Late developers or autism?

[Lolly2803]

Hi I've posted a while ago and wanted to wait a bit longer to see how they've developed but I still have a few worried and wanted to get some advice.
I have 20 month old twins. Born at 33 weeks so 7 weeks early. Adjusted age just over 18 months.
My DD is my main concern. She isn't talking but babbles a lot and does say Dada and Mama. She doesn't point or bring things to me except a book when she wants me to read it to her. She doesn't always answer to her name but is getting so much better. I'd say she answers more than half the time on balance. She doesn't seem bothered by other children. She is very affectionate. Very good fine and gross motor skills. She understands a few instructions and acts accordingly.

My DS doesn't point but will take my hand and bring me to things he wants. He also bring me toys and things. He says Mama Dada and Peppa and also tries to say Dinosaur. He babbles lots. He's very socialable. Good fine and gross motor skills. Understands a lot of instructions.

I have made an appointment at the GP for my DD in a couple of weeks time and they've just started going to nursery 2 mornings a week.

So my questions are. Should I be worried? About DD or DS or both?

[BackforGood]

What you have posted doesn't raise worries about autism for me.
Your twins (adjusted) are just over 18months.
Some people will dispute it, but I've come across quite a lot of twins that aren't early talkers - almost as if they can communicate with each other in their own way. Yours are communicating.

Always worth getting hearing checked out though, when you have any concerns about development at this age. I would ask your GP for a referral to audiology.

I would talk with Nursery staff about your concerns, and let them baseline the children, and see how they are in 3 or 4 months time, when they've had chance to settle and be used to being with others.

[AladdinMum]

I think you have valid concerns. I wouldn't worry about expressive language, that is the least of any concerns as speech delays are very common. The adjusted age is what counts, so from a development point of view they are 18M. Not pointing to share interests and to request by 18 months is getting on the late side specially as not pointing by 20 months nearly always means autism. However I have seen infants start pointing as late as 19M and turn out to be neurotypical. Have you taken the mchat test for both of them? you can find it online, it's the gold standard in autism screening at 18M, it's only 20 questions takes 10 min to complete.

[Lolly2803]

I haven't but I'll do the MChat for both of them and see how it comes out.
I'm not massively worried about my DS as it's literally just the pointing thing. Which I know is a big thing but he does share things with me like toys etc. Let me do the test and report back. When reading the signs of autism on google my DS has none apart from pointing. My DD has a few more but none of the behaviour things. And the last two days she's answered to her name every time. So tricky isn't it. I've also read twins can be behind in their language by 6 months. I just want to make sure if there are any issues or autism etc that I get her or them help asap. I don't want to let them down. I'm also almost 7 months pregnant with number 3! I've also read it runs in families which worries me but neither of us have anyone in our family with a diagnosis or even concerns. But I know not always the case.

[Lolly2803]

Ok so I've done the test and it says no risk for my DS but does say risk for my DD. It's difficult as it's yes or no an some of the things she does sometimes. So I just put no as a worst case.

[AladdinMum]

I agree, the pointing is the big one but they still have time to catch up in the next month. The mchat tends to be very accurate and will highlight the areas you should be looking at. Lack of speech is not even covered in the mchat because it's normally not concerning, speech is only a very small part of communication at this age.

[Lolly2803]

Ok got makes sense. Just strange that my DS isn't pointing but didn't have a risk. Although I can see the logic behind the pointing. My DD will sometimes randomly point the things in a book. Or if there is a long word in bold or big letters she will run over it with her pointing finger. So difficult to know isn't it!

[rainbowbash]

sorry you are having these worries.

I would discuss both with GP - re DS, lack of pointing would concern me but also the leading you by hand. It's not that uncommon in children with ASD.

[Lolly2803]

Oh really? I thought the hand holding was a good thing! What is the issue with hand holding? I'm so worried now. Especially with another on the way. What if they all have ASD? How will I cope! Sorry just having s tough morning.

[rainbowbash]

I don't know why it is a problem - my daughter with severe Asd never did it but I have lots of friends in the ASD world and it seems to be something quite a few children with asd do. Definitely mention it.

[Lolly2803]

Ok I'll mention it all. It such a worrying time isn't it. I don't know what to think.
Of course it wouldn't change anything for us in a sense just want to know so I can give them what they need to help get the best out of them.
I thought it was great the hand holding! Shows I know nothing. Maybe there's loads im missing. He hand holds for example say I'm in the kitchen and he wants me to play he'll take my hand and drag me to the play room to play. Or he sometimes just likes walking with me and holding my hand.

[magicroundabouts]

Leading by the hand isn’t a concern in a pre-verbal child as long as they are using other ways to communicate as well. So using your example of leading you into the play room that would be very common. Once there you would expect a child to use eye contact / gestures / sounds to request that a box of toys is opened. In an autistic child, however, you might see them use your hand as a tool. So they want the box of toys opened and they request by taking your hand and placing it on the lid, but don’t use any other forms of communication.

I hope that makes sense! Essentially it can be a red flag if it is part of a bigger picture of a child struggling with social communication.

[Lolly2803]

Hmmmm I'm just thinking what he does. So if he wants me to turn a toy on or open a box he will give me the box. Or give me the toy but he doesn't use my hand as such. Then if he wants me to read to him he will give me a book and turn the pages himself. He doesn't use my hand to do things he just gives me things or shows me things. He babbles all the time. But yer no gestures or pointing. He always answers to his name, no issues with eye contact. He will follow my point and looks for my response to things.

[AladdinMum]

@Lolly2803 what you describe is not concerning, he is not using your hand as a tool in any of the examples you mentioned. As @magic mentioned above, hand leading is only concerning if your hand is being used as a tool, i.e. a child leads you to a closed door, and instead of him waiting by the door, pointing to the handle and looking at you he would literally put your hand on the handle and press your hand down to open the door without even looking at you, i.e. you just represent a tool for them to open the door and nothing else (they do not recognise that you are a source of help that they can ask for help to open the door)

[Lolly2803]

Ahhh ok makes sense. Yer he doesn't do that. I'll mention him to the GP as I'm there anyway and as he isn't pointing.
My DD honestly baffles me. She's responded to her name every time for the last two days. Playing catch with me. It's just such a wonder! Anyway, only a couple of weeks till GP appointment. And I'll see if nursery pick up anything. They have been going for two weeks now so let's see how it goes. Thanks for all your advice it's so useful.

[cushioncuddle]

Please only look at their corrected age not the birth age. Also then take a couple of months off as they were having a tough time just being prem.
It takes until
Because they are prem do they automatically have a paediatrician. If your worried discus with them or chat to your health visitor.

[Lolly2803]

Yes you're right. I have made an appointment so will just see what happens. My DD who worries me more does seem to be improving. She was putting the phone to my ear yesterday when I was saying it was ringing and we've been playing catch and taking in turns! xx

[BarbarianMum]

The GP will probably suggest this but in case they don't, having your dd's hearing checked would probably be a good idea. Lots of little children get glue ear and that can really affect language development.

[Lolly2803]

So I went to see the GP this week. She basically said they were too young yet and not to worry. She said children don’t always point so not to worry about that either. Said children don’t always learn skills in a linear way so language, physical or fine and gross motor skills may develop at different rates. So I thought ok fine I’ll leave it for a bit as my DD is improving so much. Less worried about DS.
But now nursery have asked if I’ve ever had DD’s hearing checked so have made an appointment with GP next week where she’ll then be referred. Feeling confused and worried again! DS seems to be doing absolutely fine.

[MumUnderTheMoon]

All toddlers exhibit autistic behaviours that is why it's better to wait until they're older to investigate. Try not to worry about it too much my dd was 10 before she was identified as having autism I realised quite early on and just managed her behaviours until her paediatrician caught up with me.

[AladdinMum]

@MumUnderTheMoon what where the signs that made you identify autism early on? in mild or subclinical presentations it can be difficult for specialists to see the signs unless the child is constantly being observed (which is not possible in most cases) hence why parent questionnaires/observations are very important in the evaluation process.

[MumUnderTheMoon]

She exhibited no empathy or theory of mind. She couldn't identify tone of voice.
She didn't take part in true imaginative play.
She exhibited a lot of sensory seeking behaviours.
She didn't react to pain appropriately.
She was very keen to be in small enclosed spaces and seemed to be more relaxed when she was.

[Lolly2803]

@Mumunderthemoon how old was she when she showed these signs? My twins are 19 months corrected age. They don’t do imaginative play really. If I pretend the phone is ringing they will both bring it and put it to my ear and they’ll play in their kitchen but i wouldn’t say pretend play.
My DD who I’m worried about doesn’t show any sensory issues yet or show any repetitive behaviours. And she doesn’t recognise tons of voice and facial expressions. So if I’m smiling she’ll smile back and if I’m doing a cross face and telling her off she might put her head down or cry.
My DS isn’t pointing but does gesture to things and wave etc so I’m not worried as much. The GP said not to get too hung up on the actual pointing of things some don’t actually point but it’s more about sharing things with you. So let’s see...

[MumUnderTheMoon]

Dd was always this way. She wouldn't have cried if I was cross though and still wouldn't. I have to be red faced and extremely angry before she would realise there is something wrong. But the issue isn't exactly no response to emotions, rather it is inappropriate response to emotions. So either no response at all or an overly dramatic hyper emotional response that is disproportionate to the situation. I am also autistic and when I was a child I was quite emotionless whereas now as an adult my response can be disproportionate to the situation.

[Lolly2803]

Ah ok I see what you mean.
Sorry typo from me I meant my DD does respond to my emotions.

[Lolly2803]

So nursery have asked me to get DD’s hearing checked and she’s been referred to a paediatrician. I still have a few worries about her. Mainly around the shared interests. She doesn’t share things with me. The only thing she will do is put the phone to my ear or throw me the ball if she wants to play catch.
She’s SO much better with eye contact and always looks at me when I’m talking to or playing with her. She is super affectionate. She laughs when I laugh etc. She answers to her name most of the time. She takes a LONG time to warm up to new people and will often ignore them until she knows them. She’s getting there with instructions and will respond to a few instructions. Babbling a lot still but no words beyond Muma and Dada. What can I expect from the paediatrician appointment? I don’t know what to think to be honest. x