Joint Attention / Expressive Language

This may have been posted somewhere, I dont know. But I was wondering, specifically anyone with B/B Fraternal twins, or even just anyone in general. (I have B/B Fraternal twins), born at 33 wks.

I have EI come for the boys since they were 3 months old, a couple of months ago, the speech therapist started coming, she's coming weekly now, but the other day she was here with the OT, and they both had some concerns. We did an M-Chat questionaire, that Pedi's are suppose to follow to check for signs of early autism.

Well the only things the boys failed on was the Expressive Language, Joint Attention. First of all, these are our first children, so what they were asking I really had no idea at this age toddlers were suppose to be doing.

Question on the Form: Does your Child try to attract your attention to his/her own activity? Answer: NO
Question on the Form: Does your Child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things? Answer: NO. (For this one the only things my boys pretend is to Play Hide N Seek or Peek A Boo, but they do not pretend to talk on the phone Nor do they have dolls they play with)

Sooo with that said, the EI Nurses are concerned they may have some kind of austism for the mere fact my boys are not playing with a toy and try and get our attention for us to join in their playing. OR our boys do not engage us in their playing of anything other than peek a boo or hide N seek, and they bring us books to read to them and sit on our laps.

They play with each other all the time. I had no idea at this stage they s/b coming up to us and wanting us to join them in their playing, i do play with them, but when I am not playing with (ie: fixing meals) they do not come to me to play (Hope that all makes sense).

My question is: Does anyone's child at 20 months try to get their attention to have you play with them, OR try and get your attention to show you a Lego Creations they made or any other toy creation, etc. or are they just fine playing with each other or by themselves?Both my sons either play with each other or by themselves just fine.

My husband and I just think it's a developmental delay, as their words are not very strong either. I have one son who babbles alot more than the other, but they do say single words here and there. Just looking for reassurance, I feel they are not autism in any way, just delayed a bit. Their Receptive Language is wonderful, they understand exactly what we want or talk about to them with no problem.

any advice or comments would be appreciated. thank you, sorry so long.

Oh, also, my boys seem like any other normal toddler at this stage. Being a 1st time parent, I would never have thought anything wrong with them if i did not have EI coming to the house. Anything wrong as in, not having Joint Attention / Expressive Language wise. Eveything else they seem to be fine with.

 

I don't have a lot of experience with EI or ASD, but answering "poorly" on 2 questions doesn't sound like a great basis for diagnosing autism. ardon: Do your boys meet any other criteria?

My boys are fraternal (35 weekers). I've never had them evaluated because they seem pretty on track for milestones, so I don't know what "trained professionals" would say about them. Like you I'm a first time parent and they seem really normal to me.

To answer your questions, my guys do pretend to talk on the phone (they say "hewwo?") but they don't really try to get us to play with them. They ask us to sit down and read to them a lot, like us to be in the room while they play, and occasionally want us to sit in their tent with them, but they mostly play by themselves.

What are the next steps that the EI nurses are recommending? More evaluations, or wait-and-see? I were you I would push for an evaluation by an expert in developmental issues, and would probably talk to your ped to see what he/she recommends.

I'm sorry the EI nurses have you rattled. :hug: Like I said, I'm no expert but your guys don't sound that far off track to me!

 

You know, this got me thinking. Have the EI Nurses ever worked with twins before? It sounds like it's pretty common for us twin parents to have their kids play with each other or by themselves rather than having them ask to play with us. Maybe singleton children play with their parents more. ardon: I would totally bring this point up the next time you meet with EI!

 

they did suggest we put them on a waiting list to see a specialist, and if by the time our turn came if we did not need to see the specialist then we would cancel.

They do work with twins.

My husband said the same thing. He said that only children toddlers will interact more with their parents b/c they do not have siblings to play with. So we shouldnt be too concerned. And I can see what he means. If we only had one child, i am sure that child would want to play with us more, but having twins, they like to play more with each other. I am trying not to worry too much. thanks for all the feedback, i know every child is different, nice to hear what other mother's have to say.

 

So yes, both of our 20 month old ID twins bring toys up to show us, hand us toys, etc. or grunt so we look over. They don't always need us to engage in what they're doing, but they want us to LOOK.



FYI, here is a link to the MCHAT questions, http://www.ei-resource.org/m%11chat:-autism-questionnaire/ and the ‘critical’ answers http://www.firstsigns.org/downloads/Downloads_archive/m-chat_scoring.PDF



You may want to take a look to see if those are the only 2 ‘critical’ questions your twins didn’t score ‘typical’ on.



Based on what you've described, in my opinion it looks like the reason they are showing concern is that your boys failed two of the 'critical' questions, but only two. Two is the cut-off for when they suggest children should be seen by a specialist. That does NOT mean they have anything wrong, just that they should be seen by a specialist.



Keep in mind it is part of EIs job to be as cautious as possible. They want to get kids that might need help ASAP so they can maximize the positive results of therapy for kids who did need it.



Also, regarding the ‘joint attention’ and ‘pretend/imaginative play’…. Your boys may be doing some of this (a little) but you might not recognize this as these are your 1st kids.

My understanding is things like pretending to eat, making noises while pushing a car, train, animal, etc. are considered a form of this. They like to ask about ‘talking on the phone’, ‘pretending to clean, sweep, etc.’ but if you kids do any of this at all I’d at least mention it to them and ask them about this – if this is a form of imitation/pretend play that would be considered in answering the question even though it’s not specifically what they are asking for.

Do your kids parallel play or play together? They are really young to be actually ‘playing together’ – but if they show EACHOTHER toys, etc. I’d ask about this, too.



That said, I'm not a nurse or doctor or child development expert, but if they didn’t fail the pointing questions (looking when you point, pointing to show you something) they do have SOME form of joint attention. I do have a friend who does occupational therapy for ASD kids. FYI (again, NOT an expert) what I’ve been told is it is very, very difficult for kids with moderate or severe ASD to point. It is possible, but it is not typical or common. Kids who are high-functioning and/or mild ASD or have something like aspergers usually don’t have difficulties with pointing.



It will be OK, EI is only doing their job. I do think you should go ahead and have them see a specialist because if they do have a mild form of ASD (based on your description even IF, with a big IF, they are somewhere n the spectrum I couldn’t imagine it being anything but mild and high-functioning) the sooner they get help the better the outcome will be for them. That is a HUGE IF. And, the specialist might be able to help with what is going on with your twins (language wise), and how best to help them. Do keep in mind that some specialists (like the ones my twins see) will only tell you what to ‘look out for’ and don’t want to make diagnosis until age 2…. It can be frustrating, but at the very least informative and in the long-run it will be helpful.

 

My boy twin is in therapy and has been for a year and half. He just had a yearly review and it was very intricate. I'm a little stunned to see them make those assumptions off of those questions but seeing that they work with your boys often I guess it could be off of that as well.
The assessment tool that was used for my ds was the Receptive-Expressive Emergent Language Scale Third Edition Reel-3. For expressive he was in the 23rd percentile, age equivalent 23 months (he's currently 30 months), he has made 14 months of expressive language growth in the last 12 months. He also had the Bayley III test done and the Greenspan's Social Emotional Scale done and he's average on those but I would definately see if you could have them evaluate with these tools. It really breaks down where the best sournce of therapy can come from and the different types of therapy.
I think for them to jump straight to autism is questionable and wouldn't worry too much about it yet. Just focus on the things they can work with for now. The therapists should have goals in place and make sure that those goals are what you think they should be as well.
Good luck and if you have any questions about the therapy my son gets or anything for that matter feel free to pm me.

 

Hi
I have twin fraternal boys born at 37 weeks. Twin a had more then two no's on our test at our 18 month. But the pedi watched them interact and said she wasn't too concerned and said to retake it at 24months. Also we did have EI come in to test them because of language after their 15 month and twin a who we had more then 2 no's was borderline for expressive and development, but they said first they are boys and second they are twins. So their advice was to wait until/if we felt they were really falling behind in development. EI is definitely there to help and I would take their suggestions, but I wouldn't lose sleep over the tests right now. Especially with your boys being true preemies. The way I figured it was any services they suggested would only help them in the long run. Good luck.

 

In my understanding, they are still learning about autism. "red flags" are only that. They know that interventions help so any child that may show signs they want to intervene early. I have had numerous children in my ei/prek classes have "signs" of autism..who at a later date were determined to merely be developmentally delayed. Even with point ( just an example) I had I child this year (5 yrs) who was not pointing at 2. At 5 he still used his middle finger and had profound delays motorically (fine motor) however did not appear to be autsist. He had good language, pretend play and only slightly delayed social skills. I am only making the point that because ther is no cut and dry test for autism they have a hard time pin pointing it early...and would rather be safe than sorry.

ETA: sorry for the grammar errors..too many beers lol

 

I'm going to ditto desolation's post mostly. If you call out your child's name and point to something on the wall or to a bird in the air, does he make eye contact with you and then look at what you're pointing at? If he does, that is called joint attention. It means that he has the desire to share a experience with you. Likewise, when he's looking at books with you, does he ever point out favorite things and then look up at you? (Like point to a dog and look at you expecting you to name it or make the animal sound?) If he does, that would be joint attention. If he doesn't, that would be a red flag for an autism spectrum disorder.

I've posted this link before, but I'll do it again because I think it is so informative. http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm This site has videos demonstrating interactions with typical kids and autism spectrum kids to show the difference. If you log in and view the videos, you will see examples of what joint attention looks like, what repetitive play looks like, what stereotyped interests look like, etc.

It's scary when the A word comes up. I get it. I've been there. But honestly, you owe it to your children to learn more about the warning signs/red flags for autism and to follow up with recommendations to see a specialist. With autism spectrum disorders, early and intensive therapy makes a huge difference. Not saying I think your sons have autism, I'm just saying that I think it's worthwhile to heed recommendations from developmental experts/pediatricians/therapists/etc.

 

The pp's have made some great points, and I especially like Jessie's description of joint attention. If they do anything to get your attention, then it shows desire to interact socially. As for the pretending, it can be anything: driving a toy car on the floor, trying to brush their hair, basically using their imaginations while playing. I am a pediatrician and if I had a kid who was pointing, playing interactive games and understanding social interaction, I would not think ASD even with a speech delay. If they were borderline, the specialist would likely tell you to get OT and ST which it sounds like you already have. Because of that, I would likely wait before referring if it were my patient. I would ask your pedi about it at your next appt or make an appt to discuss and they can decide whether you need to be referred to a specialist.

 

I didn't read all the responses, but I will say that those questions were asked at our 24 month visit... and I remember that maybe they were doing those things... but more likely they weren't doing them all the time. Once the question was asked it made me think about it and sure enough within another month or so they really started doing both the phone thing and the doll thing... but truly I don't think ours were doing either of those at 20 months.

as for dolls! I have to laugh sometimes I think my son loves them more than my dd!!! tonight they were fighting over a new hand-me-down Dora doll that we'd gotten from a friend!

good luck!