3 yr old – Autism spectrum, selective mutism or normal behavior?

[missy7467]

My son is 3yrs.4mos.  He began Montessori in January but was often home sick & never adjusted (first time away from home).  He began school again in Sept. It has been almost 8 weeks now; and he won’t join any group activities (3, 4 & 5 year olds in class).  My son says he’s afraid. He remains at his desk or asks to go outside.  He will play with kids 1 - 1 or in small groups (3 year olds only). At recess, he often holds the teacher’s hand or will play with his cousin. When the teacher gives instructions, he only follows them if she asks him directly. On the drive home sometimes he’ll scream uncontrollably if I ask about his day and then fall asleep.

We recently went to a children's Halloween party. Initially he interacted with two kids but when the room filled up he would not talk. He would only nod or smile except once he asked me if he could leave the room.  After the party I helped tidy up.  He sat waiting on a chair; his body ridged & eyes with a distant gaze as kids played around him.  The room slowly emptied; when there were about 5 kids & 4 adults remaining, he leaped off the chair suddenly and became interactive/extroverted.  It was like an on/off switch.  At home, he then reenacted “bingo” yelling bingo many times as if at the party.

My son walked at 13mos, potty trained willingly at 16mo & is physically coordinated.  His vocabulary is advanced.  He sings the ABC song, counts to 12, knows shapes/colors, recognizes his name on paper & reads a few words. He plays well 1-1 and in small groups, shares/ takes turns, & has an active imagination. Until recently, when my son was excited, his whole body stiffened; he’d stand on his toes as his whole body trembled with his arms stiff and extended & fingers spread.  It looked odd. I asked that he clap instead when excited. Now he skips side-to-side and jumps when excited. The trembling is less now.

Could this behavior (no group participation) suggest selective mutism or autism?

Thank you so much.
  

[William L. Holcomb, Ph.D., BCBA-D]

It sounds to me like you have been looking at some information, somewhere, about diagnostic categories (most people I meet don’t ask about a differential diagnosis of selective mutism versus autism).  Based on you descriptions of your son’s behavior, it might be either of those, or actually just behavior within the typical range of development.  

I feel that the best advice I can give to parents with concerns like yours is to check with your son’s pediatrician thinks about what he or she thinks about your son’s development.  If you feel strongly that your son’s behavior is atypical and not improving, I suggest that you explain your concerns to him or her and ask for a referral for a developmental assessment.  Hopefully, your son’s doctor will agree that further assessment is necessary.  I recommend that you ask the pediatrician for help in finding an assessment team familiar with young children and autism spectrum disorders (ASD).  Furthermore, since your son is already over three years of age, the local education authority (LEA; your town or city school district that you live in) is responsible for performing a CORE assessment if you request one.  Contact your son’s school for information on how to initiate this process.

In the meantime, below are several websites with information about autism spectrum disorders (some specific to early identification).  

About.com Pediatrics
http://pediatrics.about.com/od/weeklyquestion/a/04_signs_autism.htm
American Academy of Pediatrics
http://www.aap.org/healthtopics/Autism.cfm
First Signs
http://www.firstsigns.org/

I hope you find this helpful.  

[missy7467]

Thank you so much for your helpful guidance!  I will indeed contact my son's pediatrician.