have been reading another thread - didn't want to hijack tho. ds is 18 months. has been walking holding on to things for some time but first walked independently about 3 weeks ago. doesn't talk but will copy certain sounds, has his own language IYSWIM. he has never pointed at anything - he tends to demonstrate curiosity by going towards the things he wants and grabbing them - and he doesn't engage in pretend play. otherwise he is a very lively, curious, affectionate little boywho has bags of energy. but i have seen from another thread that the lck of pointing and pretend play are matters for concern. should i be worried / asking gp for evaluation?

even a delay in gross motor skills, however mild, would push everything else back without there being a 'problem' iykwim

but if you are worried i would just ask your hv, if she is good. If not just ask your gp

my mum's a gp, feels he's completely normal. tbh am only panicking because of something i've read - would never have occurred to me otherwise therre could be anything the matter!

bump - any advice/views gratefully received

Does he usually turn his head if you call his name? Does he use social gestures like waving hello and bye bye ? Do you feel that you and he share attention when doing an activity?

yes, he generally responds to his name (unless he's very preoccupied with what he's doing). Doesn't wave at all. When we read toegther, or play with a toy, he's very inclined to grab the book/blocks/other toy and "take over" himself" IYSWIM. The main games we play together are peekaboo and chasing games - I roar like a lion, or bark like a dog, and chase him on all fours which he loves.

Responding to his name is a good sign. What does he do if you try to direct his interest to something? If you say 'look at x' will he follow your gaze or point?

If he isnt pointing at 18 months you need to see your hv. Might be nothing might be something but if it is something it needs to be found early.

Lack of pointing would concern me if he was in my nursery.

The lack of pretend play wouldnt so much and walking at 18 months is perfectly normal.

Agree that the lack of pointing and waving is a cause of for concern as these are the building blocks of later communication. Do you think he could have a hearing loss? If not, then what is the quality of his play like? Does he seem to play normally (as per his peer group) or is it more unusual, eg. bashing things or using toys in odd ways? How do you think he compares with his peer group and does he seem to enjoy interacting with other toddlers? Pretend play begins to emerge at about 24mths so I would say that its absence at 18mths is not so much of a concern atm.

why is pointing such a big thing? he does communicate in other ways eg shaking his head when he's had enough to eat, pushing away the bottle when he's had enough to drink etc. He's definitely got no hearing problems and does enjoy interacting with other children altho I don't take him to any playgroups atm (we live ina rural area and I don't drive). He likes bashing his drum and throwing stuff but I kind of thought that was normal for a little boy ...

I am absolutely not an expert - all I can do is descibe my ds1 to you. At 18 mths he was (still is) happy smiling, affectionate, energetic and interested in books, cars and so on. He was unusual only in that he didn't point or wave and when he liked something he really liked it eg phase on street lights - had to stop and look at all of them.

As his speech emerged when he was 2 it was good, but pronouns were reversed and his social interaction didn't develop from playing alongside to playing with peers as it should do.

I was also beginning to be aware that although he was a lovely boy and reaching most of his milestones, he was not 'easy' and it was hard to understand why he got upset about certain things.

I went to my health visitor when he was 3 and it took a year of seeing various specialists before he was diagnosed with Aspergers syndrome.

Believe it or not that's the short version of a very long story! Sorry if that doesn't put your mind at reat.

Pointing is a pre-lingual form of communication. There are different types of pointing, from memory I think at least two types:

Imperative pointing is when the child points to an object that he/she wants an adult to get for him/her

Declarative pointing is when the child wants to share something with the adult -(joint attention)

Both types of pointing combine sharing and socialising.

My ds is 5yrs old and when he was about 18mths old, I suddenly realised that he had never pointed. I would see babies as young as 10mths old pointing at things and it would strike me that my ds just didn't do it. I could see that the youngsters who were pointing would look at their parents to check if they were paying attention or not - skills my ds totally lacked. It turns out that my ds is on the autistic spectrum with associated learning difficulties. He is still non-verbal and never points or waves. His paed. still asks if he is pointing or waving but the answer remains 'no' to date.

When my ds was 18mths old, he would drag us to where he wanted us to go, he would push us/his food away if he'd had enough and he was quite able to communicate his needs by whingeing or via his body language. However, the quality of his play was very poor. He would throw things, bash things, chew things and generally destroy things! He had no interest in other children. Looking back now (the power of hindsight!), it was more than obvious that he was very different from his peers but at that time, although I had concerns about him, I was still hoping that it was his age and that he just needed a bit more time to develop, etc. His lack of speech at 18mths was the cue for a referral to a SALT and he was diagnosed at 3yrs and 5mths old.

If you are concerned about your ds then perhaps you could have a HV take a look? What is his speech like?

apart from saying "no" when he's had enough to eat, he doesn't speak yet. have since spoken to MIL who says that dh was the same - didn't walk til 18 months, spoke a few months after that, didn't point. dh is normal - no communication or social difficulties(he'd love me for saying that). I'm reluctant to go to HVs - they tend to take such a tick-box approach to things. will go to gp.

have been up all night worrying about this. dh is angry with me for making him worried. am feeling very very bad. am scared to triiger off a whole load of investigations by going to gp but i know i must.

I'm ss smallwhitecat, I'm assuming it's my thread thats got you all wound up

I've been awake most of the night as well, I so wanted the doc to brush away my fears but he didn't so we move on from there now.

Lo has to have a blood test next week to screen for chromesome (sp) abnormalities then its about 3 weeks before we get the results back so its gonna be a worrying time.

You are right, you must see your gp and your dh sounds just like mine by the way. He thinks it'll go away if I leave well alone, well it won't!

Best of luck.x

I really hope you get some answers soon and that in your ds's case, it turns out to be a developmental delay and not a disorder - there is still a possibility that it could be. But, even if you do find yourself going through the assessment process, your ds will just be the same little boy that he's always been - being diagnosed with anything will not change him but it will enable you to access help and support (which always entails long waiting lists and lots of banging on doors). Good luck and keep us all updated. It is a very worrying time but the fact that your ds has at least one word is encouraging. I have known many toddlers who have been non-verbal at 2yrs old yet go on to be NT. Don't lose all hope yet.

Do push for a referral - a child not pointing at 18 months does need to be seen or at least into the system. If you have difficulties getting a referral explain that you understand that child not pointing at 18 months would be picked up by the CHAT test (HV's should know about this test) and need further consideration.

They're not going to pick up anything that's not there- and it really won't trigger a load of investigations - things move very slooowly which is why it's so essential to get in at the first sign of any trouble - even if its not going to lead to anything. Remember, if everything kicks into place (and for many children it will) you can always remove yourself from a waiting list. But you can never jump one.

I first had concerns about ds1 not pointing when he was 17 months. DH was cross with me too (as was my mother and just about everyone else, only one friend would talk to me sensibly about it- and initially she couldn't see anything). I used to borrow books from the library then hide them under my mattress ffs!! Or google then clear the history. Anyway he wasn't diagnosed until he was just 3- it was a long haul and a lot of wasted time. I hope things have improved now (this was 7/8 years ago), but from what I hear they haven't.

Another thought is that at the moment I'm doing an online floortime course. If you can afford it I'd really recommend it. The aim of Dr Greenspan is to get in and start working with a child before there's any sort of diagnosis - as soon as a child start to show signs that they might deviate from normal development. I think his reasons for why the child might deviate are spot on (usually some sort of sensory processing problem) and his aim is to get in and get back to the normal developmental trajectory asap- so that in effect you end up without a formal diagnosis of anything - just a blip in development for a while. The nice thing about floortime is that it uses play so can be started really early on. I wish I'd done something like this with ds1 at 17 months- I am going to start doing it, but now, at 9- which is too late to go back to normal development iyswim.

I sound like I'm getting commission I'm not I just think it's something positive to do, that you can do without thinking 'oh my child has condition x' and I can see that it would have helped ds1 (and me!) in the early years.

It is early days so don't let us push you to conclusions too soon. Failure to point and failure to engage in social gestures are red flags ( for ASD) but then again turning his head to his name and shaking his head for no could be said to be green flags for normal development. Most people in RL will laugh off concerns about ASD so it is important that MNers give the opposite view at times - that is is possible (far from a certainty) that there is a developmental issue. Just to confuse things, I have an ASD son who has always pointed for shared attention - so there are no acid tests. You need the opinion of expert who has actually seen and assessed your son.

I think the thing to realise is that at these really young ages developmental outcomes are not set in stone. We were very worried about ds3 aged 16 months. He wasn't pointing, he was a bit self absorbed and I could see that he had some sensory processing difficulties. We knew that he was at a very high risk of autism and tbh we thought he was heading that way. We had him tested and found out that he had a leaky gut (like ds1), so we made him strictly gluten free, and removed all cow's milk switching him to goat's. Within 1 to 2 weeks the lights had gone on - he stated pointing and talking and just became 'with it'/back with us. It was very obvious. He's 3 now and I recognise a lot of his issues in the things that Greenspan talks about (he has a book on challenging (NT) children - which takes this developmental approach too). He definitely has sensory processing difficulties (he went to his CM's yesterday wearing a scarf because it was 'cold'!!!), but he is developing normally. He is NT, albeit sensitive and stroppy.

I think we had a very close call with him though (and aged 3 he's not out of the woods yet), and I am going to do some floortime with him as well.

Point being really that what you do early can in some cases make a difference.

As an educationalist and mum of 2 much older children, I have never, ever been aware that pointing was a skill to be measured/concerned about.
When was pointing decided on to be a sign of development? Maybe things have changed a lot, as my kids are now in heir early 20s, but nobody ever mentioned pointing to me, and I have never heard of it! IS that just me?!

Gross motor skills and language development - yes. An 18 month old should certainly be talking, IMO and experience. I know there is a range, but mine were walking at 7 months and 9 months, and talking at 6 months ( first words.)

If your mum is a GP she must surely be knowledgeable?

have an appointment with gp at 9. My Mum says we've nothing to worry about. Havig heard what I have about the pointing tho I'd like him to be looked at more formally. Thanks for all kind words and support. Am drawing comfort from the fact that he seems to be developing very much as dh did who is absolutely not on the autisitic spectrum (albeit a bit weird maybe)

Pointing is very important. Especially pointing to share interest (as in 'pointing at a dog or a plane or some other interesting thing. ) and following someone else's point. Far, far, far more important than talking.

DS2 didn't talk until after 2 and I wasn't concerned about his development because he was perfectly able to point and share attention.

Often people don't specifically test pointing, although the CHAT test (which measures pointing and is meant to be taken at 18 months) was trialed and found to be reliable and a good screening tool for picking up children who needed input. It wasn't introduced- the main reason (as far as I can discover) being because health authorities don't have the staff to deal with the children it picked up. It's been around since the 90's.

Anyone who works in the field of early development of communication (as I do) will tell you about the importance of following up a lack of pointing at 18 months. It doesn't necessarily indicate that there is something wrong, but it does indicate that a child needs to be watched and preferably helped. As I said in my last post development is not set in stone, but if a child is having difficulty processing information then they may need some help to stay on track.

I remember when ds1 was 17 months and not pointing and people said things like 'pointing's rude why do you want him to point? Look at how smiley and cuddly he is, he just likes watching people'. In his case lack of pointing was a sign that he needed help and input there and then - and we wasted years because it was so difficult to navigate through the system and find help and input and people were so unsupportive of me raising concerns. (That's common- my friend said when she started having concerns about her child her dh acted as if she was wishing it on her).

There are a few campaigns (mainly in the States) to introduce things like the CHAT test ('invented' in the UK btw) as a standard test because it is a good screening (not diagnostic- it flags up children - does not diagnose them) test.

As an aside whilst ds1 was waiting for his school bus Ii just tried 10 mins of floortime with him and he responded well and it was easy to do. I'm just 8 years too late

Pointing is a subtle (but important) sign that typical communication development is taking place. If my ds had pointed as expected, I too, would not have known of its significance. It was only because ds did not point that I became aware of this huge void in his development. ASDs present in many ways and have many subtleties - once you know what to spot, picking up on such subtle cues such as a lack of pointing/waving becomes easy. Any parent of a child with ASD becomes, by necessity, an armchair expert on the subject. Not all professionals (HVs, GPs) are fully versed in ASDs which is why a referral to a paed. may be necessary (as it was in my ds's case).

GP's vary enormously. One told me that 'girls don't get autism you know.' Dear God. (I corrected him). He was ancient but even so!

GP was helpful. she didn't dismiss our concerns and is referring him to HVs for assessment. if they have concerns it's then on to the paeds - i think i'm going to ask for that anyway. re the pointing she seemed to think yes it's a concern, but not conclusive which seems more or less what you guys think if i've understood you rightly.. i do wonder if he's not doing it because he doesn't see us do it and doesn't see other children do it because he's never been at nursery or playgroups. am kicking myself over not taking him to more things. he does look when i point sometimes, altho not consistently.

Hi SWC

DS2 is 3 next week and like your DS, he was not pointing at 18 months (think he started at 18 months and one week and even then it was not very often.) At 18 months he had one word (pillar for his caterpillar) and by 2 he had about 10. So I referred him to SALT who luckily were able to give me an appointment within a month (very rare, I understand). SALT seems to think he has just a delay in speech and I must admit his speech has really come on. He is estimateed at being about 6 months behind his peers. However, he strikes me as being 'different' and that is because I am now observing how DS3 has 'naturally' picked up things like pointing, waving etc, whereas with DS2, we did a lot of 'teaching' how to point, etc.

How is your DS' understanding? At 2 years old DS2 did not understand 'where is' we had to teach him that. However, DS3 (13 months) knows and understands this question.
I know how you feel about the 'investigations' and everyone around me feels that DS2 is fine, but I do still have some concerns and have asked for a referral to a dev paed (although SALT was even discouraging of this) so we shall wait and see.

Please take on baord what Yurt1 and others have said. Your DS may have something or nothing but the earlier you get it checked out, the better the prognosis

Oh yes, just wanted to add that DS2 ALWAYS followed/follows a point and turned/turns to his name. Just wasn't very intersted in sharing info with us, although that has vastly improved now. Eye contact is hit and miss. If he wants to tell you something, he has fab eye contact. If you are trying to tell him something, it's not so great.

We read a lot more to him and sang nursery rhymes to him to improve communication. We explained everything all the time to him. So if he said 'drink' we would extend the sentence and say 'you want a drink?' Now he says 'Want drink pees' so we are getting there .

My main reason for a ref was to make sure that if there were any probs, that they were flagged up in time for when he starts school.

yes, it does seem the quicker you act, the better! re your ds, you will of course compare him to his sibling, but they vary so much in how they develop, don't jump to conclusions from that! understand why you want referral tho, seems you have to be quite persistent in order to not get fobbed off!

Oh, I know it sounds as if I was comparing . I have a DS1 of 6.5 years and I don't remember much of his early development but I know we did not have to 'teach' him those things IYSWIM. Hence why I feel DS2 is 'different', albeit not drastically. But hey, I may be proved wrong yet!

Good luck.

I hope you get some answers soon. I wouldn't worry about whether you took him to enough playgroups or activities - they will not influence your child's development at that fundamental level. Pointing and checking for shared attention are innate behaviours - so innate that as previous posters have said, if your only experience is typically developing children, you are very unlikely to even notice it happening, it is just one of those things that is taken for granted. It is only when it is absent that questions should be raised. I don't mean the answer is always ASD but you need to find out what you can do now to build shared attention. From what you say about him following your direction, he might well respond quite quickly to some additional help.

Agree with cyber- playgroups etc make no difference at that level.

Exactly, cyber. That was the point I was trying to make, albeit not very clearly . Do not remember exactly when DS1 pointed or waved because he just 'did', just as DS3 is 'doing'. However, all DS2 milestones are logged in my mind .

dd2 19months doesn't point but she makes it extremely clear what she wants, or doesnt want, and when
i am not worried i think there are many ways of communicating your needs, pointing being one of them

what sort of things could i be doing to encourage him to communicate better?

If you can afford it I'd really recommend hoping onto that online floortime course. It works with anything from mild delay to serious disorder, and is easy for parents to implement.

A cheaper way of learning about Floortime is from the PLAY project DVD although it looks as if its changed a bit since I last saw it.

Floortime isn't just for autism, it aims to get in and tackle any sort of delay/deviation - it doesn't work on a diagnostic label iyswim- it's just about playing effectively with children at risk of not developing 'optimally' (and I would include my NT ds3 as someone who would benefit from floortime).

Try to build on what he can already do - if he follows your direction/point, praise him and say 'yes that's x'. You haven't mentioned how he is for copying/mimicing but you could try encouraging him to copy you more - clap hands and ask him to clap hands, put your hands on your head then gesture to him to do the same. What does he do now if he wants juice or a biscuit? How does he let you know?

he doesn't ever really ask for food or drink tho he's more than happy when he gets it! he does copy me sometimes, other times not interested.

for example, when he walks independently, dh and i would clap and cheer him, and shout "yeah, yeah, yeah Tom!" he really laps up the applause, big beaming smiles and strutting about to get more of it, and says "yeah, yeah" himself. it's this sort of thing that seems so unlike my understanding of autism! plus from about 9 months, whenever we are out in restaurants and cafes, he likes to play a game of smiling at someone nearby til they smile back. he's not disinterested or wary of people, far from it. fogive me for going on, am a bit fraught.

Don't panic about autism yet -really- not just on lack of pointing (it's difficult because it is a red flag that needs to be followed up but it doesn't necessarily mean anything awful either now or later) think of it in terms of different potential developmental pathways from now on. If a child isn't pointing by 18 months it just shows a weakness in one area of understanding about communication. It does not mean that a child has autism or will become autistic. You can help overcome that weakness that's all. The child might overcome it anyway whatever you do, but it's better to give some help via play.

Imitation is a really important skill as well, you can encourage that in lots of ways, by copying him for example. He may well be imitating well anyway. I didn't realise that ds1 wasn't imitating- I thought it was normal to have to teach things like drinking out of a cup or using a spoon, hand over hand - although ds1 would join me in nursery rhyme type games quite happily, his lack of imitation was more fundamental and was impacting on his learning.

The book Babytalk by the late Sally Ward has some good games that encourage communication in it and is easy to follow. Lots of good ideas in there.

If he's enjoying and responding to attention and saying 'yeah yeah' , that would seem to point away from ASD. ASD is an enormous spectrum and so is the normal spectrum. Many ASD children do things that they are not 'supposed' to do and many normal children do things that are 'supposed' to be autistic. My nephew used to line up cereal boxes obsessively all day and when he was older, he would talk obsessively about bus timetables. However he met all the milestones and hasn't had any problems socially or academically in later life. (he's 12 now). You could read the CHAT test questions yourself and think about them in relation to DS. I can't remember the age it is meant for but 18 months is probably at lower end of the age range so will be less reliable. The things you mention could still be nothing very much in an 18 month old but if still seen at an older age would be more significant.

The CHAT test is meant to be taken at 18 months. If a child 'fails' it should be retaken at 19 months (so one month of watch and wait) but referral to a waiting list could be pushed for from 18 months.

My son likes people (always has). He's pretty sociable. Is interested in new people - tried to force a new tutor to go and work with him yesterday- she was there to meet us/have an interview. He has real difficulty sustaining interactions though. So he's always been smiley, always enjoyed nursery rhymes etc, but would have had trouble when we started with more back and forth type pretend play. Especially if I tried to introduce and idea, he might have shuffled off to do his own thing. That wasn't really that noticeable until he got closer to 2 and over though.

here's the CHAT test and it tells you how to score it. Also a good introduction to what it's telling you and what it's not telling you. Remember it is not diagnostic. It's a great tool for identifying children who could benefit from a little bit of extra input, but it is not an automatic awful diagnosis if all areas aren't passed. You could take this along to the HV to discuss.

First signs is a pretty comprehensive website, although could send you into panic mode unecessarily. Remember its really hard to distinguish between normal and disordered development in such a young child. I was still hawk watching ds2 and ds3 at 18 months and wasn't entirely sure either way until they were older.

Oh they have changed it a bit (they used to ask you to point at something and see if they child followed a point). I can see why the new version would be more accurate.

The scoring is more complicated than it used to be. The link gives you the 'failing' answers for each question. If a child 'fails' 3 overall, or 2 of the bold answers then they are deemed to need an eye kept on them. DS1 would have failed on 6, 7 and 13 at 18 months. DS3 at 16 months would have failed on the pointing (6 and 7) but was fine on everything else and would have passed the CHAT reading their new scoring system.

Yes that's right, I think the CHAT test was designed for the 18 month old sliblngs of ASD children - to see if the symptoms could be seen at an 'early' stage. Most parents (who don't already have an ASD child) start to have concerns around the 18 month mark but often don't get the assessment until the child is older. DS2 was dxd NT at 6 months because he was there at DS1's assessment. I don't know if it was meant seriously but the prof did some basic tests with him and said 'Well at least you don't need to worry about this one'. I never thought he was ASD anyway because he was so obviously different and just like the babies in the books that I used to read about the first time around.

Just wanted to add that I agree with Yurt1 re the autism/asd thing. For what it's worth, I don't think that DS2 has autism/asd, as he does not tick enough boxes on the triad of impariments (well, in my opinion anyway) and he has always copied/imitated. However, he obviously had/has mild communication problems in terms of speech and language and that was picked up because I noticed the lack of pointing and speech (as I said before, the pointing/waving issue was resolved way back).
We have seen real improvement in his communication and now he is almost three and understands most of what you say to him and can talk so I am not so worried.

BTW, when I mentioned in earlier posts that we needed to 'teach' him things, I meant that we needed to make more of an effort to show him rather than letting nature take its course.

Please try not to worry (easier said than done I know)

thanks posh paws. we've been away for the weekend and met up with friend of mine with pades experience - he gave me his opinion quite robustly that he had no concerns which has helped. also, now have actually seen ds do a number of things i wasn't aware he could do - waved at his grandma today for example which i hadn't seen before.