26 month old boy diagnosed with autism

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Hi,
I would like some assistance regarding my 26 month old grandson who was diagnosed with autism last week.
My daughter and her husband are looking at ABA therapy in their home; we are all feeling very overwhelmed and confused right now.
We are in Australia.
Thank you.

Hi, Melrose23,

Welcome to WrongPlanet!

What kind of assistance are you hoping to find? Many people here will find it easier to respond if you ask more specific questions. I don't know if you are looking for feedback on ABA, for stories of what our kids were like at 26 months, for next steps, etc.

It would help if you could also tell us about your grandson. What kinds of issues led your daughter to seek an evaluation? What are the things you find most challenging now? What are the things he can do?

This is a good place to get information, but it seems to be running a bit slow as of late (from my perspective), so please don't feel offended if it takes awhile to get some responses.

Autism is a spectrum, so depending on where your grandchild is on the spectrum there may be different approaches. Sometimes communication is the main issue sometimes it is rigidity and frustration type issues. Sometimes it is all of the above.

The main thing IMO is interacting with the child in a way the child is comfortable with. If the child is uncomfortable with an approach, it probably will not work. Playing on the floor in ways the child likes for example, like maybe parallel playing lining up blocks, helping build a tower of blocks etc. is a way to enter their world. You can try things that may be outside the child's comfort level, like say feeding stuffed animals (if that is a non-interest) but I would not spend a lot of time on it, if the child rejects it. Trust and communication is more important than getting the child to play in a "normal" way, IMO. You can always revisit these other types of play at a later time, to see if the child is more receptive. I had a nurse drive me crazy with shoving pretend play down my son's throat when he was not ready, and he ended up doing it when he was ready. I wish I had not been pressured with it--because it really was a function of his timetable.

The other thing is as a parent, myself, I would like to add that you don't want to overwhelm the parents with too much unsolicited advice (unless you know it is welcome, of course) I am not at all saying you intend that -- but it is a caveat I always like to mention, if nothing else for others who may be lurking, b/c often parents get inundated with advice intended to be helpful and it can be overwhelming especially in the early stages when you are just starting to get a handle of the diagnosis and the related emotions involved.

Hi,
Thanks for the responses.
My grandson was only saying about 4 words on his 2nd birthday and he his comprehension was not developed as he could not understand what you were saying.
My daughter and son-in-law started speech therapy and in those two months his language has developed somewhat and he is now saying approximately 40 words, but not always in context. You can teach him a word. For example show him a ball and play with him for about 30 minutes saying ball. He may say the word 'ball', but will not use it in context again.
He is a very bright and happy young man; laughs and smiles a lot, loves cuddles and enjoys the company of others. He shows a lot of empathy and initiates conversations with people and interacts well with others. Most people say that they cannot see any autism traits in my grandson.
However, there are some areas of concern. He does not always respond to his name, eye contact is not great, he gets into his own little world quite a bit, he has very limited comprehension and cannot follow instructions. If you were to ask him to point to his nose or to get his shoes or ask him to point to mum etc, he would not be able to do these tasks. He also has temper tantrums, but these are not too bad and can be controlled by re-directing him.
My daughter and son in law are looking at establishing an ABA program in their home. They have recently heard about the Son-Rise Program although this is not very well known in Australia.
Whilst he now has a formal diagnosis of ASD, we do not know where he is sitting on the spectrum, as they have a follow up appointment with the developmental pediatrician later this week and should know more then.
The speech therapist who also diagnosed ASD feels that it is mild ASD without any other conditions and no accompanying intellectual disability.
We are all just feeling quite overwhelmed and confused and looking at which therapy would be the best way to assist him.
Thanks in advance.

So, at this point the main thing seems to be communication and speech. Just so you know, his receptive skills may be much better than his expressive skills. This is fairly typical, and it makes it hard to know exactly what his receptive skills are if he does not respond predictably (again common) Often speech will come in all of a sudden, and often it will take an echoliac path, meaning he will collect words, and possibly phrases or sentences in a mental database. Some of them may come out at random, but some may be plug and played appropriately and used for conversation.
(Think of those social games for little kids like Club Penguin if it is still around, where the kids are not allowed to type original sentences, but have to pick set sentences) With an autistic child that can be a perfectly normal stage of development. Then later, original speech will develop.

If his tantrums are meltdowns from an inability to communicate, there are a number of routes that can be taken. if he is good at gestures, you could try sign language and see if it is easier for him to communicate with gestures. Alternatively, if he also has a disability in this regard, you could try a version of PECS, which is a brand name for a picture system, that you could also rig without the fancy system by making clip art pictures for him to point to for common needs wants. If his recessive needs require it, you can also use it to communicate back, but you always want to make sure you do so, with the accompanying speech, which I would also do with the sign language, so that he can grow in receptive language skills while you work on speech. I would not worry about either method stunting speech b/c communication of any kind is more important at this point.

My daughter was behind your grandson at that age. She had no language. She also did not respond to her name all the time and at first I thought she was MR because she could not follow commands. She, however, did not have good engagement skills. She would engage at times, but she could also be left alone in a corner with a stack of paper to tear up and she would be content for hours if she would be left alone.

You may want to look into Verbal Behavior therapy. It is an offshoot of ABA, but focuses more on language acquisition.

While she was too young to self-report, I am convinced that the reason she did not speak was because she did not understand the point of speaking. After she gained speech, she would often do/say things that made me realize she thought that I automatically knew what she was thinking.

Fast forward, she is almost 11 and has better than average verbal skills. She is doing well in school, and although she is quirky, she is happy.

It is overwhelming in the beginning, but from your description it does sound like he is on the mild end of the spectrum. If that is true (being a mom of two on the mild end), then I think the most important thing your daughter can do is to learn to understand what her son needs, without referencing what other kids his age are doing. Spectrum kids have their own developmental trajectories that often do not match that of their age-mates. She might also want to learn about sensory integration issues, because I think they are pretty much a "given" for any person on the spectrum and oftentimes, sensory dysregulation can be the cause of some challenging behaviors, but if you don't know what that is, you may not understand what you are looking at. Both of my kids have sensory issues, but it looks very different in each of them. My daughter has a lot of oral sensory issues and problems with emotional regulation when the environment is chaotic or unpredictable. My son has issues with motor planning, proprioceptive issues, and vestibular issues. Understanding what is going on helps me figure out how to help much quicker. My son's issues have gotten significantly better as he has gotten older, but for my daughter it is more a matter of learning how to adjust to her issues.

First, good job on getting him assessed early. That is key, and can make a world of difference in terms of both helping him, but also helping the entire family to communicate better.

I'm not a clinician, but it does sound like a mild case. My twins (5) had fewer words at that point, but were similarly affectionate and happy. We did a mix of ABA and play therapy (Floortime, in our case). ABA helped with discreet skills, i.e. learning to point to pictures to get what they wanted, etc. Floortime was much better in terms of the social-emotional skills. We also did speech and OT. And I found that OT was extremely helpful for the social-emotional piece too. My boys didn't have major issues, but they do like to jump and throw their bodies around for the sensory input. The purpose of OT wasn't to stop that, instead we were able to teach them how to do it safely but as importantly, social skills like turn taking and reciprocity. They learned how to have fun with others in their games, which the boys were then able to extend to other non-physical types of games. That was huge for our household.

You'll find a lot of information about the different therapy methods here. The biggest piece of advice I can give is that he's your son/grandson/nephew and not a project. He is a whole person, and he has social emotional needs too. Don't ever let a therapist talk you into something that feels wrong. There's a difference between a little discomfort to gain a new skill that is essential, v psychological,soul-killing warfare. Many therapists are excellent. But many are young adults who don't have children who can cross the line between teaching and attempting to control/dominate/win. Parents know where that line is with their children. So, research the therapies, but then be present. And if something is overly stressing your child, stop the therapist. And if they still don't get it, fire them. A happy, confident child who feels safe (emotionally too) in his/her own home will have the best outcome.