question re CHAT test for jimjams

[maggiems]

I noticed in an older message which had a recent one added on to it that you asked a parent whether a child now 3 would have passed the chat test at 18 months. Just wondering whether it would be possible for a child to be autistic and fail it at 18 months but go on to do it at 3. can you teach a child to point? . My DS was a bit slow to point ie about 18 months and used to use his whole hand rather than his index finger initially. However he is pointing perfectly well now at 3 and has being doing so since shortly after 18 months.He would have passed the test then. You did ask the parent whether their child was pointing now so maybe the test is still relevant at 3??

My autistic ds1 would have failed the CHAT test at 18 months but would have passed it at the age of about 2.5yrs.

IME with ds2 (also autistic) it's possible to teach a child to physically point but not necessarily to convey the meaning behind the point if you see what I mean. Ds2 is now 22 months old and will point at pictures in books but doesn't yet understand that the idea is to use the pointing to either show me something or get my attention. If there's something he wants he will still either cry or flap rather than point at what he wants.

Yes I relate to that post totally coppertop, although my dd wouldn't have passed the CHAT test at 18 months and still wouldn't today and she'll be 3 this week!!! However, she will point to pictures in books exactly like you say. The reason pointing is thought to be important (I think) is that it is a way of testing for shared interest in something. Also, autistic children don't point to things they want because they don't understand that they have to get your attention to meet their needs.

Thamks for your input. I was going to ask the question , is it that autistic children dont know that you dont know that they need something and I think you answered that Socci. Coppertop , would your DS1 have passed the test at 2.5 years without having been taught rather than doing it instinctively and would he then have understood the concept of pointing?

Maggiems, my DS1 (diagnosed as high-functiooning autistic) would have failed the CHAT test at 18 months but did spontaneously begin to point at things when he was nearly two. I am not sure that CHAT test would be used in assessment of a three year old. It was not used in diagnosing my DS1 (who did get his diagnosis when he was three).

Ds1 seems to go through phases where he stays the same and then all of a sudden seems to have huge bursts of progress. The pointing appeared during one of those bursts. It coincided with the time that he first started noticing other people so my guess is that pointing was something that he copied. At first he used it in answer to "Where is the X?" type questions. Using it to show what he wanted seemed to develop at about the same time as his language did (about 3yrs old).

With ds2 we suspected autism much earlier so were able to attempt to teach him about pointing. He was prodding some stickers with his index finger so I gave him a sticker. He thought that was great so pointed again - so I gave him another. He now knows that if he wants a sticker then he needs to point. What he can't do at the moment is to transfer that across to other situations, eg point if he wants a biscuit, a pen, a drink etc.

I agree with Dinosaur about the CHAT test not being used in assessments. Ds2 was only 21 months when he saw the Paed and the CHAT test wasn't even mentioned.

An important part of the CHAT test is that it can be passed by 18 months. If It can't be passed by 18 months then it says that the child is at risk of developing an ASD (not that they are autistic- just at risk and need further watching/assessment).

DS1 can do all the elements of the CHAT test now (age 5) but not in the free and easy way that ds2 could by 15 months. He's quite good at pointing now- even does it to show things of interest- although he tends to use his whole hand. He does at least understand that he has to point in the correct direction now (used to point anywhere).

My Ds2 was also slow to point and I think he might well have failed the CHAT test at 18 months. In fact I think he would probably fail it now in terms of pointing. He did have a period in between where he pointed a little more but nowadays he rarely shows me things by pointing and when I ask him where something is he will not automatically point in response. Along with various other things this made me very concerned he might be autistic but it has been investigated and concluded that he is unlikely to be. However I can see that the association between not pointing and autism is so strong that it still worries me even though I am really very sure he is not on the spectrum.

So why does he not point much!!!??? He has a global developmental delay especially in his motor skills and the only explanation I can come up with is that his poor motor skills mean he will do anything he can verbally, rather than physically. So he often tells me about things of interest (e.g. "I can see sheep in the field") but wouldn't usually point. He also can't follow a point very well although he does understand why you are pointing (i.e. he doesn't just look at the finger).

Maggiems, do you think that something physical e.g. difficulty with finger isolation (fine motor skills) or problems with visual tracking might have delayed your son's pointing?

Saker- remember its only a screening tool - so just says the child needs further watching to ensure they are not autistic/have communication problems. Your son is being assessed etc - with globa developmental delay he would be late to point anyway iyswim.

maggiems- do you have any other concerns about your ds? If not I don't think it is of any significance that he would have been unable to point at 18 months- its only relevant if you still have concerns about him now iyswim.

Thanks for your input. My ds was diagnosed with being longsighted at 2.5 years so that may have had something to do with the slightly late pointing. Jimjams you are right, I know logically that lack of pointing at 18 months should not cause me worry now but I am a bit paranoid. My DS had some speech and occ therapy which started at 13 months and ended at 2 because he was a bit delayed in walking and doing things like waving. Nobody mentioned it at the time and I didnt know about the significance of waving and pointing at that stage, but I now suspect that they kept an eye on him with a view to eliminating something like autism. He was doing most things within the norm. He met his speech milestones along the way, ie 12 words at 18 months , 2 word phrases and 200 words at 2 etc. He was discharged when he was 2.He is now speaking in 8 to 9 word sentances which include pronouns, plurals, verbs and past tense. He is a friendly fellow and enjoys pretend play . Sorry for the rant but when I see something about autism I always get paranoid.He is in nursery school now and doing well .Maggiems

I ran across this thread and I had to add my question. This is exactly the type of thing that is on my mind. DS was a little late on certain milestones (ie - didn't point or wave at 12 months, started at 15 months), didn't use mama or dada specifically until 13 months, didn't walk till 14 1/2 months. He used to like to play with the wheels on his toy cars. He struggled with solids As you can see, back at this stage, I was very worried.

I took ds to be evaluated. The dev. ped. had no worries about him as he was very social, engaged, connected, gave things to people, sort of showed off a little.

Gradually over the months that followed, many things fell into place. By 17 months, he waved, imitated, played appropriately. Symbolic play emerged. He was extremely verbal, speaking at least 250 - 300 words. He knew animals and their sounds, letters, shapes, the beginning of colors. His receptive language blossomed, and he would follow commands. He went through a shy stranger-anxiety phase, but came out of it around 17 months. He loves playing with kids. He knows the names and is very attached to everyone close to him. He eats everything. He loves trying new foods, loves exploring new situations.

He is now 21 months. He puts 2 - 3 words together. He's very verbal, that's kind of his area.

HOWEVER, I can't stop thinking that if someone gave him the CHAT, he probably wouldn't pass. I mean, on a really good day, he might. But he practically NEVER points when asked. If I point to something - anything - in a book or anywhere else and I say , "What's that?" he will tell me, whether it's an apple or a calculator, chances are he will know and share the word. But when we look at a book and I say, "where's the apple?" He will just look at it but he won't point.

He occasionally points to things in his environment that are interesting - a star, a picture. This will be accompanied by his telling me, "star! oh, yeah!" or whatever else he is excited about. He sometimes points to things that he wants. But it is a very infrequent sometimes.

He is much more likely to use words than to point.

Also, he was a whole hand pointer until 16 months, then for a few months, pointed with the finger isolated, now pointing is pretty rare and it's eratic - just as likely to be a vague whole hand gesture in the direction of something as a finger point.

Worry bells went off in my head when he was a little younger. Despite much progress for which I am so grateful, I haven't been able to turn them off completely. Occasionally, I will observe a little quirk - he toe-walked the other day for a minute, for example, he had never done this before - and I start panicking. But inevitably the quirk fades after a day, and I chalk it up to experimenting.

The pointing thing doesn't seem to fade, however.

Should I be worrying about this?

I guess the other things are pretty minor. He doesn't refer to himself as "me" yet, but he will refer to himself by his name. If I ask him if he wants something, like juice, and he doesn't, he will say "no," and will push it away. If he does want it, he might say okay, or he might just repeat "juice" in an enthusiastic way, depending on his mood. But he uses so much spontaneous speech as well that I haven't let this small repition bother me. Should it? Most of the time he will answer a question. But just today, I said, "who do you want to play with elmo or grover?" and he just sat there and said nothing. Anything he needs or want, he asks for by name.

Or one more thing, recently, he started pulling his dad and me around by the hand a little. He will take our hand and say, "mama, come on!" and we will accompany to him to whatever toy he wants us to come to - he will direct us to "sit" or whatever it is he wants from us when he get there. This is usually when we are reading or something and he wants us to come and play with him.

The people who know him and see him - family, sitter, friends, other moms, ped - think I'm crazy and he is doing great. And I recognize that he is doing very well in the verbal area. He is also social, which is great (I worried so much during the shy phase when he would back away from other kids, but this only lasted a few months and coincided with the time he started walking).

I am a first time mom and prone to worry to begin with.

I just don't know what to make of this pointing thing.

I see other kids pointing all the time, and ds just doesn't do it, especially not when asked or prompted.

Any thoughts?

Thanks so much.

Hi, I know that your queries were not directed to someone who shares your worries but I thought I would respond anyway.

My DS2 didnt point regularly until he was about 21 months although he did it at 18 months. Since then he has being doing it regularly. I think lack pointing is only one symptom of autism and there have to be lots of other symptoms also , including lack of social skills which your DS doesnt appear to have. Also speech delay can be one of the first things that a parent of an autistic child notices and the fact that your DS is advanced in his speech sounds good to me. Both my DS's only had single words until they were 2.

My DS2 repeated a bit too and I worried. He didnt repeat questions back to me but repeated the last words of a sentance. I have a friend who is a speech therapist but who has not met my boys and says that repetition in 2 year olds is common and a certain amount of repetition is essential for language development. She also said that limited usage of pronouns is common intil 3. Both my boys referred to themselves by their names until 2 and a half when DS1 started to say I and You. I worried of course about DS2 but within a couple of months he was saying all pronouns. he now speaks in 10 to 12 word sentances having had a big spurt since he started using pronouns . I dont think either of my DS's would have always answered to a choice question at 21 months. I think this would happen more after 2.
I'm not sure about the pulling business. AS far as I know autistic children tend to pull your hand and place it on the object that they want rather than the way you describe. My 2 DS's both pull me to what they want and order me to sit down. It would be silly of me to say dont worry as I am also a worrier but I know that i tend to latch on to one symptom and then imagine the rest. I knew when I was posting my message that it was irelevant as to whether my DS would have passed the chat test or not all that time ago , but like you I tend to panic when I read about something he should have done. A lot of people have told me that a lot of children have some autistic tendancies bt its the degree and perseverence that makes them autistic. Sorry for the rant but just wanted you to know my thoughts Maggie

Leelee - as you will see in this thread, I have also worried about the lack of pointing in my ds2. He does point in books but not much when we are out and about. He often uses more his whole hand too. We have no diagnosis for him but he is definitely delayed physically and to some extent in language and I suspect might be dyspraxic. I was interested in that Aloha wrote in a different thread (I will try and find the link) that her slightly dyspraxic 3 year old also points very little and has difficulty following a point. If there is any association between dyspraxia and pointing it is likely to be to do with poor body sense rather than a social thing. I am not saying your ds is dyspraxic but just that there may be other reasons for not pointing than autism. Plus I guess some children may just not point much - there is likely to be variation in this as in all things. Your ds sounds like he is doing well in loads of other ways so I shouldn't worry about it too much.

This is the thread I mentioned: here

Lack of pointing is a language/attention problem rather than specifically an autism thing. I would woorry about "late pointing" remember the chat test iis to be passed by 18 months (so to start pointing at 15 months is fine).

I wouldn't worry too mucch about toe walking either. It's seen in autistic (and dyspraxic) kids as its a sensory thing, but lots of NT children toe walk as well (ds2- age 3 and definitely NT keeps tip-toeing at the moment). The lack of pointing would worrry me a litttle - but only because you've picked it out iyswim- If I saw him and he was acting completely "normally" in all other ways then I probably wouldn't notice.

Autistic pulling tends to take the fomr of being grabbed - tugged or pushed to the requested item and then pushing the adult hand in the vague direction of the requested item. For example yesterday ds1 wanted a video on- I was shoved towards the TV and then my hand was vaguely pushed towards the video (not placed on the video). I've seen other autistic children do exactly the same thing. For example the first time I met my friend's dd some washing blew down and she grabbed my hand and pushed it vaguely towards the washing line. DS1 also sometiimes points using my hand- so he'll pick my hand up and place it on aa specific picture in a book .

If his play and social ineraction (wiith children especially- ds1 has always interatced failry well with adults- just blanks cnhildren), and if he can copy well then I wouldn't worry too much about pointing- just keep an eye on development (especially language) over the next few months. Who was the developmental pead you saw? If they thought he was fine- chances are he is and not pointing is a quirk.

sorry should be wouldn't worry about late pointing

Thanks to everyone who responded! I really appreciate it. I am starting to feel a bit better, as I am beginning to accept that sometimes, kids have quirks and they are just that with nothing more to it. But I will be keeping an eye. Actually, I called our dev. ped. and had a pretty lengthy conversation about my concerns with him (had to wait 4 days for him to call me back with some time on his hands, but it was well worth it). The dev. ped. will be coming to our home in a few weeks for a home evaluation as he feels this is a way to get a true sense of what the child is typically like. It's been some months since he was eval'd and I think it would be a good idea for him to see what I'm talking about in person. I will keep you posted on the outcome. Thanks again so much. PS Jimjams, since discovering this site, I think I read that you have recently given birth...CONGRATS!