A Mother Wonders

A colleague asks:

A therapist, writing on a listserve for therapists, asks for suggestions on behalf of a client whose concerns about her 3 year old son have to do with what she describes as social/behavioral issues. This mother wonders about some unusual behaviors in her son, including that he often doesn’t seem to perceive or respond to body language. He often doesn’t look at his mother in the eyes, sometimes walks with his head cocked and, when walking, often doesn’t look up and around to make sure that he won’t run into things. In addition, he often doesn’t smile at people who smile at him, holds his hands in unusual positions, and likes to walk in circles and spin. Her pediatrician seems inclined to disregard her concerns.

Dr. Einhorn replies:

Your client does well to notice her son’s behaviors. There aren’t really any tests to determine whether a 3 year old with these behavioral signs does or doesn’t have a diagnosable issue. A professional who is experienced in working with children, particularly those on the autistic spectrum, might be able to identify some signs or tendencies in that direction, if they are present. If issues were identified, the interventions would be social: helping the family encourage more socially responsive behavior in this child, helping them to communicate more effectively with him (if that’s an issue), helping him to self-regulate more effectively, finding a preschool program where these interventions could be implemented to some degree.

Pediatricians often disregard subtle behavioral signs in children which are of concern to parents, and they are usually right to do so; most of the time, parents are overly concerned and/or the kids grow out of whatever behaviors their parents are concerned about. However, in my work with children with learning disorders, it has often been the case that pediatricians dismissed signs that parents, usually mothers, identified early on that actually turned out to be of real concern as the child grew up and did not grow out of them.

A behavioral assessment of the child would involve meeting with his parents first, then observing him at home and perhaps elsewhere (playgrounds, preschool if he goes to one, etc.). A psychologist with experience in working with children on the autistic spectrum, and their families, could provide this. Occupational therapists who are experienced in working with children on developmental delays and on the autistic spectrum can also contribute to the evaluation and treatment as well.