Joint attention deficit anything but autism

[gaelle79]

Hello everyone,
I posted here before about my DD. She is such a mixed bag that it is difficult for people and me to figure out what's really going with her.
She doesn't point at all and can't follow a point either.
On the other hand, she has some pretend play and imitates people in their daily routines etc.
Now I'm wondering if anything else than ASD can cause an impairment in JA ?

how old is sge?

sorry what is ja and hiw old is dd

Hi OP.

I'm not sure how old your DD is but I wouldn't base anything on just not pointing. My son doesn't really point either but he does follow a point and its very easy to get his attention. He responds to his name right away, not just from us but to anyone who calls him.

How is she with other people? Does she play and interact with other children?

If she is over 18 months then pointing to objects of interest and following a point is really important. How old is she and who has assessed her?.

OP, as you mentioned posting about this before, I did a search and indeed this is all you have posted about. Unfortunately, you apparently live in France so much of the information that people may give you will be UK-centric. Obviously, development markers should be more or less consistent but people will advise health visitors, etc which are not relevant to you. On one of your previous threads you said your DD was having hearing tests and being seen by a consultant, what has happened as a result of that?

I think people would like to help but it is more difficult to advise someone in a different country and you do sound very anxious. Some of what you are posting may be a concern but some sounds totally normal or just a child who will be on the late of side of normal to do some things. Do you have anyone in real life you can talk to about this?

Oh and to those who asked, OP's CC seems to be about 16-17 months.

Rather than thinking a lot about very specific criteria such as pointing, try to think about the bigger picture; does she have the 'triad of impairment' seen in Autism? (Repetitive behaviours, social difficulties, communication difficulties?)

Pointing is a really important indicator though - but at 18 months. If a child point at 17 months it's fine. If a child isn't pointing at 18 months the standard protocol here is to retest after 1-2 months and then refer on.

Do they use the M-CHAT test in France? You can get it here www.m-chat.org - this might get you a referral?

Devilishpyjamas - I have to disagree with you on that. Just not pointing on its own is not an indicator, because following a point is more important. Specialists look at more than just that to see if a child has an issue. I would know, my DS has been assessed privately by a SALT, OT, and a highly recommended developemental Paed who have all told us he is not ASD.

He doesn't really point, its very rare, but he follows a point and understands everything we say and responds to everything we say, interacts with all adults and children, pretend play, loves books etc.

Hello everyone,

DD is 16 and 1/2 months.
I was concerned but hopeful since I thought she had/has some strong positives:
Decent eye contact, some pretend play, can wave, clap and understand some words. She’s always giving us things, engaging us, likes other children and has 0 repetitive behaviors or sensory issue. She sleeps and eats well.
Her father was a late walker and talker and ended up with a bad stuttering that just got better (In adulthood) after years of ST. So I was really hoping that DD was just like her father, that eventually, she would be fine.
But she’s coming close to 18 months and when I look back, I realize that she is exactly as she was at 13 months. No progress whatsoever in months.
And the more I read, the more I realize how important joint attention is in autism. It seems like it doesn’t matter how many positives a child has, if he lacks the ability to point and follow a point, he’s autistic. I even thought at some point that her “positives” could mean she will be on the “mild” side of the spectrum. That is also untrue. She could end up being severely autistic anyway.
I took the mchat and she scores 6/7 (not sure how to respond to one item).

Does she walk? Does she show interest in books when you read with her?
DS, now 6, didn't point at 18 months but is doing very well at school now.
I remember getting stressed about the pointing but I guess every child is different.

Unfortunateevents: we have to retake the hearing test. The results were bad but then the MD found out she had a double otitis. She did not cry or complain before (not a good sign here han?). The PT who saw her said she is not ready to work and needs help, the ST can’t say anything yet and the developmental pediatrician want to see her again in 2 months.
OreoDream: I know about the triad and to me (could be wrong), as off today she’s impaired only in the communication department. Problem is these things are tricky. For example, to me, she has good eye contact but now I’m second guessing this. Once or twice, I heard people saying: “hey look, she won’t look at me” and then laugh because they think she’s just playing shy. Is she? Am I overestimating her eye contact? Anyway, from what I understand the lack of pointing is just an early screening marker. The “rest of the triad” can quick in later on (closer to 2 yo)
Mscongeniality: can you please tell me some more about your son? How old is he? What’s his dx then? I agree with you on the importance of following someone’s point. I was really focused on HER lack of pointing and just recently came across an article saying that JA works like language: you have the receptive language and the expressive language. A child who lacks expressive but has good receptive is probably fine, just delayed and will catch up but a child who lacks both has an underlying condition. Same goes with JA. A child who can’t point but can follow a point his less impaired than a child who can’t do neither.

I’m not a specialist at all and don’t want to come across as a no it all. What I’m stating her is just my understanding of the numerous medical papers and posts on different forums that I read.
I can be totally wrong (hope I am actually) so if you can enlighten me, please feel free 

Unfortunateevents: we have to retake the hearing test. The results were bad but then the MD found out she had a double otitis. She did not cry or complain before (not a good sign here han?). The PT who saw her said she is not ready to work and needs help, the ST can’t say anything yet and the developmental pediatrician want to see her again in 2 months.

OreoDream: I know about the triad and to me (could be wrong), as off today she’s impaired only in the communication department. Problem is these things are tricky. For example, to me, she has good eye contact but now I’m second guessing this. Once or twice, I heard people saying: “hey look, she won’t look at me” and then laugh because they think she’s just playing shy. Is she? Am I overestimating her eye contact? Anyway, from what I understand the lack of pointing is just an early screening marker. The “rest of the triad” can quick in later on (closer to 2 yo)

Mscongeniality: can you please tell me some more about your son? How old is he? What’s his dx then? I agree with you on the importance of following someone’s point. I was really focused on HER lack of pointing and just recently came across an article saying that JA works like language: you have the receptive language and the expressive language. A child who lacks expressive but has good receptive is probably fine, just delayed and will catch up but a child who lacks both has an underlying condition. Same goes with JA. A child who can’t point but can follow a point his less impaired than a child who can’t do neither

Paperthinspider : no she doesn't walk, only cruises. We are seing a PT who said she's not even close to walking because she has 0 balance but she refuses to say how long it could take her to get there.
She likes books but will spend most the story time turning the pages :)

F1ipFlopFrus you're probably right. If only i had never googled so much

Miscongeniality - you will see I linked to the M-CHAT test - which assesses following a point and pointing to objects of interest (along with imaginative play, understanding, ability to imitate and responding to name). I have a severely autistic son, am a researcher in autism and am about to train in SaLT (!) pointing is an important screen - no it is not diagnostic - but it is important.

OP - it sounds as if she is too young for services to be willing to diagnose but you might feel better doing some bits and pieces with her. If she is able to imitate introducing makaton will help her communication. If she struggles to imitate then hand over hand PECS or a communication app may help - all of this is easier with a therapist on site. TBH supporting any difficulties is more important than dx.

FWIW at 2 I was told my son definitely wasn't autistic as he had good joint attention, good eye contact and a good sense of humour (wasn't pointing or imitating though) - he's actually severely autistic. What really helped him was finding communication that worked (PECS in his case) - that was far more use than the diagnosis. I know it's hard but if you can put thoughts of a dx to one side for a few months it might help.

If you don't want to get into makaton etc yet (which is fine) then looking up games that encourage communication are good. The book
Babytalk by the late Sally Ward is still excellent.

Oh and if you can the Makaton nursery rhyme video by Dave Benson Philips it's good - all my kids loved that.

Babytalk
www.amazon.co.uk/gp/aw/d/0099297205/ref=dp_ob_neva_mobile?tag=mumsnetforum-21

Makaton Dave www.makaton.org/shop/shopping/stockDetails/Nursery-Rhymes-DVD

Devilishpyjamas - you're right that it is important, but not on its own. It has to be the lack of pointing along with other things that can indicate a problem. I have taken the MCHAT for my son and the only thing he doesn't do much of is point at things of interest, and despite that it comes back as Low Risk and 'no cause for concern'.

Gaelle79: I've been tracking my sons progress on this thread if you want to have a read. I started it when he was maybe 18 months actual (he's a premie). He's turning 2 tomorrow and he has made a lot of progress now.
www.mumsnet.com/Talk/behaviour_development/2793821-Did-anyone-have-a-child-with-limited-understanding-at-18-20-months

Feel free to PM me if you need to chat. xx

Oh and my son doesn't have any diagnosis (yet anyways) and we don't think he will be getting one. He just struggles with some sensory stuff due to being a premie, but nothing that is impairing him from interacting and learning.

That's great she turns the pages when you are reading, if she is cruising then I'm sure it won't be long before she walks.

I know that mrscongeniality - but my point was it shouldn't be dismissed (as people often do - I was told not to worry about lack of pointing by almost everyone - in fact it was extremely significant in my son's case - particular as he was showing joint attention in other ways and the fact he was affectionate & had good eye contact seemed to throw everyone).

My son's original diagnosis (at just under 2) was mild language delay - in fact this was a complete hindrance as he then got stuck on a waiting list for mild language delay type interventions - when in fact he was severely autistic and needed proper intervention. I'm not sure how they got it so wrong really. Having said that I think watching and waiting in terms of diagnosis is very appropriate at this stage - some kids who looked very much worse than ds1 aged 2 have gone on to do an awful lot better.

More important than the diagnosis is communication games. The thing that really held ds1 back was an inability to imitate (it means you can't learn anything by watching and have to be taught hand over hand). Although no-one tested that so it took us a long time to realise he couldn't imitate. If imitation is in place something like Makaton Dave or Mr Tumble or even just using some sort or sign will bring communication on loads (along with hands on games - Makaton Dave is a good way for adults to learn makaton as well). If imitation isn't in place it all becomes a bit more complicated (but you can teach it & you can teach other comunucation systems) - but it is one of the most important things to start with.

And I don't know about France but the Americans are much better at getting in with toddlers and getting them going on communication aids than us Brits. Ds1 didn't get a proper communication aid until he was 12 (although to be fair iPads were only just invented then). I often wonder how different his life would have been if he had had access to one at 2. It might not have made any difference at all but when he did start using it his expressive language development came on on a very toddler like/natural way - if that had happened at 2 rather than 12 I can imagine it might have been significant.

@Devilishpyjamas: I don't know if my DD has proper imitation skills. I mean, if i do something with a toy or a tool and hand it to her, she will do it too. But if i make a funny face, stick my tongue out or make a sound, she won't do it back, will just laugh. The other day, my mum was doing her yoga, she came next to her and tried to do the postures does that count ?

BTW, would you mind telling me how your son was at her age ? Dis he have other signs beside lack of pointing ?
And how is he doing now ?