Concerned about 20 Month Old

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Hi,

I have a 20 month old who isn't saying a lot of words yet. We just came from a pediatrician visit, and he recommended speech therapy. We're currently waiting on the specialist to call us and get an appointment. Naturally me and my wife are very concerned, and after the visit I started doing some research and putting in some terms of some things my son did and it kept coming up with Autism. I'm worried because I had him in front of the TV a whole lot. I would work at home during the day and put him in his play pen, turn on the tv, and give him a few toys. I'd like to share some of the things he's currently doing and get some feedback.

Some things he does that I read were linked to Autism.

- Not saying many words (Dada, Go, Baba, and babbles a whole lot, mostly dada related babbles)
- Flaps his arms and spins occasionally (I wouldn't say he does either a lot, usually flaps his arm when he's excited)
- Very picky eater still eating 2nd baby foods mostly just eats chips, crackers, milk, and juice. Acts like he's gagging if we give him certain foods he doesn't like.
- Doesn't point or wave
- Occasionally doesn't answer when we call him (Most of the time he answers if not preoccupied with toys or TV. But, if we say his name with a tone in our voice he'll usually answer then.)
- Kinda awkward around other kids, He's not scared of them or doesn't want to play with them, it's just if they wave or speak to him he likes to give them a hug, and they will have to initiate play with him otherwise he'll do his own thing. (Now I am self-employed and kept him the entire time so he's not been around many kids at all)
-Doesn't play with all toys the correct way or have much imagination with his play (For example sometimes he'll just press one button and press it over and over for a couple minutes before he does something else, and likes to put them all in his mouth.
-Likes to bang the doors together sometime
-Doesn't know body parts (If he does he doesn't show us)
-Can watch TV on certain shows he likes for hours and can't be distracted.
-When we sing the clap your hands song, he wants to come clap my hands instead of his hands.
- Once he's comfortable somewhere he just walks off and we have to call him to come back.


Some things he does that were not signs of autism.

- Not usually attached to things or certain routines, if we turn off the TV, take a toy, make him stop doing certain things, he may whine for a minute but gets over it pretty quickly or we can distract him with something else pretty fast. Doesn't have any patterns or have to have anything a certain way.
- He makes eye contact with us and smiles when we smile at him. When we play games and sing to him he looks back and forth between my wife and I if we both are singing.
- He seems to know facial expressions and tones (If we make a serious face and tell him to come here he usually whines because he knows he is in trouble, and he comes to us).
- He listens to commands for the most part (He knows come here, get down, no, give me that)
- He's hit all his milestones up to 18 months.
- Very cautious when trying or climbing new things, he'll usually look to grab my hand or make sure I smile or give him the go ahead before he does it, but then after he's comfortable he'll explorer everything and we usually have to call him back.
- He likes for us to sing to him and loves to cuddle. (He still sleeps in bed with us still)
- Imitates some things we do. (For example if he sees me with my toothbrush and I give him one, he'll brush his teeth as well, he also knows how to give high fives, he opens his mouth if I open mine and say "Ah". He also does "bibble" which is where i flick my bottom lip and make a bibble sound, if I do that he will do it as well.) But, those are the only things we can get him to imitate.
- Never been sick or had ear infections.
- Reaches to be picked up, or reaches his hand to hold hands. Or holds his hand up to give a high five.

I know no one can give a diagnosis over the internet. I know we'll have to have the therapist and specialist look into the situation. But, from experiences has anyone ever seen a toddler show this many signs and not have autism, could it just be speech/communication delay, and he's a picky eater? Any advice or experiences are much appreciated.

Thanks!

Hello!

I wanted to start off by saying that watching television (even a lot of it) does not cause Autism. Whatever is going on with your son, try not to find ways to blame yourself. Plus, if there are any delays/ neurological issues, he still is, and will be great.

I don't see much from your list of possible signs that jump out to me as "Autism." My older son never wanted to show us his body parts either, and is not on the spectrum. Kids can have speech delays for many reasons, and it is not always a red flag. One of my brothers did not speak much at all until he was almost three, then suddenly spoke as if he had been speaking all along. Kids your son's age are still doing "parallel play." It is still completely age appropriate for him to be more interested in doing his own thing than to want to engage with other kids. I would not worry too much about the picky eating yet either. Lots of toddlers are like that. My older son also never pointed. I think that him only responding to you when he is not distracted by a toy is also fine. He is just interested in what he's doing and does not want to be interrupted.

The only thing I would suggest is to try and get him engaging more. Although I don't think you "caused anything" by putting him in front of the tv so much, I think he needs more active engagement with humans. Can you put him in a playgroup or hire a babysitter to take him to the playground/ engage with him? I think he may need more stimulation.

Other than that, I would see what the speech therapist says. If there is anything else going on, it may be too early to tell.

Fitzi,

Thanks for your reply. We actually just came from the audiologist and his hearing is fine. Still waiting to get a call back from the speech therapist to get an appointment. I guess the things that seem to worry me the most is the arm flapping, spinning, no pointing and waving. And whenever you google those terms Autism is the first thing that comes up. I don't know any other toddlers that arm flap, is this common, do other babies/toddlers do this?

I don't know the answer to the arm flapping. I'm sure there are kids who are not on the spectrum who do this when they are excited, though. I am certainly not telling you that you should not consider that your child may be on the spectrum. I guess what I'm saying is to watch and wait. I suspect it may be too early to tell yet.

How does he play with toys? For example: Does he play with a car by pushing it the way a car moves, or does he just hold it and spin the wheels? Is he starting to do any pretend play? Does he pretend to talk on the phone (even if he babbles)?

Does he get upset by sounds? Or textures? Does he have to touch everything?

FWIW, my son was diagnosed at seven, and I doubt he would have been diagnosed before that. It became more clear for us when he was older and unable to socialize in an age appropriate manner.

I think if you have concerns that he has delays beyond the speech, it is definitely worth getting him evaluated more thoroughly.

ETA: My son was not diagnosed with Autism Spectrum Disorder until age 7, but I did have him evaluated by the Department of Education at 3. He did have some delays and received services. Although he was not diagnosed until later, he was really helped by the services he did receive.

I would start worrying if my kid doesn't start talking in sentences by age 3. Otherwise, I really wouldn't worry.

He seems to have lots of normal social behaviors like making eye contact, social smiling, reading non-verbal cues, checking for go-ahead before trying something new.

Picky eating, spinning, flapping are normal behaviors of young children.
For spinning and flapping, it's how much a child does it rather than if a child does it that indicates normal vs. abnormal.
If a child spins or flaps for hours a day and can't be distracted from these repetitive motions, then it is not normal, but if a child spins or flaps for a few minutes at a time for fun or when excited, that is normal.

It sounds like you understand him and he you and you're worried about things that can be signs of autism rather than puzzled by your child all around. Often kids who wind up being diagnosed are a bit more of a puzzle....I know that is probably not much comfort.

Speech delay is quite common, and hesitancy around other children can even be a result of trouble communicating. I would try not to worry what it means and focus on the speech therapy if needed. Someone who engages him can probably make a big difference.

It is easier when kids are on time with doing everything, but you wrote some really great things about your child. If I could go back and change one thing, I would want to worry less about differences and enjoy those early years more.

He plays with some toys correctly, others he doesn't. For example he has a train, that's like a jack in the box type of toy. Where you press a button or turn a button a character pops up. He'll turn the button and press the button for the toys to pop up then press them back down, like your suppose to do. He'll also bounce a ball like your suppose to as well. Other toys like his blocks he may bang a couple blocks together for a few seconds or put one in his mouth then just throw them on the floor. With cars he really doesn't push them, he'll hold them or put them in his mouth. If I push it for him, he'll look at it and may push it the next time, but then just goes back to putting it in his mouth. Also, some toys that play sounds he'll press it over and over for a couple minutes or stare into the lights, before he does something else. He doesn't seem to be overly attached to any of them, I can easily distract him from any of his toys.

As far as sounds, textures, and touch. I've never seen him get upset by certain sounds. He has a 3 month old sister that cries all the time, never seems to bother him too much. We go out all the time and haven't really seen a sound that has upset him. As far as textures, he's a really picky eater if that counts. He's starting to just store foods in his mouth instead of eating them. We have to feed him 2nd baby food most of the time because he doesn't want to try other foods. Also, on the 3rd baby foods, he'll act like it's gagging him or spit it up because he doesn't want to eat them. And as far as touch he likes to put stuff in his mouth, but he doesn't have to touch everything.

To btbnnyr....

He only spins or flaps occasionally and can be easily distracted out of it. He usually flaps when he's excited about a certain part of his show on TV or if he's upset because we're trying to give him a certain food he doesn't like. And he only does it for a couple of seconds then he stops. He usually spins when he's running around the house, he'll like stop a spin for a second, and I'll tell him to stop, and he'll stop doing it.

And thanks again for the feedback. It's kinda frustrating the pediatrician recommends your kid for speech therapy, then they tell you it's going to be a couple weeks before you can even schedule an appointment.

If you contact your local Early Intervention services, they'll send out someone to do a screening. We did this at 30 months when my son was still only speaking in 3 word phrases. He wasn't delayed enough to qualify for a speech eval, but they did observe some behaviors and referred him on to a psychologist who did the ADOS. The whole thing was free and couldn't hurt. (Although in our case it did turn out that the psychologist missed the diagnosis, which he got at age 5.)

Sounds a lot like my 1,5 year old daughter. Me and her mother have Asperger so my daughter probably has Asperger too.

I am a little worried but we will sort it all out. She is gonna have a good life.