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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Does Lack Of Eye Contact In A Toddler Indicate?

Hi, I have a 3.5yr old daughter, my only child who has just started school. We live in Jeddah in a nuclear family, me her and her father. Emaan completed her early milestones on time, sitting, babbling, crawling, saying first words, interactive and friendly with people in her first 2 years. She walked proper at age of 14months, at age of 7 months she started building her vocabulary and always delivered words properly, like light, plane, moon, byebye, cat, dog. Her learning vocabulary process had always been extraordinary till date MashaAllah. She has a great memory, whether it be memorizing a rhyme, or a story or a place we visit or routes to her favourite places to go, or remembering people. At age of 3.5yrs to be exact, she knows all that a preschooler should know and even more(alphabets, phonics, count till 30 and tens to hundreds, shapes, colors, planets, animals, birds, parts of body, words with opposites, shes great in sorting puzzles and creating things with blocks) She can say phrases and can communicate her mother when she s hungry, what she wants to eat, when she wants to go somewhere and where she wanna go, she frequently uses the sentences with I want..... let s do this let s do that, let s go byebye or let s go to the park, she does says sentences that makes sense when she wants to. She s toilet trained and can eat on her own. But she doesn t get into a dialogue even with mother. She has started school this week and now m more focused on what she s be doing at this age. My concerns are: 1. Emaan doesn t make a good eye contact with people (not including parents and some people she s attached to) 3. When she s happy and excited, she has this special way of bringing her hands in front of her face and she flaps her hand while running with joy or dancing on a rhyme. 2. she wouldn t respond when she s callout by her teacher or a stranger or somebody not of her interest, she might respond sometimes but that s her choice. Ignoring when her name is called out is that she has always done but got improved with time, she responds her mother when she calls her. 3. She would greet people sometimes when she s asked but sometimes she gets agitated if asked to greet someone. She s not totally anti social but she loves more to be by herself. She s friendly to her few people and kids and unwelcoming to many. 4. She s very strong headed, if she doesn t want to do something and u force her, u cannot convince her. And when she wants something her way and you don t let her, she throws worst temper tantrums. It can be as minor as asking her to sleep or not stopping by to her favourite mall or eating at her favourite food place or not buying her a third candy. 5. Emaan doesn t sit in class, she keeps on moving around, doesn t listen at all to whatever her teacher says. 6. She has passion and obsession for animals, insects, flies, sea animals- and that s her biggest distraction in class too that she doesn t want to do any activity at all but play with animals. I have tried taken away animals from her and it worked for me at home but whenever and wherever she sees them or get them, u cannot keep her away from them. 7. Her aggressiveness and tantrums have increased after she turned three, before that it was easy to divert her attention and pacify her. When it comes to her getting upset or angry she had always holded the other person tight in a manner of scratching which trait had diminished to as low as after 11 months, I am told by her teacher that she tried to scratched her when she refused to allow her to play with animals. 8. Since preschool, she s not even doing that she does normally on things like not eating in school her fave meal (same meal she would eat at home after returning) sitting and coloring (on the other hand she does it at home), not following directions at school ( follows mother at home sometimes instantly sometimes with repitition), though she s very intelligent but she s not responding to things she knows besides animal toys. 9. She loves to go to public places, parks, playlands, she s not bothered with loud noises in these places. But she wouldn t like a loud noise at home( be it be another kid, mother scolding, kitchen machines noise is her fear) but television and music she wouldn t mine being loud. There are days when I see Emaan as a perfect 3.5yr old and I don t expect her to behave perfectly decent after all she s a kid. But then there are days when she ll have her worst meltdowns and I fear if something is wrong with her personality or behavior. People have couple of times alarmed me of Emaan not doing eye contacts and doing certain hand movements, not getting social and lacking in communication. And this scares me to death if there s something that s not normal. And please I want to know about my foremost concern why is she not keeping a dialogue, she can say complex sentences and the toughest words but all what is told to her, she uses them at right time and at right place that makes sense. But doesn t form a sentence on her own, talk at all, as in conversation. Like if u will ask her how was ur day at school ? What did u do ? Either she won t answer and stay quite or she will repeat ur question. ( we communicate in English and Urdu to her), ( she has spent 90% of her time with mother alone on daily routine, haven t seen people talking around her on routine) I hope I am clear and elaborating enough to tell my concerns and my daughters milestones and issues. Please highlight her problem and guide what should I do !
Thu, 2 Aug 2018
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Pediatrician 's  Response
Hello and Welcome to Ask A Doctor. I have read your query and here is my reply.

From your excellent history your daughter has some features of autism:
-lack of eye contact
-flapping hands
-placing hands in front of face
-impairment of social responsiveness
- no friends other than her classmates

She does not show all of the usual signs of autism so please do not interpret my opinion as making a diagnosis. Also, I am neither a child psychologist nor child psychiatrist and am not able to examine the child. However, I do feel it is important that she have an evaluation by a mental health specialist experienced in assessing autistic children. The sooner the better. In the meantime to deal with her temper tantrums, I suggest placing her in a location where she cannot hurt either herself or others nor damage property. Let her be and don't give her the attention she wants. In two or three minutes pick her up and sit down with her in your arms. Even if she continues crying, be calm, show her love, warmth, and security. At no time show anger. It will be important that she spend more time with other child her age. Are there any children where you live? Finally, inform her pediatrician and see if he/she agrees with the plan.

Hope I have answered your query. If you have any further questions, I will be happy to help.

Arnold Zedd, MD, FAAP
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What Does Lack Of Eye Contact In A Toddler Indicate?

Hello and Welcome to Ask A Doctor. I have read your query and here is my reply. From your excellent history your daughter has some features of autism: -lack of eye contact -flapping hands -placing hands in front of face -impairment of social responsiveness - no friends other than her classmates She does not show all of the usual signs of autism so please do not interpret my opinion as making a diagnosis. Also, I am neither a child psychologist nor child psychiatrist and am not able to examine the child. However, I do feel it is important that she have an evaluation by a mental health specialist experienced in assessing autistic children. The sooner the better. In the meantime to deal with her temper tantrums, I suggest placing her in a location where she cannot hurt either herself or others nor damage property. Let her be and don t give her the attention she wants. In two or three minutes pick her up and sit down with her in your arms. Even if she continues crying, be calm, show her love, warmth, and security. At no time show anger. It will be important that she spend more time with other child her age. Are there any children where you live? Finally, inform her pediatrician and see if he/she agrees with the plan. Hope I have answered your query. If you have any further questions, I will be happy to help. Arnold Zedd, MD, FAAP