No Comprehension skills 18 months?

[Landladymews]

Hi

I’m feeling quite concerned about my 18 month old who shows limited signs of comprehension when we are talking to him, doesn’t point/wave and probably as a result has no words. He won’t for example stack blocks despite my showing him how (he just likes re arranging them). I ask him if he wants milk or yum yum and he looks at me blankly. He won’t imitate words that I say. I ask him to bring me a particular toy and he ignores me.

He is sociable in the sense that he loves meeting people and babbling away (has a lot to say in his own language), makes eye contact, smiles, has lots of funny expressions etc. He will hand me toys of his own volition so I think this is an example of what’s called ‘joint attention’. He loves peekaboo. He has clapped a couple of times when asked but now refuses to do that too.

My husband thinks he’s too young for investigations and that we should wait another 2-3 months before seeing the GP.

Has anyone else had a child who didn’t seem to be developing comprehension skills at this stage? Is there anything I can do to help his comprehension? Should I push my husband to have him seen now?

@SinkGirl are you able to describe how the child who likes to be around people is different?

It’s really hard to explain without watching him in a room with other children and seeing how differently they act. Other children in general are really interested in what others are doing - so they’ll watch others (adults first, then children) and maybe start to copy things they see, whereas he is very self directed. He will seek you out because he wants a cuddle or to be thrown around (loves rough and tumble games), but much of the time he’s paying you no attention at all. Unless it’s song time at which point he will sit on your knee and be absolutely engrossed in your face and the actions. It’s really hard to explain, but it’s definitely not as simple as being sociable or not. Sorry that probably doesn’t help much!

He’s just recently started pointing and now points at everything he wants, including at people if what he wants is a cuddle or to be picked up. But he would never point to show you something, or look at you when something is funny to share his emotion.

It’s quite complicated and hard to explain!

I didnt necessarily mean that the op's child has asd(that was just what it turned out to be in my son's case). It could be many things, or nothing at all. I was just saying I wouldn't ignore a red flag, or the fact that she is worrying generally about her son's development. I also wanted to emphasise that peoples natural and well intentioned reaction is to reassure, and that family members who love the child as an individual find it hard to look at them objectively(especially if they don't see them in the context of other children outside the home).

Have you checked what are the milestones at that age?? I can't remember them correctly but talking is most definitely not one of them! Some kids may start saying one word but that's it. Some kids start talking at around 2. DD1 was a bit later but she caught up ;) there is a big variance around.

Check the expected milestones and then give it a few months either side. Your kid may be advanced in some, delayed in some. If he is very delayed in many, talk to GP.

Btw, forget about the hearing test! It is very much a luck thing....

Did it with DD1 and she got so shy and scared that the test didn't work. The doctor was terrible at connecting to kids, absolutely no clue! He wrote in the report she may have autism such an irresponsible thing to do! I should have made a complaint...

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

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.

*delays in receptive (not delays and)

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.

Thanks I did the Mchat and it shows medium risk. He doesn’t always follow my pointing finger and never points himself, doesn’t ask me to watch him or understand when I tell him to do something. I think he’s capable of imitation if he wants eg he always claps if I clap but only waved back for a period of a month when he was around 12 months and has stopped now, he also likes copying some of my facial expressions eg if I’m eating he will pretend to eat too as he thinks it’s funny and if I make sounds that he often makes eg mumumumum he will start making those sounds but if I try to get him to say a word that he doesn’t yet say he won’t.

We haven’t put him in nursery because of Covid. He sees his grandparents pretty much everY weekend. Because they’re high risk if he went to nursery I wouldn’t feel comfortable seeing them any more. Sometimes I feel like we should just put him in nursery and accept not seeing them over the winter months. It’s so tough.

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.

@Winifredgoose

I didnt necessarily mean that the op's child has asd(that was just what it turned out to be in my son's case). It could be many things, or nothing at all. I was just saying I wouldn't ignore a red flag, or the fact that she is worrying generally about her son's development. I also wanted to emphasise that peoples natural and well intentioned reaction is to reassure, and that family members who love the child as an individual find it hard to look at them objectively(especially if they don't see them in the context of other children outside the home).

Completely agree with this - often non-professional people (Eg, friends, family, even spouse) try to reassure you with the best intentions, but if you know in your gut that they IS something wrong, then this almost amounts to gaslighting and actually makes you feel worse, not better. Don’t ignore your instincts on their say-so.

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.’

[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.

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!

So I’m not a medical professional but my gut feeling based on seeing other autistic children is that he isn’t autistic. I think he’s just an overall late developer. I think global development delay is more likely. I don’t know what the outcome or long term implication of that is.

I checked my health insurance policy and it doesn’t cover developmental disorders including autism and language development issues

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.

Did anyone have a child that didn’t point that went on to not have issues later on or is that almost always a sign that there’s something seriously wrong? I think that’s what’s worrying me most

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.

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.

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").

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

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

Upon reflection I do feel like it’s my fault as I haven’t been able to give my son much time over the last 4 months as I have a 4 month old as well who I have been really focused on. I haven’t really asked my son to do much and now I’ve realised he should have some understanding of language which he doesn’t I’m starting to panic. My husband is getting annoyed that I’m expecting him to start doing things after only a couple of days of asking him to do stuff. I guess he has a point. Luckily my husband is between jobs for the next 6 weeks so I will be getting him to take the baby so I can focus on my son.

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.

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.