Devlopmental age

[sunnydays]

I have a dcb who has been with me for some time. I would like some advice regarding his development. He is now 28 months (so going on 2 1/2) and still mostly non-verbal. Parents say he has about 90 words that they have counted...I understand maybe about 20, but even those are not clear, it's only because I am with him all the time. He does not put two words together. He cannot or will not point to all of his body parts (I can get him to do one or two sometimes...other times nothing). He sometimes follows simple directions (pick up the truck), but often not. The other kids come running when I say it's snacktime...I have to go and bring him almost every time. He doesn't do much imaginary play (he will bring me playfood occassionally to feed me, but that's about it). While the other kids are making pizza and cake with playdough, he is sticking it in his hair or picking at it. He has a physical aversion to things like wipes on his bottom (he flinches physically when I wipe him and cries) or grass on his feet. He is mostly happy and behaviourally pretty good (except that he swats at me if I remove him from something I don't want him doing and he hates holding hands and will pull away). He plays mostly on his own, but does interact a lot with me and with other kids with full eye contact and laughter and lots of smiles...it just has to be a physical type game like peekaboo or chase. While I did manage to get parents on board (with much encouragement) with getting him on the waitlist for First Words, they keep telling me they are not concerned because he is learning so many new words now. It is true...he is learning new words...but they are not at all clear and he is not using any verbs, just nouns (at least from what I have heard him say). It is hard for me to know what to say when his parents say this as I am actually quite concerned...but don't want to upset them or label him when I am not qualified to do so. It is just that, to me he behaves about a year younger than he is overall...and I dont really know how to relay that to his parents or if I even should. They seem not to understand it isn't just about the number of words he can say (and even there he is way behind). Any ideas? What would you think about this development?

[playfelt]

Behind for sure and a lot of the things you mention would put him on the autism spectrum - the aversions, the delays in speech and understanding, the limited ability to use imagination, limited play skills, apparent lack of peer awareness - what others are doing (following others to kitchen), inability to copy ( what others do with the playdough).

So much of learning is tied to language but a more important measure is the social development because we take our cues from others, we copy others, we need to be on the same page as others when growing up and interacting and school is based on a group mentality.

Using one of the assessments such as that Nippising development scale and then sharing it with the parents - or even give them a copy and you keep one and both of you do your own assessments as the child may be producing different things at home because they are comfortable in the environment and interacting one on one with an adult. At the same time when you show them what child is like at daycare and ask them to take it with them to a doctor's appointment or their first words appointment so the person can get a reading of where child's needs are it should also alert a professional that they are dealing with something more than slow to develop oral speech.

I would be less concerned if the child's understanding was better even though their actual verbal was delayed. For sure it sounds like some form of cognitive learning disability with or without an actual syndrome diagnoses. Melissa has learning disabilities - cause unknown and was in special classes most of the way through school. Her language was delayed and she did fine developmentally for the first 18 months and then she started to progress slower and slower to the point she was a whole year behind when she started school and then fell further and further back all the way through.

[sunnydays]

Thanks Playfelt! This is exaclty what I am thinking, but you have so much more experience, I am glad to have your input. I have kids almost a full year younger than this child in my care and they understand everything I say and they play with the other kids in an age appropriate way. This dcb will not go and get his shoes, usually will not sit at circle time (even the 20 month olds sit nicely most of the time) even though he loves songs and loves circle time, will not clean up toys at clean-up time...sometimes I can get him to put away a couple of toys and then he puts his head on the floor and cries if I try to push him more, oh and one other thing is that he is always yawning...always sleepy! Parents say he sleeps well at night and he naps well for me, but when he arrives at 7:45 am he is yawning and continues to yawn all day long...this doesn't seem normal to me. The thing is, I have always understood that he is a bit different, so I do not get frustrated...I have different expectations of him than I would of most kids his age...that sounds bad, but there is no other way to say it. Like I said, he is happy most of the time and doesn't cause me any big problems (other than the swatting me, which is not appreciated and I do discipline for). My neighbour who is a care provider as well also sees him as different for sure though we both struggle with the concept of autism as he makes eye contact a lot and smiles and interacts (especially with adults, but also with kids). It's just that in general the sounds he makes, the things he does, etc are like a baby, not a two year old. And when parents say they are not concerned, I really am at a loss for words because I know they have no comparison...they don't realize or are in denial about how different he is from others. I guess I will wait until he is going for his appointment in October at First Words and then I will fill out the Nippising and send a blank one for parents in the hopes that it will help someone else tell them that he is developmentally different in some way.

[sunnydays]

Oh, and I forgot the other thing that actually concerns me as well. While he cannot communicate basic needs and wants, he knows all of his alphabet (letters and the sounds they make) and points out letters everywhere. If we are reading a story, he rarely listens, but when he does come and sit, he will be pointing out letters instead of listening to the story. Now he is starting to learn numbers and shapes as well. Parents are thrilled and while I agree that this is amazing, it concerns me that he is able to do this before actual communication.

[playfelt]

Another sign of autism is that the child is super smart in one or two areas and totally behind in others. It is these abilities that parents are using to assess normal and missing out on the fact he is not socially at an age appropriate stage. Not all children with autism have the aversion to looking at others but usually will with strangers till they become familiar. They generally prefer to interact with adults or look to an adult for clues of how to respond to others.

[sunnydays]

So Playfelt, what, if anything, would you say to his parents at this point? I want to find a way to say "your child is very different from other children his age" and to list the things I observe...but I don't want them to get defensive or for them to feel I am attacking their parenting (I think they are very loving parents).

[sunnydays]

I am concerned that if I continue to say nothing, once they do get a diagnosis, they will say "Why didn't you tell us he wasn't normal?"

[playfelt]

I am concerned that if I continue to say nothing, once they do get a diagnosis, they will say "Why didn't you tell us he wasn't normal?"

You for sure have hinted and you could simply come back with a I tried but you weren't ready to hear the information. Now that we know for sure we can proceed with a plan.

For now write down your observations and areas where you notice he is falling behind the group. That info will be of benefit. Even knowing when he finally started doing a task helps as it indicates how far delayed the child is.

I have one in care now too that we are monitoring. She will be 2 in Oct. At her 18 month check up the pediatrician was concerned enough to reschedule a visit for 3 months later (will be in the next couple weeks). She was concerned child was not talking much, seemed to not care when spoken to as in interact with doctor, could not point to body parts nor point out things in a book, make animal noises if asked, etc. For your boy it may be that the doctor is not very thorough either and that won't help at all.

If you can find subtle ways to show them that the others that are younger than him are doing things that he still isn't that should at least give them the info to be thinking even if it is to just make excuses why he isn't but answers to the I tried to tell you concept. Mention things casually like he didn't get very much time to do a particular activity because he didn't respond to my requests to come nor did he follow the other children to the kitchen area so by the time I got XX and YY who did come ( name two younger children) set up and then had to go get him to escort him personally to the kitchen he missed out on most of the activity. Down the road it should get them thinking or they will be able to look back and then you can put it in a nutshell saying you tried to point out areas of concern based on the fact younger children were passing him by developmentally but since you seemed to be the only one concerned you had no choice but to let it be.

[sunnydays]

Thanks Playfelt! I just don't want him to miss out on help he could be recieving at his young age. I have no problem having him in my daycare...in fact he is easier than most two year olds...he is almost always happy and doesn't/can't ask for anything or argue. But I feel in my gut that something is not right and I want to make sure I at least tried to point it out somehow so he can get the help needed. I know his parents have mentioned before that they don't get to see him with other kids, so they don't always know what is normal. In fact, just this morning, a girl a few months younger came up to this dcb and said "Hi Billy" and the dad was amazed and asked how old she was...I wish she had said more than just that so he could see what an average 2 year old should be doing!

[playfelt]

Just take advantage of any "teaching moment" like that to work with the parents. That is about all you can do till they want to see the issues.

You could try making a list of the things you are working on in daycare and ask the parents to help reinforce at home. It could be that they just do everything for him and don't realize he can't do it for himself = get shoes on command, come to me when called, use words to ask for something, etc.