Autism or Apraxia

ccollins08

My son in 28 months.  He has been going to a special preschool for speech, O.T. and I'm requesting P.T.  He has been in early intervention since 18 months. My son is severely delayed in speech.  He says about 30 words, and a couple of phrases, lots of Jibberish, and the words he does say can be very hard to understand.  His speech therapist thinks it is more a motor delay, possibly Apraxia.   We took him to a neurolgist last year around when he was 20 months and he deemed him as not Autistic.  He has great eye contact, very personable.  He plays with his peers the ones he knows, but has a hard time adjusting to new children.  He has an extremely difficult time listening to directions, and tantrums any time he doesn't get what he wants.  What is leaning me towards being on the spectrum is his obsession with opening and closing any door, (cabinets, toys, room doors, sliding glass door, any door)  He is obsessed and will do it non stop, when go to people's houses or in our own house.  We have locks on the doors in our house so he can't do it.  He also has an obsession with turning lights on and off..  Toe walks about 10 percent of the time.  Any thoughts and past experiences would be much appreciated.  (FYI, I have been a teacher working with middle school autistic students for 7 years)

greyt00

Did he have the behavior with doors at the age in which he was evaluated for autism?  For DS1 that behavior (he was into light switches first, then doors a little later) started around 22 months.  I would be concerned as well and seek another evaluation.  

FWIW, DS1 was diagnosed with autism at 30 months old.  He started ABA therapy 4.5 months later.  He has been in it for 9 months and his obsessions have calmed down some.  He is still interested in lights and doors but doesn't often obsess over them and can be deterred much more easily now.  DS1 never played with his peers, though.  It is great that your son does!  He may not be autistic (I'm having trouble remembering the exact social criteria) but he might benefit from some different therapy.

abs05

My daughter has mostly resolved apraxia. Now at almost 4 she just has some lingering articulation issues.

At 2.5 we really weren't sure. She had good eye contact and was social but she also had a lot of fears and things just seemed off. She was late to point and she stood out as being different from her peers. We had her assessed and we were told it was just the apraxia/motor planning.

She will be 4 next month and things look much clearer now. She has friends, tells stories, asks and answers questions, and she has matured greatly. Her motor planning issues are still apparent when learning new things but she seems very typical now. Because of her history I am keeping a close eye on things but am no longer overly worried.

Good luck! It may just be too soon for you to know.

ccollins08

Hi guys the opening and closing of doors, and light switches are new.  However, he does play with tons of toys correctly and he does the make believe play. He enjoys his friends that he knows (but is shy around new kids). Eye contact has never been an issue. I don't know if that is just a toddler thing.  I feel like that lack of communication is so very difficult.  For the longest time he was not even able to mimick back the words although he knew what it was .  For example Kiernan say "cat", he was not able to do that for the longest time, until he started this new school about a month ago.  The obsession with the doors and lights are concerning to me.  What age is appropriate to get either Apraxia or ASD properly diagnosed. I'm not one those parents who are in denial, I'm just trying to make the right choices in order to help my son.  Thank you all for your advise.

ccollins08

wife07mom09 what made you consider your child was on the spectrum.  If you don't mind me asking.  

meldoo2002

I think that's hard for any of us to say.  I would probably seek a developmental pediatrician.  I'm assuming there's more to his language delays than him having 30 words if he's considered to be severely speech delayed at not quite 2.5   Yes 30 words is delayed, but many children I see in EI have less words than that and I wouldn't consider them to have signs of either apraxia or autism.  It can just be a language delay.   Children I know that have apraxia often have 0 words close to 3 years of age… or they have a handful, but most sound exactly the same because they can't motor plan to change the sound production to make the words sound different.  I'm close to Boston which is where I typically send children that I have concerns regarding apraxia (I'm an SLP in EI) and they won't even make an appointment for a child with suspected apraxia to make a diagnosis before they are 3 years old.  

ridesbuttons

DS2 (now nearly 6 years old) was diagnosed with childhood apraxia of speech.  He had zero words at 18 months which is when we started speech therapy.  I suspect he had zero words at 28 months.  I remember his second birthday and I'm almost certain he couldn't say anything let alone 30 words or any phrases.  We attended twice-weekly sessions with 2 different speech therapists for over 2 years (one supplied through the public system and one private therapist).  Now, with the exception of some difficulty with the "L" and "R" sounds (we still work on those), his speech is on par with his peers.  He is now attending French immersion school full time and is doing very well.

We never experienced tantrums at all despite his inability to make words.  He still communicated effectively and obviously understood us as well.  I remember observing him watching an interactive video for children which was geared towards getting the child to mimic the mouth movements on screen.  One exercise was to stick out your tongue and move it from the left side of your mouth to the right side of your mouth.  DS pushed his chin up and moved his head side to side, like you might see Stevie Wonder do.  It was a very telling moment for me.

Having said that, he too had some behaviours that were worrying to me, particularly between the ages of 1.5 and 3 years of age.  Opening and closing doors, turning light switches on and off were pastimes he would often engage in.  He also was very good at entertaining himself with his toys rather than play with other children.  He didn't always respond when you called his name though his hearing checked out fine.  He would walk away on his own without concern.  But on its own, the doors and light switch interest faded and as he got older he was more apt to seek out kids to play with.  His 'elopement' phase resolved as well. However, to this day, if he his focused on something he either legitimately doesn't hear when he's being called or can actively choose to ignore it.  I have had several discussions with his DP on this trait but the DP is not concerned.  In his words, it may serve as a strength later on, the ability to focus on an activity and block out distractions.  Time will tell.

I was highly anxious for that couple of years and even had a psychologist (that was evaluating DS) suggest that I back off and seek help for my anxiety as it was obviously affecting me and most likely rubbing off on DS.  It was a tough period of time for me.  What I tried to focus on instead was being productive in addressing the known deficits.  I knew he had a speech delay so we worked on that.  We stayed on top of his well visits with his GP, saw a pediatrician at regular intervals and had child psychologist evaluations over a period of 18 months or so.   

Best of luck.  I know its tough.

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chertmm

Hi there, 

I am a behavioral specialist specializing in early intervention ABA therapy.  Not sure if you want my 2 cents...but here it is:  I agree with the others that you should see a developmental pediatrician.  The tantrum behavior isn't too much of a red flag because, 1) toddlers tantrum, and 2) many "inappropriate" behaviors stem out of frustration at the inability to communicate wants and needs effectively.  If your son already has an identified language delay, this frustration can be assumed.  It is the other things that you mentioned that I feel need to be evaluated.  Remember that one of the biggest criteria of autism is onset of indicators at or before age 3.  Even though he did not show some things at 20 months an ASD diagnosis should not yet be completely ruled out.   Perseverations and compulsions can lead to other difficulties with behaviors and routines.  It also sounds like there may be some relative weaknesses in the areas of sensory processing and socialization.  8 months have passed since he was evaluated...that is almost 1/3 of his total age and developmentally, SOOO much can happen in that time.  Chat with your doctor

ccollins08

Thank you all so much for your tips.  We have seen a lot of progress with Kiernan socially, and the opening and closing of doors has lessoned.