I'd like to know if my son, who will be three in a couple of months, should be seen for possible autism. The truth is, there are conflicting signs. On one hand, he is bright, affectionate and, quite frankly, a hell raiser. He will deliberately defy me, but there are times when he blows me off or seems to not hear me at all. He also walks on his toes, occasionally lines up his toys and didn't start to talk until he was about 2 and a few months. Now he's a chatterbox, always asking, "Why?" but he also has a tendency to ask the same questions, such as "Why wear seatbelt?" or "What does policeman do?" Should I be concerned?
I think if you have some concerns you need to get a multi disciplinary assessment carried out through Health. This usually starts with a Speech and Language Assessment. As a general rule those with autism tend to have language problems whilst those with Aspergers don't. I'm not sure if Aspergers can have language delay, but you could describe some Aspergers children as chatterboxes. (But under ADHD they also talk about continually chatting and being impulsive). But you also have to remember that children are unique and not born to fit criteria. Sometimes they do. Sometimes a child may just have traits of autism, but not enough to get a diagnosis. It is quite possible to have traits of a number of Disorders, but not enough of any of them to get a diagnosis.
Did/does your son ever repeat phrases you have said to him or that he has heard on TV? If you google echolalia this explains what that is. There is also something called perservant speech and that is repeatedly asking the same question over and over. Children with autism can do that as well.
Toe walking and appearing deaf is a sensory thing. Are there any other sensory behaviours you notice such as oversenitive/undersensitive to touch, hearing, smell. Does he seek movement jumping, spinning etc.
How is he with social interaction with age related peers?
Lining up toys is also classical, but lets not forget that 'normal' children can also do this. But it is a case of what is the quality of his play like? Lining up toys occasionally but then playing with toys and other children appropriately using imagination is okay. Lining up toys, playing with bits of toys rather than the whole toy, eg. spinning the wheel on a toy car repeatedly, not being able to socially interact/join in games or sustain play or conversation is a different story.
If you google DSM IV for autism you will get the clinical criteria the professionals will be looking for.
I think, because you are concerned, you should go and speak with your paediatrician about this. Your son will be starting nursery and needs to be able to cope within that environment and if there is something going on then he needs those supports in place.
If there is something going on, the fact that he is speaking and communicating is a really good sign and points to the fact that he may be mildly affected, if at all.
I don't know specifically where to get information on toe walking. Does he do it all the time or is it when he is excited or is it when the floor changes eg from grass to concrete flags or other kinds of patterned floor coverings.
You can google the name Olga Bogdashina and that will bring up an article printed in Autism Today. This woman has published a number of books eg. Sensory and Perceptual Differences in Autism and Aspergers. Although toe walking is mentioned in that book, it is just one sign of many behaviours that may indicate sensory overload. Alot of nerve endings are in the feed and therefore if they want to limit incoming sensory information because they have got enough to cope with they tend to go up on their toes. If there are sensory issues going on the professional who would address them is an Occupational Therapist. They can put together a sensory diet that will helpl de-sensitize your child as well as exercises that will help integrate the senses better. But you need to get an OT with experience of autism and Sensory Integration Disorder.
She also has a book about communication differences as well.
Although it can be a HUGE question to deal with, the bottom line is, if you have concerns...YOU are the best judge of character of your child, then likely you need to have your child evaluated. If for nothing else but "peace of mind". In the area that I live, it is VERY hard to get your child in for a medical diagnosis/eval because so few people are qualified to do so, in fact, it took me 8mo. to get my son in for testing because there were so few trained in this. My first recommendation would be to take him to a speech therapist as they can get you in rather quickly and see if they notice any signs themselves. They can also recommend if they feel OT can help. Also, call around for Psychologist and specify that you are wanting to have your child tested for a possible Autism Spectrum disorder. There are sooooooooooooooooooooooooo many that fall under the spectrum that your child could fall into, yet not have "autism" specifically. Many variations have similair issues, such as toe walking, late speech development, rocking, toy lining, etc... Yet, if there is one aspect that he does not fall under, then they will not diagnose the child with "Autism" but instead something similair such as Aspergers, Retts, PDD, PDD-NOS, Sensory Integration, etc...etc...etc... One thing for sure, it is best to have him/her evaluated as quickly as possible as the best odds of high functionality are possible when diagnosis is made by the age of 3-4yrs old. Bottom line is...If you feel there is an issue, then have him tested and make sure it is by someone that can give you the "medical diagnosis" for it. Hope that helps~
P.S. You mentioned that there were "Conflicting signs" because he is affectionate and bright. Many people have the misconception that Autism is a mental disorder such as mental retardation and other disorders; when in fact, Autism is more of a Social disorder in many ways. My 3yr old who has Autism is VERY smart and somewhat gifted in many areas and he is also affectionate towards us, yet there are little things in there that are "different" such as that he does not really know how to receive the affection in some ways. Like a hug for instance, he will hug; but it is not a "complete and enveloped" hug like you would expect. i.e. Many kids will fold right into you for a hug where as he stays more "stiff". So a child that may have Autism or a spectrum disorder can be very bright, very affectionate, and very happy even. I actually almost cancelled my appointment for my son because everything I was reading was saying how your child is non-responsive (which in some ways and some times they can be) and very un-emotional. My thoughts were...No way my son has Autism, he is ALWAYS happy and enthusiastic, etc... But there are things, if you have your child evaluated, you will start to see and learn that were always there, you just never knew the "relationship" they had to Autism or his behavior. I wish you the best of luck! I wish there was a cut and dried answer for you on this, but the best advice I can give is to have him tested no matter what. If he has a Spectrum disorder, then you caught it early and can start treatments to help. If he does not have a spectrum disorder, then you have peace of mind.
I agree with mrst76. The very fact that it is a 'spectrum' disorder means that all the behaviours can fall somewhere between very mild and severe. So you may get a child with autism who does have some theory of mind (that means being able to see another person maybe thinking something different to yourself because they do not have the information that you have). My son can do that, but not in all situations or all of the time. He also has a sense of humour, some of it is his own, but today for example he said he wanted to tell me a joke (so he wanted to share something with me which they autistic kids have difficulty with), but he then went to simply repeat a dialogue he had heard on TV that had been funny. But, you had to see it on the TV to get the context and the joke. He didn't understand that. He thought he had told me a joke. He is also very affectionate and very emotional. He has empathy for other people and animals. He wanted to move the snails off the pavement because someone might squash them. But as mrs t76 says, as you begin to learn more about autism you will see that although they may get somethings or be able to do some things that autistic children are not supposed to be able to do, you will begin to recognise that they don't have a complete full understanding of things as we do. So it is not just whether they are capable of doing something or not it is the 'quality' of it and the 'frequency' of it.
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