaming is the rule. Because she’s always grabing something we are always helping her so she can go down the slide or climb, etc
Another thing is that since the begining I always gave her her food pureed because I’m scared she would choke. From her firts birthday I added more texture and now I shred her beef or chicken, she likes to eat peas and cheerios, so it’s evident she knows how to chew. Sometimes she gags and ends up vomiting, but it’s because she has a lot of food in her mouth. She only eats fruit if it is pureed, I would give her a banana and she won’t eat it unless it’s pureed. She’s trying to use fork and spoon so that’s a good thing.
The way she plays is functional, she does lots of pretend play, but recently she turns her little people farm upside down and puts the animals or other toys inside, maybe that’s just her way to play???….
I would appreciate you can comment on this, thanks again!!
Comment by Andrea on 5 September 2008:
ohh, and we insisted and finally got an appointment with a paediatrician in one month
Comment by Laura on 5 September 2008:
Andrea - It sounds like you continue to be concerned about her, so I am glad you are seeing the doctor. Here are my thoughts about the things you mentioned -
Mouth overstuffing is pretty common at this age until 24 months or so, so that’s not a huge concern, but the throwing up is. She should also really be eating a full diet of table foods by now and eat a variety of foods. By variety, the experts say at least 10-15 different foods is common for toddlers.
Wanting to constantly hold on to leaves or sticks outside or (or little toys when inside) is also a pretty common occurence for toddlers. Watch for this when you’re out. So many kids are carrying something!
Screaming when you take something away…. that’s totally common for toddlers.
Now, each of the things you mentioned does seem to fall within the realm of “typical,” but again, because you keep feeling uneasy about her, I’m glad you’re following through. Sometimes mothers just know when something isn’t right, even if they are the only ones who feel that way. Keep pursuing answers until you feel satisfied.
One possibility to explain these quirks could be a “sensory processing” difference. You could google “sensory processing issues,” and get some information about this. Another great resource is Lucy Jane Miller’s book, Sensational Kids. The Out of Sync Child is another older book about sensory processing issues that I really like. This area plays such a factor in a child’s overall development. Our oldest son had, make that HAS, sensory issues that really affected nearly every area of his life, so I’ve “lived” this from a mom’s perspective, in addition to my professional interest. I haven’t written too much about this on the site, but I have been planning to for a while. I will also tell you that I’m having an occupational therapist on the show in a few weeks to talk about what sensory issues are and how they can affect a child’s ability to understand and use language, so look for the show announcement about this in the next few weeks!
I have written you a novella about this, so let me end by saying that I would mention sensory issues to the doctor, but don’t be surprised if he or she looks at you like you have 2 heads. Some pediatricians are not trained in this area. After your research, if you decide this could be the issue, you’ll want to find a great occupational therapist who specializes in sensory processing disorders. Good luck and let me know how it goes! Laura
Comment by Andrea on 5 September 2008:
Thank you so much Laura for your response!! you’ve made my day!! I’m finally getting answers and now I feel that I can really enjoy my time with my daughter and stop thinking that there’s something wrong in everything she does.
Still, I will continue to keep an eye on those things that I mentioned and I will do everything I can to make sure she lives a wonderful, happy life , but without overworrying…that’s for sure…Thanks again and God bless you
Comment by Andrea on 5 September 2008:
…and off course I’ll let you know how everything goes with the ped!
Comment by Angie on 17 September 2008:
My son in almost 13 months old. He used to have a vocabulary of about 15 words and now he rarely says mommy or daddy. He still isn’t walking and has a very short temper. He sometimes also tends to hold his hands over his ears when he gets angry. His doctor says that he is just a normal 13 month old but he seems to be a little off at times to me.
Comment by Laura on 18 September 2008:
Angie - Sometimes moms pick up on when things just aren’t going right long before others will. I hear this over and over as I work with children with developmental delays. I might get a referral on a child at 24 months, and when I ask the mom when she first started to worry, she often says, “For a long time.”
You can do 2 things - either wait it out to see if it’s a temporary little bump in his development OR go ahead and be proactive and call your state’s early intervention program for an assessment. To find out the number, you can google your state’s name + the words “early intervention.”
It is NOT typical development to lose all of the words you’ve used previously. Sometimes a child may say a word or two and then “lose” it in lieu of practicing other things, or not talk as much while he’s so super focused on learning a new skill like walking. Since he’s lost all of his words and isn’t walking yet, I’d be concerned. Again - it’s not so out of the realm of normal not to be walking or talking at 13 months or to have frequent melt-downs, but I’d listen to that nagging voice inside your head and pursue an evaluation thru your state program, especially if things don’t move along by 15 months. If he doesn’t qualify for services at this point, they should still be able to give you some tips to help him at home.
In the meantime, keep reading the articles here to give you ideas to use with him to build his language skills - both with the words he’s saying and what he can understand.
Good luck! Laura
Comment by Holly on 18 September 2008:
Hi Angie,
Good luck and keep us posted.
From a mom’s view I say, get him evaluated now….the sooner the better for him if something is wrong and if there’s nothing wrong, the better for you to rest your worries
Comment by nicole on 20 September 2008:
hi my name is nicole, my son had some similar symptoms to autism. i had him evaluated and they said he didnt have autism and they just suggested a head start program because his speech was delayed. i on the other hand think he has autism.. he gives me eye contact all the time. but what gets me is that he is very mean to other children he hits them and takes things away, and now its to the point where his own uncle doesnt want him at his house because he hits his son. hes always very hyper..he doesnt flap his hands or anything.. but he lines his hot wheels up not all the time though.. so i dont know its very confusing to me. they say he doesnt have it.. what should i do. Do i take him for a second evaluation or a second opinion.. or should i get him evaluated for something else like adhd?11
Comment by Laura on 20 September 2008:
Nicole - Anytime a parent thinks they might need a second opinion, they usually do. You didn’t say how old he is, or what else they said about him during the assessment other than language delay.
Children aren’t usually diagnosed with ADHD until they are school-aged and have hyperactivity/behaviors that are interfering with academic skills or following the rules and routines in the classroom.
You also didn’t say where or by whom he was assessed. You might try a team that includes a pediatric psychologist since you mentioned his aggression with other children.
Did whoever evaluated him mention sensory processing issues as a possibility for him as well? There’s a great book that explains sensory issues called Sensational Kids by Lucy Jane Miller. Another good resource for sensory information is The Out of Sync Child. You might want to explore this as a possibility for him too based on his high activity level. Occupational therapists are the professionals that evaluate and treat this kind of issue.
I hope these suggestions will help you as you continue to pursue help for your son. Please check out the other articles for ideas at home for working with his language. Aggression with other children is sometimes caused by frustration since he may not be able to communicate with them, and he resorts to hitting and hoarding toys.
Please let me know if you have other questions! Laura
Comment by nicole on 21 September 2008:
well my son is 3 years old.. his father travels alot from arizona to california all the time. when he was evaluated it was in california. I also think maybe hes experiencing a little jealousy since i recently had a baby boy.i think thats where the hitting and the taking away of toys came from. but he was evaluated 1 on 1 by a speech pathologist. she came to my home and got out toys and basically watched him play and she asked my neice and nephew to come out and play with him i guess to see how he played with other children and she said he was fine. and she suggested a head start program and for us as parents to encourage more imaginative play.
Comment by Andrea on 21 September 2008:
Hi Laura, a couple of weeks ago I asked you a few question about my daughter. Shae’s now 20 months and 2 weeks old. I’m very happy because she’s talking a lot and she’s even using 2 word sentences and tends to favor the english language. One thing that I forgot to mention is that at 18 months and 3 weeks she would tell me when she had or was about to have a bowel movement, she did for a week or two, but then she stopped doing it…could’ve been that I failed at not buying the potty at that time (and still haven’t)???…is this something to worry about?? Thanks once again
Comment by Janese on 22 September 2008:
My daughter is 20 months old. When she was just 12 months she had a pretty extensive vocabularly for her age. She also seemed to understand and follow simple instructions. She had an unusually long attention span when it came to television. She was the only toddler I knew of at that age that could watch television and seem to interact with what was going on. Since she liked to watch certain programs, I let her. Lately I have noticed that her vocabularly has decreased, she does not speak as much as she used to, she responds to her name sometimes, but mostly only when it is accompanied by something else such as eat eat or bye bye. She points at things sometimes, but for the most part she grabs my hand or clothing and pulls me towards what she wants. Developmentally her speech has reached the milestones, but I have noticed that she has not really learned any new words from when she was much younger. She does flap her hands when she gets exicited, and she sometimes “gathers” her toys and various objects and arranges them on the outside of her so she can sit in the middle. I am concerned about her language and her lack of following directions.
Comment by Laura on 22 September 2008:
Nicole - Then I would get him enrolled in a program as she suggested. If you are still concerned after a few more months, then you could reconsider the second opinion. Good luck with whatever you decide! Laura
Comment by Laura on 22 September 2008:
Andrea - I’m so glad your daughter is doing well and making progress with her language! Keep up the good work!
Oh the dreaded potty training question - this is not my area of expertise, but I’ll tell you what I know. Many children experience an initial period of interest just before they turn 2, and then seem to lose interest. All 3 of my own children did this, and only one of them successfully trained during this time.
If you can train them during that period, great, but if you can’t, then it may not happen until she’s between 2 1/2 to 3.
Children with any developmental delay, including language, may be a little slower to train. But it’s also very common not be trained until that time, with or without a language issue.
Good luck with her, and again keep up the good work with her language! Laura
Comment by Laura on 22 September 2008:
Janese - I know you must be very worried about her. You could go ahead and have her assessed now by your state’s early intervention program, or you can continue to watch her for a couple of months and see what happens.
Anytime a child “loses” words, it’s a red flag. You may want to go ahead and schedule a visit with your pediatrician in the next couple of weeks to discuss these issues as well.
In the meantime, don’t just watch her at home. Get very involved in her world and encourage her to interact with you, let you join her play, and use the words she knows. If you act early and aggressively enough, this could be just a little bump in the road for her. Read the articles on the site for ideas with how to help her at home. Let me know how she does and if there’s any other question I can answer for you! Laura
Comment by Elizabeth on 29 September 2008:
I am really worried about my son, Chase. He is 26 months old and is displaying a whole range of worrisome behaviors. He has been ahead of others his age until recently. Physically, he is at the 90% percentile for his weight and height. He is extremely active, constantly moving, wanting to play, and is very coordinated. He loves to play outside, loves animals, is completely obsessed with cars, likes Bob the Builder… ultimately he enjoys the typical boy kid stuff & activities! But… there are several things that keep distressing me.
He has an outrageous temper. He has at least one blowout tantrum daily. If I even say the word ‘gentle’ he will just go crazy. He hits and kicks me constantly. He has recently added head-butting and attempted biting to that list. He will take whatever toys he is holding and hit them against household objects or himself - especially his head. He will grunt and scream and cry and sometimes shake if it’s bad enough. When we put him in timeout he will take whatever he can reach and throw it and if there is nothing to throw he just lays on the ground and spins around kicking and violently crying. He understands the word ‘no’ so when we say ‘no hitting Mommy’ etc he will pretend to hit me - just barely touching me. When we tell him not to do something or to do something he doesn’t want he has an emotional meltdown. Even if we say it as gently and calmly as humanly possible it doesn’t change his reaction. When I try to take him out to a store and put him in a cart he will just throw everything out of the cart if something isn’t going his way. I have bruises all over my body and have no idea how to discipline him. He looks at me with the most sad and angry eyes that it just breaks my heart. The timeout isn’t working, taking things away doesn’t work, gently spanking hasn’t worked, trying to get on his level and just talking to him doesn’t work - I don’t know what to do and I feel like I’m on the verge of an emotional breakdown. I don’t understand why he is having such aggressive reactions.
His speech is also another concern. He has said TONS of words - at least 100. But he doesn’t use those words often. He says bear, bottle, juice, mommy, daddy, etc - about 50+ for the appropriate things and times… he has only combined words after hearing us say them. For example, “I’ll be back” or “shoes on” things like that. I’ve yet to hear him come up with anything on his own. Majority of the day he uses his own language which I somewhat understand because of the physical motions and pointing. A lot of his speech is just noises for excitement or anger - a lot of high pitched whining. He responds to his name majority of the time, but other times it seems as though he doesn’t even hear me. I scheduled an appointment for a tympanogram with our local ENT next week - in hopes that they could rule any ear issues out.
His eating habits are also extremely difficult. His meals consist of any kind of fruit really, bologna, peanut butter, chips, ground sirloin, and ravioli. He wont touch anything new or veggies. He recently weened him off his bottle and he refuses to drink milk out a cup. We tried the milk juice boxes and he wont do it. He doesn’t like cups typically and will only drink juice out of a juice box. We have been having to give him a bottle with water because we worried about his hydration. We can’t get him to sit down and eat - he just runs away with his food or wants to eat it in front of the tv (which I hate)! I started giving him a vitamin because I’m worried that he isn’t getting proper nutrients. Does this sound like normal picky behavior or something to be worried about?
He doesn’t like to sit down and work on projects unless it is playing with his cars or watching a movie. He is very loud and rarely uses an ‘inside voice.’ He likes things to be very neat and organized… the other day he wouldn’t go to sleep until his cars were put away. We couldn’t figure out why he was going crazy so we let him get out of his bed (he was pointing all around his room) and he put away his cars and then went to bed. Some of these things sound like your typical toddler boy - but I just don’t feel like it’s normal.
He is extremely affectionate to some people and wont even look at others. He doesn’t like to cuddle (unless he is sick) but will give you a hug if you ask for one. He does walk on his tip toes daily but not for extended periods of time - just for like 5 second intervals. I talked to his pediatrician regularly about these things and he always says lets see where he is at in 3 months.
I’m a stay-at-home Mommy. I have been since he was born. My husband works 12 hours a day, 5-6 days a week… I truly feel for these other parents experiencing even more extreme behaviors. I pretty much cry daily because I’m so overwhelmed with him. I try to engage with him inside, outside, with his cars, with books - you name it… and everything seems to end with a tantrum or timeout. I love my son dearly but want to enjoy my time with him and I don’t know how to get through to him when he expresses these kinds of emotions and demands. I hear about ADHD and Autism mostly - but are there other things I can research with these kinds of behaviors?
My mother-in-law always says he is amazing for her and they just have the greatest times together - so I feel like I’m doing something wrong. My husband and I have talked about montessori school 2 days a week or something just so I’m not constantly disciplining him… I know that probably sounds awful but I am starting to feel like my son hates me. Although he gets very shy around other children and new adults to the extent that I’ll have to carry him. We’ve tried play groups and whatnot and nothing has ended well. I am all ears for any advice or support groups!!!
Comment by Laura on 30 September 2008:
Elizabeth - Although Chase does have lots of good skills to build on, he is exhibiting some red flag behaviors that I too would be concerned about.
Per your report, he is displaying some sensory processing issues (need for constant movement, food aversions, low frustration tolerance, lack of social interaction at times, restricted play interests) and speech-language delays (lack of phrases despite an adequate single word vocabulary and not using his words to communicate in an understandable way when he needs to ask for something).
Any of these issues alone are not a huge concern, but put them all together, and it does seem to suggest the possibility of what could potentially turn into a very real developmental issue. The good news is, with early intervention, so many of these things can be addressed so that it’s a little bump on the road in his development, instead of a problem that continues to escalate throughout his preschool years.
You are so smart to want to address these things now instead of waiting to see if he’ll outgrow it on his own. Just so you know, moms are usually the first person to be worried about a kid, often long before dad and especially grandmothers, are! Love for our children can sometimes blind us to what needs to be done in order to help him.
If he were my child, I would seek out early intervention services in your state or a multidisciplinary evaluation. Usually these kinds of programs are affiliated with children’s hopsitals or universities. He should be evaluated by a speech-language pathologist and occupational therapist and perhaps even a pediatric psychologist who can help you figure out better ways to deal with his challenging behaviors. You are his mother, and you know him best, so you need someone to help you address what is happening.
While mother-in-laws who help you take care of your children are wonderful, they sometimes too are oblivious to what is really going on. As I said before, you are his mother, and you know him best. Don’t let other people make you feel guilty for seeking out help for Chase. When he grows up, he will thank you for it!
In the meantime, keep reading the articles on this site for very practical ways to work on his communication skills at home. The DVD could also show you several techniques you could use to help him learn to USE his words on his own, expand to phrases, and improve your ability to teach him to learn to interact consistently through play. It’ll also give you new ideas for things to entice him to want to play with you.
You can do this Elizabeth! You sound like such a thoughtful, engaged Mom. Chase is lucky to have you! Let me know if you need any other help. Laura
Comment by Andrea on 1 October 2008:
Thank you Laura for sharing your personal experience potty training your children.
My daughter is talking a lot! three days ago she started to answer ok or yes when I ask her if she wants something…has never said no, though. She loves to label things she sees on a book, on tv, at the playground. Sometimes she points to the sky and says ‘moon’ or ‘baloon’, even if there’s nothing there. Today she wanted to show me a toy and said ‘look, cat!’, also, she crushed a banana and I asked her what happened, she just said ‘poor banana’, that certainly made me laugh.
She says her name and a few days ago asked an older kid ‘what’s your name?’, he didn’t pay attention to her, maybe he didn’t understand, but I did. She loves older kids and is starting to get interested in her peers, she grabs other kids toys and plays next to them, as far as I know this is normal for her age (almost 21 m/o)
She loves reading books and constantly asks me or my husband to read them with her, when I’m busy I just tell her to read it by herserlf and that’s exactly what she does.
I know in my heart she’s doing fine, but one thing that still worries me is that she sometimes labels things she sees on tv or books just because, but, doesn’t point at them and doesn’t expect a reaction from us…I don’t know if that’s something to worry about…is she supposed to point and look at us whenever she labels something??
We have the appointment with the pediatrician on friday, though. I’ll let you know how everything goes. Thanks.
Andrea
Comment by Laura on 1 October 2008:
Andrea - I’m glad she’s doing so well! I rarely tell moms “don’t worry” because that’s what good moms do, but it sounds like she’s moving right along. Hopefully the pediatrician will confirm that for you.
Most kids at her age do label things just for the sake of labeling them. It becomes a problem when they NEVER or RARELY seek you out to help them get things they want and won’t respond to your attempts to interact with her. By your report, she is doing well asking you for things (wanting to read books), directing your attention (when she said, “Look! Cat.”), responding to your directions, and is even beginning to like to be with other kids. Again, from your report since I can’t see her, it sounds like she’s doing things expected for a toddler her age. But I’m glad you’re going to the pediatrician, and I hope that it relieves your anxieties about her. Let us know - Laura
Comment by M on 5 October 2008:
My son is 27 months old. There are only a few behaviors that have me concerned but they are really worrying me. He knows many words but isn’t putting them together to form sentences. He likes to call all numbers and letters “A”. I will count 1 2 3! And he will reply A 2 A! He also refuses to call me mom, he calls both me and his father daddy. Sometimes he doesn’t respond to his name but he usually does. He knows how to communicate very well using gestures, facial expressions and tone. He follows directions very well. He is very affectionate and social. He loves imaginative play and to pretend. He has his stuffed animals have babbling conversations to each other. He can be very independent when playing but always prefers to have someone to play with. He’s very bold about approaching kids at the playground to play with him. He’s not picky at all when it comes to food and he mastered feeding himself a long time ago. So, it’s really just the language issues that concern me. When we read his first word books he will go through and point out only the words he knows, not wanting to pay attention to the other pictures. He goes straight to “cookie” or “key” and will say them a few times. But if I name the items he will accurately point them all out to me. He just won’t say them. Are these language issues enough for me to be worried about autism?
PS - He has three older siblings, 14, 12 & 10. I’ve heard that this can affect speech development. Could this really be the cause?
-M
Comment by Laura on 5 October 2008:
Dear M - From what you’ve said, this sounds more like an expressive language delay than anything else I’d be concerned about at this point. I’d go ahead and have an early intervention evaluation or speech-language evaluation since he should be doing a little more than he is according to the information you provided. The good news is he’s got some great strengths to build on - his social skills and his ability to follow directions. He may just need a jump start from working with an SLP who can not only work with him, but more importantly, give you new strategies to try with him at home. 27 months is a great age for speech therapy to improve his expressive language skills!
AND being the youngest in and of itself doesn’t account for a language delay. The only time this is the case is when there are absolutely no demands placed on him to talk, but it sounds like you are encouraging him to use words. Read the articles in the expressive language section for more ideas to use at home so that you can be sure you’re setting up situations that would entice him to talk.
You may also want to check out the DVD for ideas for all of you (even those older siblings!) to use at home to help him use his words and expand to phrases.
Either way - good luck with him! Laura
Comment by Jessica on 13 October 2008:
Hi, I have a son Harley who is 21 months, i am worried and need some advice, he has started to head bang a lot, when we are at the park when he cant do something, when he cant have somthing etc… unsual attachments to his dummy and his blanket, like older children and doesnt know how to act around other children younger or his same age, or just ignores them. his speech is delayed but he can say no, doesnt say yes but knows how to nod and shake head at both words. he is a very fussy eater, i am worried, he also likes the wheels on his cars and buggy although he pushes them too.. am i just worrying too much i dont know..
he is profoundly deaf in one ear and they did say that this should not interfere with his speech.
he does point to things and loves the washing machine.
just dont know what to do x
Comment by Laura on 14 October 2008:
Jessica - Thanks so much for your comments. I hope that you are finding the ideas on this site helpful so that you can be proactive at home in helping Harley learn to use language. By this age, he should be well on his way to using single words often, and by helping him learn words, you’ll be doing lots to alleviate the frustration he’s feeling which may be causing some of the head banging.
If he continues to do these things which are of concern to you, and especially if his language doesn’t improve, please talk to your health care provider. If you are still worried as he’s approaching 2, insist on a referral to a pediatric specialist and SLP. I know it’s more difficult to receive a referral and treatment in the UK than in the USA, so I would be very persistent.
In the meantime, use the ideas on this site. Check out the DVD too since you could watch this using your computer rather than a DVD player. It’s filled with lots of ideas, and so many parents have written me to tell me how it’s helped them work with their children at home. Laura
Comment by D's Mom on 24 October 2008:
I have a 20 month old that I believe is exhibiting signs of autism. I know this is young, but going through the list of red flags, he has more than 75 percent. He was speaking coherent and intelligent words by the age of one and has completely regressed. He will not answer to his name and totally tunes you out. He will not reciprocate signs of affection and in fact doesn’t want to be touched at all (rarely). At times he seems as if he is deaf - I can make loud banging noises to try and get his attention, but when he is focused on something else the house could collapse and he would not acknowledge. He lives in his own little world and wants to play alone at all times. When he wants something he throws and explosive tantrum, falling to the floor and screaming and weeping until he is exhausted. He has begun talking gibberish rather than using words. He used to wave bye but no longer does this. He absolutely will not make eye contact. He does not follow even the most basic directions. The things he likes to do he does repeatedly. He doesn’t play with other children, acknowledge them, etc. He constantly walks on his tip toes. He is covered in bruises from his clumsiness. He can watch a cartoon and totally fixates on it and absolutely nothing can get his attention. He has a high tolerance for pain, i.e. he can stumble and fall and hit his head and get up and go about his business. When he gets his shots he never even whimpers. Is it too early to insist that he be checked or is this typical 20 month behavior? I am worried sick.
Comment by Laura on 25 October 2008:
D’s mom - None of this is “typical” 20 month old behavior. The key here is that he has “lost” skills, and this is what you should emphasize to any professional that sees your child including his pediatrician.
I would also recommend that you call your state’s early intervention program very soon and request he be evaluated. 20 months old is not too young.
I will tell you that of the 28 children I am currently treating right now, 9 are children of physicians, therapists, or nurses, and every one of them started therapy before age 2.
With early intervention services, many children who exhibit “red flag” behaviors, can and do overcome them. Research tells us that early therapy can helps change the way their little brains are wired. Even children who don’t completely achieve skills within the normal range are still much better off than other kids with problems who did not receive services as toddlers. Waiting until 3 or 4 or (HEAVEN FORBID) later to get services is most often a huge, huge mistake that parents don’t need to make in our country with good resources in 2008.
In the meantime, please check out the other articles on this site and begin to implement your own “therapy” at home until you can get help. Good luck and let us know how he does! Laura
Comment by Jennifer on 27 October 2008:
Hello,
My son is 2.5 years old. He doesn’t talk at all. The only thing he says are the first 2 letters/sounds of some of the words. For example instead of “mommy” he will say “ma”, instead of “daddy” he will say “da”. That’s pretty much all he says. He has bad tantrums. If he doesn’t get something, he may hit himself on the head or face with his hands or fist. Or he will bang his head on back of the chair or the floor. He is very aggressive toward other kids. He hits, pinches and bites other kids for no reason at all. Not all the time, but very frequently. He may play alongside other kids, but then out of nowhere hit or pinch someone very hard. He always wants to take away a toy that another child is playing with. The other kids don’t want to play with him because of that. He doesn’t seem to follow any directions, not interested in reading or doing any projects. He likes several cartoons that he can watch over and over again. Is this autism? thank you.
Comment by Camille on 27 October 2008:
I have a son with autism, diagnosed at 2 1/2. I’m starting to worry about my daughter, who is now 20 months. Although she has many words and says a variety of phrases like “go outside” and “want toy,” she uses few gestures. She also sometimes says “what do you want” instead of “i want,” which her autistic brother sometimes says. She doesn’t point with the finger, it’s more like a gesture with her entire hand. She doesn’t nod her head yes or shake her head no. She’s very attached to her blanket and stuffed dog and often picks up objects and carries them around with her and gets upset if we take them away. She isn’t cooperative in dressing and getting her diaper changed. She does engage in some social games, like throwing the ball back and forth and kicking a ball. Over about the last 2 weeks, she’s been a very picky eater, when she used to eat pretty much everything we gave her. I noticed at a birthday party this weekend that she was climbing up and down a play structure and going down a slide, repeatedly, until I directed her to something else. She transitioned fine, but I was curious as to the repetition of what she was doing. I had her looked at by a developmental psychologist at 12 months, and they didn’t see any red flags. But I’m concerned because I don’t know how much she’s getting from her brother or how much of it is abnormal behavior. Does anything I described sound like autism? Should I be worried? Everyone I talk to about this says I’m overreacting, but I have this nagging feeling.
Comment by Laura on 27 October 2008:
Camille - She could be imitating some of the things your son is doing rather than truly exhibiting the traits or autism herself. I have one little guy on my caseload whose sister has apraxia, and he began to imitate her off-target word attempts and words with speech sound substitutions (like “wo” for no). I really thought he also had apraxia, but we started therapy with him, and his mother really stepped up her play with him at home, and wah-lah, he is doing GREAT now with no characteristics of apraxia. This could also be happening with her, but….. researchers believe that autism may have a genetic component meaning that siblings of children diagnosed with autism are at higher risk to be on the spectrum themselves. These things she’s doing could also be an indication that things aren’t moving along in a typical fashion as you would hope.
I would continue to watch her closely and implement some “mommy therapy” at home to be sure she continues to make developmental gains. Keep helping her transition when she’s having trouble or seems to get “stuck.” If she’s still making you wonder in the next couple of months after you’ve continued to implement strategies with her to deal with the things you mentioned, have her reassessed. I would go thru your state’s early intervention program since you would also get help with treatment, not just an evaluation, as you would with the developmental psychologist. She made need some OT to help get her (and you!) over a little developmental sensory lag.
Just for the record, I don’t think you’re overreacting! I think you sound like a concerned Mom! Laura
Comment by Laura on 27 October 2008:
Jennifer - I can’t tell if it’s autism since I can’t actually see your son, and it would be very unprofessional and unethical for me to tell you something like this about your son without having laid eyes on him!
But, based on what you’ve said, he is exhibiting red flags developmentally and behaviorally that certainly do warrant you having him evaluated by your state’s early intervention program or another program that specializes in developmental issues with children. You can find out how to contact your state program by googling “early intervention” plus your state’s name.
You should also discuss these things with your pediatrician, knowing that sometimes unfortunately doctors are the last person in a child’s life to recognize a developmental issue, but it is worth mentioning, and then still following thru with the referral yourself to have him assessed. Waiting to treat these issues until kindergarten is not a good idea since you would have wasted so much precious time. Research tells us that the earlier a developmental issue is treated, the better the outcome for the child, so don’t delay! Moms usually do know best! Thanks for the good question -Laura
Comment by Barbara on 10 November 2008:
I just read this article and now I am very worried about one of my twins. The boys were born 10 weeks premature, and are now 17 months chronological, 15 months adjusted age. They have been getting physical therapy through our local Early Intervention program for almost a year. Now that they are walking and are doing well with their motor skills, they will stop getting weekly PT.
Both boys are speech delayed, but babble with inflection quite a lot. I thought they had said word at various times over the past six months, but they don’t ever say anything consistently, not even mama and dada. We do have a speech evaluation scheduled for next month, and it could just be a normal speech delay, common in twin boys.
However, while one boy “T” has been clapping his hands for some time and will wave bye bye (sort of) when prompted, the other boy “S” shows no interest in doing these. In fact, neither one of them do much in the way of imitative behavior, and really never have.
I’m not as worried about T, because he is very social and seems to be interested in learning new things. In contrast, S seems to want to do the same things over and over. For example, he will pick up a toy and walk back and forth from the table to the couch and set the object up high. He does this over and over, and seems to enjoy it a lot. He doesn’t respond consistently to his name, and doesn’t gesture or point at all, except for raising his arms to be picked up. His eye contact is okay, but not great.
On the other hand, he smiles and giggles and laughs and plays with his brother. He snuggles for brief periods, until he goes off on another adventure. He likes peek-a-boo. He is interested in our pets and likes to chase them and pet them. Maybe it is just his personality?
Comment by Laura on 10 November 2008:
Barbara - I’m glad you’re getting the speech eval soon, and that SLP will be able to tell you what’s going on with your sons since she’ll be able to observe them and play with them in addition to hearing your concerns. Congratulations for going ahead and pursuing the assessment now rather than waiting. In the meantime, you can start implementing some of the suggestions from articles here on the site. You don’t need a speech assessment to do that!
Now about your questions - have you listened to last week’s podcast Teach Me To Talk with Laura and Kate here on the website? In that show I discuss the criteria for diagnosing autism, and there’s also a link to document I used for reference in the comments section. You can listen to the show by clicking the top link under the blogtalkradio icon. I forgot to number last week’s show, but it’s the introduction to this month’s series on autism, and that information may help you decide in your own mind if autism is a possibility for your son that you’re concerned about.
That being said, autism is just one of the reasons a child may show a delay in communication skills. Prematurity and late gross motor skills are also contributing factors. Late walking and late talking are very common in children who were premature and multiple births, as you’ve pointed out. I hope their communication skills move along as well as their motor skills have! Keep us posted on how they do! Laura
Comment by ashley on 11 November 2008:
i looked at your list and our son who is 28 months displays 18 of the listed characteristics. We first noticed a problem with his speech, he has maybe 20 words that he uses, but only 10 that are used on a regular basis, and then only is the word is said to him like we are asking him if he wants that item/thing.he can only make some sentences like we go, mommy get, things like that. we had his evaluated by a speech therapist and was told that he wasnt behind at all. im in doubt about her diagnosis. he does alot of grunting and groaning when he wants something. he also seems very independant, and gets extremly frustrated when he cant do something or if we try to help. hes obssesed with lining up his toy cars, and will only play with the cars and none of his other toys. he gets hysterical when asked to stop doing something or if we try to have him do something such as eat, he will lay on the ground grunting and screaming for up to an hour. we have tried to get him to interact with other kids but he seems content to be by himself and gets violent when others try to play with him. his eating habits are another concern, eating time has become a chore for us. he simply refuses to eat unless its frys or something sweet. we cant get him to sit down and look at a book or do something other then what he wants to do. im at my wits end and dont know what to do with him, the therapist says hes fine, but obviously something is wrong, i started doing research on autism and he seems to be showing alot of the signs. where can i have him evaluated for autism at?
Comment by Laura on 11 November 2008:
Ashley - University programs and children’s hospitals often have teams to evaluate children. You could also ask your pediatrician for a referral to a pediatric psychologist. Even if he’s not on the spectrum, the psychologist can help you with managing the frustrating behaviors.
One other thing I would do is to get him evaluated by an occupational therapist since many of the behaviors you’re describing could be linked to sensory processing disorder, with or without him being autistic. Call your early intervention program back and ask for OT, or find an OT privately. Even if you have to file insurance or end up paying for it yourself, I think you’ll be on track for getting the help you need for him.
I don’t know if you listened or not, but on my podcast last week we started a series on autism. In the first show we discussed the official diagnostic criteria for autism, so this info might also be helpful to you before you visit another professional. Going in armed with very specific diagnostic information can be helpful so that you can say to the person I’m concernred about autism because he exhibits these qualities, and then spell them out. You can listen to the podcast by clicking on the top link under the blue blogtalkradio column on the right. Hope this helps! Laura