Developmental Issues: Is Your Young Baby Showing Signs of Autism?

Hi Dr. Heather, I came across your website when doing a search for signs of autism in infants. Our 3-month-old doesn't look at us very much, doesn't track objects across the midline well, and doesn't often respond to our voice. He stares at the wall or just beyond us pretty much anytime we hold him in our lap looking up at us. He is very calm and mellow, and only cries when he is tired or hungry. He would sit in his bouncer or swing all day if we let him. We also have a 3-year-old very active boy with sensory processing problems so I know our baby doesn't get as much attention as i would like to give him. We know he is way too young for any of these signs to be a definitive answer, but I am having a hard time finding information on what we can do preventatively as we observe him over time. There is a program in our city, but other than that, everything I find is geared towards 18 months to 2 years, since that is the time that it is easier to see more clear signs. Can you help?

Jennifer

Dear Jennifer,

I'm so glad you are aware of this crucial aspect of your baby's cognitive development. I think most parents would be happy to have a "mellow and easy" baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important "give and take" and communication that he needs to trigger important aspects of his development. He needs to engage with you and play "Baby Games" in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?

I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it's also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic "give and take" in the parent/infant interaction, and in the ability of a baby to pick up on his parents' feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.

That said, there are many things that ALL parents can -- and should -- be doing to maximize this incredibly important time in a baby's development:

Carefully watch your baby's sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he'll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby's best expert; try to figure out when he's most approachable.

Then, make a conscious effort to play "Baby Games" during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.

Don't give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for "Baby Games". Give him time and keep trying.

Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can't help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there's a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.

Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents' detective skills to determine WHICH senses your baby tolerates -- and DOESN'T tolerate -- very easily. Use this information to "fine tune" your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I'm quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she's much more likely to stay engaged in our "Baby Game" than if I coo or talk back to her. Eventually, she'll develop the ability to tolerate my voice as well. But until then, I'll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.

I also double-checked on the expected timeframe of infant response to parents' voices, and most authorities agree that this isn't regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.

Now, I'm not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son's development. Over time, you can judge his progress and if you're not satisfied, have him evaluated by the program you mentioned in your city. If they're not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I'm a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there's nothing really atypical with your child.

And I can't stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few "rounds" of interaction between you and your baby at this age. Over time, you'll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently "hatched" -- our psychological term for the opening of awareness that marks the end of the "squirrelly newborn" phase. So manage your expectations accordingly.

Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you'll write back to update us on your progress!

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

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 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.