How to tell family you think there is a problem?

[jssw]

My sister-in-law has a little boy who is almost two and I believe along with my husband, her brother that the child is demonstrating significant signs of autism.  My sister has worked with autistic children for many years and she confirms my fears as well.  However I don't know how to approach this with my sister-in-law.  She tells us that he does things that we know he doesn't do, such as counting and saying his alphabet, I have never even heard him say mama or dada.  He does not speak at all to my knowledge, he doesn't make eye contact with anyone including his mother, he using many forms of self-stimulation such as running in circles for hours, twirling his hands around and pill rolling with his fingers.  He will not play with or acknowledge that there are other children around him.  I truly believe that there is something wrong but don't know how to tell her my fears.  Her mother-in-law said something to her a few months back and she got really mad and wanted to know how she could possibly say something like that and now she won't let her really see the baby at all.  I don't want this to turn into a fight or upset her more then knowing something is wrong with your child would upset you to begin with.  

Does anyone have any idea on how to approach her or how to go about helping her realize that I think her son needs some kind of help?

[jssw]

I want to thank everyone for all their input, this gave me a lot of information to look through.  My husband is the one that mentioned it to me in the first place that he thinks there is something wrong with the baby.  He did hit his milestones within normal range, we were talking about it over the weekend by ourselves, and think we are going to talk to her about the speech a bit and maybe she'll be a little more receptive to that.  Thank you again to anyone that gave me information, it is so appreciated.

[RockRose]

What does your husband think about his sister's child?

[mich97]

i agree w/ the other post..if you say the word "autism" it could ruin your relationship w/ your sis-in-law..everybody handles things differently and clearly she got upset w/ the mother-in-law for saying something..
i've been on that end before, i had an aunt about a year back that asked me if i ever had my son tested for autism..she noticed that my son did an occasional hand flap,rocked on the couch while watching tv,language delays,and had pretty good tantrums back then..i remember after i cried and could not believe she asked me, however it did get me to push my pediatrician(who had no concerns of my son/autism) for a referral to see the neurologist..as much as my aunt did upset me, and at times i wondered why he had these quirky behaviors?? i thought "gesh, if other people are noticing i need to have him tested" not everyone is like that, some shut down and get so upset they may push people away..
BTW,my son does not have autism,or considered on the spectrum..he does have mild sensory issues and language delays that has improved every year..Little different then your nephew..i did write my aunt a nice email and thanked her for her concerns and told her what the neurologist told us..
Perhaps someone could approach her w/ having speech for him or if she ever brings up her concerns suggesting she take him to a specialist and let them decide..
he is on the young side and if there are issues it should be picked up when he goes to preschool..it would be great to get the ball rolling now and some early intervention but if she's not ready or in denial it may not happen unless someone can figure out a gentle approach for getting thru' to her.... Good luck w/ that

[Sally44]

Sometimes it is hard to see any problem yourself, especially if it is your child and you're with them every day.  How they are is just normal to you.  The child may also be different when you are not around.  
The other two postings sound really helpful.  At two years old they will just be starting to become more social.  If there are speech delays and social interaction problems then these will/should get picked up at nursery.  
I agree that if anything is talked about, maybe it would be any speech delay because communication becomes very important when they start nursery because not only do they have to make themselves understood, they also have to understand the instructions/information being given by the nursery staff.  And if there are problems with language it is usually 'understanding the spoken language' that is worse than 'expressing themselves'.  So, for example, they may be able to say they want something to eat or drink, but when they are asked a question, or something is said to them, you either get no response, or you get a response that is totally unrelated to what has been asked/said.
If he is assessed by speech and language therapy and they find there is a problem then that would be the time to get a full multi-disciplinary team involved to see what difficulties, if any, there are.  It is probably better not to mention the word autism because that can scare some parents off asking for help.  And it is quite possible that it isn't that, or it could be traits of autism but not enough for a diagnosis.  If speech and language is okay then it may be a question of waiting a bit long to see how he develops socially.
I think if anything is said to her by anyone it should come from her side of the family.  If she has a good relationship with her brother then maybe he could have a word with her.  But it may take time for her to see that there is a problem and this usually becomes more evident when they are in social settings eg. family gatherings, parties, nursery, school.

[mjthewriterdad]

If he is almost two, this means you have only observed him in these behaviors for say, less than a year.  One question is if he made the early milestones?  When did he start  to sit, crawl, stand, walk?  One way to apporach the subject is to ask questions about these developmental milestones and compare them to a good baby book.  Sometimes questions are more important than answers.

[888mom]

Mention the developmental delays, but don't mention the word autism.  Some people totally freak out and will shut down when they hear any label word.  If he's a late speaker, then he needs to go through speech therapy.  If he's not making eye contact, an occupational therapist would do wonders.  You don't even need a diagnosis.  Anyways, if the mom is in the US,  she could ask her pediatrician about her state's 0 to 3 program.  Pediatricians usually screen at 18 and 24 months for autism and developmental delays.  At 24 months, if a child is not talking in 2 word phrases, then there are speech issues.  Developmental delays do not mean autism either.  My husband didn't say a word until 24 months and didn't say mama or dada until well after 3.  His first words were all numbers and the alphabet and he was reading by age 3.  He did not want anyone to touch him for years and he had social issues with other kids in school and eventually had to see a psychiatrist in middle school.  They didn't really diagnose Aspergers officially back in the 70s and 80s.  He might have a very very mild case of it (that's what the psychiatrist said back in the 80s).  He didn't go through any therapy at all ever through his schooling... and he eventually went to a science and math magnet high school, on to college, and now has a PhD from Yale, and he now has no problems with people touching him though I would say he has a lot of OCD tendencies and is probably mildly OCD.  He is also fairly social as well.  So if they diagnosed him with aspergers when he was a child, which they probably would do nowadays, they probably would have had it wrong.  He grew out of a lot of those things.

So, autism... takes many years to diagnose.  

But, issues the child is having?  If there are speech issues and behavioral issues, those need to be addressed at an early age, regardless of whether it is autism, just some sensory issues even if the child might outgrow them.  Because in the end... if it is autism, it is better to have early intervention.  And if it wasn't autism and just delays, all that therapy is not going to hurt the child, and if anythign will help the child succeed.  So the important thing, in my opinion, is as a toddler/preschooler, focus on the issues, the delays, the behaviors, and address those... and then worry about giving it a label later on.  I really think labelling freaks a lot of parents out that they will refuse to go through any of the therapy at all, which even if it was just speech delays, therapy really helps that too.

Good luck with your sister-in-law.  Oh, trust her when she says her child is saying the alphabet.  My daughter has been saying it for many months now, but she usually only does it when she is alone or when I am with her and no one else is.  I recorded her doing it once, though, because nobody believed me.  It hurts when people have told me in the past that I was making things up because they just couldn't believe what I was saying and they didn't witness it themselves.  My daughter was using our digital camera at 18 months old.  Nobody believed me until they saw it themselves.  She also knew how to go into review mode and zoom in and out and crop photos.  And take a picture and then look at it.  I wouldn't believe it except I saw it often.