Worried my nephew has ASD

[usamum212]

My brother lives in central London and has a 22 month old son. They are visiting my family in the US with his wife. I have a 22 month old daughter, so I know understand the milestones for this age, and I am deeply concerned about my sweet nephew. These are the symptoms I've observed:

Speech delayed (has 8 - 10 words)
Hyperactive (does not sit still)
Very floppy, low muscle tone
Walked at 17 months
Did not breastfeed successfully
Looks at things out the corner of his eye
Crosses his fingers
Very picky eater
Falls down a lot, very clumsy
Hits himself and my daughter
Does not interact with my daughter (no parallel play either)
Repeats noises over and over
Does not like to be cuddled
Holds his hands awkwardly
Doesn't consistently respond to his name
Obsessed with wheels
No interest in toys
No interest in books

He is a sweet little boy who makes some eye contact and occasionally smiles. My brother and his wife have said nothing to me, but I suspect they are worried on some level (they exchange looks when my daughter counts or names shapes - she's very "average" for her age). But they do not seem to be thinking he has autism. They have limited interactions with other young children.

My question is, do I say anything to my brother before he leaves this weekend? In the US, they aggressively screen children at 18 months, but I’m wondering what the process is in England (I don’t know how the doctor in London hasn’t raised any concerns). I adore him and his family and I’m deeply upset about the situation. We are close, but I don’t know how to broach this subject. I’m also afraid what lies ahead for them and want to be as supportive as possible.

Any advice? Thank you!

I would be led by your brother. He hasn’t brought it up therefore I would not mention it. He and his wife are probably acutely aware of their son’s developmental differences, especially after spending time with your daughter. Just because they haven’t mentioned it to you, doesn’t mean they aren’t concerned.

Health visitors do a developmental check at 2 years old. He’s unlikely to have seen a doctor other than his GP if his parents haven’t raised concerns.

just for background: children in the UK do not have routine check ups with paeds. we go to the GP for most things and we have a 2 year developmental check up with a HV - health visitor, a type of nurse who, in my opinion is onlz fit to give weaning advice and who has very little to understanding of atypical development. Any delay is usually be due to the child being a boy (cause they talk late, don't they) or because the child grows up in a multilingual household or other nonsense and they love a wait and see approach until the child is 3 (after all, it could just be a late bloomer). and once referred and diagnosid, you get very little anyways. Maybe a handfull of SALT sessions and an OT assessment. but there is no such thing as true 'early intervention' in the UK. in that sense, your brother hasn't got much to lose.

Do you think he is aware of his DS's issues? If mentions anything, you could take his lead and gently let him know your worries. But otherwise, I would not say anything.

I wouldn't say anything at the moment. They will have noticed differences even if they are not 100% aware and I would wait for them to come to you.

I can remember casually mentioning to friends that I was concerned about DS not interacting with other children at a similar age. I received the standard oh he's fine response. You are in a good position to support them and not dismiss any concerns they raise and gently point them in the right direction.

I am so grateful for your responses - this is excellent advice. I will follow his lead. Thank you.

He does say "mama" and "daddy", and "doggie" for the dog and "bubble", "blueberries" and a few other words. Which makes me think that if there is an issue, he could respond well to early intervention. I'm afraid it is pretty evident that he is not neuro typical. Some of his words are clearly parroting a phrase over and over. He had a very difficult evening of falling down repeatedly, hitting, throwing, and crying. His parents are at their wits end.

I don't think that early intervention is aimed at fixing asd.

We had nothing on the NHS but paid privately for an ABA type intervention. DD is still severely autistic and learning disabled but it gave us tool to reach DD, to teach her the meaning of communication, self help skills etc. It was life changing for DD and us but it didn't change the dx. We never intended to fix and cure her. We just needed to find a way to reach her and to teach her vital skills.

Thank you both for your responses. We do not have autism in the family, but my best friend is a pediatrician (in the US) and she has been giving me guidance. And coffeemachine's comments are exactly what I mean by early intervention - not "fix" or "cure" but help build skills. There is a huge push here to start therapy by 2 years.

And yes, I'm encouraged by his use of words. It also could be some combination of CP or another issue (there were mistakes made at his birth, but NHS has been very opaque about it).

And you are correct, I do need to tread carefully. Everyone's advice has been extremely helpful and I am grateful.