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Autism

Identifying Autism

10/25/2005

Question:

My 3 year old son talks in a high sing song voice and often sounds like a robot. He is currently in speech therapy. He has failed 2 hearing tests although I know he hears. He learned the alphabet by the age of two, he knows upper and lower case letters and also know what sound each letter makes. He can write his alphabet perfectly as well as his numbers. He has fixated on the alphabet, numbers and shapes since just before the age of 2. He prefers playing by himself, and often won`t respond when called. He doesn`t ask questions and responds to most questions with his name. He tends to repeat what he hears over and over. He is engaging, he has begun pretend play but becomes upset when his sibling tries to play with him or touches his toys.

Should I be worried about Autism? Should I have him evaluated? He is definately not like most kids his age.

Answer:

Dear Parent,

The fact that your son is enrolled in speech therapy suggests that you are already concerned about his development. The question you are now asking is whether there is more to address than a speech or language delay alone.

You clearly described several aspects of your son's development that warrant a comprehensive developmental evaluation. There are several areas that are worthy of checking into.

1. Speech development is closely related to hearing, and your son failed two hearing tests. I would be interested in obtaining comprehensive, ear specific audiological testing to understand the specifics of his hearing. Sometimes children can have mild to moderate hearing impairments or even fluctuating hearing due to middle ear fluid. It's important to understand the specific aspects of his hearing status. I would look for a pediatric audiologist to do this testing as the clinician may need to behaviorally teach your child how to respond to the testing stimuli before he/she can complete the testing.

2. Features of your son's speech raise potentially-important questions. These features include the following: (a) not asking questions, (b) responding to most questions with his name, and (c) repeating what he hears over and over. These suggest that he is having difficulty using language functionally to communicate his needs as well as socially to play and learn from others. The issue here is not that he doesn't have or know words, but that he may not know how to use words to interact socially with others. This has important implications for his social language learning as the primary way young children learn to communicate is through social communication with others.

3. Some of his behaviors suggest the possibility of an overly narrow repertoire of activities and interests. Included in this category are the following: (a) Fixation on the alphabet, numbers, and shapes; and (b) a robotic, sing-song like voice. These suggest the need for a comprehensive developmental evaluation.

You also mentioned that your son has started to play pretend but doesn't like his siblings to play with him. This raises a question about his social play: How regularly does he play with others (both adults and peers) and do you see him incorporating play ideas he has learned from others into his play?

One of the primary reasons for a comprehensive developmental evaluation is to develop and implement individualized interventions that will prevent or minimize disabilities. These can be obtained at most University Centers of Excellence for Developmental Disabilities. (The following website provides a list of potential providers by state: www.aucd.org.) Most Children's Hospitals have professionals who are skilled in such assessments as well. Most medium-to-large cities have private professionals (e.g., physicians, psychologists, speech therapists) who have specializations in working with children who have developmental disabilities. It is usually possible to figure out who they are by carefully inspecting the yellow pages of the telephone directory. Evidence strongly suggests that effective early intervention can minimize developmental delays.

Lastly, such an assessment will relieve anxieties you might have regarding his behaviors if you can discuss them with a knowledgeable professional. Good luck in finding the right resources!

For more information:

Go to the Autism health topic, where you can:

Response by:

Michael G Aman, PhD Michael G Aman, PhD
Professor of Psychology and Psychiatry
College of Medicine
The Ohio State University

Paula C Rabidoux, PhD/CCC-SLP Paula C Rabidoux, PhD/CCC-SLP
Clinical Associate Professor of Psychiatry
Clinical Associate Professor of Speech & Hearing
College of Social and Behavioral Sciences
The Ohio State University