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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, December 8, 2016

Is It Autism? Interesting Questions about a Toddler

Here is a comment on eye contact and other possible "red flags" for autism. It couldn't be placed on any of the pages I have on that topic, for some reason, but I thought it would be useful for other people to read these intelligent questions and my (I hope intelligent! ) responses.
Hello Dr Jean Mercer,
I'm not sure if you are still actively replying to comments, but I would love your thoughts on my 12.5 month old son.
In the effort to fully disclose, I would like to mention that my oldest son who is 2.5 followed a similar pattern of development, in which I was convinced he would be diagnosed with autism until about 16-18months old. He is now very advanced in his language and very social (almost too social!).
As with my older son, I have had long time concerns with his eye contact. This has spewed into constantly analyzing if his joint attention is enough. He has many strengths but they seem to be over shadowed by a weakness/red flag. I guess I am not sure if they are developmentally expected at this age or my my expectations are too high. I have brought concerns up to my last two well baby visits only to be brushed off. Here are my strengths and concerns:

1) Showing/giving: He has been showing like crazy lately, everything he picks up he makes eye contact and "says" something BUT virtually no giving. If I reach my hand out he will "fake me out" and hold onto it. He was giving but not showing about a month or so ago.
Showing is actually a lot more complicated than giving. For giving, he just has to respond by letting go when you put your hand out. For showing, he has to figure out where you are looking and hold an object so you can see it-- not let go, not drop it. To combine showing and giving in the right sequence is even harder. I don't think he plans to fake you out (that would require some pretty advanced cognitive skills), but he is probably not yet able to inhibit the showing action and start the giving action.

2) Pointing: he points a hundred times a day. BUT never looks at me during/after point. Very occasionally he will quickly glance my way but it's quite rare. He has done some 3 point gazes but I'd say maybe 2-3 times a day definitely not a lot.
Pointing can simply be a way of indicating behaviorally that he is interested in something-- I mean indicating it to himself, not to you. If he does do joint attention a few times a day I would say that's fine.

3) Engagement: he plays and laughs with me. BUT not much eye contact during it. In fact very little. For example we played with a ball for about 5 minutes together, he was laughing a lot (he would hold the ball and drop it and then I would roll it to him or pass to him) but I was watching intently and as much as I could tell he was enjoying it he didn't once look up at me. He focused on the ball the entire time. He also can play by himself for lengths of time without looking up (my oldest did this as well so I'm not as worried compared to the engagement with the ball example).

I think the ball play is probably still pretty challenging to him. To look up at the same time is kind of like patting your head and rubbing your tummy at the same time.  He's not ready to multitask or to stop and start actions easily.

4) other gestures: this one has me stumped. A month ago he wasn't clapping but had waved bye bye a few time on his own. He would also makes kissing noises when I said give me a kiss. Now no waving or kisses but will clap on demand. I thought he caught on to the toy telephone because he seemed to do it once but not again. He continues to say no no no while shaking his head so that's a definite strength that has stuck around. But it's like he completely forgets how to do it??? 
They do things and then don't do them any more for a while, quite often. Sometimes it's because the skill is so well mastered it's not interesting any more--  other times, who knows!

5) mirror: He shows zero interest in a mirror
Do you mean he doesn't recognize himself in a mirror? I wouldn't expect him to until about 18 months. Then you could try putting a dab of lipstick on his nose and showing him a mirror-- he will probably put his hand to his nose at once.

6) no walking but my oldest was 16 months before he walked so I'm not concerned about this
No reason to be concerned.

7) I can tell he understands some things I say, like get the ball, take a drink, where's dad etc. as for words, he has said dog, ball, and bear (along with mama and dadda), but now only seems to say ball appropriately
Receptive language (understanding) is much more important then expressive language (speaking).. Knowing what they actually say can be so difficult because they may not make the same sounds every time. You may just be missing what he says, or possibly he's busy on some other aspect of development. They don't work on everything at the same time or the same rate of speed.

He gets a kick out of feeding me, which I see as a huge strength but it's the eye contact that has me the most worried. I guess I'm hoping for either reassurance that he seems to be developmenting on the right track or a push to request services regards of being brushed off.

It sounds as if he does a lot of social interaction and that's on the right track.  They don't actually make a great deal of eye contact, if you measure it objectively-- a quick glance is all it takes, not a long gaze.

          Thank you for the support ;)

Thanks to you for the great descriptions! I'm sure other readers will benefit from them.

Just try to keep in mind that what toddlers can do and do do is so different from what adults do that it's really hard to figure them out. Jean Piaget referred to children this age as "cognitive aliens"-- their thinking is so different from ours that they might as well come from another planet. Or, as one of my grandsons says, They're ca-RAZY!

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