Autism or Speech Delay?

My best friend has a little girl who just turned 4 years old (Jena). I am increasingly concerned with Jena. She practically hates all other children, adults, babies, etc. She just acts as though they don't exist in her world. Not that she's mean, she just totally ignores them. I've tried talking to her mom about it and she insists that she's had a hard time hearing b/c of ear infections (Although her hearing is tested every 3 months and it's always been perfect) and that Jena only has a speech delay. Jena does not speak .. very RARE and simple words (mommy, daddy, etc.) and it's not clear.. My husband who sees her often can not understand her at all when she does speak. When Jena gets upset and has a "tantrum" it's not like any other tantrum I've ever seen, she will make fists and bang on her head, throw herself on the floor, and scratch her face and kick anyone who comes near (including her parents). Jena makes no eye contact.. rarely with her parents (if ever). When we go out Jena only runs aimlessly around or sits by herself which leaves her parents to only run after her. It's not for her parents lack of trying she definately goes to the doctor (Although I believe her mother has herself convinced that it's not a big deal and isn't completely honest with the doctor about what Jena is and is not doing), she has a speech tutor. Jena has switched daycare centers 4 times because the center has tried to talk to her mom about a possible ADHD or autism diagnosis and her mom doesn't want to hear it so she changes. It's also worrysome to me that whatever Jena is doing she is mumbling and rambling very quietly just making noises (clicking her tongue and smacking lips) to herself. When and if Jena does play (by herself, as always) she doesn't really play.. she has tons of toys and things to do but she just carryings things around or throws them up and down. She also displays a lot of repetitive behavior (such as always having to have 3 crayons or 6 books.) Am I overreating?

[Rachel Thompson, Ph.D., BCBA]

An accurate assessment can be made only by a qualified professional during an in-person assessment. The responsibiltiy for assessment and referral is in the hands of the professionals with whom the familiy interacts (e.g., speech therapist, pediatrician). If the mother of this child is your best friend, I recommend that you support her and her family as much as possible. Interactions with children who have limited skills and behavioral difficulties are often not very rewarding. It sounds like this is your experience with your best friend's child. Do your best to focus on the positive things that the child does and recognize those to both the child and her mother. Often, the best approach to reducing unwanted behavior is to work to increase appropriate behavior while mimizing the focus on the unwanted behavior.