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18 month old not pointing, not engaging in pretend play

(54 Posts)
smallwhitecat Thu 08-May-08 17:41:56

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FioFio Thu 08-May-08 17:48:24

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smallwhitecat Thu 08-May-08 17:51:37

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smallwhitecat Thu 08-May-08 18:03:48

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cyberseraphim Thu 08-May-08 18:11:59

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?

smallwhitecat Thu 08-May-08 18:15:23

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cyberseraphim Thu 08-May-08 19:28:43

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?

dylanthecat Thu 08-May-08 20:46:54

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.

MannyMoeAndJack Thu 08-May-08 20:56:08

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.

smallwhitecat Thu 08-May-08 22:22:43

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luckylady74 Thu 08-May-08 22:36:11

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.

MannyMoeAndJack Thu 08-May-08 23:38:00

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?

smallwhitecat Fri 09-May-08 02:04:02

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smallwhitecat Fri 09-May-08 06:23:09

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Flower3554 Fri 09-May-08 06:44:56

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

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 aloneangry, well it won't!

Best of luck.x

MannyMoeAndJack Fri 09-May-08 07:39:24

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.

yurt1 Fri 09-May-08 08:12:39

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.

cyberseraphim Fri 09-May-08 08:12:44

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.

yurt1 Fri 09-May-08 08:24:25

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.

hls Fri 09-May-08 08:41:57

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?

smallwhitecat Fri 09-May-08 08:45:53

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yurt1 Fri 09-May-08 08:59:35

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

MannyMoeAndJack Fri 09-May-08 09:02:31

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).

yurt1 Fri 09-May-08 09:04:14

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!

smallwhitecat Fri 09-May-08 09:29:25

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