Deveopmental Issues: The Amygdala, Babies, and Autism

Following up on yesterday's post is an interesting new finding from the University of North Carolina, where researchers are confirming more evidence for an actual structural brain difference in babies with Autism. Please excuse the "science geek" in me, but this stuff is really important for us to understand. It will help us to better diagnose and help even very young children with Autism-related difficulties, and it will help us to screen out those who SEEM to have Autism, but don't (see yesterday's post).

For my non-science-geek, non-shrink parent readers, this is the bottom line here: It's important to really be watching the quality of your baby's social development. Your baby's glances, smiles, gestures and babbles in his first year of life tell you a TON about whether he's developing normally. The article highlights the importance of "Joint Attention", which is what your baby does to attract and sustain your attention, in order to share something interesting with you. If he likes doggies, when he sees one, he'll try to get your attention so that YOU can see the doggie -- and get excited by it -- too. He'll want to share his interests with you, even if he doesn't yet have the words to tell you about them. By the end of his first year, you should see him doing this more and more. Children with Autism have trouble with this -- and now we have more information as to why.

If you're interested in more, check out the summary article here.

And as always, post a comment with your questions or thoughts, if you'd like.

Aloha,

Dr. Heather The BabyShrink

Developmental Issues: Possible Signs Of Autism In A Young Infant

I've written before about the confusion and difficulty around the diagnosis of Autism in young children (before the age of 3). My regular readers know that I'm a strong proponent of Early Intervention screening, and also of early intervention therapy services. This means having your local Child Development center see your child BEFORE the age of three, should you have any concerns about her development, social interaction, or communication skills.

But you also know that I am loathe to jump on the autism-hysteria bandwagon. I worry that there are many other problems that are being missed because we're jumping to the Autism diagnosis too quickly. Issues of sensory, cognitive, medical, environmental, or even genetic problems can be missed when a diagnosis is made too quickly. Also, the range of child development is so wide, that what can SEEM abnormal may not be. And I blame my field; many of us are so concerned about the number of developmentally delayed children out there, and so few of us are adequately trained to truly evaluate for Autism in the early years, that too may children are mistakenly diagnosed as Autistic. And then their REAL problems go undetected -- and untreated. If I had a million bucks (or ten) I'd start a training foundation centered on the intensive training of Early Intervention clinicians in the detection and treatment of Autism-related conditions -- and other problems that might SEEM like Autism, but are NOT. We need a nation-wide (heck, world-wide) training initiative so that psychologists, pediatricians, speech and language therapists, occupational therapists, special instruction teachers -- indeed the whole range of Early Intervention professionals -- can get the advanced training we all need in this very specialized area.

In the meantime, you can read this very interesting article at Time.com summarizing some of the newest research on signs of Autism in the very young infant. It also helps to explain why this is truly a very difficult disorder to diagnose in the early years. And if you missed it, there's also a link to a popular post of mine on the diagnosis of Autism.

Click here for the Time.com article, and

click here for my own article on Autism.

Aloha, Dr. Heather The BabyShrink

Developmental Issues: Does Your Baby Have Sensory Integration Issues? So What?

NancyToday is the final installment of my extensive interview with Nancy Peske. She and Lindsey Biel, co-authors of Raising A Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues, have given us some terrific information about sensory development in both typically and atypically-developing children.

Today, she'll be helping us manage our expectations of our children. What is reasonable to expect, as a parent? If our child has sensory differences or challenges, how can we avoid disappointment, and respect and value our kids for who they really are?

BabyShrink: My readers are talking a lot about the emotional side of having babies who challenge their expectations of what it will be like to be a parent. If their baby is somehow different than they expected; needs more (or less) stimulation, comforting, sleep, etc., they are often surprised when their babies do not match the descriptions of newborn behavior in the "What To Expect" type books. They start to feel guilty that they are somehow not "making the grade" as a parent.

What can you say to these parents about the realities of parenting such a baby? How can they themselves cope with the strong feelings that may arise in such a case? How can they avoid beating themselves up, blaming themselves, and instead enjoy their own, unique child?

Nancy Peske: We're told by books and experts to not compare our children to others, but then we constantly get the subtle message that we should do exactly that! In general, most people don't look at a child's behavior or development and say, “Oh, I wonder if there's something unusual happening with that child at a biological level?”

And some people don't believe at all in biological causes of behaviors, and will quickly judge you and your little one, saying, “Send him over to my house for a few days. I'll straighten him out.”

When you hear criticism, consider the source. This is not necessarily someone who understands you, your child, or your child's special needs, and they might very well completely fall apart if they had to deal with your child 24/7 not knowing all that you've figured out! Picture them dealing with the screaming tantrum, the panic attack, or the diaper showdown, and just smile.

The more you use your sensory smarts to discover what's going on and come up with solutions to problematic behaviors and to help your child move forward developmentally, the more you'll truly understand that your child is dealing with a system that functions differently from that of other children. When you hold your toddler in your lap, gently squeeze her feet, legs, hands, and arms, and “magically” transform her from an overstimulated, fussing child into one who will walk over to the other kids and begin playing next to them, you start feeling empowered, because you know her shyness and whimpering is not due to her being a “bad” child or you being a “bad” parent. You're able to recognize what she needs and help provide it (and as she grows older, you can teach her how to get the sensory input she needs in a socially acceptable way).

One thing that can be extremely helpful is to join a support group or play group where you can talk to other parents whose kids aren't developing or behaving typically. There are many wonderful online support groups where you can hear from parents who have been there, who have advice and encouraging words that will make you feel that you're a competent, wonderful parent who is simply dealing with a bigger challenge than you anticipated. A special needs playgroup or Mom-and-Baby group can provide your child with a chance to socialize in an atmosphere where his “different” behavior will be accepted and honored, and where you can be supported by other parents as you support them. Parents of typically developing children--even when they've known you for years or are family--may never understand your child's issues, but over time, they may well come to see that you truly did have a very different challenge to face.

BS: What can you say to these parents about the realities of parenting such a baby? How can they themselves cope with the strong feelings that may arise in such a case? How can they avoid beating themselves up, blaming themselves, and instead enjoy their own, unique baby?

NP: I always think it's a good idea to keep records of your child's milestones and to celebrate them. Bake cookies the first time she takes a bath without a meltdown. Write it on the calendar and mark it in the baby book. Take a photo of her smiling in the bath. On your worst days, go back and look at your photos, or your home movies, of your child and remind yourself how far she's come.

Focus on development as a process and forget about timelines and what he "should" be doing by such and such an age. Again, this is where support groups can help. I learned I'm not the only one whose child didn't dress himself until age six, and so what? He eventually learned, and it certainly didn't prevent us from having a happy family life.

Try to let go of your ideas about what's “normal.” What's so very important about being “normal” anyway? Many of the most interesting, creative people in the world are wired differently, whether they're dyslexic, have ADHD, or whatever. If your child isn't typical, it may mean she's meant to do something very special. Then too, really make a point of noticing your child's wonderful qualities. It's so easy to see them as a bundle of problems when you first begin dealing with diagnoses such as sensory integration dysfunction. Isn't it great that your kid has such high energy that he gets plenty of exercise? Isn't it great that she has exquisitely sensitive hearing and truly appreciates various types of music? Whether your child's special qualities are being empathetic, creative and resourceful, or able to deeply focus on tasks, remind yourself of these gifts so that you don't become disheartened by all the challenges in raising a child who is different, and so you don't start thinking that “different” is bad.

Mahalo and aloha to you, Nancy and Lindsey! Don't forget to visit their website for loads of support and information.

Dr. Heather

The BabyShrink

Developmental Issues: Does My Child Have Sensory Issues? Nancy Peske Helps Us Decide

Nancy Peske, co-author of Raising a Sensory-Smart Child: A Practical Handbook for Helping Your Child with Sensory Integration Issues, has been so generous in her support of BabyShrink. Last time, Nancy told us about what it's like to have a baby with sensory issues. Today, she'll tell us about how we can begin to sort out our baby's sensory preferences.

Dr. Heather: Tell me about the "detective process" that parents must go through in order to figure out their baby's sensory issues. It starts out being a vague sense of something wrong, or just having a "difficult baby". How do parents start to narrow down the issue to find what's really going on? What do they need to observe or record? What can parents do to better understand their baby?

Nancy Peske: There are different "detective" methods. For me, it was simply a matter of tuning in to my own senses. I have mild sensory issues, as many parents of kids with sensory issues do, so when my son would fuss or show signs of anxiety, I would automatically think about the sensory environment, focusing on anything that was unusual or perhaps intense: lighting, smells, background noise, wind, temperature, and so on.

Journaling can be very helpful. Write down what your child did each day, and at what time, including what he ate, when he was cooperative and happy and when he was miserable and uncooperative. One mom told me this helped her realize that she was keeping her child too busy, not giving him enough quiet, unstructured time. Another told me she realized her daughter was always cranky if she went more than 3 hours between snacks or meals. If there's a sudden change in behavior, look at what might have changed. Always consider sleep, nutrition and eating, and external stress as well, from seasonal allergies and the sniffles to a substitute teacher at daycare that the child isn't yet comfortable with.

Focus, too, on when your child is unusually comfortable with a situation that would normally bother him and try to determine what's different. A mom told me her toddler suddenly wasn't agitated about his evening bath, and she realized the one thing she'd done differently was keeping the door closed while running the tub. Apparently, the harsh sound of water hitting porcelain was what had been agitating him, so after that, she always ran it with the door closed and he was fine with baths.

You can also run down the list of senses as you try to analyze what's working or not working in the environment for your child. Consider sight--is there a lot of visual clutter in the room overstimulating him? Is the lighting too bright or unusual in some way? Are the colors or contrasts too intense? Is it an unfamiliar sight-the yogurt container change its look and now your toddler won't eat the yogurt? (Hint: try not to serve kids foods from the container to prevent this!) Think about sound, from background noise to volume, to direction of sound (is it behind her? does she think that the rumbling truck outside might be coming toward her?) and quality of sound (stringed instrument vs. brass instrument, someone singing on a recording vs. someone singing live). Touch--this involves textures, temperature, wet vs. dry, and amount of pressure on the skin. Keep in mind that eating is very tactile, involving skin in the mouth. Your child may eat only one brand of mac and cheese and insist that the sauce not be too runny or thick. Taste and smell--children can be exquisitely sensitive to differences in taste or crave strong smells or tastes. Don't forget movement and body awareness. And finally, remember that transitions and getting used to new sensations are difficult for children. A child who just came out of a car that was driving on hilly roads may need a good, long stretch of lying on the ground or sitting quietly to regain her equilibrium after that vestibular stimulation. Leave extra time when shifting activities, and give plenty of warnings, so that your child's atypical nervous system has a chance to adjust to the change.

If you recognize that your child is processing sensory information atypically, that doesn't necessarily mean you need professional help. Simple accommodations for her differences, and gently encouraging her to try new activities that will broaden the range of sensations she'll tolerate and help her system function more typically, may be enough to make her feel more comfortable in her world. However, if sensory issues interfere with learning, socializing, and eating to a degree that's concerning and significant, more help is probably needed. A pediatric occupational therapist trained and experienced in dealing with sensory issues, who has worked with children your child's age, can be extremely helpful.

Aloha,

Dr. Heather The BabyShrink

Developmental Issues: Sensory Issues in Young Children

We’redeep into Sensory Integration week, so I thought I’d describe some of the remarkable cases I’ve had that have triggered my interest in the area.

I’m a licensed psychologist, and as such, I must fiercely protect the confidentiality of my clients. But some of my cases are so fascinating – and provide such a valuable learning opportunity – I will disguise the identifying information in order to share an important issue with you. Please know that I’d never, ever sacrifice client confidentiality for any reason other than legally or ethically mandated situations. At the same time, there are professionally accepted ways of illustrating important case material, and protecting private information.

Are All the Senses Functioning Properly? First, there was the little two-year-old boy I’ll call “Liev”. Liev lived with his father, 4 siblings, and several foreign nannies. His mother was off on another continent, using drugs. She had abandoned her family.  Father was struggling to deal with the terrible strain of the effects of her behavior on all of them, especially baby Liev. Luckily, the family was well-off, financially. Because father had money, he was used to delegating tasks to others. But he couldn’t “phone in” his parenting responsibilities; he needed to be present with his son. 

His son worried me. At first, we thought Liev was autistic. He constantly waved his hands in front of his face. He didn’t make eye contact. He had constant tantrums. He was very awkward, and seemed to move as if he didn’t see what was in front of him.

Ahhh…that was the key. Nobody thought to ask, until I found it scribbled on a page, deep in his file. Liev was nearly blind.  He had a congenital condition that made him not completely, but nearly, blind. The family had moved from place to place, and in the process, his medical situation had become muddled. The stress of the situation with Mom made things more disorganized.

Once the team recognized his visual impairment, his progress was amazing. I saw him six weeks later, and literally did not recognize him. His occupational and physical therapists helped him use his senses of touch and hearing to move around the room. They got his attention by using touch and sound as well, instead of expecting him to catch their eyes. He listened. He followed directions. All of his “autistic” behaviors vanished.

Sensory Integration “Diagnoses”, or Just Mild “Differences”? Let me also tell you about a little girl I’ll call Leilani. Leilani was referred to me, also at age two, for being “hyper”. She didn’t want to nap, didn’t want to sleep at night, and was constantly “on the go”. She didn’t seem to listen, and her speech was slow to develop. Her parents were exhausted, and they had two other young children to care for as well. There were constant power struggles, tantrums, and now a strain on the marriage. Dad thought Mom was being “too easy” on Leilani. Mom worried “something is just not right”, but had no support in her exploration of that possibility.

Their Early Intervention provider (there’s one in every community, funded by Federal dollars) sent her to an Occupational Therapist (OT). The OT found that Leilani overall had no severe sensory diagnoses, but there were some mild sensory differences that were worth noting.

Leilani was found to have a minor difficulty filtering out noise; when things were noisy in the house, she couldn’t really focus on what was being said. With that information, we helped the family speak quietly to Leilani. Instead of talking loudly over the “din” of the household, we instructed them to try talking in low, quiet tones to her.

The OT also found that Leilani responded well to “heavy play”; she suspected that Leilani needed a great deal of vestibular stimulation in order to get “centered”, regulated, and able to listen and pay attention. The OT demonstrated providing Leilani with very physical playground activities. Swinging was a huge favorite for this little girl. Like many kids with sensory issues, she could swing and spin endlessly, and never get dizzy. After the activities, Leilani was calm and willingly sat down to engage in quiet activities.

The combination of tactics; “low talking” and “heavy play”, utilized throughout the day, resulted in a little girl who shot forward in development. The family saw remarkable improvement in 2-3 weeks.  They especially noticed the improvement in her nighttime sleep if they provided her with at least 45 minutes of “heavy play” at the playground each day.

If you suspect any difficulties like this with your own kids, know that children aged 0 -- 3 (and 0 -- 5 in many communities) qualify for a free developmental evaluation with their local Early Intervention provider. Certainly, your pediatrician should be involved, as well.

I've learned so much from such cases that I analyzed the sensory tendencies of our whole family. It’s helped tremendously. One of our kids is a bit over-sensitive to sounds. So I decided to pick him up first from school, to give him a few quiet minutes in the car before we pick up his sister. He’s much happier to see her now; in the past, it was constant squabbling in the back seat. But now that he can “chill out” in the car, in peace and quiet, for just a few minutes….it makes all the difference in the world.

Stay tuned for Part 2 of my interview with Nancy Peske. She’ll be talking more about how to do the detective work in your own family….who has what sensitivities? How can you help to manage them?

The BabyShrink Interview: Nancy Peske on Raising a ‘Sensory-Smart’ Child

Untitled1_2 I am honored to present my two-part interview with Nancy Peske, co-author of Raising a Sensory-Smart Child: A Practical Handbook for Helping Your Child with Sensory Integration Issues, now in its ninth printing. Nancy and occupational therapist Lindsey Biel wrote their groundbreaking book to continued rave reviews in both the parenting and special needs communities. A National Parenting Publications Award-winner, Raising a Sensory Smart Child is easy to understand and provides real-world descriptions of sensory/developmental issues in children, and gives loads of activities and suggestions to help with our kids.

Nancy is a freelance writer and editor and has co-written, ghostwritten, and edited several bestsellers, including co-authoring the successful Cinematherapy series. She lives in Shorewood, WI with her husband and son, who was diagnosed with sensory integration dysfunction and multiple developmental delays at age two.

BabyShrink: How do sensory issues affect even very young babies? What is it like to be the parent of a new baby who has sensory differences?

Nancy Peske: Babies with sensory issues overreact to everyday sensations, or underreact, often seeking the sensory input their body needs. My son, who never stopped spinning and kicking in utero, was a very physically active baby, and he never seemed to touch things so much as whack them with all his strength – yet he never quite understood that he was hitting people instead of patting them. He also seemed to be constantly teething because the drooling just never stopped; I now know that this can be a sign of low muscle tone and poor body awareness, both of which are associated with sensory issues.

He was also a bad latch; it took three sisters-in-law and a lactation consultant to help me figure out how to get him to nurse properly so that he was getting milk and not whimpering every thirty minutes. Again, this was a problem with body awareness, and with motor planning. He was also overstimulated by wind, becoming hysterical whenever it kicked up, as well as by swinging. He would pitch a fit if we tried to take him out of the baby swing after 45 minutes. So you can have sensory seeking and overstimulation, but you can also have overstimulation and sensory avoiding. A baby might scream and carry on every time it's bathed, or its diaper is changed. Feeding might be an issue; if the food is the wrong color, temperature, or texture, she won't eat it, or will even gag on it. A baby might need to be held a certain way, such as on her stomach instead of her back, or get motion sickness extremely easily if she is sensitive to movement.

Sensory issues also affect the body’s internal regulation. Falling asleep, waking up without being groggy, and calming down after stimulation and excitement, can all be very difficult for a sensory baby. Letting the baby “cry it out” a few times does not work with these little ones!

Habituation (getting used to a new situation) is also an issue. The toddler who is chilled just can’t seem to warm up, and if she's used to wearing thin little cotton dresses and sandals, she'll insist on wearing them up until the first day of winter because heavier, warmer clothes just don't feel right. She may take a week to feel comfortable with that new, short haircut she got because her scalp feels tingly and different for a long time.

The confusion caused by sensory issues makes babies and toddlers resistant to transitions. They need a lot of preparation before changing activities, and they need a lot of external structure, such as a more rigid schedule. They also tend to be more anxious and sensitive than other children, and are often reluctant to try new activities, but then may love the activity once they’re coaxed into it. The key is to gently introduce a new sensory activity in a pleasant or playful way. Persuade the toddler to fingerpaint, to offer her a smock and a paintbrush and the chance to wash her hands every thirty seconds if that will help her to do this type of important sensory exploration.

Pushing her, or berating her, will just make her more anxious and uncomfortable. Try to make new sensory activities fun.

Also, we expect babies to be inconsistent and a bit of a mystery, so it can be difficult for a new parent of a baby with sensory issues to acknowledge her gut instinct that something is “off” with her baby. Her concerns are likely to be dismissed by others, from her husband to her pediatrician to her mother and sisters, and well-meaning friends who have more experience with babies. The parents most likely to be encouraged to listen to their instincts about their child’s sensory differences are either parents of other babies who were much easier to deal with (less fussy, less inconsistent in their sleeping and eating habits, and so on), or parents of babies who were adopted from overseas orphanages, born prematurely, or experienced birth trauma or medical interventions shortly after birth. This is because the experts expect some difficulties in these situations. Often, the NICU will send them home with instructions about what unusual behaviors to look for, or the adoption agency will educate them about sensory issues and developmental delays.

But it’s important for parents to realize that if they feel there’s something different, or just not right about their child, they shouldn’t dismiss that impression. The more you learn about sensory issues, the more you’ll start to understand why you instinctively hug and massage your child in a crowded room before letting him down to the floor to play with the other kids, or why you put a snug cap on her head when she’s getting antsy. One mom I met swore that her toddler, who it turned out had visual processing issues, behaved worse on days when he wore red or orange shirts, and better on days when he wore less intense colors.

If you have the impression that your child is experiencing the world differently, then that’s probably what’s happening.

My interview with Nancy continues tomorrow. In the meantime, check out the Sensory Smarts website for more info!

Developmental Issues: Sensory Integration Week on BabyShrink

I’m devoting a great deal of time, space and energy on BabyShrink this week to sensory issues in your child’s development. It’s a topic that effects many families around the world, and I think this week you’ll find some great tips to try out with your own kids (and maybe even yourselves). Young children are a work in progress, neurologically. New connections are made every day, connecting the body and bodily sensations with the brain. Sight, sound, smell, touch, taste, the vestibular sense (the sensation of the body’s position in space) -- all of these sensations are bombarding your child’s brain with new information. How can the brain sort it all out? How can the brain “filter in” and “filter out” certain information? For instance, in a noisy room, how can your child pick out YOUR voice, when he’s hearing several? It’s a complicated neurological process that develops slowly, throughout childhood.

Children differ in how they process sensory information. They can be over- or under-sensitive in any (or several) of the senses. This can be overwhelming for the child and result in frustration and behavioral problems.

Our Children, Ourselves I don’t know about you, but I certainly have my own sensory preferences. If there’s a lot of background noise, I find myself extra-tired at the end of the day. Conversely, my husband likes background noise and is calmed by having the TV on while we sleep. (I hate it!) These are normal variations in temperament and biological constitution. We all have our preferences. If we understand those preferences in our children, and ourselves, we can work with them better and have more comfortable lives.

Some children have sensory differences that are stronger than usual. Occupational therapists, specially trained in pediatrics and sensory issues, can be extremely helpful with detecting what those differences are and what to do about them.

Questioning the Legitimacy of Sensory Integration There is some controversy over whether sensory integration issues are “legitimate”, from a medical standpoint. Many pediatricians will dismiss the topic as unfounded or irrelevant. Studies are ongoing as to the efficacy of treatment approaches. But while these studies continue, many parents are finding these approaches extremely helpful. In my practice, I have seen exceptional progress made in cases with sensory issues, and I work closely with OTs who provide invaluable assistance to families. I do often recommend that an OT conduct an evaluation of a child with behavioral difficulties.

An Important Topic for BabyShrink Readers Many of BabyShrink’s regular readers work with OTs and find the exercises extremely helpful for their kids. I have learned a great deal about myself and my family’s sensory preferences, and I have modified things in our everyday lives to maximize what I have learned. It works for us! (But of course, your child’s pediatrician should be involved and consulted at every stage of the process.)

It should be an interesting week on BabyShrink. As always, your participation in the discussion is welcome.

Developmental Issues: How To Tell If It Is Autism

*Please note: This post was updated by Dr. Heather on 11/22/2010 .

Autism diagnoses are skyrocketing, but is the incidence of autism really increasing? Are there really more autistic kids out there than there were before?

We don’t know for sure, but one major contribution seems to be the increasing recognition of developmental problems in children by professionals like me. In other words, is it possible that the increase in autism is simply an increase in our diagnosis of the disorder?

Yes.

The single most frequent referral question I get, as a BabyShrink, is: “Is this child autistic?” Often, I see a two-year-old who is head-banging, language delayed, or performing repetitive behaviors. He may already have a speech therapist or other specialist who worries about autism. Or his parents may have seen Jenny McCarthy on Oprah, and say, “my kid does that!”

The New Autism?

When I went to grad school in the 1990s, we learned that Autism was a rare, severe, and life-long disorder of communication and social relatedness. These kids exhibited the most obvious signs of the disorder:

Near complete retreat from communication with others

Hand-flapping and other odd self-stimulatory behaviors

Severe developmental delays and behavioral outbursts

These kids really could not be taught in any regular school setting; They needed support and help in daily living for a lifetime. But as time went on, clinicians started to see less severe forms of these symptoms; we got better at recognizing them in their more subtle forms. As more behavioral health-care professionals were trained, we had more “eyes” looking for the problem. Parent advocacy and special education laws increased pressure on the school systems to widen the array of services for kids with less severe symptoms. Soon, I had parents and teachers asking me to diagnose autism or a related disorder so the child would qualify for intensive, expensive help that was only available under the autism spectrum range of diagnoses.

The pressure is tremendous; here is a child who has communication and other developmental delays. His parents have few resources. The school will only pay if there is an autism diagnosis. Many clinicians admit that they rationalize labeling the child “autistic” if it helps them get the services they need.

Digging Deeper: When Autism Diagnoses Are Misguided

So, back to the typical 2-year-old head-banger referral. A toddler I saw recently already had a new speech and language therapist, and an occupational therapist. They were concerned about his lack of progress in therapy. He had “lost speech”, meaning he no longer used the words he once did. One psychologist had already labeled him “autistic”, after spending just 60 minutes with him….in an office, not the child’s home, where he is most comfortable and most himself. I found a shy little boy who needed a lot of reassurance from his parents with me, a stranger, in his home. But he was outgoing and comfortable with his siblings and cousins on the playground. Later I found a buried note in the records about ear infections and asked about it. Fast-forward two months; after an ear/nose/throat and audiology consult, the child had ear tubes placed to drain the accumulated fluid behind his eardrums. He immediately began speaking meaningful words and his head-banging decreased by 90%; Nobody is worried anymore about him; he is progressing beautifully and is on track to start preschool at age 3.

That child had painful, unremitting ear infections that interfered with his hearing and language development, and caused him to bang his head in an effort to deal with the pain; His “lost speech” was a result of his shyness with the new speech therapist, and his hearing difficulty. He never truly “lost” any speech; he just was too shy to use his words with a new stranger, the speech therapist! And he was diagnosed with autism, and that diagnosis is “counted” in the statistics of the increasing “epidemic”.

I’m not arguing with the possibility that the actual incidence of autism is increasing. But I am not 100% convinced that that is taking place. And I’m worried about the panic and alarm caused unnecessarily to parents.

Misdiagnosed?

I am worried that there are several other distinct disorders being thrown together inappropriately with autism. Children with these disorders deserve to have them studied and understood uniquely, and not just lumped together with other disorders. In particular, there is a large group of children with sensory and motor problems; for example, a baby born with difficulty in tracking her vision. She cannot control her eyes properly so she cannot make eye contact with her parents. She does not learn to communicate well because she cannot make her eyes look where she wants them to go. Her parents think she does not “want” to look at them to communicate. These days, when clinicians hear that a baby does not make eye contact, they immediately think “autism”. But in this case, it is primarily a visual problem – one that, if corrected, will completely eliminate all her delays and symptoms.

Check out the following illustration I found online…(if anyone knows the source, please email me! I have been trying to locate the author but cannot find any information.)

Figure 2. At the age of four months this baby girl turned her head away when an adult tried to interact with her. This was interpreted as a sign of infantile autism. Since two of the older three siblings had esotropia, the infant was referred for an examination. She had normal looking eyes, a refractive error of +1.0 I both eyes and no accommodation to accommodative targets. Therefore +4.0 lenses were placed in front of her eyes to give her a clear image on the retinas. The effect was immediate, the baby looked surprised and a few seconds later showed a normal social smile for the first time.

One thing that health-care professionals seem to agree on is the fact that “Autism” is really a general term for many different disorders, each with different causes and outcomes. We need to work harder at understanding all of the unique disorders that are now being lumped together under one umbrella.

A Word About Vaccines

People are desperate to find a cause for autism. Childhood vaccines protect children from some of the most horrible, deadly, disfiguring, dangerous illnesses that routinely used to kill thousands. Are there dangers with vaccines? Of course. As for all medical treatments, you must weigh the potential risks with the potential benefits. But this problem has been studied extensively by gold-ribbon teams worldwide. Their findings? Vaccines do not cause autism. Not even the older vaccines with thimerosol, a type of mercury. Mercury poisoning by itself does not cause autism either. My kids have all their vaccinations. I have relatives who are survivors of diphtheria, polio and other horrendous illnesses. They don’t want me to lose sight of the misery (and death) that these illnesses inflict. And honestly, when other families choose not to immunize their children, they put the safety of others at risk; especially babies who are too young to have their full complement of vaccines, and other children and adults with compromised immune function. Please do not be misguided by the misinformation out there on vaccines. If you have any questions, please review them carefully with your pediatrician, who will probably agree with what I am saying.

True Autism Symptoms

Now, what does make me worry about autism in a child? Here are the main things I look for when evaluating a baby or toddler. (Remember: each child needs to be seen and thoroughly evaluated in person, preferably in your home, by an experienced professional.) These are some things that should trigger an evaluation, often to simultaneously include the evaluation of developmental psychology, vision, hearing, genetics, neurology, and occupational therapy/physical therapy specialists.

 

* No eye contact after four-to-five months of age;

* Inability to comprehend any language by 12 months (comprehension of language is far more important than spoken language or speech);

* Lack of gesturing (including pointing) by 18 months;

* Not turning to parents for emotional support/reassurance;

* Exclusively preferring objects to people at any age;

* Lack of imaginative play (make-believe/pretend games) by 18-24 months

There are many other possible, "lesser" symptoms, such as lining up objects compulsively, not responding to the child’s name being called, frequent tantrums, making “strange” sounds, and the apparent “loss” of speech. Often, these symptoms are problems, but are better explained by other diagnoses, such as the visual/motor example above, family stresses and problems, or even complex genetic disorders. And sometimes, these “problems” are simply normal expressions of toddlerhood!

So the bottom line is this: if there are any concerns, get an evaluation for your child sooner, rather than later, since time is of the essence. But make sure you get a comprehensive, thorough evaluation that takes all of the above into account. And if someone does use the word “autism”, don’t panic. These days the word means many different things to many different professionals, and often, the symptoms can be completely ameliorated by the right therapy.

Do you have stories to share about the diagnosis of your child's developmental delays? Please share!

Aloha,

Dr. Heather

The BabyShrink