I can't sleep.

I haven't talked much about Annabel's continued lack of speech lately because I'd finally managed to genuinely convince myself it wasn't a problem--that she gave all other evidence of being a bright, normal child and would talk when she was good and ready. But the fact of the matter is that she's plateaued. She isn't talking any more now at 18 months than she was at 15.

Last night Dylan brought up the possibility that, based on Annabel's behavior patterns and our own backgrounds/issues, she might be somewhere on the autism continuum, as something we should look into just in case so she can get early intervention if there's an issue. I won't go into our whole discussion, but suffice it to say that all sorts of things that I thought of as neutral or good qualities now seem, when coupled with what now does qualify as a genuine language delay, like a potentially frightening pattern: 1) Her independence, the fact that she doesn't seem to need or even want a lot of interaction and snuggling. 2) A certain fascination with organizing her world--taking pieces of a puzzle out and lining them up in a row, putting them back, then repeating the process again and again, or stacking up giant legos of like shape and/or color, or spending a long time arranging and re-arranging groupings of similar objects. Before tonight I'd looked at that as a sign of spatial intelligence, that maybe we had a future engineer or architect on our hands, but apparently that kind of behavior can be a sign of autism. 3) She's not the most empathetic kid ever. It's not that she's never shown empathy--that first time we were in Alabama this summer, when Dad was still alive, she'd sit in his lap for long stretches of time, while when anyone else attempted it she'd be squirming to be down running around within minutes. But she doesn't start crying because other kids do, and never has. And times when she's pulled my hair or squashed my breast enough that I yell "ow!", she seems to find it more funny than sympathy-enducing. 4) She's not frightened when we show anger and often seems downright amused by it. Before I thought that meant we're doing something right--that we're angry rarely enough that she doesn't know what it means, or else that she knows we love her and would never hurt her. But now I wonder if it means she's not picking up on the emotional cues. 5) In general, she's one unflappable kid. I'd thought that was a virtue--that I had a brave, calm girl on my hands--but now I'm wondering if she's just lacking the emotional range she ought to have.

None of which would be scary without the language thing, but I think it's safe to say now that she does have a language issue. It could be a perfectly normal case of late talking, or it could be motivated by a physical issue like her lingering tongue tie or a mild hearing impairment (I know she's not deaf, but one of her other quirks is that loud noises don't especially perturb her, so I occasionally wonder if her hearing is below average). But it could also be part of a pattern.

She has her 18-month physical on Thursday, and I'll bring up these issues with her doctor. Also, there's an autism study at UW looking to enroll toddlers and offering evaluations, so we're going to look into that. But I need something to help me get past the fears that are currently eating me, and I'm typing this post because I figure just googling "autism" is the worst thing I could do for my sanity right now.

The specter that's keeping me awake is the thought of the more extreme forms of autism--the thought of having a child who seems utterly disconnected from the world, who isn't really here with us. If it's something milder--if maybe she needs treatment or therapy, but is ultimately going to learn to talk, learn to read, and generally be *here*, or if she's just showing early signs of being a more or less antisocial geekish sort--well, then that's just one of those things, and something I know I'm more than capable of managing and (continued...)

( continues...) supporting her in. But the worst-case scenario has me paralyzed, has me wondering how I'm going to sleep enough to get over this nasty cold and think about anything else to the extent of being able to continue my job search and polishing my novel at a time when I very badly need to do both. I mean, I've got people wanting to read this book. I need to strike while the iron is hot. But if my worst-case scenario turns out to be true, I don't know how I'll ever manage to write another word in the face of it.

So. If any of you out there have any knowledge of how likely my worst-case scenario is, of how likely a child with Annabel's range of traits at 18 months is to have severe autism, or even if severe autism is still as terrifying and untreatable as it was when I read about it years and years ago, talk to me. I'm going to try to go lie down again, see if I can sleep now that I've gotten this off my chest, but I'll be back within a few hours.

Susan, how is her eye contact? I get the impression that it is pretty good...she looks into the camera for pictures; she seems to smile at you, etc. I really think your worst case scenario is pretty unlikely. And, if she's on the other end of the spectrum (Asperger's), she's gonna lead a fine and wonderful life.

Did you know that Brad Cohen, developer of BitTorrent, has Asperger's? There's other stories, of course, but I won't go into all of them.

Honestly, I'd be more concerned if Annabel *had* been talking and started to lose words. That's more typical of autism. She's right about the right age, though, to start thinking about a diagnosis and early intervention, so that's good that you're thinking about that. Definitely talk to the doctor. I think you're right to have her tested. This has been a long time, and you are genuinely concerned...and that is valid. But, honestly? I think autism is pretty unlikely, from what I've seen of Annabel. Of course, I've never interacted with her, so I could be totally off-base here, but just the way you've described her doesn't fit with so many things.

Hugs to you and Dylan, though. This is tough, and you've been a trooper through it all. You'll continue to be too. Talk to the doctor. Get her evaluated, but STAY AWAY FROM GOOGLE!

Susan, I'm no expert, but I had the exact same fears for Chris (and to a lesser extent, Ben) and they were not realized.

What you're describing as her lack of empathy/unflappability and other traits in your numbered items, isn't unusual (imo) in a bright, well-loved toddler her age, just so you know. All three of my children shared most of those traits.

I definitely think you should make a good list and take it with you to her 18 mo. check-up, so that you can remember to address all your concerns with the doctor. If Annabel has any sort of delay or autism, early intervention is key.

I would also though, recommend you discuss whether or not to enroll her in the study with your doctor. Sometimes, medical providers who specialize in one area can find things that aren't really there. It's what they're looking for.

Given that loud noises don't freak Annabel, and that I've never read you mention that she doesn't like you to touch her, or gets over-stimulated too easily (to an amount that is abnormal for a baby--not an adult), and because she is doing some talking, my guess is that your worst-case scenario has already ruled itself out. I'm saying this based on only my experience with my cousin's high functioning autistic child who was not as well developed as Annabel, at her age.

Autism is a HUGE umbrella diagnosis. There are probably kids that were in our classes when we were children, that today, might be diagnosed with one type of autism or another. If you are facing it, then Annabel is blessed to have you and dw. I hope you are not, and I don't think you are. I think you have a laconic child, and I hope that's what your pediatrician finds.

Sometimes, medical providers who specialize in one area can find things that aren't really there.

Yes.

If you google autism, you'll get admonishments to take your child off of wheat, some good stories, some reassurance, and some scary stuff. Don't bother. Pretend I did it for you.

Aidan's autistic behaviours are, I recently discovered, "blindisms." You might consider having Annabel's sight and hearing tested.

I can't stick around because it's time for the schoolbus, but if you want to talk about it Susan, drop me an e-mail. My experiences with Aidan, despite his diagnosis of mild autism, I think was me being paranoid and a doctor who didn't take his vision impairment into account.

2) A certain fascination with organizing her world--taking pieces of a puzzle out and lining them up in a row, putting them back, then repeating the process again and again, or stacking up giant legos of like shape and/or color, or spending a long time arranging and re-arranging groupings of similar objects. Before tonight I'd looked at that as a sign of spatial intelligence, that maybe we had a future engineer or architect on our hands, but apparently that kind of behavior can be a sign of autism.

This is typical behaviour for a kid her age. Seriously. Mom talks about it all the time, how kids do this to start learning and they like to put things in and out of containers, stacking things, etc. Annabel is learning how to group objects by shape and color, developing fine motor control ,etc.

Also, babies and young kids learn in spurts. While they are learning a new skill they usually don't do as much of the skills they already know. But then they'll start using all their skills once they get comfortable with the new ones.

My suggestion would be to go get her hearing checked and have a language assesment done. This way you will know what's going on. I'd start by contacting the university and checking what programs or information they have. Annabel is young enough that this testing will be free.

I have decided not to go to lab today. Unlike last week, though, this decision was made so I can better be effective in lab, rather than me being in crisis. I have the option to go to a lab later this week. So, this gives me the opportunity to spend today's lab time listening to the lectures online that I missed and being better prepared to understand the lab when I go.

I feel like I need to say this somewhere so I don't give myself a hard time about it. I really think it is an effective decision, as long as I use my time wisely to get caught up. It's not like I'm skipping...

vw - you are making considered decisions. This is a good thing. Reread your tagline.

vw that sounds like some good planning.

I just wanted to say it so maybe I'd actually believe it. My distortions are high these days...