By: Rachel Ottley OTR/L, Occupational Therapist

Shortly before my 40th birthday, I discovered I was pregnant with our 4th kiddo. It was a surprise to say the very least! Our other kids, all girls, were 12, 8 and 6 at the time and we were quite done with the diapering, sleepless nights, newborn phase of childhood. It took some adjusting, but we prepared for this new wee one and were delighted to discover it was a boy!!

We named our boy Finnian. He was a very responsive baby. In the hospital he would calm immediately upon hearing my voice and we have lovely pictures of him gazing at and smiling at family as a new baby.

finn-infant(Finn @ 19 days old)

Around 6 weeks though, things began to change. He wasn’t looking at me while nursing. He was less responsive to my voice. And so fussy. Sleep was very hit or miss. I ended up sleeping in a recliner with him for 2 years to maximize our sleep. 4am was our wake up time for the longest time. I noticed changes in Finn, and hoped I was over reacting. He would look at fans and loved to talk to them, but did not talk to people. He had difficulty looking at people at all. I remember clearly talking to him on the change table while he looked over my shoulder at the ceiling fan and ignored me all together. Finally, my husband commented that he thought Finn should be talking to and smiling at us and asked did I think something was wrong with him.

I’m an Occupational Therapist. A pediatric one. I’ve worked with kiddos diagnosed on the Autism Spectrum for over 20 years. I knew that what we were seeing were often called “red flags” for Autism. I called a Speech Pathologist friend and asked would she come and play and tell me what she thought. She was present when he was a newborn, and knew him well. Her face fell when she greeted Finn and got no response. Finn was 3 months old.   At 3 months old, babies should have well established reciprocity – where they are looking at and listening to the other person, changing their facial expression and body posture during the interactions, and responding to the interactions with smiles and vocalizations. It is a dance of communication, of mutual interest and love. It is what keeps mommas going in the middle of the night, it is important for later speech and language skills, and my Finn was not demonstrating any of these skills.

Because of my experience and fabulous friends in the therapy business, we started “therapy” right away. Therapy for babies really means looking at how they are most responsive, and changing our own interactions to best fit them. We discovered that Finn was the most responsive to people when he was lying on his back and the person was directly over him. He loved my Speech Pathologist friend’s voice and high animation and was very responsive to her interactions for short periods of time. I read and reread “Little Blue Truck” because it was the only time Finn seemed to “tune in” to my voice and he loved the rhythm of the book. We had his vision and hearing checked. We found out he was intolerant to apples, dairy, chocolate and mint and I changed my diet accordingly, helping his poor sore tummy and little butt. We increased our use of people as toys. His sisters were excellent play partners and were taught how to play in ways that best met his needs. They became excellent observers of when he was showing signs of having had “too much” or when they needed to ramp up their affect. During these times of “therapy” there was not the push to “normalize”, but rather support Finn’s preferences and interests. Much later, I read this article and thought it was so beautiful and supportive of individual neurologies and preferences.

“…you often prefer not to look at our eyes at all, unless to examine while we look elsewhere. We respect this; we honour your preferences and ways of learning and interaction. On these days and in these times, you hang out on our bodies, gaze over our shoulders, snuggle tight in a wrap, or kick in the bath. Your selective eye contact is your journey and your right. It’s not a big deal; it’s just a preference. I long to drink in your features and I am drawn to your smiles, but I give you the social space you seek.” http://respectfullyconnected.com/2015/11/ten-weeks-old/

I have video of Finn at various ages spinning and spinning the wheels on a truck and repeatedly opening and closing wooden shutters. He started Speech Therapy services with Sooner Start due to delays in expressive language, but his receptive language skills were off the chart awesome. He has had strong preferred interests in lawn mowers and trash trucks to the exclusion of all other play interests. He would watch YouTube videos of Trash Trucks over and over again (God Bless YouTubers!!). He had long and loud and extreme meltdowns over all kinds of different things.

finn-lawnmower

 

finn-holding-box

 

 

 

 

 

 

He is currently a delightful almost four year old. He is very smart and hilarious. He loses his verbal language when stressed or sick. He loves vehicles of all kind and is often heard saying “Honda!!” when he sees the Honda badge that matches our new van. He attends Mothers’ Day Out and has real and imaginary friends. His play is varied and interesting and he gets very mad if you play “the wrong way.”

finn-dad

He is increasingly self restricting the different foods he will eat and often thinks the lukewarm bath is “too hot!” He is reading some words and loves letters and numbers. He is currently loving crossing days off the calendar as we head towards Christmas. He mixes up his opposites frequently, saying his food is too hot and could I put it in the microwave. His sleep is still terrible and I am perpetually tired. If you come to our house he will hold the door open and say “welcome to we home!” and then run around like crazy because he is not sure what to do next. I would consider him “quirky” and embrace his neurodivergence (different from typical).

The traditional “red flags for autism” charts usually start around 12 months. The M-CHAT (Modified Checklist for Autism in Toddlers) starts at 16 months of age. Many parents report that that they knew there was something different about their kiddo much earlier than 12 months of age. If you have concerns regarding your child’s development at any stage, contact your pediatrician. You can also complete the Ages and Stages Questionnaire on Sprouts website. Occupational Therapists are specialists in child development and can offer insight into the status of infants and toddlers.

http://www.nursing-informatics.com/reciprocity.html

http://www.icdl.com/DIR/6-developmental-milestones/stage-1-self-regulation-interest-in-the-world

CHILD DEVELOPMENT 0-12 months

PLAY/COGNITION LANGUAGE MOTOR EMOTIONAL
Children Age 0-3 months
·  Alert to sounds

·  Inspects surroundings

·  Knows the difference between a happy and angry voice

·  Watches a speaker’s mouth

·  Expresses hunger cry

·  Vocalizes pleasure

·  Quiets to a familiar voice

·  Coos and goos with lots of vowel sounds

LEVEL 1

·  Can maintain regulated state (take in sights, sounds, touch)

·  Turns to caregiver’s voice

·  Affective exchanges (emotional)

·  Engage communicatively

·  Focused on attachment and bonding

Children Age 3-6 months      
·  Inspects own hands

·  Enjoys repeating newly learned activities

·  Uses hands and mouth to explore toys

·  Awakens or quiets to mother’s voice

·  Begins to recognize own name

·  Responds to “no-no”

·  Smiles when talked to

·  Takes turn vocalizing

·  Blows “raspberries”

·  Maintains eye contact with speaker

·  Turns head to another’s voice

·  Imitates facial expressions of adults

LEVEL 2

·  Uses eye gaze with sounds to coordinate attention

·  Shifts gaze between people and objects

·  Uses affect cues (smile, frown)

·  Joint attention – attends to toy and caregiver

Children Age 0-6 months
·  Sensorimotor play

·  Develops accurate reach for objects

·  Secures object and brings to mouth

·  Transfers object hand to hand

·  Examines object with eyes

·  Plays with hands at midline

·  Lifts head

·  Lays on tummy with head up and weight on both hands

·  Sits propping on hands

·  Rolls

LEVEL 1-2

·  Repeats actions for pleasurable experiences with another person

·  Integrates information from multiple sensory systems and stays regulated

·  Recovers from stressors with support from another

·  Looks to caregiver if frightened, stressed, hungry, happy, excited (shared affective experiences)

Children Age 6-9 months
·  Imitate gestures of adults

·  Responds to noises that are not visible and searches for hidden objects

·  Looks at pictures in books

·  Begins to play games with an adult like peek a boo

·  Responds to “come here” (crawls, rolls, reaches)

·  Vocalizes in response to objects that move

·  Shouts or vocalizes to gain attention

·  Produces a variety of sounds (consonants & vowels)

·  Says things like babababa, dadaada, dagu, maga

·  Plays with voice in turntaking manner with adult

·  Responds to questions from caregiver “want up?”

·  Points to two body parts

·  Imitates in games

·  Says “mama” and “dada”

·  Says 1-2 words spontaneously

·  Repeats sounds and syllables that an adult says

·  Requests a toy by pointing, vocalizing or looking

·  Follows simple directions

LEVEL III

·  Follows focus of attention

·  Looks at people regularly

·  Back and forth affective exchanges

·  Can use repair strategies to continue communication eg Mom is distracted and looks away, baby will coo or yell to get her attention back

·  Responds to vocal tones

·  Uses gestures to protest or draw attention

Children Age 9-12 months
·  Plays peek a boo

·  Waves “hi” & “ bye”

·  Holds out a toy to show others

·  Uses play toys in realistic ways eg feeds baby a bottle, talks in a phone, brushes hair

·  Plays 2-3 minutes with a single toy

·  Hands a toy back to an adult

·  Begins to generalize from past experiences

LEVEL IV

·  Back and forth interactions with caregivers

·  Responds to others’ vocals/gestures

·  Uses objects conventionally

·  Can look and/or focus on caregiver’s mouth

·  Responds to   names and familiar words

·  Uses voice to get attention

·  More than 20 back and forth interactions in a row, long dance of communication and engagement

·  Solves problems with another eg can’t reach cup, tugs on Mommy’s skirt & when she looks down, points to cup.

 

Hearing and Understanding Talking
Birth–3 Months

  • Startles to loud sounds
  • Quiets or smiles when spoken to
  • Seems to recognize your voice and quiets if crying
  • Increases or decreases sucking behavior in response to sound
Birth–3 Months

  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs
  • Smiles when sees you

Rachel Ottley OTR/L, Occupational Therapist

Greenhouse Pediatric Therapy www.Greenhousepeds.com