My friends son has lack of eye contact and his speech therapist says he does not make choices........

[mum2twins]

My friend has asked me to post this (she has just had new baby so long typing out of the window) and is looking for some reassurance or advice on some problems with her 2.8yr old DS.

Her DS was identified as having glue ear at approx 2yrs, he was not speaking and clearly could not hear at all. Following the op 8 months ago he has started to say a few single words or two word phrases. He was given some speech therapy which was play based, but his speech therapist commented that he did not make choices. We have been offering choices but still he seems unable to grasp the concept. He very rarely gives eye contact and when you speak to him he only repeats what you say. He does not seem to do any independent speech or link any words together. My friend has taken to focusing his face on her face when she talks but he is quick to look away. He babbles away as if he is trying to talk. Obviously this is frustrating for my friend especially as she now has ds2 who is only a few weeks old. Has anyone got experience of this and the choice / eye contact thing.

I can recall him doing this over our push along car which he loves and always goes for when he arrives. But mainly leads her too it I think. He will appear silently and take your hand and lead you to whatever he wants more than pointing. If this helps, these are the things I know he can do; eat with a spoon, push along trains and cars, line up cars behind one another, jigsaws, likes TV, loves opening and shutting doors.
No real interest in drawing or painting (but then his mum isn't overly creative) loves his mother throwing a ball to him. Knows & recognises places, such as when we are getting near my house etc. It is mainly things he has instigated and wants to do. It is hard to engage him in an activity as he appears to have little understanding and what you are trying to do.

He needs to see a develpmental pead.

Thanks Aloha- change of school has worked wonders for the entire family. (They even send home his clothes washed and dried if he has a nose bleed or something!)

I have a 3 year old son with Aspergers Syndrome (a form of autism). I would definitely advise your friend to take her ds to see a specialist paed. It may be that there is nothing to worry about, but if he is having some problems then the earlier he gets help the better.

The more I think about this thread the madder and sadder it makes me. I cannot believe the SALT isn't referring on- well I can as it happened to us. A communication disoorder definitely needs to be considered if only to be ruled out.

Please be aware that your friend may not get seen by a paed for a long time, so please be there for her in the background as much as you can be. We were eventually referred to a paed ('s waiting list) when ds2 was a 2 week old baby; it was a truly awful time. I don't think I've ever cried so much.

Aaah,jimjams,we are taught quite a lot actually! (smile)It's no picnic training as a salt,although undeniably there are good and bad ones as in e very profession.

FWIW, we sometimes find dev.paediatricians great on the tangible medical stuff and less appealing on more nebulous developmental issues. Seem so far removed form the day to day implications of living with such impairments.

I particularly enjoy working with child development nurse who are very clued up on preactical issues (where I am at least.)

Your ds was two weeks old on referral???
What did you notice that was amiss at such a tender age?

No mizmiz- ds2 was 2 weeks old when ds1 was referred. Ds1 was just short of 3 (he was dxed at 3 and 2 months).

Ok Sorry,misunderstood.

But mizmiz- if the little boy does have a communication disorder then to get help he needs a dx, which a SALT can't give. Sorry but I saw too many community SALTs to knew nothing about autism and couldn't recognise i. And I'm still astounded that the autism specialist told us he defintely wasn;t autistic because he was too affectinate and his eye contact was too good. That misdx led to a years delay in getting any help

I'm not knocking individual SALTS - the specialist SALT who worked with ds1 weekly for a year was fantastic (and private obviously!) but community SALTs have told me they know nothing about communication disorders (when they were giiven ds1 on their caseload - took one look at him and were like "wtf?" )

I was just thinking of the pooor mother with a newborn baby as well. It was a really hard time. Hormones were all over the place and we were desperate with worry about ds1. It was truly awful.

Well yes, to a certain extent you are right.
Communication disorders are so disparate that it is impossible to know everything. I am pretty clued up on A/AC for example,but wouldn't have the first idea what to do with a stroke patient for example (well I would but to no great depth).
I am presently doing a lot of reading to get my head around my own dd's SLI.

The sort of SALT you tend to see in a community health clinic are generic in most cases and should refer on to a specialist salt at least in particularly worrying situations.Many of these can offer a diagnosis.

(BTW,it is always worth asking what extra qualifications your salt has beyond her degree. I do not want my dd seen by the salt who ostensibly works in her school as to be honest, her knowledge is outdated
I am sorry you have obviously been let down baly,but as an aside it may interset you to know that many of us disapprove of diagnoses which makes salt and comm. disorders seem clear cut and medical which they patently aren't.

In many cases,a diagnosis serves no useful purpose,although I am aware that sometimes a (to me) arbitary label can make a big difference in the maze of bureaucracy and government speak that parents have to navigate.

Sorry,typing to pot. Very tired and have had a glass or two! Need to retire I think.

Good night!

But in the case of this little boy, if the worrying signs he is showing are an indication of his problems a diagnosis would make a huge difference to the help and support he would be getting. I do think any child who isn't playing, making eye contact, is leading by the hand rather than pointing, lining up cars, opening and closing doors, using echolalia and has poor adult directed attention should be referred on. I meant commication disorder in the narrow sense of the term. If SALTs are currently not being trained to recognise the significance of these signs then that needs to be corrected.

The same thing happened to my friend btw. She took her dd to Christopher Place when she was 2 ish and was told that she "definitely wasn't autistic" and had global developmental delay. GDD? She was walking at 10 months, climbing like a monkey, drawing exceptionally well, couldn't speak but knew her alphabet- how on earth could she be dxed with GDD?

Of all the children I've met personally with autism- her dd and my ds1 are the most classically autistic (without additional problems or without beiing very high functioning) and both were misdiagnosed by SALTS (allthough in my case it was a different SALT who said that he defnitely needed to be seen with a view to autism). I know of other cases on one of my autism lists. After HV (who are also notoriously bad at spotting anything)), SALTS are often the first professional seen- so they need to know when to refer on. A year is a huge time in a young child's life. I suspect sufficient training is not beinig done (and I suspect that from talking to friendly newly trained SALTS). There's nothing more cringy than seeing the SALT waving the bubbles in air cryng "bubbles" whilst your child inspects the sink in the corner or the room.

thanks jimjams for all your comments. It really must have been terrible for you to have gone through all this especially with a new baby. I hope now I have told my friend about the dev paed that she will persue that avenue and forget waiting for the SALT.

I am hoping that as I am not his mother, that I have missed some vital signs that would convince everyone that he is ok and just suffering from his prolonged deafness. Also, when we chat together it is easy for my friend to air her concerns which when listed may seem magnified. But I am a great believer in approaching something head on and even if there is no problem - here you have a new mum in a very vunerable postion just needing help and reassurance. Not to be told by her SALT that her quiet nature should be altered so she is more outgoing and animated!

PLEASE tell me the SALT didn't say that? Shocking. utterly shocking. Wanting to play and engage is inbuilt (realised that when I had ds2), its not something that needs to be taught. If it does need to be taught then there is something up- its not something the mother is doing wrong. I was told (by the manager of the nursery he was at- not for long!) that a) I wasn;t talking enough to him and b) I must be talkng over him......

The glue ear may be causing him to have autism-type symptoms. Is his hearing okay now? He may just have some catching up to do. Children with bad hearing often exhibit PDD-autistic type behaviours like poor eye contact, but if he will lead you by the hand to take you to what he wants, it seems unlikely that he is autistic. The developmental paed would not hurt, of course, but I would be wary of drawing premature conclusions in that direction. If he points as well, waves bye etc, then that is an additional sign that autism can be ruled out. Pre-verbal kids are often hard to 'engage'. I know my dd was.

Why Caththerese? my son is severely autistic and his main way of requeting is to take me by the hand and lead me things. Likewise he used to point in things in books by using my hand (still does). i;m always telling him to 'get a pecs" rather than drag me off somewhere.

Just wanted to add: JOSIE3 seems to think that if a non-verbal child leads people by the hand to show them what they want, this is a 'bad sign' vis a vis autism! That is the opposite to what I have heard. I read that autistic children did not do this as a rule.

Hi jim jams
look, you would know more than I, having an autistic child yourself (which I don't although my dd was mildly speech delayed).
My guess (this is tentative) is that maybe an older autistic child (ie older than two) would pick up the pointing skill, and the leading skill? But a two year old who could point and/or lead people to things would probably not be autistic?
Did your little one point and lead you around when he was only two?

but josie they do - my severely autistic son does- and the first time I saw another child doing it they were also autistic. NT children point- autistic children tend to lead then either push the hand in the required direction or place the adult handf on the rwequired object. It's what the lists call "usingan adult hand as a tool"

yes he did cathterese (sorry didn't mean josie last time). from before 2- and he used to place my hand on picture books in resp[onse to eg "wheres the dog" from the time he wasd a toddler.

Do you mind my asking: how old is he now? I don't mean to tell you your business, but if he is still very young, is there a chance he has been misdiagnosed? Reading around on speech delay.com (an excellent website, if you are not aware of it) there are many stories of young kids diagnosed as autistic who began to speak and interact more or less normally when they are three or four or even older. I have a friend who couldn't talk until he was five, and he is now a literature professor! And another friend who couldn't talk properly until she was SEVEN (I kid you not) and is now completely normal. I'm sure you know your situation best, of course, but I think the big 'A' is often misdiagnosed.

ct- ds1 doesn't point very often even now (he's 6) although will when asked to-usually using the wrong finger- but his very first point to an object of interest (using the index finger) was to a chicken accompanied by a "deedan" when he was a young 2. Children usually develop pointing skills from 9 monthish - definitely by 18 months and they then point a lot. They also follow points easily (don't just look at the end of the finger).

he is definitely not misdiagnosed. He is 6, non verbal and displays the triad in all its glory. He's also affectionate. friendly, happy, funny and naughty. But autistic through and through. A "complex little chap" as his headteacher says.

Sorry jim jams - misread your message and thought you said that your son did point things by himself. I guess making someone else point for him is different. Nonetheless I stick by my belief that autism is overdiagnosed, and that you shouldn't draw conclusions about a non-talking toddler. You just can't tell for sure what is going to happen until they are older.