3 yr old language/conversation delays

Many thanks again for the guidance that I have received so far.  Now, I need to ask a new question.  My daughter, that I have been discussing previously, continues with her inability to answer open-ended questions and actively converse.  Is this something that can be addressed adequately through speech/language therapy?  Is there a larger problem that I am unaware of?  Is there some kind of processing problem? At this point, we have discussed Autism and Asbergers, both of which I do not feel are the issue, unless I am misinformed.  In all areas, beside conversation, she is a happy, healthy, loving little girl.  She is very active, and but does have a somewhat short attention span. She maintains good eye contact, does not care what she wears, eats pretty much anything (if we can get her to sit at the table long enough), is very loving & empathetic.  She doesn't have any unreasonable fears and is not a daredevil.  She can be somewhat shy around new people.  She does speak, answers most yes or no questions, sometimes she ignores us I think.  If someone appears to have hurt themselves, she will run over and say "OK, (name of person)?"  She uses please, thank you, and welcome at appropriate times.  "C'mon (name of person).", "Let's go.", "Gimme", "Hey wook (look).", "Wook at dat!", "Whatcha doing?"; if we are going somewhere its "Go School", "Go see cows?", "Go town" or "Go find Daddy" (fill in with where ever we are going).  She will sometimes speak to inanimate objects or toys..."Hi puzzle", "Hi rock." Generally though, she gets her needs/wants across through one or two word phrases. Instead of I want chocolate milk, its just "chocolate nilk (milk) please." Also at bedtime, its "Goodnite kiss."  Never "I want" or "I need" or "Can I have" I try to get her to mimick me in speaking the correct way and using sentences, but she just echoes the last one or two words.  She said, "Swing please." I said to her, "Audrey, say, I want to swing please."  Again it comes out "Swing please."  When I break it down into two words each: "I want" (she will repeat) "to swing please." (She will repeat.)  Then I will put the whole sentence together and it is still "Swing please."  If she is having a good time she will giggle and say "Hey this is fun."  But if you ask her if she had fun, she will not answer.  The doctor asked her questions like, "If you are hungry, what do you do?" (No answer.) "If you are cold, what do you do?" (No answer.)  I thought maybe she was being shy, so when we got home, I asked her the same questions.  No answer.  Today she got into my wallet and found a picture.  She looks down into my purse, "Hey its dark in dere."  Pulls out her sister's picture and says "Dat's sissy in dat picture." (That's quite good for her, especially if unsolicited.)  She likes doing flash cards, but again, it requires only a one word response.  I have scheduled the first meeting for her speech eval. with the school on 4/27.

[Kevin Kennedy, Ph.D.]

The very recent anecdote you described (with the wallet) indicates that she is developing this aspect of language. Developing language skills, as you know, is a process. And, like other aspects of development, children proceed at different paces. Your daughter happens to be slower in her development of language skills than she is in other areas of development. However, while it is not unusual for a child to display various rates of developemnt in the various spheres of development, it does make sense to pursue the Speech/Language evaluation and therapy. From your various very detailed descriptions of your daughter's progress in various areas, I do not see her language behavior as indicative of any serious emotional condition. Could it be symptomatic of some type of learning disability? Yes, it is possible, and this will become clearer as she continues to grow. You can also pursue a pre-school evaluation through your local school system, since she is now 'aging out' of Early Intervention.

[jennykerty]

Our son started speech therapy, a few months before he turned 3.

You sound somewhat similar to me, because I was afraid that it could be more than just a speech delay--but my gut told me that is all it was.  (I was right, that is all it was)  
What does YOUR gut tell you?
With so much talk of Autism, it is hard not to worry about it--I was.  Your daughter is talking more than our son was at her age.

The progress he made in speech therapy was tremendous.  Perhaps your daughter does not answer, because her expressive delay is preventing her from anwsering.  Why say "I want milk please", when just saying "milk" gets results?

There a several kinds of delays:  the 2 I know about are:

expressive--trouble articulating
receptive--trouble understanding speech

We knew our son had an expressive delay.  But we could not tell if he had a receptive delay.  Can your daughter follow simple instructions? If she can, then she is understanding you.

With the help of our speech therapist, we began using some sign language as triggers for speech.  When he said "milk", we made the signs for 'I' 'want' and 'please'.  This triggered him to say 'I want milk please'  He had to say it before he got milk--and the next thing you know he started saying it on his own.

Had we not learned this from his speech therapist, we never could have come up with something so simple to help him.  Speech therapy helped him, but also gave US the tools to help him.
Over time, he made tremendous progress and any irrational fear I had about some other delay evaporated.

Right now, your daughter is saying more than our son said at that age--meaning he had alot of words, but was not putting them together.  What you describe sounds VERY similar to our son.  He had speech therapy for 1 1/2 years.  He did wonderfully, speaks beautifully now (alot better than some of his peers)--except he pronounces Kansas City as Cans of City...LOL

He is 6 years old and in kindergarten.  I think once you get the evaluation, you will feel alot better.

Jenny

[2brilliantbabies]

Jenny...Thank you so much for your kind words and encouragement.  With my first daughter, she was advanced on EVERYTHING, so now with Audrey, I have been sent into a tailspin.  Yes, she does understand everything we say, and can follow complex instructions as well.  It is just her ability to articulate and converse.  In most everything she is ahead, except for speech.  She can write her numbers to 10, identifies all of alphabet, can sing it, knows all colors (even some more difficult ones), all shapes (hexagon, octagon, etc.), has advanced art/drawing skills, is very social, loveable, athletic, and then there's the speech.  She can sing songs, like Twinkle, Twinkle, but can't tell me if something is wrong, or have even a small conversation.  My GUT tells me it's only a speech problem, but you know sometimes your mind can imagine the worst.  Thanks again for sharing with me and I am glad that your son is doing well...maybe there's hope for Audrey with speech therapy as well.  I LOVE Cans of City!!!  My favorite with Audrey is grasshopper (Gas ka pepper)!!!  Thanks again!  Amy

[jennykerty]

I read your original post about the possible autism diagnosis after a 45 minute evaluation.

Our son had been in speech therapy for a few months and our therapist seemed to be frustrated with him.  She asked her boss to sit in on a session and give his opinion.  He felt our son needed a developmental evaluation--because of the 'way' he pronounced some words...

We refused.  We knew nothing was wrong--and just so you know--that will become more apparent as speech progressives. For us, his speech was improving, communication was improving, we were feeling relieved and any fears we had were dissapating(I should say me, my husband never felt anything else was wrong.  I was the only one worried).

We talked to our pediatrician about it and he told us to go with our gut.  If we really felt that nothing else was wrong, then we were probably right to turn down the developmental eval.

It turns out that we were right.  Nothing else was wrong.  Our son also knew his ABC's and counting etc.  He was very bright.  He had no other delays that we could see.  He did not fit into the autism symptoms--except his speech was delayed.

My point is that they had seen him for months and wanted a developmental evaluation and they were mistaken--how could anyone possibly diagnosis a child in 45 minutes?

For me, my husband was my anchor.  I was so worried about so many different things being wrong, that I was very easily influenced by any little comment by a therapist or dr, or a list of symptoms on the web, or any little odd thing our son would do.  My husband was the one telling me to calm down.  I think I was so worried about it that I conveyed it to others--There really must be something to worry about here if she is so worked up.

Your daughter sounds smart and kind and very aware of the world around her.  Just a little slow getting started talking.  Someone told me, that once our son starts talking the way kids do, I'll be sorry.  (they meant it jokingly in a nice way.)

I have never gotten tired of his little voice asking questions, telling me silly things...

Your evaluation is less than a week away.  I think you will find that with the start of speech therapy, alot of your fears will go away too.

Good Luck to you
Jenny

[mom3g1b]

My daughter who is now nine started speech at three.  At the time she was diagnosed with adhd, severe seperation anxiety and developmental delay.  Now they have changed all of that and they say she has aspergers.  The sympoms she has now she didn't have at three.  The most noteworthy is her trouble with peers and understanding body language.  All I can advise you to do is to stick with the speech and keep your eyes out for your child.  If it's more than just speech it might not show up until later.  Good luck

[tomel]

From my understanding "true aspergers" dont have any type of speech delay, in fact they usually have very advanced speech. Who gave your child this diagnosis?

[xmsrlong]

Tomel, according to the DSM IV, Asperger's is characterized by no clinically significant delay in language at this age (3-4).  My son certainly fits that category as do most of the children being discussed on this board.  However, his autism is pretty apparent for the casually informed.  Asperger's kids do have problems with the pragmatics of speech as well as pronoun reversal.   Much of the information out there about Autism Spectrum Disorder and Asperger's Syndrome often times only contains "nuggets" of truth and not the full picture.  Some children with Asperger's do have advanced speech, but delayed or absent analytic and social language.  Social language is perhaps the most important of all speech because it helps us to learn to live and work with each other.  When Asperger's kids get into the workforce, this is where they often fail and their "language" becomes a very real and true disability.  Other Asperger's kids learn to adapt while others do not.  Early intervention is an important key.  If your child has a problem, do not try to talk yourself out of it but address it while they are young!

[tomel]

I have had my son in early intervention since he was 19 months old. He is now 3 1/2 He was diagnosed for "at risk autism". When he turned 3 I was told that he no longer fit that category but was still probably ADHD and still "at risk for Autism",so in other words keep him in therapy and keep an eye on him. I was told by one of the best psychologists in the state where I live that "Aspergers" children dont have speech delay. I also know someome whose child has Aspergers and he never had a problem with speech. If there is a child that has the symptoms of austism with a speech delay that it is "High functioning autism", although I know that they are pretty much one in the same. I just think that there are alot of people out there that are trained to look for everything wrong with kids and a little to over zealous in giving them a label, which does no good unless it is needed for services.

[tomel]

I also think (although in alot of cases with good cause)people are getting freaked out about the autism thing. Every little thing children a child does or doesnt do is under scrutiny.I was just reading something recently about sypmtoms to look for and one of them was "reading comprehension" and then after all of the noted symptoms to look for it said "onset prior to age 3" what the heck does that mean, a child is supposed to read before age 3. I do agree that there is alot of misinformation. One of the big ones is that "echolalia" is only a symptom of autism. Not true typical kids learn langauge thru echolalia as well. Also, that if a child doesnt like haircuts or doesnt eat certain foods, oops sensory problems must be autism. Or a child that likes everything in order in their bedroom, oops OCD. The reason I am giving all these examples is because I have seen them all in "typical" children. Some children might have a sensory problem, or a speech delay or lack of social skills. But there are other known and researched causes for some of these. Apraxia (which is a motor planning problem that affects speech and coordination) & Sensory Dysfunction are a couple of them. I do think people should keep and eye on their children, if I hadnt done so who knows how much progress my son would have made. But sometimes I think it goes a little overboard.

[xmsrlong]

Tomel, I agree with everything you wrote.  However, the psychologist you referred to is just plain wrong.  Some Asperger's kids do have "slight" delays in speech, most do not.  I also agree that untrained people are often looking for "red flags" in everything young children do.  We need to love our children for who they are, and at the same time help them along in areas where they need it.  I'm not sure where it was written that if a 3 year old can't read at an age appropriate level that is a sign of autism.  I've never heard of that and would have to say that it is also just plain wrong.  If a child can read before 3 then that might be a sign of autism/hyperlexia if other criteria in the DSM IV is met.  Autism is an uneveness in skills with some skills age advanced and some areas age regressed.  My son can read certain books and knows hundreds of words (he's most definately hyperlexic) but he can't learn to sit still for 1 minute.  He often doesn't say no, he just screams to get his objection out.  Sometimes he is just super smart and I think "how is this autism" but then I think, will this kid be able to learn in a mainstream setting and then I have my doubts because of his behavior is more like a 18 month old.  By the time he is in kindergarten, I expect he'll be reading like a 4th grader but he will have severe behavior problems that will interfer with learning.  HFA and AS are both just very frustrating nerological disorders because of the glimpes of brilliance followed by distressing behavior.

[tomel]

I am familiar with hyperlexia.There are also some people who think that when a child memorizes the words in a book that this is reading. Well this is a pre-reading skill but not true reading(Im not saying your son is doing this). My sons preschool teacher encounters this alot, and when she tells the parents to open the book in the middle and ask them to read they cant do it. The other thing that I was just reading was if a child has an excellent rote memory that is a sign of Autism as well. Well that is how children learn letters numbers, colors etc. Any small child can learn these things if you show it to them enough. My son has memorized all of the above as well as some sight words, but that is because I showed them to him over and over.
Let me ask you this can your son understand body language? Like if someone gives him a mad face when he's doing something wrong, or a tickle gester etc.

[xmsrlong]

Tomel,

We've never taught our son to read, he just picked it up and the developmental pediatrician was the first one to really make note of it when he was 26 months old as he was reading road signs.  He can read no matter what the font size, rather capital letters or lowercase letters.  He reads from books he's never seen before.  I don't think he understands most of what he reads, but he does understand some of the more simple words.  His preschool teachers are flabbergasted at his reading abilities so maybe they've never seen something your child's preschool teachers apparently see routinely.  It's gotten to be a little disturbing to me because they want to see him read and now I'm starting to think that he is being treated as some sort of "freak".  

From my understanding of early learning, most all children learn in a rote fashion until about the 4th grade when more abstract learning begins.  Many autistic children do have excellent rote memory, you should see Kim Peek (the real rainmain).  He is exceptional.  However, he is severely autistic and not much like my son.  Autistic kids concentrate on the details and concrete thinking.  Whereas a normal child this age is more interested in other people than in things.  One way you can tell my son is autistic compared to normal children is when we are in the grocery store.  He doesn't look at other people but concentrates on the things on the shelves.  At times, he gets so wrapped up in the detail, that it is hard to distract him.  You can bounce a ball off his head and he wouldn't break his concentration on an object or toy of interest.

Another problem he has every once in a while is unusual fears.  For the longest time he was mortified everytime he saw a particular fuzzy soccer ball.  I eventually helped him overcome his fear of the ball and now he loves the ball and calls it "Mr. Soccerball".  He is currently afraid of public toilets and gets very panicky when he is near them.  He's still not potty trained.

He also has certain ways of touching objects.  For some reason, he likes to rub his fingernail across the plastic eyes of his toys.

Question:
"Let me ask you this can your son understand body language? Like if someone gives him a mad face when he's doing something wrong, or a tickle gester etc."

Yes, he understands when someone is mad.  When he is doing something wrong, usually all I have to do is give him a look and he will stop.  He lies too.  For instance, we have this full length mirror in the hallway which he knows he is not suppose to touch.  While sitting in the living room, I could hear him run down the hall and slap the mirror (he knew he wasnt suppose to touch it).  He turns back around and runs into the room I'm in and I sternly asked him if he touched the mirror.  He says "No".  
He loves to be tickled and understands the "tickle bug" gesture.  I'm not sure what this information is suppose to demonstrate though.  If your thinking "Theory of Mind" and Executive Function, he doesn't have much of a problem with theory of mind.  I have seen those issues with other children on the spectrum but that is generally not the case with my child.  He laughs at appropriate moments during his videos and is scared at appropriate moments.  I remember when he was about 16 months old and he was watching Monster's Inc. and in the beginning, it showed a child sleeping in the bed.  The child becomes scared during the scene.  When I looked at my son, he was shaking because he recognized that the other child was scared.  I don't think he relates to people with quite the same empathy, unless the feeling being expressed is very obvious.

He's a great kid, but very difficult for non family members to like because of his egocentric behavior.  Also, some of the more advanced children in his preschool I fear are starting to notice that he is a little different.  He's making great strides but I fear he will always be a little behind in a lot of areas.  Much like his father (me).  I'm most likely on the spectrum and I'm sure that I would have gotten the diagnosis if I was a child today.  Many times, I'm the only one who seems to "get it" when it comes to his behavior because I have this deja vu of "been there, done that".

[tomel]

Yes, from what I understand about Hyperlexia they can read words but not understod what is being read.
If it makes you feel any better my friends little girl (typical child)was afraid of one of those furry dress up things you wear around your neck. So the furry soccer thing or the tolets really isnts so strange. My son was afraid of Snufulofogus (Sesame Street character) for a while.
I guess the reason I asked about your son understaanding body langauge and social cues is because I am still keeping an eye on these things in my son. So it sounds like your son understands body langauge and social cues, but may not always pay attention to them.
What are the things that you find he does that makes it difficult for him to relate to pears his age?
Also, I do think lying is a typical preschooler trait as well.
And, I dont think empathy comes for a while, at this age they are still very egocentric.

[xmsrlong]

What makes it difficult for him to relate to his peers?  Many things.  His unusual interests for one.  He doesn't approach other children to engage them.  He's often anxious in a large group of children, but better in there are only a few.  He seems comfortable in a gross motor play environment than in a classroom setting.  He has outburts where he yells to imitate animals (i.e. dinosaur, tiger).  I don't know if he means to imitate those sounds but that is the excuse he gives for the yelling.  I'll ask, why are you yelling and he'll say "like a dinosaur" or "like a tiger".  I found a short video on autistic children that shows a range of severe (the kid in the tye dye) to moderate.  I see glimpses of my child in some of the moderate children.  There aren't any high functioning children in the video, at least they didn't seem high functioning to me.  Here is the link:  http://www.autismspeaks.org/sponsoredevents/autism_every_day.php

One of the things that should be in the DSM IV criteria, but isn't is anxiety.  All these kids have extreme anxiety whether its performance anxiety, social anxiety or generalized anxiety.  If you feel your child is unusually anxious throughout most days, and he exhibits DSM criteria from mild to severe, he is likely autistic.

[tomel]

Thanks for that web link. I just saw their commercial on TV the other day. Yeh, none of those kids were high functioning.Now here I am with another question. Is what your describing about your son really anxiety or is it hyperactivity?
Cause my son definitly had the hyperactivity, thats where the possible ADHD comes in. However I do know this is a trait of Autism as well.
Is your son pretty mellow most the time? Excluding the large groups.

[xmsrlong]

Tomel Says:  "Thanks for that web link. I just saw their commercial on TV the other day. Yeh, none of those kids were high functioning.Now here I am with another question. Is what your describing about your son really anxiety or is it hyperactivity?
Cause my son definitly had the hyperactivity, thats where the possible ADHD comes in. However I do know this is a trait of Autism as well.
Is your son pretty mellow most the time? Excluding the large groups."  

Your questions are a little hard for me to answer because I'm not quite as up on the latest with ADHD and its manifestations in children my son's age.  Do I think he has ADHD?  Yes.  But I can't quite pin down what is normal hyperactivity in normal boys his age.  I was quite hyper as a child too so he isn't all that strange to me.  Is his behavior anxiety or hyperactivity.  That is sort of a chicken or egg question.  Here is a very good example of how his anxiety manifests itself:  My son hates to go to the doctors office.  When we get there, he starts to obsess over the exit signs and will constantly point out the sign and say "look exit sign".  The longer we are at the doctors office, the more he repeats the phrase, each time a little more quickly and anxiously.  This is how he handles the doctor's office.  He fixates on those exit signs, knowing full well what they mean.  Its his way of reassuring himself that he will be leaving at some point.  At other times when he gets anxious, he acts just plain goofy, laughing to himself.  Most of the time, he insists on leaving and will say "leave or I want to leave" etc.  Hyperactivity is when he just can't seem to sit still, always fidgeting etc.

My son is pretty mellow at home and not usually anxious.  However, he still is pretty active but I think he is mostly normal at home.  I don't think his hyperactivity interfers with learning at home.  If the ADHD or anxiety interferes with functioning, that is when its a problem.

Tomel, here is my blog:  http://morethanalabel.blogspot.com/

In one of the more recent photo's I have a picture of me in kindergarten.  See if you can find me in the picture.  I'm the kid who is hyperactive and probably HFA.  If you click on the picture, you'll get a larger version.

[xmsrlong]

Oh, by the way.  Napoleon Dynamite character I would say is definately Aspergers Syndrome.

[tomel]

Thank you for your weblink. I was reading some of it. I did read the one about Parents asking the pediatricians for a diagnosis of Autism. I was one of those parents. I did that when my son turned 3 so I could get long term care for him. He has never had a formal diagnosis, so I thought that would help so we could continue services for him. It turns out even with that it doesnt always matter, they can still reject you and you have to appeal it over and over. So we pay OT and Music Therapy out of pocket, while he gets speech and OT at school (which is not very good).
I know where you are coming from with your fight. I would guess you are alot like me and that is you are not always sure what is "normal" and what isnt. I struggle with that everyday. I thought my son imitating a dog was weird. Well its not its actually very creative. I remember pretending we were horses when I was young.
My son does ask question, uses his pronouns properly and loves to be social. He is very active and can be very noncompliant.  Right now he is having a hard time with his fine motor skills ex:writing letters. Gross motor is defintley his favorite.
Well im not very concerned about those even though preschool makes you beleive you should. Children are not supposed to write their name until at least kindergarten and the attention span of a 3 yr old is 6 minutes (double their age) especially boys. The only social problem with peers he is having is that sometimes he just goes right into a group and tries to play without asking which makes them mad and he also likes to copy other kids a little to much. But the only people that can work on that are his parents in social situations. Being an only child we keep him very socialized.  I agree with you about the pediatricians not keeping an eye on VERY IMPORTANT milestones.
I think some of them are frickin idiots! Everyone who has a child in my opinion should get a good developmental pediatrician and make sure they know their stuff. You would think in the age of autism the peds would know better.    

[xmsrlong]

If your son is asking questions frequently and using pronouns properly, he is most definately not autistic.  I agree, too much is expected of boys at this age.  That is one of the problems with our educational system.  It's not set up where boys can succeed at an early age.  It's all about making them act like girls.  We lost our way as a society sometime shortly after my generation.  I think it has a lot to do with lack of corporal punishment and overly protective parenting.  Now I'm not a conservative, (I'm just to the right of communist), but we have to get back to teaching boys using their strengths and not to expect them to behave like girls at this age.

By the way, I'm curious as to whether you could pick out the child in the picture who was hyper and non compliant, and perhaps a little odd?

Also, go to the October 2005 post (Alexander's Story) and you will get a very detailed story of my son's first 2 years of life which many parents of autistic kids relate to.

[tomel]

BRAVO! I couldnt agree with you more about the educational system.
It is especially hard for me because everyone we know has girls and they are all excelling at everything.
Were you in front on the right?  
I did read about your sons 1st 2 yrs. and we did go thru some of the exact same experiences. I to know about living in a small apartment with a screaming (inconsolable)infant. We had the police called on us one night because someone thought we were abusing him. We were in between homes for about 4 months and that is when I started to think hmm, something isnt right. He was also about 12 months at the time. I kept on it though and had a good developmental specialist, so I was able to get him started with therapy by the time he was 19 months old.
I dont know how many other people you know with typical children but here are some of my friends kids
My friends daughter used to scream when they would go into a grocery store, she would scream and cry so hard that she would vomit. She was about 2 to 21/2 at the time (totally typical child).
I have another friend whos son is always bouncing and always making noises (same age as my son) again he is a typical and normal developing child.
I dont know what kind of speech services you get for your son the ABA (4o hours especially) is great.
We didnt do ABA to a tee because we thought it was to rigid.I  did use PECS and sign and alot of hand over hand.
There is a great book "More than Words"by the Hanen org.it is for kids on the spectrum that speak,it teaches you how to step it up.
If my son asks me a qstion I know he already knows I will say "What do you think that is" or "Where do you think so and so is" Mabye when your son keeps talking about the exit sign say "you want to go out that door dont you, you are not happy to be here" that exit sign means you get to leave and go home doenst it" (I aplogize if you are doing these things already)
We also did use a hab worker for our son, and she did use the trial method of doing things with him (I think that is kind of an ABA) Are you using any homeopathic methods or supplements for your son?

[tomel]

Also, The Hanen org. and the autism research center where I live consider ADHD on the spectrum.

[xmsrlong]

Yep, the 2nd from the right on the front row in the blue unkept shirt and brown pants.  Now, my son looks and stands exactly like that when you are asking him to stand still.  We don't do 40 hours of ABA anymore.  We switched to Verbal Behavior and even now we are running out of things to teach him because he knows it all.  We do about 20 hours of Verbal behavior a week focusing on asking questions interverbals, play, attending and so forth.  One of his therapists attends preschool with him and in a week we will begin intensive potty training.  I'll check out the Hanen book.  I looked into a scripting book from Princeton Univ. but my son seemed to advanced for that books instructions.  We would like to do OT but he doesn't seem to care for it and I'm not quite sure what it does for him.  Speech therapy seems to be a waste of time for us because he just won't pay attention to the therapist in the clinical setting we have to take him to.  We've had 3 seperate speech assessments and they show he is only 3 months behind, but I suspect that as he ages, he'll be a little further behind than that.  The typical kids are starting to catch up now and some of the girls in his preschool are talking very well.

[xmsrlong]

We use just a multivitamin and a b6 supplement.  Unless there is clear scientific evidence which has been published and peer reviewed, we don't use it.  We took him off dairy products a year ago and that made a huge difference.  He is on a gluten free diet right now but I don't think it does anything but my wife insists.

[tomel]

Ah yes the good ol Gluten Free and Dairy Free diet. My husband and I never see eye to eye on that one.
My son does get OT at home. She helps him with attention to task and works on his trunk area. He has mild hypotonia. She also works on his fine motor. Prescissors skills, stringing beads etc.
My son also has a hard time listening to the speech therapist at school. We pay the Music Therapist out of pocket he seems to enjoy her. This also works on attention to task and following directions. Any good therapist will "follow the childs lead" especially at this age. Unfortunately not alot of them realize this and again expect them to act like typical little girls.
I know that there have been studies done on the Omegas (fish oil) this has helped my son alot.  
3 months behind is not bad. My son at 3 was (now 3 1/2) was 6 months behind. But he seems to keep catching up. Using new words and pronouncing better everyday. If they stay at 3 months or even 6 months behind, it wont matter when the are older. It would be like as adults us telling someone we are 6 months behind for our age.  I know with my son when he is in therapy it seems like "how the heck is this gona help", but if the child keeps progressing, it is helping. Although there is always that debate of well would they have progressed anyway. Who the heck knows.

[tomel]

Another thing my ot does is play is games with him, which this is important for obvious reasons. When my son turned 3 1/2 in April I took him to the child dev. specialist and she seemed to think he was caught up with his speech or at least closer than what he was. It sounds like your son may be to advanced for the Hanen book, but mabye check it out anyway. You may be able to find it at the library.

[tomel]

Good luck with the potty training. We were lucky with that one we were able to get him trained when he was 26 months old, which is very rare. Does your son go to an all special needs class at preschool or is it typical kids? My son is in a class with special needs and typical kids. The typical kids are called classroom peers.

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I wish we could do the OT at home but cannot find anyone and at $100 per hour, I want to see some dramatic results.  The OT assessments didn't find any major sensory issues but they also said he was hypotonia.  We work on fine motor skills in the verbal behavior session with the bead stringing (which he'll do but doesn't enjoy), building block designs and some others.  I think he would like Music Therapy but we haven't tried it.  We tried Omegas but it didn't seem to do any good.  There is a lot of good science behind Omega 3.  

I looked on the Hanen sight and they do have some very good things on there so I will have to check it out a little further.

My son is at a preschool with typical kids.  We haven't let the school system know yet of his diagnosis.  Autism is a very scary diagnosis to most people and they think the worst.  The first preschool we tried we told them his diagnosis and they wouldn't take him, despite the fact that we told him he loved other children and wasn't self injurious or aggressive.  We also let them know that one of his therapists, a former teacher, would accompany him.  We told the present preschool that he was delayed and needed an aide to help him socially.  I think they know because the director has a nephew that is autistic.  He's done well and has been invited back for the fall semester which I think is a great accomplishment on his part.  We have made the decision that we will wait as long as we can before we tell the school district in the hopes that he will be able to pass kindergarten as a somewhat hyper and odd child, but not labled autistic.  Once your child gets that label, they are very much discriminated against.  Most educators I feel really don't quite understand the difference between HFA and LFA in very young children.  Very young HFA children are often more prone to be non compliant than LFA kids.  However, we realize that there is a very good chance that he will be "found out" once he has been there for a few weeks, but at least he'll have an opportunity to start with no label.  We realize we are taking a risk with this, but we're spending our entire savings on his therapy and we want to go with our gut.  We'll know a lot more after this summer's preschool because he'll be going to a different one for 5 days a week.  I really believe that by 4 years old, we will have a much better idea of where he is going to be on the spectrum.  There aren't a lot of choices for autistic kids in school.  I've learned that special needs kids are not usually the autistic ones, but the learning disabled or physically disabled.  Many times the autistic kids in certain districts are put into special autistic units or self contained classrooms.  Where I live TEEACH is predominate and this method has absolutely no peer reviewed studies behind it.  My gut tells me this kid is 95% just like me.  He'll be a little more advanced in some areas (academic) and a little bit behind in emotional regulation.

[tomel]

I cannot believe that preschool wouldnt take your son. Isnt that illegal? Are these very prestegous preschools?  I'm think the public school system cannot deny a child. The preschool where my son goes which is thru the public school district the teacher told me all of her students are maintreamed into regular kindergarten. Although we are considering Montessori for him. I have him enrolled at a Montessori for a month in the summer and I just told them "a little ADHD".
Did you ever apply for long term care for him? That covers therapy from 3 to 6. Then a review at age 6. At least I know thats how it is here.

[tomel]

Ah yes the poop problem, defintely have been there. We also give our son probiotics.  I agree with you about not telling schools about your son. I think from here on out Im not even gona mention it to anyone. Your son will get there with the creative play, just keep modeling for him. Thats great that he imitates.

[tomel]

I was reading some of your blog.  You talk alot about the DSM-IV, I was wondering do you know anything about the ADOS test?

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The first preschool was in a church and they are exempt from the ADA laws.  In our state, we have the infant to toddler program up to 3 which he was in.  After 3, its taken over by the school system if the parents wish to continue.  We live in the south where of course most preschools are run by churches.  Oh, I forgot to tell you we also use probiotics which have made a big difference in the bowel movements.  Until we started using them, his stools were basically "oatmeally" and after they were solid.  We've thought about Montesorri as well but for whatever reason, we took a different route.  As the structure increases for him, he'll struggle more I'm sure because his biggest problem is of course focusing in a chaotic room of other kids.  However, this time last year he was unable to handle preschool at all and we took him out.  He was running for the door and trying to leave.  Now he realizes that it can be fun and most days he enjoys other children.  Fortunately for us, our son is  a very good imitator which will serve him well in learning from school and his peers.  Most ASD kids are not very good imitators.  I've learned that imitation skills are one of the most important prognosticators of whether a child will continue to learn and grow.  Without imitation skills, a child is unable to learn in his natural environment.  Now if we can just get him to use more imagination in play he'll be fine.  He's starting to, but its very slow growing.  You can teach a child imaginary games, which they can learn rotely, but I'm not sure how you teach them to come up with the games themselves.

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Autistic Diagnostic Observation Schedule.  Yes, our son has had one of those also.  There are very few people who are well trained to give this test.  There are a few versions of the test depending on the age level.  In his case, any score from 12-22 is in the autism range.  It's suppose to be highly accurate.  When we had him evaluated at UNC, they first did the ADI-R with his mother and me which is an interview that lasted 5 hours!  He scored in the autism range on 2 out of three areas.  However, on the third area, stereotypies and repetitive behavior, he did not score high enough to be considered autistic.  A child is suppose to meet all three areas for a diagnosis for autism.  Then they decided after a couple of weeks that they would give him the ADOS.  He scored an 18 (at 29 mos old) on the ADOS, which I highly disagree with.  One of the reasons he scored that high was a lack of eye contact some anxious behavior and he used very little language.  Once the test was over, I told the examiners that I'll show them how to elicit what they were looking for.  When I played with him, like boys like to be played with, he was talking up a storm and laughing and so forth.  The look on their faces was priceless.  What I didn't understand at the time was that the ADOS is used to push the kids to show the symptoms of autism.  I don't know if they use the test to determine if a higher functioning child has autism, as it is not as apparent unless they are pushed.  I disagree with his score after reading a large study and the scores along with IQ for dozens of children.  Typically, the higher the IQ, the lower the ADOS.  However, in my son's case, his IQ was normal but he had a high ADOS.  I think it should be a 14, not an 18.  I pointed out this seeming contradictory score to the UNC folks and they seemed to be surprised that I went to that level to research it.  Anyway, I don't think it matters now because I'm no longer trying to convince myself or others where my kid is on the spectrum because as he ages, it is becoming all too apparent to everyone that he is on the HFA side.

[tomel]

Where do you get info on the ADOS? I am taking my son somewhere where they do the TOVA test for ADHD and the ADOS.
I have been told some of those test are contraversial. My great Aunt who had been a special needs teacher (who is also a member of MENSA, why couldnt I have inherited that) had told me that. Also, what is used for testing IQ at this age? I didnt think it was done so young.

[tomel]

What can I expect with the ADOS test? What are some of the things they do?

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IQ testing was done twice, once using the Baley Scales of Infant Development and the one at UNC was the Mullens.  UNC first tried to use the Stanford Binet IV, but that test is largely for very verbal children who can pay attention to very long winded questions.  There are several other tests that are useful but IQ is not stable at this age (2-3).  After 4 years old, the IQ is a little more stable and by 7 very stable.  My son's IQ could go up or down.  In autistic children, the biggest obstacle is cooperation with the tester.

I don't know anything about the TOVA.  With the Ados, depending on which one they use, the child enters the room and their are certain types of toys in the room and the tester.  In our case, we were allowed to be there.  The toys consisted of a ball, some blocks, bubbles and a stuffed animal.  I knew when we entered the room that he wasn't going to be interested in those toys and I said that to the tester.  I told her I didn't think they were age appropriate but that I've since learned that is the point of it.  The tester tries to engage the child with very little language.  Looking for eye contact, imaginary play and adaptive skills.  Adaptive skills is what is really missing in autistic children along with imaginary play.  The point of the test is to see if the child will engage on a social level.

Perhaps your Aunt can tell you about what is controversial with the ADOS because of all the testing done, I think this one is probably the best, even though I don't think it was scored correctly.  Parental reports are just not as accurate because we see things differently than others.  I can send you some studies by email if you like.  Some of them have excel charts with them as well as Power Point charts.  My e.m.a.i.l address is foxglovenursery at at mac dot dot com.  Remove the at at and use the symbol and remove the dot dot and put a . in it.  I had to spell it that way because there are software programs on the internet that troll for that information and we all don't want to get spammed.

[tomel]

We didnt specifically talk about the ADOS test, just alot of the tests in general. That gives me a good idea of what to expect. I may email you.

Thanks

[tomel]

Yes my son did have the Bayley test done on him. I didnt realize that was a measurement of IQ.

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Tomel,

Here is an abstract of a scientific study on language development in Aspergers and HFA:

Comparative Studies

Language and Communication

According to existing diagnostic systems, autism and Asperger Syndrome are differentiable in terms of language development.  Delays or disorders in language areas are required for a diagnosis of autistic disorder, while one diagnostic criterion for Asperger cases is the absence of significant language delay.

Nevertheless, there exist data from a number of investigations (eg  Eisenmajer et al 1996) which indicate that some children whose symptoms largely support an Asperger diagnosis have experienced significant language difficulties.
Meanwhile, it may be so for the majority of cases, but not all children diagnosed with autism have a severe language delay.

One common emphasis in exploratory studies has been upon pragmatic skills and weaknesses.
For example, Fine et al (1991) found that children with high functioning autism could be differentiated from those diagnosed with Asperger Syndrome in terms of their poor use of intonation in conversation.
Other findings have included a weakness in referencing during conversation among both groups, but a typically greater level of difficulty among the autistic group in linking current utterances to what has gone before.

Further, there is some converging of evidence that echolalia and pronoun reversal are more common in an autistic group compared to an Asperger group, although few differences have been reported by parents in the frequency of initiating speech, the use of repetitive language, or using/understanding non-verbal forms of communication.

Methodological problems again have to be acknowledged, both in terms of possible bias from a  reliance upon retrospective information from parents and of the timing of such studies before the development of formal diagnostic criteria for Asperger Syndrome.

However, further converging evidence has it that echolalia is less common among Asperger samples during the pre-school period; but inconsistencies are revealed when it comes to parental reports of the use of repetitive speech in  the two groups from pre-school onward.

The use by Ghaziuddin and Gerstein (1996) of taped examples of speech, evaluated by speech therapists unaware of the diagnostic label attached to the children in question, suggested that pedantic speech was more common among adolescents with Asperger Syndrome.  This finding appears to fit with other evidence that, with increasing age, fewer differences between the two groups are noted in respect of communication difficulties and a greater similarity gradually emerges.

Meanwhile, Ozonoff et al (2000) used groups established according to strict DSM-IV criteria and found that they could be differentiated on the basis of the age at which words were first uttered (according to parental reports).
Further, the autistic group showed more severe language dysfunction during the pre-school years, including a greater probability of delayed acquisition of speech, impairments in two-way conversation, and stereotyped or repetitive language style.

However, when the children were into the primary school period, many of the earlier difficulties which had differentiated the two groups in favour of the Asperger group were no longer apparent.  The only consistently differentiating area was performance on tests of expressive language where the Asperger group produced superior results.

This kind of pattern was also identified by Gilchrist et al (2001) who found that echolalia and pronoun reversal were more common among children with autism, and that these children also showed delays or anomalies in their use of gesture.  Similarities with Asperger children were noted in regard to verbal rituals, stereotyped utterances, or inappropriate questioning.
By adolescence, the only observable difference between the two groups was that the individuals with Asperger Syndrome were more willing to engage in

[tomel]

That is interesting. Just goes to show there is alot of conflicting info. out there.I think there is still alot to be researched and learned on these subjsets.I do have an article about the echolalia I will send to you. My son did go thru a period of echolalia.
What do they mean by "repetitive speech" and "pendatic speech"?
Does you son initiate conversation with you? You said he doesnt ask any questions? Does he ask whats this? or anything like that? Does he use any pronouns?
My son does refer to himself as I or me and he does refer to us as you and does use we.
He doesnt use any "Why"questions yet, but does ask where someone or something is,what are you doing, whats this or where did so and so go.

I was also gona tell you another thing the OT introduced to us that is body brushing. This helps with sensory input. It has helped him alot. You can actually buy the brushes yourself and you can find directions on how to do it yourself in the good ol internet.
We actually havent done it in a while but I knwo it helped him in the past.
I read your post about Temple (I call her the cow advocate).

[tomel]

My son also shares his accompleshments, Mom I ate my food, I made this, Watch this, he also asks what happend.

The presence of echolalia has actually been identified as a positive sign in persons with autism. Lovaas (1977) found that the presence of echolalia is an important prognostic indicator for future language growth. It appears that echolalia provides the "raw material" for further language growth. Howlin (1981), in fact, discovered that children with autism who were echolalic developed good phrase speech later in life whether or not they received intensive language training. If you think of echolalia as one of the phases of normal language development, it would appear that continued echolalia indicates that the person with autism is "stuck" at that level of development for a time but then seems to overcome it and develop more normal speech patterns. Lovaas (1981) believes that children who were once mute and later develop good speech, inevitably have passed through an echolalic stage in their speech development.

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Tomel Says:  >>>"Does you son initiate conversation with you? You said he doesnt ask any questions? Does he ask whats this? or anything like that? Does he use any pronouns?
My son does refer to himself as I or me and he does refer to us as you and does use we.
He doesnt use any "Why"questions yet, but does ask where someone or something is,what are you doing, whats this or where did so and so go.

I was also gona tell you another thing the OT introduced to us that is body brushing. This helps with sensory input. It has helped him alot. You can actually buy the brushes yourself and you can find directions on how to do it yourself in the good ol internet.
We actually havent done it in a while but I knwo it helped him in the past.
I read your post about Temple (I call her the cow advocate)."<<<<<

My son only recently started to ask questions because we have been teaching him how and so now he has the script memorized so when he wants to know what it is he says "I don't know, what is it".
It sounds like your son is using pronouns correctly, so therefore I highly doubt he is autistic, therefore, the ADOS may be a waste of time.  We tried the brushing but I don't think it helped.  My son's use of pronouns is sporadically correct.  He seems to learn language in chunks and then changes around the words to fit the situation.  He is definately in the gestalt area and not yet in the analytical area of language which I expect he will be somewhere around 5 to 6.  On the rare occassion that he uses analytical language, its often shocking to us because its so rare.  We have only recently been able to tell that he learns phrases in "chunks" and then changes it.  Echolalia comes in a couple of different varieties.  His echolalia, other than the "language chunks", happens when we ask him a question he doesn't understand or when we first introduce a new word.  Barry Prizant is someone I've come to read about language acquisition in autism.  He seems to be very good.

"Pedantic" speech is frequent amongst people with Asperger Syndrome, that is marked by the avoidance of slang words (and other abbreviated speech used in daily life). The language is impeccable, but wordy, to the point of appearing "pedantic". This speech is marked by the use of "technical", or "scientific" words, or even a "high-brow vocabulary" obtained from reading an old encyclopedia (example: kinematography, instead of cinematography, I used this word, after reading an encyclopedia from 1910).

Repetitive speech is when someone gets half way through a sentence and loses their train of thought and then has to go back and repeat the beginning of the sentence to regain their thoughts.