3 year old with delayed development - is this autism?
My son is 3 and his name is William. He appears to have delays in speech and communication. He knows and can speak all letters, numbers through 10, and all the rainbow colors (and combine them - i.e. red A, purple ball). I have a list of pictures in a Power Point (cup, house, chair, tree, t.v., etc) and can name them all. On his own, he discovered a card match game and a "Where's Waldo" like game on his brother's GameBoy and plays them successfully. He is a great stacker of blocks, but does not usually do anything else with them. He has recently begun to play with cars in a nearly appropriate way. He sometimes makes odd hand gestures and blinks his eyes tightly for no reason. He appears to be somewhat sensitive to noise (if you tap a spoon loudly he blinks). He does like music and has a good sense of rythm (bounces to the beat). He does not usually ask for what he wants. Instead he will take you to, or bring you what he wants. With prompting, he will say milk or juice or cracker. At times he will look up from his game and say, "I play game". Other times, he will walk into the room and say, "Hello William". We're pretty sure he knows his name is William based on how he responds to being called. He is pretty good at echoing what we say. He does not generally answer questions (with the occasional, "No"). He will sit down, climb on his bed, and a few other actions on command. He does not appear to be sensitive to other peoples feelings.
Does William behave as an autistic?
We noticed his speech delay at 18 months. He has had a speech person once per week and attended a social group for delayed children once per week for the last year. He will be starting a pre-school for delayed kids in the fall at least 2 days per week (up to 4). We have been advised not to seek a medical diagnosis of his condition because 1) he will only be labeled which might cause issues later in life, and 2) there is little more the medical profession will be able to offer than what we will get through the special-ed pre-school. What is your opinion?
While developmental delays are clearly present, it is not obvious that the delays indicate autism. The reason I make this conclusion is that your description indicates that William displays fundamenatl relatedness and he also has some skills re: communication, however much those skills are delayed. The nature of his problems will be clearer as time passes, because it will be evident how he proceeds in the various developmental spheres (cognitive, motor, social, emotional). I wouldn't shy away from developmental assessement because of worry re: label, but it may well be that intensive diagnosis at this point won't result in more of a plan than you already have. I would certainly guide you to seek more, rather than less, exposure to the pre-school setting, primarily because it will afford stimulation and social interaction (provided the peer group is an appropriate one). His speech therapy should also be increased, and perhaps there is a higher chance of this occurring if he is in the school setting.
Also, if your son is "echoing" at this age he needs help in how to stop this. Does he answer simple questions? Or does he just repeat what you said? If he is doing this it is echolalia and there are ways to help him with this. Which I would find it very unlikely that any speech therapist at his school knows how do deal with tis. I lent a book to the speech therpists at my sons preschool, cause she didnt know how to stop children from echoing.Does he ask any questions? The "wh" questions.
>> I would certainly guide you to seek more, rather than less, exposure to the pre-school setting...
We plan to have William attend 2 days of special-ed pre-school and 2 days of "regular" pre-school. My wife, being the optimist, wants William exposed to his non-delayed peers so that he will have some positive role models. My opinion is that his delay will make it difficult for him to function in a normal pre-school setting, but I'm willing to give it a whirl. The special-ed pre-school indicated that he could move to 4 days if necessary.
>>How does your son interact with other children? How does he interact with you? How are his motor skills? Is he potty trained?
William will interact a little with his older brothers, but not much. He likes to watch them play Gameboy, but that is not really interacting. The other day at dinner he "sang" a song that made his brother laugh. He enjoyed that experience greatly. William is not potty trained, but we are working on this. Too early to tell. William can climb up in our large wooden fort (even when the first wrung was missing). He can draw lines and the occasional circle. He even made eyes on one of his circles not long ago. The special-ed eval indicated they thought his fine motor was a little delayed but didn't seem overly concerned.
>> Does he answer simple questions? Or does he just repeat what you said?
William does not usually answer questions (except to say, "No" sometimes). When I was teaching him to name pictuers in the Power Point I mentioned above, I would say, "What is this?". William would follow by saying, "What is it? Its a cup." So, he was incorporating (echoing) my question in his response.
What book would you recommend reading on "echolalia"?
Look on CDC website for milestones at age 3
There is a book called More Than Words by the Hanen org. I took a class at the Autism Center where I live and they used this book it costs about $53, but is helps alot. They also have other language help books.
If he is having a hard time telling you things he wants, instead of having him "take your hand" (which alot of autistic children do, Im not saying he is, but even the most severe will do this) Try using PECS or picture exchange to start with this is a picture of the item whether it be food, toys etc. have them where he can access them and have him give them to you when he wants something also say the word. Another thing that will help is language is label, label, label. This cannot be emphasized enough. When your at the store in the backyard Also, really emphasize pronouns and prepositions, these are hard ones for alot of kids.
If I were you I would get an eval. You may be able to get more serivces for him. Even though his fine motor is ok he still might need OT (again Im not diagnosising your son) Im just a mom who has been dealing with a delayed son since he was 19 mos old hes now 3 1/2. Again you can keep it between you and whoever does the eval.
Heres the weblink for Hanen org.
Your son I would say is on the spectrum from your description. The doc says that he thought there was a delay but due to fundamental relatedness, he didn't think it was autism. That is probably "THE" biggest myth in the medical community and they should be re-educated on that aspect. Autistic children can and often are very affectionate children and they can relate to others. I would suggest an eval as well. He is definately on the higher functioning side, like my son. When he first began to speak, he would label things in his environment and pull you to something he wanted rather than using words. I played games just like you are doing with him as well because he seemed to enjoy it. My guess is that he is more interested in "cause and effect" toys (such as gameboys)than toys that would require interaction with another person. I don't mean he wouldn't play with interactive toys, but that he is drawn more to the cause and effect ones.
I don't know your child, but if he is on the spectrum, taking him to a pre-school, without an aide to help him learn social interaction< won't do him any good.
If you have the mean$, Verbal Behavior will work wonders for you son.
One suggestion about the echoing that I am remembering now is when he wants something say it how HE would say it.
Ex:You hold a cup of milk in front of him and say "I want milk please", then he will repeat that phrase. Eventually you can just hold the cup and he will say that. If I remember more I will let you know.
It has been a while since my son had went thru this in his langauge. Although once in a while he will repeat part of what was asked and than answer.Ex:"What was the name of the kid you played with" He says: "Name was ...". Keep in mind this is also a way of them comprehending what was just said to them. This sometimes has to do with auditory processing.
My son is definitley a visual learner not and auditory one.
I have a son who is SEN, suspected mild autism. He attends mainstream school and has been there part-time for a year though now attends fulltime. He will be five in August. He has two learning support teachers, one for morning and one for afernoon. We live in the UK.
Your wife is right to include him with his non-delayed peers. My son has gained so much from this - yes there are set backs but generally he is well liked and he himself enjoys school.
He did echo - to ask for a drink he would say 'Would you like a drink - but this has now disappeared. We found there was a big gap he was doing baby things and things appropriate for an older age group. Being with his non-delayed peers has closed that gap considerably.
He does still need specialist attention, of that there is no doubt and I think you are proceeding along a good route.
SEN? Never heard of it and you won't find it in the DSM-IV because it's not an authentic diagnosis. A child on the spectrum will not just learn from his natural environment at this age (3) and to suggest otherwise will lead this parent down the wrong path and further dealy the child. The "bedrock" feature of autism is the social problems these children have whether they are on the "highest functioning" level or the "lowest functioning" level. If a child is able to learn "normal" social responses in the natural environment, then that child is not autistic!
SEN = special educational needs. He is fully statemented i.e. has full one-to-one support throughout the school day including lunch and playtimes. As I said we live in the UK. We were advised to send him to a school specialising in autism spectrum disorders but he passed a couple of developmental milestones (started to become social) so with the backing of the educational psychologist, we opted for mainstream. I know of a couple of children on the high functioning end who attend mainstream - and it does work for them. Also my nephew is Aspergers and he attends mainstream successfully. Our son has his own workstation and was not forced to do anything. But gradually he has opened up and is warming to his environment. His diagnosis is on going and not complete, though we feel his behaviour is more akin to development delay.
Sounds like your child is making good progress, and very similar to mine who is also in a mainstream classroom. He enjoys other children as well but is not always cooperative with the circle time they do here. If I didn't have a therapist with him, the preschool would certainly tell me he is doing well. The problem is that these children want to interact with their peers but the social clues just seem to escape them at times and they have a hard time learning how to approach and carry on a conversation or share with their peers. Teachers will often report a child is doing fine as long as they aren't disruptive to the class, otherwise, the children are left alone and they don't have any guidance on how to interact with their peers. This is where our therapist comes in with our son. She will constantly guide him and show him how to interact and make friends. I assume the aides working with your child are giving you daily data and you have an action plan in place and a set of goals you are working on.
Asperger's kids have the same problems as their High Functioning cousins when it comes to social skills, my nephew has Aspergers and he is a social wreck, but otherwise extremely bright. Certain social skills such as making sure your hair is combed, your shirt is tucked in, and overall neatness completely escape him because he doesn't understand the importance of appearance in a social setting. To him, its a "why bother" issue. His appearance hasn't been an issue yet (he's a college student), but he will need to learn these skills when he enters the workforce, unless of course he is working in a lab alone somewhere.
Yes the social clues are missing of that there is no doubt and it can lead to frustrating moments. But with daily contact with his peer group he is learning more and more, and when home freely offers up information about his day i.e. so and so wouldn't sit beside me at lunch. His learning support assistants are there to cement the social interaction skills and use an emotions story board to work out the different scenarios. We also have a school/home diary which I find invaluable - very simple yet effective. My son has a blue plastic circle which he uses to sit upon during circle time. He now offers up information about his home life - I'm sure some of it must seem very strange!!
My nephew is the opposite of yours - very ordered - and as you can imagine this is just as problematic. He too is very intelligent.
"when home freely offers up information about his day i.e. so and so wouldn't sit beside me at lunch. His learning support assistants are there to cement the social interaction skills and use an emotions story board to work out the different scenarios."
Your son/daughter is clearly not autistic as this is an example of social language and at such a young age. Clearly, your GP or whoever gave you the "semi) diagnosis didn't know much about autism.
Good for you and your bright child. It also appears that your nephew doesn't have true Asperger's either, maybe OCD. I don't know an Aspie who has a compulsion to be neat and tidy.
If your interested, you might want to check out http://www.autism-hub.co.uk/
This site contains a large number of both parents of autistic kids as well as autistics. The webmaster is also based out of the UK as you can see from the address.
Thank you for that. I will check out the web site you mentioned. Yes me and hubby have wondered about our son. Certainly the pediatrition (sp?) is sceptical about him being autistic. But he is to continue with the assessments from the County Council autism team i.e. speech and language and behaviourial. Many thanks for your input and comments they are certainly thought provoking.
My child has autism. I think the best thing i did was to push for a diagnosis because by doing this i accessed the care that he needed. Speech therapy, cognative therapy, applied behavioural analysis, behavourial therapy, all came about because of early intervention. A child under the age of 7 years old cannot be labelled as you put it but can be queried as having autism. So dont worry about that aspect of things as children under that age can be identified as having strong autistic traits which they may keep or may later lose. A child with the special needs of autism is different and does need to be treated differently. There is a different way to teach, reprimand and play with autistic children than there is for ordinary kids. Dont let your fear of autism stop you from learning a new way of interacting with your child, it will improve everyones life.
Only the professionals can tell you if your child is autistic or may be just presenting with autistic traits for another reason. Dont wait until it is too late. EArly intervention is crucial. Find how William will communicate his needs to you and how you can get through to him. Picture exchange, or hand signs, or aba are all great and i know my son is a lot more mangeable because of them
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.