Signs of autism in 4 year old nephew

[concerned aunt]

I am myself a medical professional, although not in the field of childhood behavioural medicine. I'd like to ask for advice regarding my nephew. He was good sized full term baby, and was noted to have a big head, which has consistently stayed above the 90th percentile although height and weight parameters have been at the 50th percentile. He was not speaking till just before his second birthday, although once started, has been progressing relatively satisfactorily in terms of vocabulary acquisition, and is able to answer simple questions in phrases or short questions. At the age of 2 and a half, we noticed that he was fascinated with rotating ceiling fans as well as playing with light switches. He also also spins bucket covers and overturns bikes to spin the wheels. Now 4, he continues to be disinterested in peer play, but does occasionally take part in imagination play such as cooking etc, although how much of that was spontaneous or taught I am unsure. He had immediate echolalia at about 21/2 to 3, as well as pronoun reversal, but these have since improved. At present, his parents are working on his tendency to chant favourite phrases out of context. He appears otherwise to be a bright child, with a good memory , and his parents have not noticed any learning disabilities. To my mind, he has displayed some of the textbook descriptions of autism, although whether he satisfies the full criteria, I'm unsure. We have alerted his parents to the possiblity of autism in their child, but this has been met with reluctance to further pursue the matter. The question is that, given today's therapeutic options, how much difference will it make to him whether or not he is formally diagnosed, as he appears to be at the high functioning end of the spectrum. I have been given conflicting advice by child development specialists and child psychiatrists, with one indication that maybe increased speech and drama stimulation will be sufficient. Both parents are devoted to the child and there is no lack of physical and mental stimulation for the child in the home, and their reluctance is understandable, particularly in the local context, where the stigma of a developmentally impaired child is not insignificant. Please advise. Thanks.

[Kevin Kennedy, Ph.D.]

With some mild varieties of emotional conditions, diagnosis is not particularly relevant because there may be no significant ramifications in relation to intervention. On the other hand, even if your nephew displays some higher-level manifestation of a condition along the Pervasive Developmental Disorder spectrum, accurate diagnosis would be useful, for two reasons. First, relative to immediate treatment, options may be available (particularly relative to peer and general social skills). Second, for future reference, depending on the course of development, early diagnosis can set the stage for access to services, particularly within the educational settings.

[sully600]

A related discussion, is pronoun reversal always autism? was started.