Should I encourage Dsis to seek help for 2yo?

[DrBronnersWorstNightmare]

Dnephew is 2y4m. He is so unlike any other toddlers I know. He has a handful of words but just doesn't seem to communicate at all - he doesn't look at you when you speak to him, doesn't respond to his name, doesn't listen to any instruction at all, doesn't try to engage anyone else in play (adult or child). There's just no interaction.

Dsis claims his hearing is fine because he will come if she tells him it's time for a snack.

He has also has absolutely no safety awareness - will run into the road, throw himself into water etc, repeatedly.

She was offered SALT at his 2yr review but says she doesn't think he needs it. To me and our other siblings there's something just off with him, but I'm not sure - anyone got any thoughts?

Yes, is the short answer, but you'll have to be tactful to avoid offending her. You mention several things which could indicate autism, he needs to be evaluated by a professional and that process can take time. If he does have an ASD or some other social-communication problem he ideally needs a diagnosis and appropriate support in place before he gets to school.
How much contact do his parents have with other children that age? That might affect whether they pick up on differences. Does he spend time at nursery or preschool where staff might identify an issue?
If HV has identified an issue and his mum doesn't want to follow up on that you might have your work cut out.... Hopefully the HV will follow up on the concern at the 2 yr check.

You might want to look through the Mchat questionnaire with your nephew in mind and see if he raises concern. www.autismspeaks.org/what-autism/diagnosis/mchat

My first thought about what you've described is autism-spectrum, but it would probably not be a good idea to mention that to your DSis. Seeing a SALT would be helpful because they will support his communication as a whole - not just his speech but the development of all his social interactions. And if there is an underlying problem then a SALT would pick it up and point your DSis towards extra help for him. So I would encourage your DSis to accept the SALT referral, but not push too hard if you see what I mean.

I just took the Mchat and he came out high risk.

Argh, this is tricky. I was really shocked when she told me she'd refused SALT but we got distracted by my DS before I could really ask her more about it.

She has a group of Mum friends with similar aged kids and she sometimes talks about how precocious a couple of them are when I think what she's describing is normal. He doesn't go to any care settings but I think he will start nursery after his 3rd birthday.

I just think it's such a shame because even if it's nothing but speech delay, and it does seem to be more, she's not doing him any favours. I just don't really know how to broach it with her.

Do you have any soothing anecdotes of young children who had a few sessions of SALT (or something similar) and have been totally ordinary and problem-free ever since? Your own or a friend’s? It ‘s probably better to push the reassuring “it’s quite normal to see a professional about this or that, just giving your child a boost along the way, lots of people do it, I’m surprised you didn’t” line. Though you may be best off acting as a support and "listening ear" for your DSis rather than trying to initiate anything.

I do know a little girl who needed various therapies because of complications at birth. Quite a different situation though of course! I think I will just have to take the listening ear approach, it's hard because she struggles with his behaviour but also seems a bit blinded. I like your line about giving DC a boost.

It would be an awkward one to approach esp if she is resistant to any help. I wonder if you could privately contact the hv or doctors who did the two year check and ask them to discreetly ask her in for a follow up check. Maybe a step to far. Or could your mum say something. I wouldn't speculate about what you think is wrong, maybe just say if you were offered an appointment, maybe you should take it just in case they spotted something you can't that they can help with.