I am wondering if my 21mo niece is showing signs of autism.

[IControlSandwichMonkey]

I'm not entirely sure what I'm asking here. Perhaps whether you think there might be some signs of autisms being displayed by my dn and whether you think it's something I should mention to my brother. At 21mo, she...

Does not point, either to indicate that she is interested in something or to ask for it

Does not bring things to you or show them to you

Does not look at things if you point and if you ask here where something is she will not show you

Does not 'play' with things. A toy car for example she will put in her mouth or drop on the floor repeatedly but will not use it as a toy. Also does not pretend to drink from a cup or use a toy phone etc

Has strange mannerisms. She flaps her arms wildly frequently and not in excitement, more in a habitual way

Does not show a preference for her parents ie does not bother if they leave the room or if a stranger talks to her/sits next to her

Does not make eye contact at all and will actively try not to look at you

She can say single words, sometimes in context but more often just the same word repeated over and over and over. SIL says she does recognise things from pictures but rarely from the real objects. She can count and recognises numbers and letters but not if asked to.

I don't know if any of this signals that she could be autistic. Her half sister, my db's dsd has Asperger's and was diagnosed recently (aged 8) and I know there can be a higher chance if an older sibling has autism.

I did wonder if maybe it could be a global development delay instead. She has been walking for 6 months but still walks like she has just learnt to take a few steps. She doesn't change direction when she walks, has to stop and turn first and her leg movements are very awkward, I can't describe them, just flat footed and as if she is following instructions in how to walk as opposed to just walking naturally.

She had viral encephalitis in August which did cause some physical regression for a time but db and sil confirm she has recovered all previous abilities.

I don't know whether to say something to my brother, or hope that the hv notices something at her 2yr check (or even better notices nothing and I'm imagining things).

I hope you don't mind me posting in special needs. I'm just putting out feelers to see if any of this sounds of concern.

Have you read up about the CHAT test? It si the Check for Autism in Toddlers. It si not a diagnostic test, but flags up toddlers who may have symptoms that should be investigated further.

i wouldn't necessarily think that the hv will notice something. I had 3 different hvs tell me all was fine for years, when I knew it wasn't. It was only when I went ot a different hv, and presented my case differently (rather than trying to get them to tell me something was wrong, i tackled it head on and said "I've been doing some research, and dd1 fails the CHAT test. I think she needs some help" and then the ball got rolling. whether it was becasue it was a different hv, or because I'd taken the bull by the horns I'll never know.

What do you think your db and sil are thinking about things? It must be tricky to be in your position - not knowing whether your input would be welcome.

Does you sil spend any time with other childrne of the same age? has she mentioned to you at all that she sees difference in her dd's behaviour?

I don't think they necessarily notice anything wrong but I think that comes down to several things. No, sil does not spend any time with children of a similar age and without revealing too much info on here was very poorly indeed when her dd1 was young and her dd1 lived with her grandparents for a little while so doesn't have historical experience of that age.

Their dd1 quite understandably pre-dx was very demanding, especially recently (since the birth of dn2) and I think they have been so caught up in trying to deal with dn1 that they haven't noticed or haven't worried about dn2's traits. They still don't seem to know anything about autism/asperger's and have chased medication to help dn1, I think in a misguided belief that it could solve everything. They certainly didn't see anything untoward in dn1 beyond 'naughtiness' and 'tantrums' until the school suggested there was something beyond nt behaviour causing the problems.

Also, as a tangent, dn2 is VERY slight indeed. Tiny in fact and I do think that her not doing many things like pointing, pretending, engaging etc seems to be acceptable because she looks much, much younger than she is. But then when I think about dd at that age, I know that had she behaved similarly it would have stood out much more.

I had thought about buying them a book about autism in general but they wouldn't read it I don't think.

I had a look at the CHAT list and it does seem that dn2 would fall down on many if not most of the criteria. And she's a little past 18 months now too.

I just don't know what to say to my db.

I would have posted exactly what SF said, and yes there are reed flags there. Just red flags, but nonetheless worth checking. The HV here doesn't bother with CHAT any more- she's not even doing a check on ds4 with two asd siblings, just totally off the system.

Has your DB got any ideas whatsoever that his child is developing a bit differently? If nothing at all I would persoanlly leave until after Christmas (I know, but we got one dx on my birthday and one just before Christmas and tbh, that was very cruel of fate) but definitely say something- the pointing for a starter is significant. Depending on what your personality is like you can either go in with a concerned 'I was reading something about babies who don't ppoint before 18 months (and its point to share interest not just to request) needing screening for ASD', or you could be a lot mroe subtle with trying to ennagge them- try and get your niece to point,make gentles emphasis on it not happening, see if they decide to walk away and maybe google before you go in harder.

The one thing I would say is that early dx is proven through research to be an important factor in a good outcome, a DX can take a good while so do consdier saying something. Maybe have a chat with your aprents, if they are about and involved?

I am sorry, idon't know what to suggest. It can be such a minefield with families, can't it?

what age are oyur children? are you close to your sil? would she take offence if you mentioned anything?

would you be able to approach ti form the angle of "I've been doing some reading, in order to try to understand any difficulties dn1 has, and one thing that keeps being mentioned is to make doubly sure in siblings. this thing called the CHAT test keepsa coming up - have you heard of it?" and then maybe discuss?

but if sil is not likely to want to hear, then I'm not sure there ismuch you can do.

what about sil parents? would they be able to introduce the subject?

In fairness though Starlight, when you know it you do have to manage how you 'reveal'- we have a firend whose child is getting an AS dx now and we have known for 3 years or so. Her ds is in the same class ds3 was in before trasnsferring to the SNU, but Mum was vulnerable so we took a gentler approach and it seemed to be right- in the meantime her ds has also gained a dx of epilepsy so the AS did indeed become secondary. Now she is able to prioritise the AS, we have a friendship that means she is able to talk to me and I am glad I didnt scare her opff in the first palce, I just chatted to her about my DS and that sort of thing.She's in goodhands though- her Mum was a pioneer of getting decent SN provision for SLD kids so the child will do well.

Yes, thats understandable- it can be a bit hit and miss trying to establish where peopleare in it all though, last thing you want is to entrench someone further into denial if they're headed that way anyway.

Thank you for the replies. This is my brother's first child. I don't think that he would for a second stop to think about his dd's development in terms of anything out of the ordinary as he has no benchmark for ordinary iyswim. I don't think he held a baby before his dd was born, let alone spent any time with a toddler.

Softly, softly doesn't work with my brother in anything. It's blunt and to the point or he misses it entirely. I get on very well with him and SIL. We've just been talking about dn1 being allocated money for respite care once a month and I think she might be coming to us for a weekend a month as she knows and trusts us and sil is very happy and keen for this to happen. So I know sil trusts me but, oh god I don't really know how to phrase this. I have a dd who is 8 months older than dn2. My dd is quite clever, talked in full sentences at 18mo, knows all colours, shapes, letters, numbers, the way of the world. Is just very bright and able. And the first grandchild on my and my db's side. She is very close to my parents too and sees them a couple of times a week (this sounds like waffle I know, but am going somewhere). I know my db would feel any suggestions from as to dn's development to be a comparison to my dd. And I understand. If I highlight anything that I see as lacking in their child, they will hear it as an affirmation of what is not lacking in mine iyswim. Ditto with my parents. If they approach it, I worry that it could be misconstrued. Am I making any sense?

I broached it with my Dad today and he nodded quietly and confirmed that it isn't just me seeing things but he admitted that he doesn't know what to say as he in particular is close to my dd and my db has insinuated a level of favouritism there (there isn't btw) that I don't want to come into question.

Sorry, gotta run, dh failing to convince dd to go to sleep. Will be back when she's asleep.

agree with the other posters, there do sound to be some legitimate concerns, but very difficult indeed to discuss these things with relatives. I would flag up that not pointing by 18 months can be a sign of a communication problem, and given the family history, worth checking out right away, given it can take ages on waiting list etc.

cross-posted. oh lord sounds terribly difficult with the family situation - and well done for being sensitive and realising that any perceived comparison with your DD could add an extra layer of awkwardness.

I have two with asd (albeit with one in between and one after) and tbh I didnt see ds3s issues for ages, I was too wrapped up in ds1's dx and Dh and I spent many hours pretty much talking ourselves out of any worries. It took a sharp meeting with nursery teachers at preschool (so 3.5, ds3 is a July baby) to get us, knowledgeable about ASD, bright enough etc to see that ds3, non verbal, in nappies and not socialising,wasn't NT. We're now 2.5 years on and he's doing well, but oh for thgose years back again for early input.
I would love them to bring abck CHAT to reassure me about ds4 who I think is doing fine (and I know a fair bit about it hteese days), but nope, scrapped locally.

I think you will need to be blunt for the sake of your DN2. 'It will be good if I can have DN1 sometimes, so you can focus on finding out if her delays are going to pass or signs of asd like they sayy in the books'.

They may but if they are like me, they will need it that blunt because I could have written something else into mopsdt things people told me until Nursery said @DS3 needs to see a Paediatrician, something isn't right'

I would say that you cannot rely on a GP or HV to see the signs many of us have sat in rooms and listed signs only to be dismissed. You need to go in with a list which says refer my child. So if the parents are not seeing the signs then they won't be flagged up and they will probably be missed assuming you even have a 2 year check (they have been scrapped in my area). Getting an ASD diagnosis at 18 months would be hard, most paeds won't commit themselves that young.

Presumably the child was under a paed for the encephalitis - this carries a chance of brain damage doesn't it - perhaps you could suggest they go back to the paed and say that she seems delayed and her walking hasn't sorted itself out and you could also say that you are concerned about other signs eg speech, play skills, social skills. I think it is important to say that it might not be autism, sometimes other communication delays and disorders mimic autism. You can also have autism on its own and normal intelligence or autism + learning disabilities. My son is also clever and could read, write, talk and count before 2, but he still has autism. I would think if she had encephalitis then they would have been told at the time there was a risk longer term and perhaps they might be more prepared than you think having been through that experience once.

Hearing news like this about your child is devastating even when you are prepared and I know that I took alot of helpful stuff people said to me the wrong way because I was hurting, so don't be surprised if you don't get a good reaction. Could you and your parents not speak to your brother together and then this might avoid the implication of favouritism / comparisons with your DD?

Just wondering about the virus - was she social before this eg play peek a boo, make eye contact etc and its stopped or was this always absent and were her milestones late before her illness?

This all sounds very familiar to me. My daughter is 33months old and was diagnosed with classic autism about 2 months ago.
All of the other posts are right though, the health visitor nor gp will probably even notice anything. When i originally took my daughter to the gp he told me that it was all due to the fact that she was premature! I had to fight to get referred to a peadiatrician.. I always say go with your gut feeling, as this is normally right.
i have no idea how best to bring up the subject to your brother, it is a very difficult thing to do.
My daughter has a lot of stims which include flapping her arms, looking at things out of the corner of her eyes, pacing the same piece of floor, spinning in circles. She also does not like other children too close to her. She is verbal, as in she can name lots of things but not actually have a converstation and still would not know the answer to what is your name? or what did you do today? etc.

Best of luck
x

Just to say, re developmental delay...looking at the CHAT test, DD, who has developmental delay, would have scored highly at 21 monthsshe had no imaginitive play, could just about walk but did not point, had no language, wasn't apparently interested in what we were looking at, did not bring toys to us, wasn't interested in other children, etc. But her paed says she is definitely not on the autistic spectrumshe just wasn't developmentally able to do the tasks required, such as isolate her index finger to make a point, or follow my finger with her eyes if I was looking across the room. So, it's definitely possible your dn could be delayed too...so I would second the advice to return to the paediatrician who dealt with the encaphalitis, or is there a drop-in SALT session at the local child development centre or sure start centre your SIL could visit?

So, it's a year later. I thought I'd come back and update. DN is 2.8 now.

I'm ashamed to say that I didn't really do much that helped. I tried buying db a book about autism so they could help dn1, asked pointed questions about whether they worried about dn's chances of being on the spectrum considering dn1's dx. DN was seen at hospital several times because she is still so very, very tiny. She weighs less now than my dd did at 6 months. She wears the same size nappies as her baby sister (9 months old). She was declared physically fine, if small but they were obviously very wrapped up in her physical development for several months. Additionally, the birth of dn3 has also taken up a lot of their time and all my interfering served to do in the end was upset db and sil who thought (as I suspected) that I was comparing dn to my dd. Which of course I am in some ways but I'm sure that dd is an average nt child and the only basis I have for comparison.

DN:

Still does not point.

Will not make eye contact.

Cannot sit still, she paces backwards and forwards.

Cannot tolerate noise and sits with her hands over her ears if there is a lot of noise.

We took her to see a play this week and the crocodile puppet came off stage and was pretending to 'snap' at the children's noses. DN didn't react. She just gazed into the middle distance, whilst trying to pace. It was honestly like she couldn't see it.

Is utterly untrained in terms of the potty (not that this isn't normal at 2.8) but sil tried knickers and dn doesn't notice if she's wet.

Does not like to be touched in any way unless she is tired.

Does not use language in context. You can 'teach' her a word ie if you repeat it several times, she starts to repeat it. But then she will just repeat if for days on end, not in any context and not talking to you or demonstrating an ability to name, just saying the word.

Will not 'play', doesn't interact, does not follow any instructions etc.

She's happy though which is why it slips under the radar. She doesn't really complain about anything, laughs (randomly) and smiles and just rushes about doing her own thing. While dn1 has asperger's and dn3 has quite difficult reflux issues, the fact that she is happy means that she isn't demanding the attention that would help.

Anyway, my db phoned me a few days ago and asked if I thought dn might be on the spectrum. His dd3 at 9mo has started clapping, giving kisses and showing real preference for her parents. Things her 2.8yr old dsis does not and never has done. DB has noticed and is worried. He asked for advice.

So what do I do? I said that I thought it was worth looking into and the sooner the better. Do they go to the GP? Or a health visitor? There's no way this is just a delay is there?

I hope you don't mind me posting here again. I'd like to help my dn. She's a beautiful and very happy little girl but something's not right.

Can you explain what you mean by imitation? Of others? Or concepts?

Hi

firstly, I don't think there is any more you could have done when you raised the original concerns. I was incredibly sensitive to any comments of my DS1's lack of speech around the 21 month mark from family members (even though I'd asked for a referral to speech therapy). I can remember snapping at my (lovely) FIL for an off-hand comment he made

From what you've said, I think it would be wise for your DN to be seen sooner rather than later.

The parents can contact the Speech and Language Therapy dept directly to get her on a waiting list. Some areas do drop-in clinics but it varies wildly area to area. Suggest they make a list of her difficulties with communication beforehand so the lack of pointing, play skills, atypical language etc. Do tell them to follow it up with a letter confirming what was agreed as unfortunately sometimes clerical errors occur and you end up not actually on the list (this happened to my son).

if they want to pursue a dx, then that is usally done via GP or HV who can refer to a paediatrician. Again there are regional variations of what happens (here they have a specific Children's centre but other areas you need to request a development paed appt). Some Occupational Therapists can do sensory assesments which may help with some of the difficulties you've mentioned (not liking being touched, noise etc). Waiting lists for that do tend to be the longest.

Also worth asking GP/HV for a hearing test to make sure there are no hearing issues.

Is your DN at preschool/nursery? They should have a SENCo and worth raising concerns with them to see if they can get an Ed Psych assessment (again if the parents feel this would be helpful - usually for getting 1:1 help in education setting).

Some areas have Portage (again not all) www.portage.org.uk/

I'm not suggesting they do all of that at once, but they are the services I am aware of.

hope it all goes well.

Thank you PolarEyes, that's all very helpful. Her hearing is fine btw.

No electra. She will not watch you, does not join in. You may as well not be there. Sort of like a much younger child who does not play with you but alongside you. She won't look at you or at an object if you hold it in front of her or point to it. She just looks elsewhere or moves away. She mostly looks down at the floor actually or up at the lights.

Not in London no. I think at this stage I just wanted advice as to where db should start with assessment. I know it's a long road and who knows what it contains. It's just starting things now and making sure that any lists she's going to end up on waiting for assessment, she is on sooner rather than later.

Just thought of another website - private Speech therapists www.helpwithtalking.com/

Depends if finances permit, but if waiting list is long for NHS SALT something to seriously consider.