On this episode in honor of Autism Acceptance month, I welcome Andi Putt (@mrsspeechiep on Instagram) . She is a pediatric speech language pathologist who conducts Autism evaluations and is a neurodiversity advocate.

I welcome her to discuss the following:

• What is identity-first versus person-first language?
• Outdated terminology when discussing our autistic community
• Biggest misconceptions regarding autism
• Common characteristics with a breakdown of questions that your Pediatrician may ask or screen for during well-visits

Tune in to learn more and make sure to follow us on Instagram (@pedsdoctalk and @mrsspeechiep)

00;00;09;07 – 00;00;36;05

Dr. Mona

Hello and welcome to this episode in honor of World Autism Day, which was on April 2nd. I am releasing three episodes today. There’s one that I released with a mom. There’s one that I released with a developmental behavioral pediatrician, and now I have Andy Putt, who is Mrs. BGP on Instagram. She is a pediatric speech language pathologist who works in the public schools and practice setting, and she is heavily involved in working with families with autism.

 

00;00;36;05 – 00;00;41;29

Dr. Mona

And I’m so excited to talk to her today. All about autism. Thank you for joining me today, Andy. Yeah, I’m.

 

00;00;41;29 – 00;00;43;00

Andi Putt

Excited to be here.

 

00;00;43;02 – 00;00;56;12

Dr. Mona

I’m so excited to have you. I love following your account. Your energy is contagious on your social media and your education is vital. So it’s the perfect combination to learn from someone like that. So thank you for all you do in your real life and all you’re doing on social media.

 

00;00;56;16 – 00;01;01;06

Andi Putt

Oh yeah, well, I love you too. I think you’re amazing. So excited to talk to you today.

 

00;01;01;12 – 00;01;15;07

Dr. Mona

Well, I’m just really excited to talk to you because you work as a speech language pathologist, but you also have a special interest in autism. So what drew you to become a speech language pathologist and what drew you to specialize in autism?

 

00;01;15;07 – 00;01;41;29

Andi Putt

Sure. So I actually didn’t even know what a speech pathologist was until about six months before I graduated with my bachelor’s degree. And I was studying psychology and worked in a lab that was studying infants perception of speech and it was just like a light switch, like I was like, oh, this is what I’m going to do. And so I graduated and then went right back into my master’s to do speech and totally loved it.

 

00;01;41;29 – 00;02;09;02

Andi Putt

Did not look back, and then right out of school, went to work for the public schools and, worked at elementary, in high school for a few years. Always just really loved kids that, have a diagnosis of autism. They are always in a preferred population to work with. They’re fun. We just connect in a way that, I don’t know, I think is special.

 

00;02;09;02 – 00;02;38;13

Andi Putt

And soon after that, I was invited to be on our school district’s autism evaluation team. And so we got to do team based, which I love. I will always sing praises for team based. But what that would be, it was me and an educational diagnostician and a school psychologist all doing autism assessments together. And because I had that opportunity to work with so many other people who were amazing at it just it was so fun.

 

00;02;38;13 – 00;02;47;13

Andi Putt

And I learned so, so, so much having those people to really guide me and teach me. And I just fell in love and like I said, have not looked back.

 

00;02;47;15 – 00;03;09;03

Dr. Mona

Oh, that’s so great. And I just love, like I said, what you share on social media and what you’re doing in real life. It means so much. And I’m just so excited for this episode because one of the things that me and Andy are going to talk a lot about is terminology, ways to be more inclusive. And part of that is something that I wanted to ask Andy about was when we talk about autism, there’s person first or identity first.

 

00;03;09;03 – 00;03;20;26

Dr. Mona

What is recommended? What do you see that most families prefer? Is there a preference? Does it vary? Do some prefer a person first? Identity. What does it even mean? Person first versus identity first identity identification?

 

00;03;21;01 – 00;03;49;03

Andi Putt

Sure. So person first is what was drilled into my head in graduate school. We were taught that is the only way to say that. And that would be saying like a child with autism or a person with autism, and then identity first would be if you were to say like an autistic child or an autistic individual. And so when you see autism talked about in academia, they still will use person first.

 

00;03;49;03 – 00;04;20;05

Andi Putt

But the adult population who has been diagnosed with autism is very, very vocal for the most part, that they prefer identity first. And so we see this is very similar to the deaf community. They feel that autism is a part of their identity. They’re proud to be autistic. It’s like a it’s like a whole culture. And so when I talk about autism, like publicly, I will say autistic because that is how most people prefer to be identified.

 

00;04;20;05 – 00;04;37;00

Andi Putt

But I always tell everybody, you know, really listen to what the family says. And if they do use person first, then it’s probably best to just use person first to respect them. And then if it’s an older child or an adult, you can just simply ask them, you know, which do you prefer? Because it could go both ways.

 

00;04;37;12 – 00;04;44;17

Andi Putt

But like I said, because the majority of the adult autistic population, does prefer identity first, that’s what I try to use.

 

00;04;44;17 – 00;04;59;10

Dr. Mona

I really appreciate that because like you said in academia, we did learn person first, right? Like you said, child with autism. And I, I am prone to talk like that when I talk about autism. And yeah, and it’s hard sometimes because and I, I say it that way and I’m like, oh my gosh, was that the right way?

 

00;04;59;10 – 00;05;14;17

Dr. Mona

Was that the wrong way? Like I’m trying to keep it straight in my head. And then I already feel like I may have offended that family when I don’t have the intention of doing so. So I really appreciate you saying that that ask the family. Because you’re right, some families may still prefer that way or they prefer the other way.

 

00;05;14;17 – 00;05;28;29

Dr. Mona

And I think this episode, along with the other episodes that I released today, that’s the point here, is that we want to be more inclusive. We want to just promote awareness and just say, hey, this is what is going on. This is what people may prefer, and asking, hey, what would be your preference? I want to learn from you.

 

00;05;29;00 – 00;05;47;16

Dr. Mona

You know, I think that goes a long way for people, and it’s not anything personal. That’s literally just asking what their preference is. And I really appreciate you saying that because I have been practicing for about six years now and I still struggle. And some families, most of my families never say anything. You know, sometimes they’ll be like, oh, well, I prefer this.

 

00;05;47;16 – 00;06;00;11

Dr. Mona

And they’re so kind about it and people listening. I just hope you know that if you are not sure, you don’t have to be scared or say, well, I don’t want to get it wrong. If you get it wrong, you’ll learn. And sometimes you’ll say it one way and it’s the other way for another family. So thank you so much.

 

00;06;00;11 – 00;06;20;07

Dr. Mona

It’s really nice to hear, how you approach that. You know, we also talk about high functioning and low functioning that is an old terminology. Also, I think that was ingrained in medical literature and in what we learned in residency. But talk to me more about how that is not the case, how would you recommend us discuss the spectrum of autism?

 

00;06;20;13 – 00;06;44;18

Andi Putt

So it is really, really, really tricky because like you said, it is a quick way to kind of identify, a child’s needs. But what a lot of people will say is you can be what people would call high functioning, except for that behind the scenes. Maybe they’re not really so high functioning, or they’re giving up a lot of their energy or themselves to appear like they’re high functioning and then still struggle.

 

00;06;44;29 – 00;07;24;05

Andi Putt

And so terminology that I try to stick to is, like a level of support that they need. So they need significant support with, you know, changing and routines or significant accommodations for sensory needs and just kind of be a little bit more specific about the things that they need help with or need accommodations for, rather than just saying, oh, they’re high functioning, you know, and nobody wants to hear their child referred to as low functioning, you know, and then but the same thing when people say like, oh, he’s high functioning about a child, then that people just assume that means almost neurotypical or that they don’t need support.

 

00;07;24;05 – 00;07;44;19

Andi Putt

And it kind of like leaves out like that. There really is a need. And so I think it’s best to just kind of describe what those needs are when you’re talking to other people. And then the other thing people will say is, nonverbal. And then we’re trying to switch that to non speaking. That’s another thing that the autistic community prefers.

 

00;07;44;19 – 00;07;57;13

Andi Putt

So instead of low functioning nonverbal you might say, non-speaking and requires a substantial amount of support with daily living tasks, you know, or just kind of find some other words to describe that.

 

00;07;57;15 – 00;08;11;17

Dr. Mona

But that’s really really great to know. And I again, I’m so happy we’re talking about this because I think myself, as well as other people in the medical community are also doing this. And I think it’s just like I said, nice to know what is better and what may be better practices, because we can all learn from that.

 

00;08;11;17 – 00;08;30;06

Dr. Mona

So I really I truly appreciate this. Even before we recorded this, I told you, you know, I really want to hash out all of these things because I know a lot of my listeners are parents and a lot of my listeners are medical professionals, too. And I think this is great because you do work so closely with, autistic families and autistic children.

 

00;08;30;06 – 00;08;47;27

Dr. Mona

I really appreciate that. Now, what are your, in your opinion, because you do work, so closely with families, what would be some of society’s biggest misconceptions about children with, children with autism, autistic children? They I did it. It’s hard. It’s hard.

 

00;08;48;00 – 00;09;08;00

Andi Putt

I know it is. It is so hard. And even like when when I start talking because it was so drilled into my head like I have to intentionally think to stay autistic. So when I’m like teaching and going on, I will just automatically say child with autism. And I’m like, oh, I messed it up. But you know, but that’s part of it is like being intentional.

 

00;09;08;00 – 00;09;10;10

Andi Putt

And when you say it wrong, be okay. I’m just going to I’m going to.

 

00;09;10;10 – 00;09;10;20

Dr. Mona

Correct.

 

00;09;10;20 – 00;09;40;27

Andi Putt

That. You know, I’m trying I’m doing my best to be an ally and a supporter. But I would say one of the biggest misunderstandings would just be like that autism is bad or wrong, or it’s something that has to be fixed or changed. And that’s another thing that the, the autistic community is very verbal about. Because as medical professionals, we do tend to use like the medical model of disability, where it looks like that looks as if the person is the one who needs to be changed.

 

00;09;40;27 – 00;10;02;13

Andi Putt

But a lot of disabled individuals feel that it’s more of a social model, which would mean we would need to change the environment. So they would do just fine if they were in a environment that was friendly to autistics and autistic communication. And so I think we need to really kind of change our view on that, you know, like it’s not bad.

 

00;10;02;13 – 00;10;23;26

Andi Putt

It’s not wrong. It’s a different, you know, and there are areas of need that a lot of people do have. But that doesn’t really mean that they’re not going to have a happy life or they’re not going to be successful or get married or have kids. And I think a lot of people don’t really understand, like the wide range of autism.

 

00;10;23;29 – 00;10;44;08

Dr. Mona

That’s very, very true. And I again, this is why the the language is also really important. And talking to you about this is important. Now a lot of families, on my Instagram and just obviously my patients that come into my office, the biggest question that we have is, you know, what are the characteristics? Is this milestone or is this, activity or thing that my child is doing?

 

00;10;44;08 – 00;10;59;06

Dr. Mona

Is this something that I need to get evaluated? Is this something that I need to bring up to the pediatrician? I want to ask you, because there’s a lot of differing, I would say, opinions because people are like, hey, this could be something normal. This could not be something that is, you know, this is not a red flag.

 

00;10;59;06 – 00;11;07;17

Dr. Mona

Whatever it is. What would you say are some common characteristics that you would want a family to bring up to their child’s clinician if they’re seeing in their child?

 

00;11;07;23 – 00;11;33;05

Andi Putt

Sure. So always, always I say that autism is a constellation of characterized tics. So it’s when things are combined. And so typically when you have just one concern, like, you know, the stereotypical ones that everybody knows is the no eye contact or they’re flapping their arms or they’re walking on their toes, or they line up their toys, you know, when you just have one thing that wouldn’t make me be like, oh my gosh, we need to look at this.

 

00;11;33;19 – 00;11;57;27

Andi Putt

And do an evaluation based off of one thing. But when we do have differences and what I call the three key areas, so that would be differences in language, differences in socialized action. And then the last one really is two areas that it’s, repetitive behaviors, special interest or sensory differences. If we have differences in two of those areas, that’s usually when I would recommend, an evaluation.

 

00;11;57;27 – 00;12;29;20

Andi Putt

And so some of the differences in language could be delayed. Like which said they’re not talking. They were slow to talk. Maybe they’re using echolalia, which is repeating exactly what a parent says. If they’re using that more frequently then flexible language, that could be, a concern. And then socialization. This is such a huge one. And this the whole reason why I say that parents only need to have concerns into the areas is because parents are not good at recognizing differences in socialization, and honestly, not just parents therapists.

 

00;12;29;22 – 00;12;46;22

Andi Putt

People who are good at this are not good at recognizing differences in socialization, because a lot of the times we think that it’s antisocial and that is totally not what autism is. So autism, they can be social, they can make eye contact, they can have friends, they can want friends, you know, they can do all of those things.

 

00;12;46;22 – 00;13;08;04

Andi Putt

It just might be different or it might be difficult. You know, and so that’s when that’s that’s why I’m like just two of the three. That’s all we need. Because parents can notice when kids aren’t talking and they can notice when their, their play is repetitive or when they are lining up their toys, they’re struggling to engage in pretend play.

 

00;13;08;04 – 00;13;29;01

Andi Putt

Those are easier things for people to notice that are happening. You know, especially sensory sensitivity. So when you cover your note, your ear is too loud noises or, you know, you can’t handle water on your face. Some of those things, those are really easy for parents to note because it’s kind of like present or absent and not what’s the quality of this?

 

00;13;29;03 – 00;13;50;16

Dr. Mona

Well, that’s I think the hardest part. Right. And that’s why I think it’s so important that parents are monitoring their child and looking at what they’re doing in different settings is important. And then they bring it up to their child’s clinician and talk to them about it. You know, pediatricians have a huge role in diagnosing autism and also walking through with the family on, okay, is this something that we are monitoring?

 

00;13;50;16 – 00;14;06;17

Dr. Mona

Is it something that, is something that I need to be evaluated because, like you said, some of those things when they’re isolated, like you said, maybe one of those things could be it’s absolutely okay. But when we’re starting to see it in multiple different areas and we’re like, okay, I think it’s best to do an evaluation. Now.

 

00;14;06;23 – 00;14;21;12

Dr. Mona

One of the biggest things that we do in pediatrics is the mCAT. So that’s the modified checklist for autism in toddlers in the United States. We do that at usually 18 months and two years. And I’m sure you’re familiar with that.

 

00;14;21;14 – 00;14;22;11

Andi Putt

Yes. I don’t.

 

00;14;22;12 – 00;14;24;21

Dr. Mona

Yeah. What are you doing it.

 

00;14;25;06 – 00;14;47;12

Andi Putt

So I did some research for us just to talk about. And so. Yeah. So what I think is the research has said about the mCAT are it is like not I think it was like 96% of the kids who fail, and get referred for additional testing will have developmental delays and not necessarily autism, but developmental delays, which is good.

 

00;14;47;12 – 00;15;12;27

Andi Putt

We definitely want to be finding those kids. Those kids are a little bit easier to find because they’re missing a lot of milestones, right? You know, so it’s good to have a screener that catches those. But only 50% of the kids who fail end up getting an autism diagnosis. And I couldn’t find data on this. But I have pulled my followers many times and and it makes sense.

 

00;15;13;00 – 00;15;32;22

Andi Putt

But so, so, so many kids are passing the mCAT only to get a later diagnosis. And I’m going to go ahead and say this is okay because I say all the time. A lot of times kids are not clear until they’re five, six, seven, eight years old because they can do a lot of those social things that we talked about.

 

00;15;32;22 – 00;15;57;14

Andi Putt

And it’s not a clear difference until they’re older. But kids that really should be flagged at this age are passing the chat. And so it definitely there needs to be some, some changes for sure. And then the other really, really shocking number was said that only 31% of kids who failed the end chat were referred for a specialist.

 

00;15;57;14 – 00;16;14;28

Andi Putt

And so people were not making these referrals. It’s like, oh, you failed. Well, let’s just wait, you know, and that’s that’s really a problem because it’s there for a reason. And if you fail it, we really I’m so pro evaluation that I’m like, if anybody has a concern let’s just do it. Let’s get it looked at and then we can move forward.

 

00;16;14;28 – 00;16;35;18

Andi Putt

And if we you know, if I see a kid for an autism evaluation and I’m like, nope, that’s not autism. Like that’s not that’s not a big deal. You know, like I’m giving the parents tons of information about this child that’s not, you know, all kinds of strengths and weaknesses and things that need to be addressed. And so it’s still really helpful to have an evaluation even if you don’t get a diagnosis.

 

00;16;35;21 – 00;16;58;11

Dr. Mona

Oh, I completely agree. I am so pro evaluation too. I think I’ve gotten more pro evaluation as I’ve become a pediatrician longer. Meaning when I first started, I think and again, I think this has to do with the experience, the families I’m taking care of, the fact that I see a lot of later diagnosis of autism. And then I look back and I think, hey, was there something that we could have done differently earlier on?

 

00;16;58;11 – 00;17;13;23

Dr. Mona

You know, that’s always what I’m doing with my families. Any time I have a family who we finally make a diagnosis, just say it two and a half years, I talk with the family, you know, I say, hey, look, what do you think we could have done differently? Two years and 18 months. And they also agree that, doctor, we were watching the same things.

 

00;17;13;23 – 00;17;31;08

Dr. Mona

I went to Early intervention. They said it was only a speech delay. We were monitoring the things that we were supposed to monitor, and we were closely doing that. Right. So you said it perfectly that sometimes that diagnosis just truly comes out later. It doesn’t mean that that was a failure to diagnose. It was just progression of maybe now we’re seeing that happen, right.

 

00;17;31;08 – 00;17;49;25

Andi Putt

Right, right. And that’s what I’ll say. I have missed it. Like I’ll have it as a child at four years old and then come back at 6 or 7 and be like, what on earth? Why did I say no? Look, you know, because it’s so clear at a later age. But earlier, the social demands for a 3 or 4 year old, they’re really not that much, you know.

 

00;17;49;25 – 00;17;57;14

Andi Putt

But then once things get more complicated with relationships and school, then it’s sometimes it’s a little bit easier to see at that older age.

 

00;17;57;21 – 00;18;13;16

Dr. Mona

Well, I would like to talk about the questions on the chat, only because I think so many of my listeners have filled this out, and I do think we have a little bit of time and I think want by doing this, we’re going to be able to kind of also talk well, if this characteristic or this thing that they’re talking about, what are your thoughts?

 

00;18;14;00 – 00;18;30;25

Dr. Mona

As someone who is very specialized in this, what are your thoughts about that? So I have 20 questions and we’ll go through. I’ll jump around if we need to. I’m going to not do all of them. I’m just going to do some of them. So the first one was, if you point at something across the room, does your child look at it and it’s, you know, a yes or no question.

 

00;18;30;25 – 00;18;34;14

Andi Putt

So which is a major problem in and of itself.

 

00;18;34;17 – 00;18;37;00

Dr. Mona

Yeah. So tell me what your problems with that question is. Yeah.

 

00;18;37;07 – 00;18;58;22

Andi Putt

Right. So the the first problem is the yes or no, because there will be zero children who point who look every single time that a parent. Yes. Like nobody’s going to do that 100% of the time. But then also probably nobody I mean, there probably are some kids that are going to do not follow you 0% of the time, but this question is so vague.

 

00;18;58;22 – 00;19;16;22

Andi Putt

And so if I was going to, like, take a probe at this, I would point across the room and look at the child. And I wouldn’t say anything. And then I look back to what I was pointing at and see what they did. And if they didn’t respond, I might go, oh, you know, and see if they look and respond to that.

 

00;19;16;22 – 00;19;30;18

Andi Putt

Gasp, okay, but parents don’t know this. And so parents could be pointing across the room and saying, look, look, look at the dog, dog, the dog, you know, and by then the dogs barking and running around and so is the child following your point.

 

00;19;30;18 – 00;19;31;14

Dr. Mona

Or.

 

00;19;31;14 – 00;19;45;28

Andi Putt

Are they listening to your directions to look at something? Or did they hear you say dog? Or were they like, oh, something’s barking. Or when the dog started running around, were they looking at the dog running around, you know. And so it’s really unclear like how to do some of these.

 

00;19;46;01 – 00;20;04;19

Dr. Mona

Yeah. And you said it perfectly that the yes or no part of the chat is really hard because you can’t put a child into a yes or no, because like you said many times, they’re not doing it. All the times I spent a lot of time talking about the responses on the chat, meaning I rather just talk to the family about the things that you mentioned.

 

00;20;04;19 – 00;20;21;28

Dr. Mona

You know, the repetitive play, the lining of the toys, the the speech, the struggling and pretend play, all those things. I rather talk to them about what they’re seeing, what they’re seeing in preschool or school or at home in other settings, versus okay, well, is it sometimes, is it not? They’re like, well, sometimes I’m like, and they even say they’re like, yes or no.

 

00;20;21;28 – 00;20;35;08

Dr. Mona

It’s not always yes or no. And I agree with you completely. What we’re talking about here is something called joint attention. And I think that’s something that commonly comes up is not having joint attention in your opinion, an automatic red flag or something that we need to evaluate?

 

00;20;35;13 – 00;20;59;26

Andi Putt

I think a lot of the times it would be a, a concerning sign, you know, a lot of other speech therapists will not agree, but those kids that are getting those diagnoses later, they will have been in an earlier intervention. They will have been working on joint attention. You know, so you see that a lot in kids history and really what joint attention actually is.

 

00;20;59;26 – 00;21;28;08

Andi Putt

You’re not even supposed to point, so you’re just supposed to look and then look at the child and then look back at the thing. And so that would be them responding to joint attention if they looked at what you looked at. But what we really want them to do is initiate joint attention. So we want them to show us something that they like by looking at the item, looking at us and looking back to the item, or looking at the adult and looking at the item and looking back to the adult to make sure that they’re looking at what they wanted them to do.

 

00;21;28;08 – 00;21;30;10

Andi Putt

It’s really nuanced, and it’s really.

 

00;21;30;10 – 00;21;31;03

Dr. Mona

Hard for.

 

00;21;31;03 – 00;21;34;25

Andi Putt

Parents to follow all of those pieces.

 

00;21;34;27 – 00;21;53;18

Dr. Mona

Oh yeah, and I have like a few more on that, chat that I think can also go into that same, well, you know, is it is or not the, the other one is the comment, or the question, does your child play pretend or make believe example, pretending to drink from an empty cup, pretending to talk on a phone, or pretending to feed a doll or stuffed animal?

 

00;21;53;18 – 00;21;57;03

Dr. Mona

You mentioned that in terms of the pretend play, right?

 

00;21;57;05 – 00;22;17;25

Andi Putt

And so that is a really good question. And I think a lot of pediatric you’re very good because a lot of the times people will be like, nope, we didn’t do any follow up questions. And so like a lot of people you get that in chat. And it’s just the questions. And then if you fail, that’s when your, provider is supposed to go over the follow up questions.

 

00;22;17;25 – 00;22;39;19

Andi Putt

And the follow up questions are actually really, really good questions. Except for that it’s way too easy to pass. And so when we have a, you know, the interest for 16 to 30 months old. And so if you have a 16 month old who can pretend to drink from a cup, that’s a pass for pretend play, even though there’s a whole list of other pretend plays.

 

00;22;39;19 – 00;22;56;23

Andi Putt

And if you say no to all of them because they did the cup, that’s a pass. The kids can do that. Like that. You drink from cups all the time. That’s really not even. I mean, that’s more of a functional play. If you were if I was going to get down to the nitty gritty, but it’s more of a functional thing, like, I know how to drink from a cup.

 

00;22;56;23 – 00;23;08;18

Andi Putt

It’s really not that creative to do that, you know? And so I think it’s really easy on a lot of the follow up questions to end up passing when really kids should probably not be passing.

 

00;23;09;02 – 00;23;25;12

Dr. Mona

The other one, is does your child make unusual finger movements near his or her eyes? For example, does your child wiggle his or her fingers close to his or her eyes? This one is one that I’m always having to clarify and ask families. Would this be something you’d want to clarify? Is this something that we should like?

 

00;23;25;12 – 00;23;30;01

Dr. Mona

What should parents know when they’re answering that question or their pediatrician ask ask them that question.

 

00;23;30;05 – 00;23;57;25

Andi Putt

Yeah. So this is is a one of the very few signs that almost always autism. And so when I’m asking a parent this I am going to wiggle my fingers, on the sides of my eyes or in front of my face. I’m doing it now. I know you can’t see me, but, like, it’s almost like if you were going to, put your two fingers beside your face and take a picture, like, click, click, those kinds of things, or waving fingers in front of your face.

 

00;23;57;25 – 00;24;16;23

Andi Putt

So I have to kind of do it with my body for them to be like, oh, okay. Yeah, they do that. Because a lot of the times they’re not unless a child’s doing it very frequently and the parent is like, I don’t know what is going on, and I can’t make them stop. Parents don’t seem to really notice that, but that goes along with finger posturing.

 

00;24;16;23 – 00;24;32;28

Andi Putt

And you’ll see this even not near the eyes as well. So if you see unusual finger movements, that is very common. In autistic kids, it is it kind of stim and it helps them to regulate themselves. So it’s a very good motion. You want them to be able to do that. It means they’re calming and regulating themselves.

 

00;24;32;28 – 00;24;37;06

Andi Putt

But it is an atypical sign. We don’t usually see that in typically developing kids.

 

00;24;37;08 – 00;24;52;10

Dr. Mona

The next one is, is your child interested in other children? For example, does your child watch other children smile at them or go to them? And again, we’re doing this at 18 months and again at two years. What are your thoughts on that question in regards to making a diagnosis? Or is this a concern.

 

00;24;52;13 – 00;25;10;12

Andi Putt

So this one is one of those really, really tricky ones because a lot of kids will watch other kids play and that can be typical. Or it could be atypical, you know, and said, this one’s one where I would want to ask a lot more questions like, are they engaging in parallel play where they’re next to them? Maybe.

 

00;25;10;12 – 00;25;30;22

Andi Putt

Are they imitating the other kids play? Are they trying to make sounds or doing some kind of interactions with them? But yeah, that one is that one is a I think it’s a good question, but it is really hard to get a good clarification, and especially now with Covid, because nobody knows what their kids are doing socially.

 

00;25;30;22 – 00;25;46;11

Andi Putt

You know, like, I don’t even my sense in school, but I don’t really know what he’s doing because we’re not having our parent teacher conferences and we’re not going into the school. It’s for the kids only right now. You know, so I think some of these questions, especially right now, are difficult to answer.

 

00;25;46;13 – 00;25;58;10

Dr. Mona

And the last three I’m going to go over again. There’s 20 I’m not going to go through all of them. But these are ones that again, I think I get a lot of common questions about on my social media. And then I talk to families a lot too. The next one is, does your child respond when you call his or her name?

 

00;25;58;10 – 00;26;05;03

Dr. Mona

For example, does he or she look up, talk or babble, or stop when he or she is doing when you call his or her name? So responding to name?

 

00;26;05;03 – 00;26;27;11

Andi Putt

Yeah. And so you want to see your child responding to their name the majority of the time. Of course, this is one of those things, especially if your child is really engaged in something. So if you have, an iPad and you’re calling your child’s name, probably you are calling their name to tell them to get off the iPad or do something that is going to disrupt their iPad time.

 

00;26;27;11 – 00;26;50;05

Andi Putt

So it is very likely, neurotypical or, neurodivergent to, not respond to that. And so when you try want to test this out, you’ll want to do it when your child is not engaged in their and their favorite activity. And then you want to see them look towards you. So even just stopping or kids will say what?

 

00;26;50;08 – 00;26;56;09

Andi Putt

But then they don’t really look, you want to see them looking and responding more often than not.

 

00;26;56;11 – 00;27;13;07

Dr. Mona

This is great. I’m glad we’re going through this because of these little educational pieces that you’re able to give in terms of having parents understand, you know, well, what how can you engage properly to see if you can elicit that milestone, or that developmental, assessment? I wanted to quickly asked about babbling. You know, that question talked about babbling.

 

00;27;13;18 – 00;27;25;23

Dr. Mona

You know, there is some thought, and I’ve been told this by some of my followers and I’ve actually read some places about delayed babbling. Right? Delayed babbling can be a concern of autism. Have you heard this, too?

 

00;27;25;27 – 00;27;31;21

Andi Putt

Yes. I mean, because delay babbling usually precedes delayed speech and so.

 

00;27;31;21 – 00;27;32;02

Dr. Mona

Right.

 

00;27;32;07 – 00;27;35;06

Andi Putt

Yeah. So they kind of go together. Most of the time.

 

00;27;35;11 – 00;27;55;03

Dr. Mona

But it’s also delayed babbling with the other things. I want to clarify the delayed babbling with the other things that you mentioned too. Right. It’s obviously a, a constellation of symptoms. So I think when we talk about milestones, especially on social media, I explain to families it’s really hard for us to make diagnoses over social media. One, because we’re not your doctor.

 

00;27;55;05 – 00;28;14;22

Dr. Mona

Number two, it’s because it is a big picture, right? If your child’s not babbling, but they’re doing other things like turning to their name, they’re starting to show signs of pretend play, like they’re doing other things. And I’m like, I’m going to be not as not be as concerned. But that’s why it’s so important that if you’re concerned about anything, you can bring it up to your child’s clinician and they can look at the whole picture.

 

00;28;15;06 – 00;28;33;21

Dr. Mona

One thing that I always tell my patients or more so my followers on my Instagram, is if you’re concerned and you tell your child’s clinician that I’m concerned and they tell you, okay, I’m not concerned, I want you to ask them in a nice way. Not like, well, why not just say, I appreciate you? What about my child is not concerning you at this moment.

 

00;28;33;21 – 00;28;52;17

Dr. Mona

I think it’s really important to hear that from the child’s clinician, because then you will get that big picture and say, you know what? I’m not concerned because your child’s doing x, Y, and Z, but I want to monitor that. I think the clinicians duty is to provide that for a family who is concerned, because if we’re saying that you don’t need a referral or whatever it is, I’m not saying that you’re pushing back.

 

00;28;52;17 – 00;29;07;23

Dr. Mona

I’m saying that you have the right to say, well, what is it? What is it about my child’s development? And, you know, they should be able to help you guide that and say, this is something that I’m seeing that’s positive. This is something that maybe I want us to monitor in a couple months. Or I want you to work with, the child on.

 

00;29;07;23 – 00;29;10;24

Dr. Mona

So I think that’s a really important point to for sure.

 

00;29;10;27 – 00;29;33;23

Andi Putt

And I think that it’s really important for doctors and therapists and clinicians to not dismiss a parent’s concerns. I think it’s okay to say at this point in time, you know, it’s it’s not a concern to me. But if you are concerned, let’s let’s go, let’s move forward, you know, or if it’s not babbling, I might say, well, that could be typical.

 

00;29;33;23 – 00;30;03;04

Andi Putt

Or it really it could be atypical. We just need to give it time, because sometimes when we really close the door and people say it’s not a concern, they’re fine, parents will start to feel like they are, were over worrying or stressing out or overanalyzing, when really that parent just needs support and understanding and somebody just say, oh, if you’re concerned, then let’s just go, you know, let’s just go on.

 

00;30;03;04 – 00;30;29;29

Andi Putt

And I’ve been so blessed that my pediatrician has has been like that with me, because my son has a variety of we’ve seen all kinds of specialists because of whatever different thing has popped up in his development. And he’s been really good with saying, well, I am not that concerned, but I’ll put, you know, let’s get a referral for occupational therapy or physical therapy, you know, and he’s really, really supportive of me going to see the specialists and sending me those referrals.

 

00;30;29;29 – 00;30;40;05

Andi Putt

And a lot of times I’ll hear parents who don’t have that support, you know, it’s more just like, no, I’m not worried. And then there’s no follow up conversation and no referrals.

 

00;30;40;07 – 00;30;57;03

Dr. Mona

Yeah, that’s a great point. This is such a great episode already, and I’m so grateful. It’s just so nice to talk to you, one, because I don’t really get to talk to a lot of specialists besides doing this podcast. Right. So through this, I’m able to talk to people like you. I talked to another, like I said, developmental behavioral pediatrician about autism.

 

00;30;57;03 – 00;31;16;25

Dr. Mona

I talk to moms. It’s just so much that we can learn, even for me as a pediatrician who’s been doing this, I so appreciate this. The last two I wanted to talk about from that, chat were, again, just a few, few more was does your child get upset by everyday noises? For example, does your child scream or cry to noise, such as a vacuum cleaner or loud music?

 

00;31;17;15 – 00;31;46;03

Andi Putt

And so this is another one where the the follow up questions are helpful. But you know it’s because it’s, it’s pointed the way that it frames it is that it’s only atypical if kids cover their ears and scream or like they get totally dysregulated. And while that is common in autistic kids, a lot of kids can stay regulated and they’ll just cover their ears and they can remain calm when those sensory differences happen.

 

00;31;46;03 – 00;32;04;27

Andi Putt

But then also so many kids, when you when I hear a loud sound like when our fire alarm goes off at school, I’m covering my ears because it’s really loud and it hurts, you know? So I think you need to consider how often these reactions are. And when we look at sensory, you’d want to look at is it more than just loud sounds?

 

00;32;04;27 – 00;32;23;13

Andi Putt

So is it sensitive to washing hair? Are they a picky eater? Are they bothered by tags in their clothing? When you tend to have a bunch of different sensory responses to their environment, that’s more indicative of this could be a sensory processing disorder and could this be a characteristic of thought of autism?

 

00;32;23;16 – 00;32;43;24

Dr. Mona

Oh great point. And I’ll get into that in a bit about the picky eating. Also, that’s not even mentioned on here. And I’ll explain what I talk to families about and what I educate parents about. And I’m just curious, your thoughts too, if you think this is appropriate. But the last thing is, on this minute that I wanted to go over, does your child look you in the eye when you are talking to them, playing with him or her or dressing him or her?

 

00;32;43;24 – 00;32;47;29

Dr. Mona

So basically the eye contact question that we get a lot about milestones.

 

00;32;48;17 – 00;32;51;21

Andi Putt

And this is another one that people in general.

 

00;32;51;24 – 00;32;52;15

Dr. Mona

Are.

 

00;32;52;16 – 00;33;17;15

Andi Putt

Not good at. Recognizing because the general population tends to think of, of eye contact as either present or absent. So you’re either seeing eye contact all the time or they never ever, ever make eye contact. And then that’s another when the follow up questions to pass. It’s just look you in the eye five times a day. Like that’s not that difficult to do.

 

00;33;17;15 – 00;33;39;28

Andi Putt

Even a child who is avoidant of eye contact can probably still make eye contact five times a day. And so this is a really tricky one because you want to see it is typical to see a child make eye contact when they’re showing you something or asking for something. When you call their name, when you’re sharing enjoyment, are they looking at you and smiling to show you that they’re having fun?

 

00;33;39;28 – 00;33;56;14

Andi Putt

There’s really a lot of really, again, nuanced differences in eye contact, that you can make eye contact 100 times a day and still be autistic. So these kids, they can do it. It’s not a present or absent thing. And then also you’ll see kids who make.

 

00;33;56;14 – 00;33;57;18

Dr. Mona

Really, really.

 

00;33;57;18 – 00;34;24;15

Andi Putt

Intense eye contact to where you’re like, oh, this is a little bit uncomfortable for me because you’re like staring into my eyeballs and, you know, probably because a parent has been scared about autism and has drilled, you need to look people in the eyes. And so they are looking into your social, you know, with the eye contact. And so that’s yeah, that’s a really hard one for non-specialists to recognize.

 

00;34;24;18 – 00;34;40;24

Dr. Mona

And again, I think the summary of all of this is that you can’t do it’s not always so clear as to do yes or no. It really may be involving a lot more explanation, a lot more well what is going on. So when you do or if you are answering this, chat and you are concerned all about the questions on the chat, absolutely.

 

00;34;40;24 – 00;34;57;09

Dr. Mona

Talk to your clinician like Andy saying like I’m saying, make sure you are expressing your concerns because your concerns are very important. You’re with your child way more than a clinician, only sees you for 10 to 20 minutes. So important. You know, one thing I often tell my families, and I want to word this in a very proper way.

 

00;34;57;09 – 00;35;14;09

Dr. Mona

So, you know, we talk when I talk about parenting, when I talk about parenting in that first five years, I talk about sleep, eating and behavior. These are three things that parents are often asking me questions about, right? Why is my child not sleeping? Are they a picky eater? How are they able to handle emotions? And I talk to all my families about it.

 

00;35;14;09 – 00;35;30;04

Dr. Mona

And, you know, I talk about boundary setting for for these children. I talk about, you know, ways to help them learn how to settle on their own, ways to help them settle with your health. And I always tell my families that if we’re starting to see that you are implementing the boundaries and you are implementing these things, but it’s just not sticking.

 

00;35;30;06 – 00;35;48;20

Dr. Mona

The sleep is not sticking, the eating is not going well, and the behavior is affected. When you start to see that trifecta affected, I am getting concerned that is there something development going on that we need to evaluate? This is not boundary setting. This is something that is coming from the child that we need to evaluate to see.

 

00;35;48;23 – 00;36;07;13

Dr. Mona

Is this child needing assistance in these areas in like early intervention standpoint, or is it something that we need to fine tune? I have had so many of my autistic children, I did it, I got it right this time, I think. Yeah, I’ve had so many of my autistic children that have seen me later. Right? Meaning I’m talking like three four and we backtrack.

 

00;36;07;13 – 00;36;21;23

Dr. Mona

And this is how I’m kind of understanding. We backtrack and I’m like, look, how is your child? I’m not saying that all children don’t sleep well and are picky eaters and, have meltdowns, but I’m looking at trends and I’m saying, hey, look, I was notice the parents say I was noticing that this wasn’t going well, this wasn’t going well.

 

00;36;21;23 – 00;36;45;16

Dr. Mona

And I know that’s probably looking back and, you know, maybe trying to nitpick everything. But I do think it’s important that if we’re seeing a lot of domains affected, right, the development but also behavior and also just, you know, like you said, the things that they’re doing, it’s important to bring that up and not say to yourself, well, maybe I’m not doing something right, maybe your child and you need the assistance in terms of developmental, you know, early intervention.

 

00;36;45;16 – 00;36;50;00

Dr. Mona

ABA what if that turns out to be an autistic diagnosis? But I think it’s really important to remember that too.

 

00;36;50;08 – 00;37;19;26

Andi Putt

Right? Well, and so I think it’s definitely important to point out that you can be autistic and not have behavioral difficulties. You can be autistic and you can sleep just great and picky eating, you know, and especially the the behavior and sleeping. Those are not key components. Like that’s nowhere in the DSM, but those are often yeah, I think that a lot of the meltdowns are what is coming from changes in routine when they weren’t prepared and becoming dysregulated because of the sensory world around them.

 

00;37;20;05 – 00;37;38;01

Andi Putt

And then I think the other thing that we need to talk about is ABA really isn’t the only option for these kids. It does tend to get prescribed a lot, but that’s definitely not the only option. And I think parents need to definitely know that and think about that and learn about it and really be aware that there are a bunch of different options.

 

00;37;38;04 – 00;37;50;29

Dr. Mona

What are some other mistakes you think that we’re making when diagnosing, autism? We talked about obviously this this chat stuff, but what other things would you want to, you know, talk to me about or just kind of explain?

 

00;37;50;29 – 00;38;15;13

Andi Putt

I think one of the biggest mistakes is that specialists. So people who are evaluating for autism are still sticking to the stereotypes, and they’re not broadening their knowledge of the wide range that autism can look like. Specifically girls. We know girls are not getting identified. You know, a lot of them are getting identified later in their late teens, or many, many adults.

 

00;38;15;13 – 00;38;39;24

Andi Putt

So a lot of times when I’m evaluating a child, the parents like, but I did that and I’m like, yep, yeah, I get it. Because, you know, and then they end up getting their diagnosis. And at 30 or 40 years old, these are the kids that were too social to get the autism diagnosis. And there’s really a big problem because people are like, well, if if nobody’s known noticing that they have a need, then why do we need to evaluate them?

 

00;38;39;24 – 00;39;02;12

Andi Putt

But there’s research. And these, women now are speaking about masking, which is hiding their differences and imitating other people. And there’s a lot of emotional trauma around that because they are pretending to be somebody that they’re not, because they think something’s wrong with them, and there’s nothing wrong with them. Their brain is just different. It’s wired differently.

 

00;39;02;12 – 00;39;25;16

Andi Putt

They think differently. They respond differently to their environment, and they didn’t learn all of the social, the, you know, the unwritten social rules that you and I learned just by observing the world around us. So they don’t understand when they make somebody mad, like why that happened, because they didn’t know that it was rude to tell the truth, you know, in certain situations or things like that.

 

00;39;25;16 – 00;39;51;03

Andi Putt

And so I think that we need to be better at recognizing the social kids or the, the intelligent kids. Those are the ones that we are missing a lot. And so a lot of times, I’ll say a lot people will, miss the forest for the trees. And so I’ll get a child and you’ll have a slew of diagnoses, and they’ll have language delay and, sensory processing disorder, ADHD, OCD and anxiety.

 

00;39;51;03 – 00;40;12;01

Andi Putt

And I can just look at that on paper and be like, why didn’t you do an autism evaluation? Because what’s more likely, could it be the one diagnosis that kind of encompasses all of those? Or is it more likely to actually be 6 or 7 different diagnoses? You know, like this is way more likely to be autism? But people will see, oh, they’re social.

 

00;40;12;01 – 00;40;20;14

Andi Putt

So it’s not autism, but it’s definitely all of the other components of autism. And then the person will be like, but I’ve struggled socially my whole life.

 

00;40;20;16 – 00;40;38;24

Dr. Mona

You know. Yeah, absolutely. No, this is so true. And you said, you know, I think it’s so important that we make the diagnosis. I think there is there’s still a fear of having a diagnosis. And I, I want to I wish I could just scream it from rooftops that the, the diagnosis, this is not supposed to be a negative thing.

 

00;40;38;24 – 00;40;54;19

Dr. Mona

This is not what we want. We want. We want your child to have the help that they need in terms of whether that’s some specialized services, anything like that. Again, we want to be pro intervention, right? Pro intervention is what we want. And I think even now there is a fear of like, well, I don’t want the label.

 

00;40;54;19 – 00;41;08;26

Dr. Mona

And I’m like, well it’s it’s not about the label in my eyes. I mean, I don’t know if you hear this too in the the families you work with, but I don’t it’s not the label. I want you to get what your child needs so that they can have the best outcome for them in that time frame. That’s so vital, right?

 

00;41;08;26 – 00;41;23;25

Dr. Mona

So I’m sure you hear that too. I mean, we talk about older, you know, 40 year olds who get diagnosed. They went their whole life. And maybe, maybe, just maybe if they got that a little bit earlier, they, you know, it would have been something that could have affected their life differently. And maybe they, you know, they dealt with that and that’s fine.

 

00;41;23;25 – 00;41;40;16

Dr. Mona

But I just think it’s so important that we’re so pro intervention. And that is the purpose of these episodes is talking about, hey, if we are concerned, you are concerned. There’s nothing wrong with getting the evaluation. And if you are evaluated, we want to get the services or intervention that’s needed.

 

00;41;40;16 – 00;41;59;02

Andi Putt

Right. Well, and if your child gets an autism diagnosis, they are the same child as they were before they got the autism diagnosis. They have the same needs. They have the same every single thing. You know, they can still have a lot of people think that that takes away their future. They’re still going to have the same exact future, really is if autism is written on a piece of paper or not.

 

00;41;59;02 – 00;42;37;07

Andi Putt

But we have a better understanding of how they’re going to learn. The report should come with a lot of recommendations on how you can help them and support them in their areas of need. And then also, we know that a lot of autistic people have depression and, eating disorders and a lot of mental health issues. And once they find out that it’s just the difference in their brain and nothing is actually like wrong with them, that can really help support a lot of those mental differences, because it takes it just takes the weight off their shoulders and they can really understand, you know, like, I’m not bad at making friends.

 

00;42;37;07 – 00;43;12;09

Andi Putt

I just go about it a different way, you know, like that’s all that it is. It’s just something that’s different and it’s not something that I was doing wrong, you know? And then it also can help them find their find their people. You know, the studies show that neurotypicals and autistics really struggle to communicate amongst themselves that autistic autistic communication is, just as successful as neurotypical to neurotypical communication and so, you know, I think I think that’s probably one of the reasons why we’re seeing in higher incidence is because they are getting married and having kids.

 

00;43;12;09 – 00;43;21;18

Andi Putt

And, you know, it’s all about genetics and, but it’s definitely, you know, they can be happy and they can have kids and, and do all the things.

 

00;43;21;20 – 00;43;30;11

Dr. Mona

Yeah, absolutely. Oh, Andy, this was so awesome. I love talking to you about all of this. What would be your final message for everyone listening today?

 

00;43;30;17 – 00;43;49;16

Andi Putt

I think, you know that, first of all, I think we all need to kind of move away from thinking autism is a bad thing, you know? So we talk a lot in the media right now. We’re talking about racism. And there’s a really similar bias when it comes to looking at disabilities. And so we do have bias against that.

 

00;43;49;16 – 00;44;14;24

Andi Putt

If I asked you flat out, do you think that people with disabilities are less than you would of course say no. But then when we look at how we go about things, it’s not it’s not all inclusive of everybody, you know, and there’s a term that’s called ablest and it’s kind of like racist, but for disabilities and even though I know all about ableism, I still will make an assumption that is ableist because I don’t have a disability.

 

00;44;14;24 – 00;44;38;01

Andi Putt

I’ve never been discriminated against. I’ve not I’ve not been in that position. But I think if we’re really aware and we, and we try, we talk openly about autism, we teach our kids about treating others the same or how they can be inclusive. You know, I think we can make the world better, but definitely just opening your mind to autism and not being closed minded about what you think it is, but broadening your awareness.

 

00;44;38;01 – 00;44;43;29

Andi Putt

I think it can change the world, and not just for autistic kids or, neurodivergent individuals, but for everybody.

 

00;44;44;05 – 00;45;08;13

Dr. Mona

Oh, absolutely. Oh, I’m so glad we were able to talk about this. And again, I just so I so loved being able to learn from you about the terminology, the, the way we speak about this. You know, the, we talked about the not high functioning, low functioning, the first person, first identity, first. These are all things that are so important that I think we need to do to just spread awareness and also just, spread education about autism everywhere.

 

00;45;08;13 – 00;45;33;09

Andi Putt

And I’m I’m not call. Yeah. Go ahead. But you did say these because we did we just say these automatically. But red flags when we say that to parents it I mean it sounds so scary. Right. And so we want to talk about it in a less. Yeah. And a less scary way. But red flags and symptoms. We are so medically based in our thinking that that’s just how we talk, and we don’t mean them to be a negative thing.

 

00;45;33;09 – 00;45;56;01

Andi Putt

But if we kind of put ourselves into parent perspectives, when we start hearing scary words like red flags and symptoms, it’s a lot scarier than than if you were to say, characteristics or traits or, you know, it’s a condition rather than a disorder. You know, you can really kind of present autism in a less scary way than what a lot of people do.

 

00;45;56;04 – 00;46;15;18

Dr. Mona

Okay, perfect. No, I completely I completely agree with that. And I even talk to you about that beforehand. And again I slip and I, I’m trying I mean, I really do try and I, you know, the more I keep talking about this with, with you and with more families and with other people, it really helps, obviously. And I think this is kind of how we, we learn because a lot of this comes from the training.

 

00;46;15;18 – 00;46;29;08

Dr. Mona

You know, we we were told that the terminology, red flags, all these terminologies that we are that we talked about on this episode. So thank you so much for calling it out. We’ve talked about that on my Instagram too. When I messaged you, I remember I remember asking you I was like the terminology.

 

00;46;29;08 – 00;46;50;25

Andi Putt

Yeah, yes, it is so ingrained. And when you just start talking and you’re and you can’t I mean, we can’t be intentional about every single word that we say when you’re having a quick paced conversation. But I think that when you are more intentional about it, you’re like, oh, I shouldn’t have said that. But then if you do that enough times, it will change what your automatic verbiage is.

 

00;46;50;27 – 00;47;11;20

Dr. Mona

Absolutely. Oh everyone, you have to follow Andy at Mississippi GP on Instagram. And like I said earlier, her account has so much education about development. Especially obviously speech language as a speech language pathologist. But her energy, like you can hear on this episode is so refreshing. I love what she brings to social media and to the world.

 

00;47;12;04 – 00;47;16;16

Dr. Mona

So thank you again for joining us. And I’ll touch her, Instagram handle on my show notes.

 

00;47;16;24 – 00;47;18;21

Andi Putt

Perfect. Yeah. Thank you for having me.

 

00;47;18;27 – 00;47;34;19

Dr. Mona

Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.