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[lemonbar]

My son is 18 months old and showing some signs of difficulties (specifically language delay, lack of eye contact). He has been evaluated by EO and qualifies. However, at his age, many of his behaviors are also exhibited by children without autism -- so it is hard for me to tell if what he is doing is "normal" and something he will grow out of, or a red flag.

Can anyone with experience tell me what I might be on the lookout for as he gets a little older? He does not exhibit any of the "classic" behaviors at this point (except for what is described above). If he has autism, will he start to exhibit more problematic behaviors over time? Or would I see them even at this early age?

I just don't know what to think. And I am of course very worried for him.

[zuzu_]

I think it is very difficult to diagnose a true "language delay" at 18 mos--particularly since there is a such a wide range of "normal" at this age. The eye contact is certainly more worrisome.

You are doing the right thing by intervening. I'm sure you've done your own research and learned that early intervention makes all the difference: it can turn a minor issue into virtually nothing and can turn a major issue into a minor one.

The other early (less reliable) symptoms might be hand-flapping and extreme interest in spinning objects. Of course, "regular" kids at this age also can flap their hands and enjoy things that spin.

Disclaimer: I am not an expert, but my SO and BFF are both SPED teachers and autism specialists. I've learned an amazing amount through osmosis.

[biomancer]

Hi Lemonbar -

From everything I've heard and read, it seems that most diagnoses of autism are made between the ages of 2 and 4 as certain "benchmark" behaviors and social skills don't appear at the expected times.  However, I'm a microbiologist, not a developmental psychologist, so I don't have much other help to offer.  I just know what I've seen my friends go through with their kids, and what I read.

You might want to see if he simply has a minor health problem that's interfering with his ability to learn - like maybe his vision or hearing isn't quite 100%.  My little brother was initially thought to have a learning disability but it turned out he was just really farsighted and this was interfering with his ability to recognize faces and read.  Once he got glasses, he turned out fine (and by the time he was 9 his vision was 20/20).

Also - is your son your first child or does he have an older sibling?  In my family we have this amusing pattern that first children (regardless of gender) are talking at 9-10 months, but later children take much longer because (a) the older siblings act as "interpreters" and (b) the parents are much better at understanding toddler-babble than they were with offspring #1 and so don't push the language skills as hard.  The trade-off is that the younger siblings often become more physically agile and strong faster because they're trying to keep up with the older siblings.  Of course, that's just my experience, YMMV.

On preview, I chime with Zuzu's point that the lack of eye contact is probably the bigger worry than the language delay - but again, this isn't my area of expertise.

[inthelab]

Chime with Zuzu on the eye contact.  Speech at 18 months in boys is not always proficient yet- some don't master until 2 yrs.  Ask your pediatrician for advice.
That's what I would do.

[lemonbar]

Thanks everyone. My son is an only child, but I think my husband and I have gotten very good at anticipating what he needs (thus, perhaps, making language less necessary for him).

He has had multiple ear infections, and is getting tubes placed tomorrow in his ears. The ENT thought he might have some hearing impairment due to fluid in his ears. So, I guess we're hoping that the ear tubes will help him to hear better and thus to speak better.

His lack of eye contact is worrisome...the EO specialist noticed it right away. It's not that he doesn't make eye contact, he does. But, I think he makes it less than is "normal." For affection he likes to back up and sit in my lap, rather than face me and hug me. He doesn't know how to give kisses yet. So, he gives affection but it seems to be in a way that avoids face to face contact. I don't know, it may be that I just need to show him how to hug and kiss (I haven't really focused on doing that -- I didn't realize I needed to!).

He can certainly get focused on something (his toys, for example) and it is almost impossible to get his attention. Or, if he's watching Spongebob Squarepants (:>), forget about getting his attention. Sometimes he will not acknowledge me if I come into the room; other times, he gets really excited and comes over to me.

The specialist thought that he was "immature" in some ways -- that's the word she used. He did not want to share toys or anything like that with her; in fact, he got really upset if she tried to take one toy away and give him another.

Anyway, thanks for the comments. I'm extremely worried.

[inthelab]

Some of it (being focused, not wanting to share) sounds like normal toddler stuff, and some kiddies will be less mature, others more (always that bell-shaped curve in range of behaviors).
Ask your pediatrician.
And what's an EO?

[zuzu_]

He can certainly get focused on something (his toys, for example) and it is almost impossible to get his attention. Or, if he's watching Spongebob Squarepants (:>), forget about getting his attention. Sometimes he will not acknowledge me if I come into the room; other times, he gets really excited and comes over to me.

The specialist thought that he was "immature" in some ways -- that's the word she used. He did not want to share toys or anything like that with her; in fact, he got really upset if she tried to take one toy away and give him another.

IMO, this description does not sound autistic or even "immature."

That being said, you should err on the side of caution at this age. Accept any therapy that is recommended.

[ms_turtle]

18 months is early, but not too early to diagnose autism. However, you mentioned that your boy will be getting tubes tomorrow. If the problem is of the ear & hearing nature, you should expect to see dramatic behavioral differences within 24 hours. When my son had his ear tubes at around 15 months, we saw differences that afternoon. Most notably, he would seek out and stare at things making noise. He stared at the telephone several times as in, "That's the thing that makes that noise!?!"

My son and daughter are the king and queen of ear tubes! PM if you like.

That being said, you should err on the side of caution at this age. Accept any therapy that is recommended.

Good advice!

[hapax]

I'd like to chime on the possibility of this being a hearing-related issue. Speaking from my own family's experience, it's easy for a kind of "familytalk" (as in how you and your husband anticipate your son's needs and so don't push the language) to develop when the child is partially hearing impaired. In our case, I was an extremely early talker, and my younger sister was taking much longer in her language acquisition - as is typical with younger siblings. Her pediatrician at first thought she was still in the range of normal development despite our mother's concerns, until we realized that while our parents and I could understand her "speech," nobody else could.

Partial hearing impairment is harder to diagnose in children than profound loss is (think of that scene with the firetruck in Mr. Holland's Opus) because it can often be mistaken for inattention. Eye contact is also an issue here - if he can't hear you speaking, he may not look at you simply because he doesn't know you're trying to get his attention. Or he may not hear you come into the room, etc.

After my sister was diagnosed and fitted with hearing aids around the age of 2, the change was amazing. Her behavior vastly improved (making my teen years a bit more bearable!) and with the help of a speech therapist and hearing aid specialist her English improved by leaps and bounds. I was only 14-15 at the time and even I the angsty grouchy teenager noticed. So, definitely look for a difference after he gets the tubes in, and you may want to look into having his hearing re-tested if the ENT doesn't do so anyway.

[collegekidsmom]

A family member has autism, and I felt that he could have it very early on. He just seemed unusual in his socializing, even as a small baby. He was not "engaged" as I would describe it-instead his gaze was far off and seemed kind of fuzzy. He never waved goodbye or gestured or pointed in any way at the appropriate age. He kind of just looked past you in a strange way. He hated the feel of grass under his feet, or going outside to play in the snow with the other kids. He didn't speak at all-not even tiny words like bye or hi by 2 and a half. He was physically delayed as well-crawling, sitting, walking-not at the usual times. You could just tell he was not responsive in the usual way. He did not enjoy nursing or being held. But, to me, it was in his eyes-his vacant sort of gaze.
He did not enjoy TV shows, or care about popular characters. He has never done any imaginary play at all, so "playing" with trucks or getting involved with games is not possible for him. He never has focused on playing appropriately with anything. He does repetitive things like switch the light on and off repeatedly, or open and close the door many times.

Each child is different-these were just the things that concerned me but did not concern his doctors enough to get him an early diagnosis. It was heartbreaking to worry so much about him while doctors continued to tell the parents(first-time) that he was just being himself, or had muscle tone issues, or that he was a very laid back personality.

He is a few years behind cognitively(elementary school age) but is otherwise a lovely, sweet boy. He loves dogs and enjoys family gatherings and being with everyone. His autism is not the main topic anymore-he is just part of the family and is doing very well in his mainstreamed situation in public school. Children invite him over because he is well liked, even though he must be assisted to do many things.

As others have said, there are tremendous variations in walking, talking and other developmental milestones. What made me believe that he might be autistic was just the total package; a lack of engagement with the world in the way you might expect. For instance, with my late talking son, there was no question of that because he played and interacted and did what you asked him and was happily engaged with the usual stuff. Another of my children who never cried(some would suggest that that could mean something's wrong) just seemed happy, and she was known to flap her arms when she was excited too. She's fine. So, it's not these discrete things; it's the whole picture of the child, and of course, hearing or other issues are big factors. Get a second opinion or see a pediatric neurologist if you or other experienced parents around you(like family members) express concern. Early intervention is vitally important with autism. Best wishes.

[lemonbar]

Thanks for all of the comments and suggestions. I will let everyone know how the ear tube implants work. I am hoping to see significant improvements in hearing after tomorrow.

To me, my son just seems a bit shy and reserved (both my husband and I are, so this is why I guess I did not necessarily think his avoiding eye contact was a problem). I would not call him "vacant" in the way that collegekidsmom describes her family member. He does seem to sometimes avoid looking at people in the face, but he doesn't do that all the time, certainly.

He does speak some words (bye, dada, "meow," thank-you, two, and most frequently, NO!), he has just started to point and wave. He does follow some directions. I guess what concerns me (besides his inattention, which others have pointed out here can be totally normal) is that I have tried to teach him what a ball is, and to retrieve a ball when asked, but he seems unable to pick up that word. In other words, he has learned to follow some directions, he has learned some words, but others he almost seems to resist learning! Perhaps this is "normal" too?

[ms_turtle]

I guess what concerns me (besides his inattention, which others have pointed out here can be totally normal) is that I have tried to teach him what a ball is, and to retrieve a ball when asked, but he seems unable to pick up that word. In other words, he has learned to follow some directions, he has learned some words, but others he almost seems to resist learning! Perhaps this is "normal" too?

My son had this same problem. Who would think 'ball' would be such a hard word? Keep us posted.

[jackit]

Hi Lemonbar -

I am sorry you have to deal with this worry.  I know from experience it can be scary as hell.

My son (now 10) is on the autism spectrum.  In large measure, what collegekidsmom said sounds common:  these kids just don't feel right.

Some warnings: the 'classic' signs of autism aren't that useful in picking up autistic kids, because they tend to act differently.  Pediatric neurologists can be a complete waste of time.  My son was incorrectly diagnosed ('well, at least it's not autism') by the dept. chair of one of the most highly ranked pediatric neurology groups in the US.  Psychiatrists who have an interest -- or a clinic -- to work with autistic kids might be best, but can be hard to find.

I met many autistic kids when my own son was younger.  Some common red flags:

1.  Doesn't seem to feel pain the way most kids do.  Never or seldom barks 'Ow!'

2.  Not as alert as most kids -- seems almost 'drunk'.

3.  Similarly:  slow reaction times, sometimes seems to be moving in slow motion.

4.  Loves bread and/or milk.

5.  Plateaued or regressive language development.

6.  Cries and seems uncomfortable often when there does not seem a reason to.

7.  (I know this sounds weird but) loves Thomas the Tank Engine.  Autistic kids can -- often -- apparently process Thomas pretty well.  Something about the faces.

Those are things that come to mind.

I hope this isn't the issue!  But if it is, many, many of these kids respond to intervention.  And as others have said, the earlier the diagnosis the better.  The idea that you can just 'wait to see if they grow out of it' is losing favor, thank goodness.

- J

[collegekidsmom]

It's great to hear that your son is communicating through waving and pointing, and saying some words-especially the common "NO." Those are all good things for his age. Make sure your pediatrician takes the time to discuss all of your concerns. Don't be rushed away, and make sure to always get second and third opinions if that's what you need. Autism is very commonly diagnosed these days and so one would think most health professionals would be well informed.
Also, a child that age may "resist learning" if you keep trying the same thing. They get easily bored or angry when they sense you are trying too hard. He may not care about the ball and is wondering why you care so much. A variety of experiences and reactions will be more telling than his disinterest in dealing with the ball.

[barred_owl]

Lemonbar--My grandnephew is about 2-1/2 years old now.  Back at Christmas time, I mentioned to my sister (his grandmother) that it didn't seem like he was talking very much.  I had concerns similar to yours.  Nephew was otherwise engaged, and would babble a bit, but was much more interested in exploring and manipulating objects--toys, shoelaces, the contents of his mother's purse.  My sister is a speech therapist, specializing in early childhood and LD issues; she pointed out that boys, in particular, may be a bit slower in acquiring language than girls, and that they tend to be more tactile than verbal at nephew's age.  Now, four months later, he still likes to touch things and play with them, but his babbling has turned into a real vocabulary and he talks virtually non-stop.  It was just a matter of time...

It's good that you're having things checked out, though, and I chime with the other sage posters here that having his ear troubles attended to could make a difference, too.  Chances are he's just fine; but do what feels best for him and you, just to make sure.  Be sure to let us know the results of the ear tube procedure.  And, give him a great big hug from all of us!  We're not shy! :)