16 month old not pointing, waving or talking - worried

[catski]

So, I've been reading that pointing/waving are pretty important developmental milestones and can be red flag for autism. My son does neither at 16 months.

He also doesn't say anything yet (there's a lot of babble coming from him but nothing that resembles a word, or even an attempt of a word. He says "babmm" a lot - no idea what that mean, if anything!). However, we live in sweden and his father is swedish so he has two language systems to work out.

He walked fairly early - 10 months - and now walks, runs and climbs everywhere. He seems a very active, physical little boy. He seems interested in other children. He turns round most of the time when you call his name (but sometimes doesn't). He likes to come for cuddles. He seems a pretty laid back type - doesn't have any real meltdowns, isn't really phased by changes in his routine.

However, there doesn't seem to be much in the way of purposeful communication from him. I tried the pointing at something and seeing if he followed the point this morning - nada. He doesn't really bring me anything to show me (although very occasionally seems to do so) and I can't detect anything in the way of pretend play yet. Is the pointing/waving something you have to teach them, or should it come automatically? We're not really a family of pointers/wavers although I do point at pictures in books when we read them (he very much likes books).

Should I be worried? I'm thinking about making an appointment with the hv on monday, but maybe I should wait until 18 months if he is still the same???? I am so worried. Any advice would be greatly appreciated.

[catski]

I should add that my son claps, and claps when you ask him to. He seems to understand what we are saying to him. He also likes it when we play with his toys together, and he seems to play with them pretty purposefully, not just bashing them around (although there is a bit of that too). He is very good at building towers with blocks and loves blocks and stones (we call him makka pakka actually...).

He smiles when smiled at and gets upset if I am upset. Likes being cuddled and will put his hands up if he wants to be picked up.

[Heated]

That pointing thing in the milestones guide is a bit odd imo. If you're not a family of 'pointers' then why should ds be? I remember reading that and then spent two weeks pointing at things so ds would! Ds was more a blowing kisses kind of baby But dd is very good at pointing - usually an accusatory finger at her brother!

We're a wordy and bookish family but really ours only started saying single words at the age your ds is now - and we're not bilingual.

How does he respond to nursery rhymes and action songs like 'Row row row your boat'?

[tortoiseSHELL]

I think the idea behind the pointing is that it shows shared attention - they have grasped that you don't automatically know what they are looking at, so they have to show you. (I think, though may be wrong, that it is to do with them realising that they are a separate person from you, and that people don't automatically mind-read them).

Would you be worried if you hadn't read that not pointing could be a marker? If you're otherwise happy, then wait a while, if you've actually got a nagging worry then see if you can make an appointment with a health professional (don't know how it works in Sweden).

If it helps, ds2 is 2.3 and doesn't say much. He has a slowly increasing vocabulary, but I'm not worried, because his understanding is clearly there. I think the understanding can be more critical then the actual speaking. And bilingual children often speak later.

[shootfromthehip]

My bilingual friend has a DS who is 2.3 yrs and still says very little and has never been a big pointer/ waver. She also had this issue with her now very chatty 5yr old DD. You are right to keep an eye on the situation and if there are any speech or eye contact issues when he is bit older eg 2 then you should pursue things. This said, I think your wee guy is just absorbing things around him just now and will be fine. HV are always a good source of reassurance though. Good luck

[catski]

No, I would not be worried if the pointing thing was not a marker - he seems a lively, curious, thriving little boy. He doesn't seem as if he's in his own world, if you see what I mean - he very much likes company and likes playing together. However, as I said, purposeful communication (particularly) verbal does seem to be lacking at the moment.

He really likes nursery rhymes Heated - but he doesn't do the actions himself - I will have to get hold of his hands and arms and do them for him (during incy wincy spider for example). But he smiles and laughs when I start singing a nursery rhyme which he recognises and really likes the ones like Round and Round the Garden, or This Little Piggy Went to Market etc.

Another thing that he does is spins - he seems to like the sensation of making himself dizzy. He spins round with his eyes closed a few times and then tries to walk (also with his eyes closed). He also flicks his ear with his hand quite a lot. He doesn't rock however.

I'm not especially worried about the lack of speech - I know some children don't really start talking until they're two or three. It's the lack of pointing and spinning thing which has really got me worried.

[uberalice]

I worried myself sick over DS1 not pointing. I took him to the GP who assured me that there was nothing to worry about. He did start pointing around 18 months. DS2 was pretty much the same, but I didn't get myself worked up about it the second time round. He's now 20 months and pointing, but he only has 3 or 4 words. Again, not at all worried.

[jimjamshaslefttheyurt]

If he's not pointing by 18 months I would ask for a referral tbh (although it depends a bit on the system- if the system in Sweden is better then here then you could afford to delay it by a month or 2).

I told my HV that I would be referring ds2 or ds3 if they weren't pointing at 18 months and she was OK with that, although she wouldn't have referred them any earlier. They both were although ds3 not until 16 months.

[ProfYaffle]

Re the spinning thing, my dd2 (18mo) seems to like that too, but she'll shake her head vigorously and giggle manically when she stops, like she's enjoying the sensation. I assume it's normal!

[catski]

Yup, DS also laughs while he's spinning and then attempting to walk (with eyes closed!) aftewards. It's like he's really enjoying the sensation.

I'm not sure that the system in sweden is that much different to the UK - probably a case of whether you get a switched on hv of not. I think, like in the UK, you have to be quite insistent to get what you need.

I think I will go and see our hav as soon as poss and see what she says (taking my husband with me so there's no language misunderstanding) and say that if he's not pointing by 18 months then we will insist on a referral. I'm not sure if they autism/developmental specialists here or whether we'd just see a regular paediatrician.

[catski]

Hmm, I've just been reading a swedish website where one mum said her son was on a 4 month waiting list to see a paediatrician, and that there was an 18-24 month waiting list for a full evaluation. Is it the same in the UK? I can't imagine it being any worse! Her son was a little older than mine - maybe about 4 or 5 years old.

[coppertop]

At this stage I think being able to understand what you are saying is much more important than being able to speak. It's a very positive sign that your ds understands what you say.

As you mention things like pointing, pretend play, routine, and spinning I'm guessing that you are thinking particularly about autism?

I have 2 boys with autism and neither of them understood a word I said at 16mths. They didn't respond to their own name at all, to the extent that for a while I suspected that ds1 might be deaf.

It's also a good sign that your ds enjoys it when you play with him. My two boys had no interest in what I was doing and were probably happiest when left alone.

The spinning is something that a lot of toddlers do as they like the sensation. I have a dd who doesn't have autism. She loves to spin herself round. The big difference is that she can take it or leave it and also gets dizzy fairly quickly. Her brothers could spin for ages and it wouldn't affect them at all.

If you are concerned about ds1 in general then I would speak to your HV, but if you were happy with his general development until you read about waving and pointing then I would leave it for a couple of months.

Good luck with whatever you decide.

[cyberseraphim]

Pointing is important but he might just be a slow pointer. Answering to his name and lifting his arms to be picked up indicate normal development. If he wants something badly, how would he let you know? Could you try 'forgetting' something you know he likes. What would he do?

[kiskidee]

I would not be worried. DD remained was an early walker and a late talker. she had about 40 words at 2yo. She was firmly still in parallel play till well over two and didn't start to initiate conversations till closer to 3yo.

Now, at 3.5 she is an amazing talker. A good friend who is a professor of English was amazed at her progress between 2.4yo and 3.1 yo.

[FattipuffsandThinnifers]

My DS is almost 16 months and has only really been pointing in the last few weeks. It didn't occur to me to be worried about it until I started reading MN! Everything else about him seemed normal, but having started delving into the pointing thing I got really obsessed by it (I mean really, really obsessed, a couple of sleepless nights, started analysing everything he did thinking "is this autism?"), so can understand where you're coming from.

However, now that he is now pointing, the fact I thought he might have an ASD seems a bit now, as it's put everything else in perspective. If your DS understands you, copies you (eg clapping, noises, etc), that seems a good sign. Other than the pointing (and if you hadn't read about it), would you say he can communicate normally for his age? What I'm trying to say is, if it hadn't been the lack of pointing, would there be anything else that was concerning you? If not, please try not to worry yet - seems that 18 months is when to start looking into it. There are a lot of people here with real experience who I think would say the same thing (?).

Oh, and re the spinning round, my DS also did a head-shaking thing for a while which seemed bizarre, but it seems quite common/normal - perhaps they just like strange sensations and making themselves dizzy?

[catski]

Perhaps he could just be a late pointer, but he really shows no sign of it at all.

Funny you should ask your question cyberseraphim - the other evening he was very whingy - I was holding a glass of water for myself and he kept staring at it and whinging, but it was only when he stared at it and opened his mouth (as if he was going to start drinking although I was a few feet away from him) that I realised he was actually thirsty - I felt terrible that I hadn't picked it up before and the poor thing was gasping for some water. But he made no hand or finger gesture to it whatsoever. I think it's the first time he's wanted something really badly and I hadn't worked it out.

Thanks for your replies and good wishes so far though. It's not easy this parenting lark is it?!

[catski]

Ha ha - I know what you mean about becoming obsessed with it FattipuffandThinnifers! All day my husband and I have been pointing and waving (and as I said, we're not really the pointers and wavers type), and I think I'm getting more upset each time he doesn't respond!

[PookiePodgeandTubs]

I went through all this worry with my son, who is over a yr older than yours. 16 months is still really young though. Will he have an 18 month check up?

The fact that your son enjoys books at just 16 months, and shows empathy is a very good sign imo.

If a stranger walks into the room, does he look at them, even from behind the safety of your leg? If he wants something, eg, a biscuit, can he make that known to you? Does he perhaps look at the cupboard where they're kept and then back to you and then back up to the cupboard. That is apparently called joint referencing and I gathered early on that that was a good sign (as an indication that the child isn't going to be autistic).

It was always very difficult to get my son's attention, if he was absorbed in an activity of his choosing, it still is, and only the other day at his SALT, the therapist was trying unsuccessfully to get him to follow her gaze and he just wouldn't. BUT, they have still decided that he is not autistic. He didn't clap until he was about 2 I think!

[FattipuffsandThinnifers]

I kept pointing at everything too (even got DP to, even though he thought I was needlessly worrying)! But hard to know if DS finally did it because he saw us doing it or not. But when he finally did, it was out of the blue - he had shown no signs of it before, it wasn't like a gradual thing, it was really sudden.

Please try not to let this alone take over from your enjoyment of him though. Obviously keep an eye out but he still is within the normal range, and sounds like everything about him is absolutely normal and lovely so far.

Btw my DS has only just really started to follow a point properly too, so perhaps the two things come together?

[jimjamshaslefttheyurt]

Give him until 18 months and then refer (Sweden sounds a lot better than the UK).

DS1 did hold up arms to be picked up, has always been affectionate, did join in games-especially when little and didn't have any routines until he got older. The only sign that anything was up was the lack of pointing (and perhaps an over passivity). He did wave but then lost that with his words, so he was waving at 12 months but not at 15.

Of course some children are late to point and fine, - and it's certainly not in any way diagnostic - it's only a screen, but from my experience a very important one. You're concerned anyway - if something is up or needs watching observing best to get in early, if everything is fine then hopefully you'll get the all clear earlier and save on some worry time.

I would give until 18 months though- the modified CHAT test actually says to give the CHAT test at 18 months then repeat a month later if it's 'failed'.

My website isn't really added to much these days - but I have linked to useful websites etc for developmental concerns before scroll down to the CHAT links and First Signs.

[catski]

He will have an 18 month check up, but I think I will have a chat with the hv and make my concerns known before then so that hopefully we can reassess the situation at his 'official' check up.

He will look at strangers when they come into the room - often with horror! But after a few minutes he'll come out from behind my legs and investigate them further.

The whole thing about making it known that he wants something is slightly problematic because of the lack of gesturing - but, as with the glass of water the other day, he will look at it and (I think) then look back at me.

He usually does turn round when his name is called, but sometimes he seems so absorbed in what he is doing that when I call his name he almost falls over, as if it's come as a real shock to him, but he does then turn round.

Thanks for the link to your site jimjams - I will take a good look at it. Do you know if the CHAT test is a fairly internationally recognised one, or limited to the UK? Part of the worry behind this is my not knowing the system in sweden or knowing where to turn to (or even where to start) if there is a problem. Oh how I wish there was a swedish mumsnet! My word, are the waiting times really longer in UK? That's outrageous - I thought the waiting time in sweden was disgraceful enough. The woman I referred to in my earlier post ended up going back to the States (she was of american descent) and getting a diagnosis there but has since had trouble getting much help with intervention.

[jimjamshaslefttheyurt]

DS1 used to look at things, look at me etc- he could share attention in that way- and it really confused the professionals (delayed diagnosis by a year).

The CHAT is very well recognised as a screening tool. If you follow the link to my website I'd recommend Forepath as well.

Having said all that - I looked at all this when I was concerned about ds3 when he was 16 months (he was very high risk for autism having a severely autistic brother) and the tools couldn't really say much about him at 16 months other than that he needed an eye kept on him (which I knew anyway as he wasn't pointing). And I really couldn't tell. He was very similar to ds1, he wasn't the same as ds2 and he did stand out as being a bit different at classes etc. BUt even having seen it all before with ds1 I just couldn't tell. Early signs are so subtle- they can be just that- early signs, or they can be absolutely nothing.

What I ended up doing with ds3 was getting his urine tested at the autism research unit (the link is on the same page of my website as I've linked you too- under gluten/casein free diets). This showed that he had the same gut problems as ds1. He was already gluten free, although we tightened up and made sure he had none and we switched him to goat's milk (goat's milk does contain casein, but it's easier to digest than cow's and has a different form of casein that most cow's milk). The lights went on and within 2 weeks he'd started talking and pointing. It was quite odd and very noticeable.

I think ds3 came very close to treading an autistic developmental pathway (these things are not set in stone - that's why it's so important to find out what is going on as soon as you have the slightest concern). He's 3 now and doing very well, developing completely normally, goes to nursery and a childminder and they have no concerns.

The other thing you could look at/explore is Floortime. It's easy to do yourself (ish - I really recommend the online course) - it's play and interaction based, it's not syndrome specific. It doesn't matter if your child is autistic/has developmental delays/is developing completely normally it will 'work' and help them and be fun. The only difference is that it is easier (as a parent) to do with a child who is developing normally - but you do the same things and you don't need to have any sort of diagnosis to do it.

[catski]

Thanks jimjams - you are a star. I took a quick look at the CHAT test and I think my son would all five key items at the moment (pretend play/pointing). The only pretend play I've seen him do is pretending to put non-existent food in his mouth with his fingers if I'm feeding him with a spoon - not sure if that counts. He doesn't have a tea set, and never sees me making tea, so I don't think he'd do that...

I also looked at the ARU at sunderland university - I don't suppose you have any idea if they'd be willing to carry out this test on a child not resident in the UK do you? He was born here in sweden and is not registered with a doctor in the UK - nor does he have an NHS number, but he does have british citizenship (as well as swedish) and a UK passport. If the pointing/communication hasn't advanced by 18 months I may change his diet and see if that has an impact.

I had a quick look at Floortime to and it seems they are not accepting registrations for their basic online course at the moment - it seemed to have finished in May this year....gutted, I would have loved to have done that.

[catski]

Uh, I meant to say that I think my son would FAIL all five key items of the CHAT test...

[jimjamshaslefttheyurt]

He is still young- the CHAT is meant to be done at 18 months and things can change a lot in 2 months. The tea pot thing is a bit weird, bit outdated, but it's just about developing sequences of pretend play really.

The ARU can be used by anyone. It costs??? £50 iirc for the urine test, it might have gone up. The person who runs it Paul Shattock, is lovely- really lovely- he has an autistic son himself. He;s worth chatting to if you have concerns. You would need to talk to them as the sample needs to reach them within a certain time- so it would need to be posted using some super fast method.

Have a look at the Floortime Respository that I've linked to- lots of videos on there - there should be links to the PLAY project from there as well- again that has more videos. Videos are helpful as you just get ideas on simple games that can work well. There's definitely a link from the Repository to Greenspan's site - lots of free information.

And the really nice thing about Floortime is that it'sgood to do with children who don't have problems. So you don't have to worry that you're taking a sledgehammer to crack a nut iyswim.

[catski]

That's great - my parents live about half an hour from Sunderland actually so I will look into arranging it next time we are visiting Grandma's (I will probably do it after his 18 month check up if it's still a problem).

Thank you again for all the fabulous links - your website is a mine of information! My printer is presently working overtime printing off some floortime stuf....