Concerns re nearly 2 year olds' attention/concentration

[socksforchristmas]

Hello

I have some concerns re my nearly 2 year old ds. Similar concerns are also being raised by nursery. He's very hit and miss responding to his name, it's 50:50 if he responds to me, but at nursery they say he never responds. They also say it's very difficult to get his attention, unless something he wants to do like painting, otherwise he just ignores them. He does respond to me at home, although sometimes I have to ask more than once. Nursery are also worried he isn't following simple instructions, although he does at home e.g. get your shoes. His understanding does seem behind and he says very little, although he uses lots of gestures and points etc as well as good eye contact, reciprocates smiles etcs.

What I can't understand is why he will respond to me, but not nursery. This also happens with grandparents, he always wants to be with his grandad and does what his grandpa asks like getting his coat/drinks/toys but then acts as though his grandmother doesn't exist, completely ignoring her. It's seems like he just decides he's not interested in someone or something, and will just act as though they don't exist?

[Kle209]

Have you had his hearing checked? Is it that he can’t hear as well at nursery because there’s more background noise?

[AladdinMum]

Yes I would also suggest in getting his hearing checked (he might have a build up of fluid which is very common at that age) - he might be able to hear only some voices (pitches) clearly while others may be muffled.

[socksforchristmas]

He has a hearing test booked for next month, which nursery are aware of. I have also wondered about his hearing and had considered background noise - but then was confused about why he ignores his grandmother, but perhaps it's the pitch or tone of her voice he struggles with.

I get the impression they think this is more than his hearing, as they've put together an IEP for him and have started to use a communication book. They have also mentioned that he 'hand leads' sometimes to get someone to help him, which he does at home but more so to get me to go with him ie he wants to go downstairs. If he wants a toy or a drink he points to it and makes 'uh' noises

I'm so confused. I feel like nursery suspect he's autistic. While I definitely agree he's behind, he is so sociable and does most of the things that if they were missing would be considered a red flag. As I say he points, waives hello or goodbye, blows kisses good bye, follows simple instructions, great eye contact, points to share an interest, looks back to me in unfamiliar situations or while sharing something... but he doesn't seem to want to do any of this at nursery, which is why they are concerned. I will of course embrace any support they give, but i just feel so confused by him

[socksforchristmas]

Thank you both for your responses

[Kle209]

I think it’s great that nursery are being so proactive! Even if he suddenly starts doing everything at nursery (and of course that’s very possible!), it’s a sign of a brilliant nursery that they are being so supportive to him.

My son had(s) glue ear and once it started improving (on its own with no intervention, just time), I’ve seen such a change in him. If they do have hearing loss due to glue ear they have to concentrate really hard just to work out what’s going on, assuming they’ve realised that something is happening in the first place.

I would try very hard to take things one step at a time, though I know it’s really hard not to worry. I would say until you have the results of the hearing test try to get his attention in other ways (eg tapping, or waving) and see if that helps - doubt it’ll hurt!

[socksforchristmas]

Yeah I completely agree re nursery - they are brilliant and I am so pleased we chose them. His key worker really spends a lot of time helping him and I'm definitely up for any help they offer or suggestions of things to do at home. It's hard not to worry and I just want to make sure I'm doing everything I can to give him the best start in life

Glad to hear things improved for your little boy!

[AladdinMum]

I will first wait for the hearing test results, it is not unusual for a child to be able to hear the vibration of a mobile phone in a different room yet unable to hear someone speaking to them (they just hear a muffled voice) - many times it is about the different frequencies of the different sounds.

It does sound like the nursery is being over cautious, however if they are not seeing what you are seeing at home then they are not seeing the full picture. All young children will do some hand leading - normal hand leading and concerning hand leading look very different.

[socksforchristmas]

Aladdinmum - could you explain what 'atypical' (for want of a better word) hand-leading might look like? At home he will do thinks like take my hand so I follow him to the hall, where he will point at the key in the door, then look back at me and say ' it's there!' (which he says often when he wants to show you something, he isn't able to say keys/ball/cup or whatever he's showing me)

[AladdinMum]

@socksforchristmas what you describe is typical and very normal hand leading where all young children will do to some extent. I recall reading a study where a large group of parents were asked about hand leading and where over 80% of parents reported that their child would hand lead (all children were neuro-typical). However typical and 'atypical' hand leading looks very different, sometime the differences are subtle but certainly different. So for example, normal hand leading would be a child taking your hand and dragging you to the door, and then letting go of your hand, point at the door knob and vocalize their desire to open the door or just look at you (indicating their desire for you to open the door for them). Unhealthy hand leading would be the child taking your hand and dragging you to the door, putting your hand in the door knob, and pushing your hand down so to try to open the door with your hand (i.e. your hand is the tool to open the door), without any eye contact or interaction with you. They do not interact with you as they are unable to see that you represent a source of help, they only see your hand as the means to open the door.

[socksforchristmas]

Thank you Aladdinmum, much appreciated. His hearing test is booked for a few weeks, so I will come back then with an update

[socksforchristmas]

@AladdinMum I'm hoping I've used the tag correctly and that you'll see this

I've been becoming a bit more concerned with DS, since nursery approached me and my original post. DS is sometimes following simple instructions and responding to his name, but even when I'm sure he can hear he often just seems to ignore my requests or if I call him. For example DH was asking him at the dinner table where mummy was (I was in the kitchen and could see him through the hatch) which he completely ignored - I'm sure he could hear his dad, as he was right next to him and I know he could see me. Other times he will enjoy pointing to mummy and I'll play peek a boo. It was as though he didn't ever register anyone was speaking to him - that's just a recent example, but things like that are more common than him responding to simple instructions or calling his name, although he does respond to both. I don't know if this is just his little personality or something else?

Do you have any suggestions of things we can do to support him and help him? I read to him every night while he drinks some milk, however if I try to read when his hands aren't occupied he just takes over turning the pages and won't let me tell him the story. He's also like this if I try to point out things on pages, unless it involves making animal sounds which he loves. Nursery have put together a communication book to try and help him understand his name, our names, grandparents and pets, but he's only interested in looking through the pages as the pictures and won't let you explain- 'were going to see grandma now'

Any help suggestions or advice gratefully received

[socksforchristmas]

My little boy had his second hearing test this week and it showed that his hearing is fine in both ears. Obviously I'm pleased his hearing is ok but now equally more concerned that his is ignoring anyone trying to get his attention.

I feel sure he knows his name as I've seen him look up at me when I say it, but often he will completely ignore someone saying his name as though he hasn't heard it.

He's been trying to say a few more words and in the right context. However he still ignores most people (other than me) a lot of the time.

I have spoken to the HV and she said she will try and come early to do his next ages and stages. She also sign posted to the local integrated therapies services and I spoke with a speech therapist, who gave me a few things to try and said call back if you don't see any improvement in the next 2 months.

I'm so worried about him. I just don't know how to help him.

[AladdinMum]

I can certainly see why you are confused - try not too test him too much, if you call his name for no reason too many times he will very soon start ignoring you too. Asking him where things are in the room can be fun but also try not to do this outside of a fun environment (i.e. try to make it a game), toddlers by 2YR old are very receptive and will be able to tell (by your tone of voice and setting) whether you are playing or testing them and they certainly don't like to be tested and start ignoring these types of requests. Name response in toddlers is always a bit of a hit and miss specially if they are a bit too active by nature, i.e. always super focused in what is in front of them and on the next best thing, a 50% response ratio is considered good name response and as they get older they tend to slow down. In addition don't loose sight to the fact that he has very strong positives, pointing to share with look-backs and social referencing would be very rare to see in a child with autism at 2YRS old. Why he does not do them at nursery I am not sure, it could be personality, it could be shyness, it could be lack of confidence but you cannot take away from him the fact that he is able to do them all (i.e. he would pass the MCHAT test which is considered a gold standard in autism screening).

[socksforchristmas]

Thanks @AladdinMum - as you say confusing, but lots of positives too

Could I have your thoughts a strategy nursery have put in place? They are trying to help DS learn his name (although I've explain I think he recognises his name), so they say his name with key words, so for example 'Johnny drink' or 'Johnny train'. I get the idea, to try and reinforce his name and simple words but I've had my concerns that, as you say, he is actually simply ignoring them even more? They share videos via their online platform and often he is very focused on what he's doing and not particularly interested in them when they are talking to him. I do appreciate though it's a challenge when there are other children to look after and overall we are very pleased as they are putting so much effort in with him.

At home I now only say his name when I want his attention (the HV also warned me not to over test!!) which I think is why I get a better response. I also try to repeat key words when he's interacting with me, for example bringing me his cars to look and these are the words he's now saying in context, so feel very positive about that!

[AladdinMum]

@socksforchristmas your nursery, while they seem to be putting a lot of effort with him do seem to be obsessed with the idea that there is something wrong and they 'need to help him'. I agree with you that their methods could backfire, i.e. ignoring them even more. However, the method they are using is a standard speech therapy method so there is some logic to it - but as with many of these methods it works brilliantly for some children and terribly for others. What you are doing at home sounds a much better approach for him and you are seeing results. I would continue doing what you are doing and hopefully as he improves they will see this at the nursery (p.s. him bringing you his cars just to show them to you is a very positive form of social communication). From your description of him I still do believe that his behavior at nursery is just due to personality, i.e. maybe he was just not very interested in what they offered him in the past and now not bothering too much with them (unless it is one of his preferred activities) - this will change as he gets older and his thoughts become more complex.

[socksforchristmas]

Thanks again @AladdinMum

I'll persist and hopefully things will continue to progress

[socksforchristmas]

We are seeing small improvements. Not necessarily whole words, but consistent sounds for words in context, e.g. shhh for shoe.

The thing I'm finding very confusing is that we seem to make progress, actually getting full words, for example 'no', which will be used repeatedly for a day in context, then we don't hear it again and he reverts back to shaking his head for no. One afternoon he started saying 'mum' and 'mummum' very clearly, saying it a lot, but we haven't heard it again since. He's back to grabbing my hand and taking me to what he wants.

[Jannt86]

It's so hard because generally if they do know something then they will have the desire to demonstrate that to you. However I think they do sometimes learn when they're being 'tested' and get a bit bored of it. He may also lack confidence a bit at nursery and they ought to know this really. I know so many people who say their kid was talking sentences at home way before they opened their mouth at nursery and then nursery are suddenly astounded coz they finally get the courage to come out with it there. If he's following your commands ok at home some/most of the time then his receptive language probably IS there so don't worry too much what he's doing at nursery. Another fun way to test what he's taking in is flashcards/picture books. My LG loves hers. She does take the micky with these a bit too and refuse to engage sometimes or deliberately do something wrong I'm sure but you will soon know whether he really 'gets it' You could also see if he will follow a 2 step command. Don't worry if he won't as it's an advanced skill for this age but if he did it'd be very reassuring. My dd 21MO will follow some 2 steps but has to be in the mood. A fun one she will almost always do though is 'go and do x and then come back here and give mummy a big kiss' so give that a go. I would go by what you experience at home and not put too much ownership on what nursery say as he's.clearly behaving a little different with them x

[Jannt86]

PS my dd ignores her name a good chunk of the time. I think as said above it's touch and go at this age. If you're in any doubt about his receptive language with yourself and his expressive language then the best thing you can do is try and involve your HV early and she can get things in place if she feels there's an issue xx