Autism or Something Else?

Jan. 8, 2007 — -- Michael's parents have started to worry.

Like any toddler his age, Michael loves to walk on his own and explore the world around him.

He laughs when he is tickled, prefers his fingers over a spoon when eating chocolate pudding, and squeals with delight when the family dog licks his face.

But something seems to be wrong. Michael is 18 months old and has yet to speak a word.

He seems to understand some of the simple things that his parents ask him to do, but he is busy and independent. He cannot stand to be interrupted.

He often ignores his parents when they try to talk to or communicate with him. When they have to redirect what he is doing to bring him to dinner, give him a bath, or put him to bed, he screams -- louder and longer than any of their friends' children.

His parents have reason to be worried.

Beyond causing mischief and getting into everything, there are certain things every toddler should be able to do. The ability to use three to five words other than "mommy" and "daddy" is something that Michael should be able to do.

Is this a cause for concern? Perhaps. But the reasons why Michael isn't speaking can range from minor delays, which will correct themselves over time, to major developmental problems that will last his entire life.

A first step in identifying the cause is to survey a more complete set of Michael's behaviors and compare it to what toddlers should and should not be doing.

At 18 months, Michael should:

He should not:

For a complete listing of behaviors a toddler should and should not have, check out the Centers for Disease Control and Prevention Web site "Learn the Signs, Act Early"

John Constantino is an associate professor of psychiatry and pediatrics at the Washington University School of Medicine in St.Louis.