No Comprehension skills 18 months?

For everyone who is suggesting a hearing test, surely he should be able to follow visual instructions Or examples eg when I show him how to stack 2-3 blocks or cups, he refuses to do this? He has another toy where you do different things to make an animal pop out of a box eg push a button, twist a button, move a button wide to side. For the longest time he would only do the one where you push the button despite my always showing him how the others were done and has only in the last two weeks started to do the others...

This demonstrates a lack of copying - mine are the same. They can work out how to do complex things themselves but they won’t copy what I do basically ever. Just doesn’t occur to them to copy what I’m doing

Today one of them was saying bababa to himself over and over again so I copied him. He then did it again, and then pointed at my mouth to get me to do it again and we went back and forth about six times.

This is really new for him, and is the sort of early communication that builds language skills - it’s a little conversation.

I’d recommend looking at intensive interaction - essentially where you copy him rather than getting him to copy you. If he’s stacking cups, you stack cups. Copy his actions and his sounds. We’ve got a lot more awareness from them than they had previously using this technique.

It gradually worsened between 12 and 18 months - he was squinting a lot by then, and now it’s constant. He has something called optic nerve hypoplasia but they don’t know if the squint is related to that or a coincidence. So it was mainly found by accident, and then a MRI to confirm also found some minor damage to his brain. He’s quite a complex one!

Regression is a strange thing - DT2 literally stopped mimicking, using basic words, clapping, playing with toys pretty much overnight. DT1 it was much more gradual to the point where we barely noticed it and just thought he was becoming more interested in new things, but he just stopped paying any attention to anyone quite slowly.

It’s not your fault. A typically developing child will pick up language regardless - I had the same fears since I had twins and figured they weren’t getting enough individual attention but all the other twins I know were picking it up anyway. It’s not your fault, I promise.

It’s really really hard to know especially at this age.

At 18 months when DT2 suddenly regressed pretty much overnight we knew something was wrong and contacted his paediatrician right away. A few people gently suggested that something might be going on with DT1 as well and I completely dismissed it at first because he was so much further ahead with so many things - okay he didn’t point or share attention but he had so many amazing skills, I figured some were just further behind. He scored medium risk on the M-CHAT at that point.

The HV did his 2 year check when they turned 2, and I went to a drop in SALT session just before their 2nd birthday, as neither were talking or understanding. I bought a book about autism because of DT2 and realised very quickly that this book described DT1 to a T.

Now at 4, DT1 is basically the dictionary definition of autistic, and DT2 is the one with more understanding and attempts to vocalise.

It’s such a confusing condition to get your head round and there’s no straightforward way to know. Profiles can be spiky - so if you look at a milestones profile there’ll be some they’ve achieved but gaps where they’ve just never learnt particular skills. This is why professional input and assessment is so important.

I know other parents who have children with very similar issues but they have other conditions. They’re now starting to think that DT2 might have a metabolic condition either rather than or in addition to ASD. He also has a visual impairment we knew nothing about other than he had a squint - it wasn’t until we saw an ophthalmologist for the squint that we found out about it.

So my advice is always to get a professional opinion - it can be a battle for some but worth continuing with where there are concerns.

My DD was the same as your DS when she was 18mo. My older DC is on the spectrum so I let the HV know my concerns with DD when she was 12mo and the HV made regular visits and phone calls to check how she was progressing. By 18mo, HV agreed DD needed investigating and referred her to SLT and a paediatrician. DD is now 27mo and the paediatrician agrees ASD assessment is the right course.
Btw, I thought my DD made good eye contact until the paediatrician pointed out she doesnt and showed me the ways DD avoided it, which I would never have picked up on! But she's trained and I'm not

Sorry, I see you said other autistic children, not just one. But the point still stands sorry

I echo other posters who suggest pushing for assessment. If it turns out he has a spurt and clearly doesn't need it, all well and good, no harm done. But in some areas it can take a while to get down the list, so getting on the list asap makes sense.

I would be particularly assertive about this because you say your son scored a medium risk on the MChat questionnaire - I know this is only a rough guide rather than a diagnostic tool, but my son also scored medium risk on that and he was diagnosed with HFA at three...

And with respect @Landladymews, you think your son doesn't present as autistic based on your experience with your DH's niece. There is a really wide variance on how kids with autism "look" to others - see SinkGirl's twins as an example - and you really can't judge just from that. Not saying your DS is autistic, of course not, but some of the aspects you mention are causes for concern, so seeking assessment purely on that basis is a good idea. As PPs have said, early intervention is key; a lot of neural pathways are being formed in the infant years so spotting issues and addressing them with therapy etc is really important. It's great that you're on the ball and picked this up (rather than being concerned but deflected by other people's well-meaning "oh he's fine, they all do that").

I wouldn't "wait and see" at this point though - early intervention really is important. With the language delay and the MChat result I'd get the ball rolling with the HV this week.

Not pointing in itself isn't a sign something is seriously wrong, especially if he is demonstrating shared attention in other ways (bringing you things to show you, calling you if he finds something interesting in the garden, looking at the crying baby and then looking at you). Pointing is just one example of shared attention and tends to be one that lots of children do.

Even if he's not developed joint attention at all yet, that isn't in itself a diagnosis of something being seriously wrong - it's just an indicator that there could be a developmental delay.

Don't underestimate the impact hearing impairment has either - even mild hearing loss like glue ear can have a huge (but temporary) effect on children's behaviour. I've met many young toddlers over the years with a query of autism who turn out to have glue ear.

My son was very similar at the same age, would just stare blankly when asked questions or to do things, but I knew he understood what we were saying he just didn’t act on it, he was always just happy doing his own thing. That probably sounds odd but as a Mum sometimes you just know. He was referred at two as he didn’t speak, had very limited eye contact, wasn’t comfortable in social situations, although by this age he was able to follow our requests so he did come on a lot in that time but not to anywhere near where my other children were at that age. He was assessed for ASD and they didn’t diagnose him with anything and in the end they just felt he was delayed. By the time he went to school he was speaking, and was in normal range with development. He is nine now and has quirky speech and is very adult in his language and social skills, and I always feel sees the world slightly differently but he is very bright and is not in any way behind his friends now and had no issues at school.

I’m so glad we had early help with it all. Lots was put in place with his ore school and all really helped his development. I would absolutely consider sending your son as for us it was the key to unlocking what was going on inside and my son blossomed when he had to come out of his bubble.

OP, we have Child Development Clinic's where the children see Paed Cons, OT, SLT and physio all in one day. Ask your GP if that's somewhere your child can be referred. Might also be worth seeing a Paediatric SLT privately if its something you can afford. Good luck!

[quote Landladymews]@doadeer what are you concerned about with your son if you don’t mind sharing? my HV was pretty useless too in the early days so I haven’t contacted her since. I have private medical cover but not sure if they would cover seeing a paediatrician for this. I guess I should find out.[/quote]
I think private health insurance would cover a paediatric investigation. Do go for that.

There probably isn't anything wrong with your son but it is worth finding out. Even if not profoundly deaf, he could have some hearing impairment. A lot of little ones have 'glue ear' and need grommets. Bless him.

I hope all goes well. I agree with you and others about Health Visitors - generally useless.

My DS has a small congenital deformity what I noticed as soon as he was born. It took 6 months of me pointing it out to even the experts, let alone family members, who all reassured me it was nothing, until finally his paediatrician agreed there was an issue and referred him appropriately. Later investigations eventually discovered he has a rare chromosome abnormality. This is so rare that it’s impossible even to know if his congenital deformity is a result, and similarly his possible dyspraxia could be linked or it might not be. But at least we’re in the system now because I pushed so hard initially, despite my husband actually asking me to stop bringing it up to doctors when he was tiny, because ‘it’s embarrassing when he’s actually fine and they keep telling you he’s fine.’

It could be nothing but I'd start the ball rolling with getting investigations under way as the waiting lists are huge and early intervention can be really useful.

Does your child go to nursery? If not it might be worth booking them in for a couple sessions a week. An experienced nursery team are aware of where there might be developmental delays or differences. Although they can’t make an official diagnosis they will help with referrals if these are needed. They can also reassure you if behaviour/development is in the normal range.

*delays in receptive (not delays and)

If you are worried about ASD you can do the M CHAT questionnaire from 16 months and if necessary use it as a way of pushing for a referral
www.autismspeaks.org/screen-your-child

My son who has ASD and another genetic condition had both delays and receptive and expressive language at that age. He was and is very sociable though but struggled with imitation. He also used to take my hand to press buttons on a toy etc rather than press them himself. He also showed some sensory behaviours at that age - hand flapping, watching wheels spin and bumping into things for sensory feedback.

His issues with imitating were a major contribution to his language delays. I recommend the book 'building verbal imitation in toddlers' which gives lots of practical things you can do.

Sorry got carried away....

There are very good YouTube videos on how to do hearing test at home. They get different household products (I remember there was a can involved) and make noise just behind the child's ear while the child is distracted playing