18 Month Old Development Behind?

[pbersha]

Hello:

My wife and I are concerned about our 18 month old's development.  He is our second child, and has been behind on many milestones. At first, we were not so worried, because his older brother walked late (15 months) and spoke late (18 months) - but is now a very active and incredibly verbal three year old. However, we hare becoming more concerned.

Some worrying signs:

We have tried teaching him signs since he was 15 months, and the only ones he has mastered are "more" and "book" (his older brother knew 40 signs before he began speaking)

He only recently began pointing at 17 months.  He can sometimes point to body parts - head, mouth, nose, but sometimes not - it seems to come and go.

He is very interested in imitating sounds, voice inflection, and even song - but does not initiate communication, or reference words with objects.

He crawled at 11 months, but did not begin walking consistently until 16 months.

It has always been difficult to read even simple books to him - his attention seems to wander.  He is very interested in making pages turn, less interested in what's on the page.

He was saying "Da" since 1 year old, but has not expanded on that into "Mama", "Dada".  (He just recently began saying "More" when signing "more")

His attention seems to fade in and out. - while playing, or eating, he will sometimes seem to stare into space for several minutes, and it will be very difficult to bring him out of it.  Calling his name, and even loud claps near him only occasionally work.

While autism is obviously a big concern, he does not seem to have many of the common symptoms - he is happy to be held, he recognizes both his parents, he laughs and shows emotions readily.   The most puzzling thing seems to be the variable nature of the behavior - he simply seems much more alert and interactive some times than others.

He has been seen by a speech therapist, who commented that the issues seemed much more cognittive than physical.  In her words, he appears to slip in and out of "joint reference" relative to objects and his environment.  He is scheduled to meet with a developmental pediatrician in the next few weeks.

We have been reading recently about how in some children milk and gluten products some time do not break down properly, and result in opioid components in the bloodstream.  I'm not sure if this is considered a mainstream theory, but it does seem to fit with some of the things we are seeing.

Can anyone help with any theories, suggestions, or other help?

Thanks!

[Kevin Kennedy, Ph.D.]

You have already taken the most important step. That is, you have arranged the evaluation with the developmental pediatrician. The early signs are that your son does not display autistic disorder. He certainly does display a range of developmenatl disorders in the context of a family history that is positive for such disorders. The pediatrician can help to pinpoint your child's status in the various spheres of development. Only then will it be feasible to design services to address his developmental delays. Early Intervention will definitely be in order.

[tomel]

The fact that your child did not point until 17 months is a HUGE warning sign right there.
The fact that he likes to sit in your lap menas nothing. The emotions as well. That is a huge myth about Autism.
Get him into see a dev. ped. and get him into early intervention.

Good Luck.

Heres CDC warning signs from their website for a 12 month old.


Developmental Health Watch
Alert your child's doctor or nurse if your child displays any of the following signs of possible developmental delay for this age range.

Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he or she watches
Says no single words ("mama" or "dada")
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures
Experiences a dramatic loss of skills he or she once had

[swesselpa]

I think it may be wise to seek out a neurologist as well to rule out seizure disorder.  Especially if he seems to "be out of touch" for short periods of time.  Petit mal seizures can present like this and certainly cause developmental delays.  I'm sure the dev. pediatrician would refer you for eval if needed, but this may be something to bring up with them.

[girl522]

I can not comment on you son's development but I can comment on the gluten free/casein free diet.  I am a psychology major and just recently starting working with a 3 year old with autism.  He is on the GF/CF diet.  I can tell you that for him the diet works.  I have seen him when he gets something in his system and what it does to him. When he is not on the diet he starts displaying more autistic behavior (hand flapping/walking on toes), his mind seems to be somewhere else and does not pay attention to anyone.  He also seems to have more tantrums and well the whole week is ruined and we can not get anything done.

[lnicole]

Diets are the best most natural way to approach a childs disorder or behavior... I know because I am doing this with my 2 children. I am not a doctor, but I do not see too much to worry about. I have a 3 yr. old who walked, talked and did every thing late as well but now is perfect, and my 15 mo. old has been late as well. Still is not walking but my ped. assures me that the most dangerous warning signs are not visible. I have asked him MANY times due to family members making comments and scaring me to death.
I do have one question that may contribute though, do your children stay at home or are they in day care? This may make a difference in development.
Either way, I do not think that your child not pointing is amything to get too worried about. As long as you have taken the steps to take him to the doctor, you will be in good hands.

[tomel]

Coming from my own experience and knowing others the communication starts with gestures, pointing, waving, clapping, nodding the head. Yes, its doenst ALWAYS mean Autism, but it does raise cause for concern if none of these are there. Not walking by 15 months and even being a late talker are not a huge concern as well. Its the pre communication skills as well as joint attention that are important.

[pbersha]

Many thanks to everyone for all the helpful comments: Our appointment with the developmental pediatrician is in a week, so hopefully we will know more.  In response to some of the comments / questions:

1) His mom stays at home with him, he does not go to day care
2) There is no near-family history of developmental disorder - (although his grandfather has a cousin diagnosed with Aspergers)
3) He has been milk-free for about a week, and we have seen some some very interesting changes. Much longer attention span, much better ability to interact with objects together (follow a finger pointing to an object, for example), and a LOT of mimicking of sounds / inflection, and even a few words.  This could all be normal development, but we think it is highly likely that substituting soy milk for milk in his diet is contributing this.  After consulting with the Pediatrician, we may elect to go Gluten-Free as well.

[tomel]

You might want to consider Rice or Almond Milk instead of the soy.

[xmsrlong]

While autism is obviously a big concern, he does not seem to have many of the common symptoms - he is happy to be held, he recognizes both his parents, he laughs and shows emotions readily. The most puzzling thing seems to be the variable nature of the behavior - he simply seems much more alert and interactive some times than others.

He has been seen by a speech therapist, who commented that the issues seemed much more cognittive than physical. In her words, he appears to slip in and out of "joint reference" relative to objects and his environment. He is scheduled to meet with a developmental pediatrician in the next few weeks.

We have been reading recently about how in some children milk and gluten products some time do not break down properly, and result in opioid components in the bloodstream. I'm not sure if this is considered a mainstream theory, but it does seem to fit with some of the things we are seeing.

Two points, your son does seem to me to be on the spectrum, and the fact that there is Asperger's in the family is another reason.  Just because your son is affectionate, laughs and shows emotions readily has nothing to do with autism.  All autistic children, even the lowest functioning, show emotion and affection.

You stated that he seems more alert and interactive at times than other times.  This is classic LD or ASD.  We took our son off milk at the age of 26 mos and saw a remarkable difference in just a week.  Gluten didn't seem to effect him.  I think you are asking some very good questions and you seem to be approaching this situation with very good scepticism.  There is a lot of quackery out there in terms of ASD, be very careful.

The Speech Pathologist is a very good source of information on development.  A developmental pediatrician is even better.  Whatever they tell you, keep in mind that you are catching this early and with the right amount of intervention, you'll see quick results.  If you get a diagnosis of ASD, skip the denial part and concentrate on intervention.  Good places to start are Verbal Behavior, probiotics, RDI, and vitamins.  Never, ever let your child spend time by himself, keep him engaged and demand no less than you would if the child was "normal".

[ehoberg]

My daughter didn't even laugh until she was almost a year old.  She is in the 2nd grade and just read To Kill a Mockingbird.

so you know.  You can't force it. But I am sure you will try, even at the expense of the kid's well being.

I think that trying to make them do things they aren't ready to do does way more harm than good.

Be patient.  Read to them, talk around them but don't force them.  If at 3 he's not speaking, then break out the specialists.

The logic portion of the human brain doesn't develop until about 5 years old.  That's why we naturally send kids to school then.  Development happens, you get a kid to do a trick like one would an animal, for example, how in the old days they used to potty train kids at age one.  But they aren't really doing the thing on actual level.

The problem isn't that the kid isn't speaking at 17 months.  The problem is you have a control problem and you are used to getting things to work by pushing and pushing.  Things don't happen with our kids in our time, they happen in theirs.

[tomel]

Im sorry, but you obviously are not familar with early intervention. Yes every child develops at their own pace, but they still all do the same things at certain stages of development. It has been a part of the infant child development for a long time.  If certain "elements" are missing then there can be a problem and if caught early enough the child can make great progress. Although the reasoning part of a childs brain doesnt really start until age 5 other elements are being absorbed from birth up until age 5. Speech and socialization are the big ones.

[ehoberg]

What is obvious is the audacity.  We come from a country that can't master Algebra and when we have children suddenly we are all pediatric neurologists.

In the 50s the popular belief was that if a kid couldn't read, he missed the crawling stage and so what did they do?  They made weak reading second graders crawl around on the floor in the class room.  

It used to be the advise of pediatrics to wipe the baby's body down with baby oil and stick them in the sun for a few minutes on both sides a day.  

It used to be believed that a kid should be potty trained by 1 years old.  I still ecounter elderly women who boast about having their 11 month olds potty trained.  

Some people feed their infants baby food soon after birth or even within the first year.  Diet is a huge part of brain development and considering that the brain and the digestive system are the last to develop, one would think no one would do this and yet it is more commonplace and way more acceptable than breastfeeding which probably would have prevented the problem the initial writer wrote about.

The idea of what is normal changes.  That's why science journals are written in past imperfect because it connotes "everything we know to now."

Always concerns are best reviewed by professionals but it's audacious if not narcissistic to have the laity cite stuff like they know from a practical position, what is and what is not normal.

[xmsrlong]

You sound like a very angry person.  Perhaps this forum is not a good place for you as it seems to make you extremely ill.  Using terms such as laity makes me believe you are in the medical profession or are in school to become a medical person.  
Perhaps some time away from the board might help you deal with your anger issues.
Here is something to chew on:  This is from a recent study from John's Hopkins:

Few Maryland and Delaware primary care pediatricians screen patients regularly for autism and autism-spectrum disorders (ASD) as part of their overall look at possible developmental delays, according to results of a joint study from Johns Hopkins Children’s Center and the Johns Hopkins Bloomberg School of Public Health.

Of the 255 pediatricians who participated in the study, 209 (82 percent) said they regularly screen their patients for general developmental delays, but only 20 of the 255 (8 percent) said they do so for ASD. Of those who do not screen routinely for ASD, almost two-thirds (62 percent) said they failed to do so because they weren’t familiar with the screening tools.  {Read that last line again.}  

“Lack of familiarity with ASD screening tools appears to be the single greatest barrier to routine screening,” said Susan dosReis, Ph.D., of the Children’s Center Division of Child and Adolescent Psychiatry and lead author of the paper, which appears in a May 11 supplement of the April issue of the Journal of Developmental and Behavioral Pediatrics.

The findings suggest that screening for ASD remains largely opportunistic rather than systematic, researchers say.

Screening is essential, as delay in diagnosis and treatment generally leads to poorer outcomes in children with developmental disorders.  {Read that again please.}

“This study suggests that current national efforts may not be sufficient to actively promote the use of ASD screening tools in the general pediatric practice,” dosReis added. “So it is important to learn what some obstacles might be and what needs to be done to overcome those barriers.”

Previous research suggests that another factor might be that many pediatricians do not feel well-trained in general developmental and behavioral issues, researchers say.

Enhancement of residency training, complemented by introduction and training in ASD screening tools, might boost ASD screening in the general pediatric practice, dosReis added.

Almost half (47 percent) of the physicians who did not screen routinely said they preferred to send the child to a clinical specialist, whereas nearly one-third (32 percent) cited lack of time as a major reason for not screening  {did you read that?  "LACK OF TIME CITED BY 32 PERCENT}. Of those who reported screening regularly for ASD, 90 percent said they were usually prompted to do so by parental concern and/or suspicion of ASD during routine examination.  {Read that again, 'USUALLY PROMPTED TO DO SO BY PARENTAL CONCERN!!!!!!!}

Of the 18 percent who reported not screening routinely for any developmental delays, 73 percent cited lack of time as their top reason. {NEARLY 1 IN 5 PEDIATRICIANS DON'T SCREEN FOR ANY DEVELOPMENTAL DELAYS.....AT ALL!!!!}

The prevalence of autism, estimated to be between 12 and 40 cases per 10,000 children, has grown over the last decade. The reasons behind the higher prevalence have flamed an ongoing debate. Some researchers attribute the increase to an actual jump in the incidence of the disorder, while others claim it is because of more aggressive screening and new diagnostic criteria, which leads to a higher number of new diagnoses.

In the Hopkins study, 99 percent of the pediatricians who believed there is an increase in ASD prevalence attributed it, at least in part, to new diagnostic criteria. At the same time, 38 percent said that underlying risk factors, other than new diagnostic guidelines, have played a role. Of these, one-third believed that environmental factors played a role, while only 7 percent attributed the increase to genetic factors, and 1 percent attributed it to vaccinations.

Researchers caution that the findings cannot be generalized beyond Maryland and Delaware because screening practices might vary by geographic area.

Co-investigators included Craig Newschaffer, Ph.D., and Lakeisha Johnson of the Center for Autism and Developmental Disabilities Epidemiology at the Johns Hopkins Bloomberg School of Public Health; and Courtney Weiner, B.S., of the Children Center’s Division of Child and Adolescent Psychiatry.

The study was funded in part by the National Centers on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention.

NOW, ANYONE WHO HAS A CHILD WHO HAS A DISORDER SUCH AS AUTISM AND SO FORTH IS A MUCH BETTER DIAGNOSTICIAN THAN A GENERAL PEDIATRIC DOCTOR, BAR NONE!  Why do we know, because we live it 24hours a day.  We've been there when the good doctor said "oh just wait, he'll be fine, all kids develop differently".  The biggest clues in this particular instance is that A. Autism is already established in the family and B.  The lack of Joint Attention is a DSM-IV criteria for ASD and one of the biggest red flags.   However, don't discount the wisdom which comes from living with a disorder just because that person didn't have an MD behind their name.    

[xmsrlong]

Oh, one last comment, you wrote:  "breastfeeding which probably would have prevented the problem the initial writer wrote about."  Please enlighten us as to your source that developmental delays and autism are caused by a lack of breastfeeding.  That belief was destroyed nearly 40 years ago {some children were actually taken away from their parents and placed in institutions because of that type of "medieval" nonsense (see Bettleheim http://en.wikipedia.org/wiki/Bettleheim).  Perhaps your not familiar with genetic research in ASD.  Here are a couple of good places for you to start (there are a couple thousand more at Pubmed) :

1: Gupta AR, State MW. Related Articles, Links
Recent Advances in the Genetics of Autism.
Biol Psychiatry. 2006 Sep 21; [Epub ahead of print]
PMID: 16996486 [PubMed - as supplied by publisher]
2: Casanova MF. Related Articles, Links
Neuropathological and genetic findings in autism: the significance of a putative minicolumnopathy.
Neuroscientist. 2006 Oct;12(5):435-41.
PMID: 16957005 [PubMed - in process]
3: Reichenberg A, Gross R, Weiser M, Bresnahan M, Silverman J, Harlap S, Rabinowitz J, Shulman C, Malaspina D, Lubin G, Knobler HY, Davidson M, Susser E. Related Articles, Links
Advancing paternal age and autism.
Arch Gen Psychiatry. 2006 Sep;63(9):1026-32.
PMID: 16953005 [PubMed - indexed for MEDLINE]
4: Vorstman JA, Morcus ME, Duijff SN, Klaassen PW, Heineman-de Boer JA, Beemer FA, Swaab H, Kahn RS, van Engeland H. Related Articles, Links
The 22q11.2 deletion in children: high rate of autistic disorders and early onset of psychotic symptoms.
J Am Acad Child Adolesc Psychiatry. 2006 Sep;45(9):1104-13.
PMID: 16926618 [PubMed - indexed for MEDLINE]
5: Risi S, Lord C, Gotham K, Corsello C, Chrysler C, Szatmari P, Cook EH Jr, Leventhal BL, Pickles A. Related Articles, Links
Combining information from multiple sources in the diagnosis of autism spectrum disorders.
J Am Acad Child Adolesc Psychiatry. 2006 Sep;45(9):1094-103.
PMID: 16926617 [PubMed - indexed for MEDLINE]
6: Yao Y, Walsh WJ, McGinnis WR, Pratico D. Related Articles, Links
Altered vascular phenotype in autism: correlation with oxidative stress.
Arch Neurol. 2006 Aug;63(8):1161-4.
PMID: 16908745 [PubMed - indexed for MEDLINE]
7: Baron-Cohen S, Scott F, Wheelwright S, Johnson M, Bisarya D, Desai A, Ahluwalia J. Related Articles, Links
Can Asperger syndrome be diagnosed at 26 months old? A genetic high-risk single-case study.
J Child Neurol. 2006 Apr;21(4):351-6.
PMID: 16900937 [PubMed - indexed for MEDLINE]
8: Baron CA, Liu SY, Hicks C, Gregg JP. Related Articles, Links
Utilization of Lymphoblastoid Cell Lines as a System for the Molecular Modeling of Autism.
J Autism Dev Disord. 2006 Jul 15; [Epub ahead of print]
PMID: 16845580 [PubMed - as supplied by publisher]
9: Vorsanova SG, Iurov IIu, Demidova IA, Voinova-Ulas VIu, Kravets VS, Solov'ev IV, Gorbachevskaia NL, Iurov IuB. Related Articles, Links
[Variations of heterochromatic chromosomal regions and chromosome abnormalities in children with autism: identification of genetic markers in autistic spectrum disorders]
Zh Nevrol Psikhiatr Im S S Korsakova. 2006;106(6):52-7. Russian.
PMID: 16841485 [PubMed - indexed for MEDLINE]
10: Azzoni A, Raja M. Related Articles, Links
[A case of pervasive developmental disorder with chromosomal translocation (X; 4) (p11; q13)]
Encephale. 2006 May-Jun;32(3 Pt 1):325-7. French.
PMID: 16840925 [PubMed - indexed for MEDLINE]
11: Ruiz-Opazo N, Tonkiss J. Related Articles, Links
Genome-wide scan for quantitative trait loci influencing spatial navigation and social recognition memory in Dahl rats.
Physiol Genomics. 2006 Jul 12;26(2):145-51.
PMID: 16837653 [PubMed - indexed for MEDLINE]
12: Germano E, Gagliano A, Magazu A, Calarese T, Calabro ME, Bonsignore M, Tortorella G, Calamoneri F. Related Articles, Links
[Neurobiology of autism: Study of a sample of autistic children]
Minerva Pediatr. 2006 Apr;58(2):109-20. Italian.
PMID: 16835571 [PubMed - indexed for MEDLINE]
13:

[tomel]

This forum is to ask a doctor a question. But it is also a place where people can get other parents advice. Everyone has their own parenting experience they can share.
While "some" of your points are valid and I agree with them. You obviously have not been around children or parents of children with ASD. Have you ever seen a 6 or 7 yr.child old that doesnt say ANY words? Well I have, and it aint pretty, they get very violent cause they are so frustrated cause they cant communicate. Your gona sit here and tell me or those parents that early intervention was or isnt neccessary.
According to your theory its the parents fault that child is the way they are. Which is the old school theory about autism. I have met and know parents that have one healthy "typical" child and one that is severely or even mildy autisitc. How do you explain that? Same parents. Also I have met mothers who nursed there child for the first year sometimes even longer whos child ended up having ASD.  
I do agree that there is way to much pressure put on young children (especially boys) I think it has to do with the insurgence of preschool and daycare.
When you hear people say their child was potty trained by 1yr. I personally beleive that is an exxageration and they had truly forgotten. preschool and daycare is probably another reason the potty training thing is such a big deal.
Noone is claiming to be an "expert" just trying to help others by sharing our stories and experience. I Cant understand why you of all people would be so angry, sounds like your kids are doing pretty darn good.

[Phoenixs_mom]

A related discussion, 18 month old was started.

[marialou]

A related discussion, please remember people there is a family going through a tough time while you battle it out to see who knows the most. was started.