18 Month Old - Questions On Autism

[CT529]

We have an eighteen month who was saying several words at fifteen months (Hi Dada, Mama, Baba).  He's recently seems to have lost the ability to say any words (he does babble with inflection) and he also does not consisently respond to his name (may respond 30% of the time).

We're obviously concerned about autism and have had a specialist to our home to assess him.  Her take is he's very social, looks you in the eye, points, engages in simulated play but obviously is "mildly concerned" about his loss of language and not responding to his name.  She's recommended one hour a week of signing/speech therapy and we're starting him on that program immediately.

After that assessment we quickly had his hearing checked by an ENT and it checked out fine.  Interestingly enough in the hearing chamber he responded (turned his head) when his name was called almost every time.

Yesterday we also had him assessed for EI......he did well on all criteria with the exception of communication (no surprise to us) and they also recommended one hour a week of therapy.  While they stated they do not diagnose autism, they would bring that up in the discussion (and recommend additonal therapy) if they suspected that diagnose (ie...their opinion was that he did not appear autistic based on M Chat, etc)

My question is this ----- we're fortunate to have the financial means to help our son at most any level.  I don't want to go crazy with this (as I dont' think anyone would diagnose him on the Spectrum at this point given his social skills and lack of other behavioral issues) but I also don't want to look back and think we should have done more.

Would appreciate any suggestions on anything else we should to at this point ----- should we sign him up for more hours per week?  what signs should we be looking for to see if he's regressing or progressing? would you recommend we take him to see any other specialists at this point?  if this is not autism what esle could it

[timmysmom2005]

Hi. Just wanted to share a little tip that helped my son with his language. You can google board maker pictures and download and print them for free. They are very simple pictures of almost anything you can think of. We had all types of food, faces with different emotions, toys, books, movies, bathtime, etc. You would begin by showing the child the card, the real item, and saying the word clearly and slowly several times. Over time the child becomes able to label things which is one of the first steps towards speech. When you are pretty successful with this to the point where even if the child can't say the word, they understand what you are telling them and can recognize the object if you say the word, then you can try something called "PEC"s (picture exchange cards) You can teach the child to use the cards to communicate, by bringing you the picture of what they want. My son was so much happier after we started doing this because we finally understood him. We used the same pictures and he heard the same words for so long that he slowly figured out how to say them. He has been getting 1 hour of speech a week for 2 years now, and he speaks in full sentences. We can have an entire conversation with our child who was non verbal until the age of 27 months. Good luck to you.

[888mom]

Oh, also wanted to comment about the punishing 2 year olds... with our daughter we removed a lot of the temptations.  I have a niece who is a little younger than my daughter who just turned 3. My sister used to spank as discipline.  Her daughter used to knowingly do something and just accept the consequences.  Sometimes she'd say something like "spank me harder, it didn't hurt."  My sister gave up spanking because she said it would borderline child abuse to get through to the girl.  She has been having problems because evidently making her sit in the corner and taking her toys away isn't phasing the kid either.  The kid will recite the lines from videos she has watched, recreating the episode entirely in her head.  That's her entertainment if she has to sit in a corner.  My sister is tired and has repeatedly asked me if I want to adopt a 3 year old girl.  She's not serious... but I can tell she is frazzled most days dealing with this child who doesn't seem to have any concept of what danger is and will run into traffic without looking, leap from things without thinking what would happen if she fell, and just get into trouble any way she can.  My sister has 3 kids, and the rambunctious girl is the middle child.

[888mom]

shaz71 -- if you aren't having luck with the psychologist, you could try a developmental pediatrician.  Though I think many of them might just be child psychiatrists... they are more apt to diagnose things like autistic spectrum disorders, verbal apraxia, sensory integration disorder, and ADHD and other things.  Sometimes sensory integration disorder or sensory integration dysfunction (I've heard it called both) can happen separately from autism but if it involves how the child/person processes language -- auditory processing -- it can affect their speech and language learning.  But, if she's got other things going on besides the language... well, anyways, you should find a doctor that you trust.  Doctors and assessments can get expensive.  The specialist doctor on our medical plan was covered with just a copay but the team of therapists he used to assess our daughter was not covered.  And neither were the genetic medical tests.  We ended up owing $3000, but as I had some health expenses that year too, we reached the out of pocket family limit... so I would have been paying more for my health stuff ... well, anyways... I wish life were not dependent on finances... but if it's a choice between paying for a specialist doctor who can diagnose your child if it costs an arm and a leg and putting food on your table for your family... you gotta put the food on the table for your family.  I was thankful we had a credit card... I was under the false assumption that it was going to be fully covered.  I guess a child psychiatrist would have been fully covered but I wanted the best... and I had a 5 month wait to get into the first visit... usually the best docs have a 4 to 5 month wait list or more.

[shaz71]

Hi i am reading the last paragraph about early intervention it is good unless they slip through the net then they don't want to know, my daughter was age 3 before i was able to understand her then 3 and half before others could understand her, even now at nearly 7yr old her speech is still quite immature, she is bad short term memory, behind in her school work, she is on iep and on the sen register but only recently as she gone on it until then they thought she would come on herself even after i told them she was quite behind with speech and even counting etc she just wasn't interested it took until yr1 to write her name and even now she still can't write her surname, she can't remember her birthday just that it is in the summer. I have asked for help as i do think she is on the autistic spectrum but due to me and her dad splitting up recently they have put her behaviour down to that not that she has done it since the age of 2yrs old, she has recently been diagnosed with reflux which nas have said autistic children  do have a lot of bowel and gastro problems ie like reflux, allergies/intolerances, constipation/diarrheao etc. But i didn't know this at the time when i saw the pscyhologist, she said i need to give her more attention i give her lots but she still wants more, i am physically and mentally tired but no one wants to know, all the pscyhologist said was get more help from family and friends, no one will help me as they can't cope with the younger two, they are like whirl winds, wreck everything, my youngest nips, bites, pulls hair, and not just siblings i have tried everything but i don't think she understands, i know she is 2 but surely it should be sinking in getting punished all the time but she always as a puzzled look as if she doesn't know why we are punishing her. Sorry for rambling. It is just hard. Sharon x

[888mom]

We didn't start our daughter in speech therapy until 24 months, and she never spoke a single word until then.  I had started teaching her sign language around 18 months, on my own.  Sign language really helps alleviate the stress of little kids who can't tell you what they want.  They can sign it.  Some kids love sign language (my daughter did), and then others refuse to learn it.  At 24 months her sign language vocabulary was somewhere around 20 words.  

When she first started therapy at 24 months, it was one time per week on speech (also one time a week with developmental and one time per week with occupational therapy because she had other issues like no contact, sensory issues, and starting to develop ritualistic behaviors).  Later on, around 28 months, she was increased to two hours per week for speech therapy.  I think the extra hour a week helped, but she was older.  Personally I'd stick with the 1 hour per week for awhile and then increase it later on, if recommended by the speech therapist.

I'd keep an eye on the other things... losing speech is strange and it is one of the indications of autism.  Might be possible it is sensory related... Our daughter has some sensory issues and for her language, sensory integration therapy was pretty essential for her receptive language to start kicking in.  Se didn't reply to her name at all or anything else until she started sensory integration therapy... and her eye contact was poor until the sensory integration therapy.  Even if you saw an occupational therapist once or twice, they could show you some things to do (there are two techniques we learned that were pretty core to "sensory integration therapy" -- a brushing technique and a joint compression technique).  Some people say that sensory integration therapy doesn't do anything to help, but we saw immediate results with our daughter... within a week her eye contact was much improved and she started responding to her name on occasion whereas beforehand it was never.  Within a few months the change was drastic.  I guess for her, it was all about the sensory processing and still is... for some kids there are more reasons than just the sensory processing.  Not a professional, so only can tell you what is happening in my daughter's case.

I have a friend whose son is in my daughter's developmental preschool class.  He has verbal apraxia and is hyper.  My friend tells me that he spoke a couple words clearly before he was 2 and then he lost language and then as words started coming back, he couldn't pronounce anything and he was struggling with apraxia as diagnosed by a specialist.  She still wonders how a boy who had no trouble pronouncing anything at 15 to 18 months lost his language for awhile and then developed apraxia.  It's easier, I guess, if you have a child who never spoke a single word because then you aren't left to wonder what happened as to why they "lost" the language.  My daughter was just late on the language like she was late on most of her milestones (rolling over, sitting, crawling, walking, and then talking).

My friend with the son with verbal apraxia found that changing his diet helped him.  His behavior was better and his talking started taking off.  She had him tested for allergies.  He does have wheat allergy and she found removing milk from his diet helped (you could google wheat and casein free diet and probably come up with a lot of info).  I tried that with my daughter for a few weeks and actually saw her language and behavior deteriorate.  My daughter does not have wheat or milk allergies or any problems with food.  She does have soy, egg, and nut allergies which is what I was replacing the milk and wheat with.  So I took her off the diet and her doctor was actually quite upset with me for not consulting him first before doign something like that.  She was progressing fine with the therapy and still does, so finding other routes in her case seems kind of strange.  My friend's son has constant ear infections, colds, allergies, and other illnesses.  My daughter has only been sick 3 times in her whole life (1 ear infection, a stomach flu which she shook within a day, and croup).  She never gets colds and does not have allergies.  Well, so the whole diet thing is baffling to me, but it  really seems to help this other kid who is sick all the time and does have these allergies and chronic problems ... but he's older and did everything with the advice of a doctor.  18 months is probably too young to be switching things around so finding a doctor who can address your issues is important.  

Personally, I liked the developmental pediatrician we saw.  Other people see pediatric neurologists or child psychiatrists.  18 months is on the young side, but if you get an appointment you will probably be on a wait list to get in to a good one which might be a few months.  Then your child will be closer to 2.  And then at least the specialist can get a "benchmark" of where your child is at and then recommend when next to see your son.  It might take awhile to get an accurate diagnosis of what is going on.  But, they might make recommendations of what to currently be doing.  Like how often to do speech therapy.  At 18 months, 1 time a week is probably great.  But at 2, or 2 1/2, and then later on as he gets older if he still needs it (hopefully he'll catch up and things will be resolved)... but a specialist may give you a better idea of how often and at what ages to have speech therapy.  

You are a great parent to be getting your child services at such an early age.  Looking back on my daughter, I probably should have had her evaluated earlier.  There was a history in the family of late talkers (my husband didnt' say a word until he was 24 months old and all his first words were numbers and then colors.  Like our daughter, my husband didn't say mommy or daddy until he was closer to age 3.  My brother didnt' talk at all until he was almost 3 and then started talking in complete sentences -- his first words out of my brother's mouth ever were: "The green car goes uphill."  Kind of threw my parents for a loop for some kid who never spoke.  Back in the 70s I think parents weren't into rushing their kids into therapy for things that were delays. Doctors didn't freak out about it that much either at that early of an age.  My sister started speech therapy at age 3 1/2.  She was also a late talker and when she started to speak everything was coming out all wrong and her grammar/sentence structure was just way off).

Anyways, I guess this current era is great for early intervention.  I think it's great because usually people who have speech delays are found to have problems with reading and writing in elementary school later on.  There have been studies that have shown that early intervention is helping solve some of the delays that are happening later on in school.  I guess that's why our country implemented the Birth to 3 program.  My guess is that if there wasn't a financial incentive to do it (early intervention now means less intervention later on?) then maybe our little kiddoes wouldn't be getting the help they need, with financial support supplemented by the government.