As a pediatrician, I know how stressful it can feel when you’re filling out those developmental questionnaires at your child’s checkup. You check a few “no” boxes, and suddenly you’re spiraling! What does this mean? Should I be worried?

In this episode, I sit down with an autism specialist to talk through what some of those screening questions actually mean and how they’re meant to be interpreted. We look at common items from the M-CHAT like pointing, pretend play, and responding to their name and unpack why these aren’t simple yes-or-no milestones.

We talk about what’s typical, what might be worth keeping an eye on, and how to bring up your concerns in a productive way with your child’s doctor. Most importantly, we discuss why one missed skill doesn’t equal a diagnosis, and how to focus on the whole picture of your child’s development.

We discuss:

• Why the M-CHAT can sometimes create more confusion than clarity

• What “joint attention” looks like in real life (and why it matters)

• Why pretend play is about creativity, not just copying

• What finger posturing means—and why it’s often a self-soothing behavior

• When to worry about your child not responding to their name

• How delayed babbling fits into speech and language development

• How to ask your child’s clinician the right follow-up questions when you’re worried

 

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00;00;00;02 – 00;00;22;18

Dr. Mona

Hey everyone, it’s Doctor Mona and welcome back to the follow up. This is a series on the PedsDocTalk podcast, where we revisit a past favorite episode, and I bring these episodes back for a few reasons. Sometimes because they were community favorites, sometimes because something’s come up that I want to revisit, and sometimes because you ask for more.

 

00;00;22;20 – 00;00;48;13

Dr. Mona

This one checks all those boxes. There has been a lot of confusion and stigma and misinformation floating around about autism lately, and I wanted to bring this conversation back to clear things up. My guest is a favorite Andy Pun, also known as Mrs. BGP on Instagram. She’s a pediatric speech language pathologist who conducts autism evaluations and is a strong neurodiverse versity advocate.

 

00;00;48;15 – 00;01;09;01

Dr. Mona

In this conversation, we talk about the differences between identity first and first and first language, outdated terms that we should leave behind. The biggest misconceptions about autism that are still out there, and what your clinician is actually looking for during screenings. It’s insightful, it’s practical and full of compassion, something that I love to do on my own. And when I can have guests with the same thing, it’s a win win.

 

00;01;09;03 – 00;01;26;14

Dr. Mona

And remember, if you want to listen to the full episode, check out the link in our show notes. And before we jump in, don’t forget to download and subscribe! That’s what helps the show grow and keeps these important conversations going. Let’s get into it.

 

00;01;26;16 – 00;01;42;20

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;01;42;23 – 00;01;59;18

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;01;59;18 – 00;02;03;09

Andi Putt

So which is a major problem in and of itself.

 

00;02;03;12 – 00;02;06;00

Dr. Mona

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

 

00;02;06;02 – 00;02;25;20

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.

 

00;02;25;20 – 00;02;45;14

Andi Putt

But this question is so vague. 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;02;45;14 – 00;02;51;26

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.

 

00;02;51;26 – 00;02;52;23

Dr. Mona

Dog, the fifth.

 

00;02;52;26 – 00;02;56;08

Andi Putt

Dog, you know, and by then the dogs barking and running around.

 

00;02;56;08 – 00;02;57;00

Dr. Mona

And so.

 

00;02;57;00 – 00;02;59;10

Andi Putt

Is the child following your point.

 

00;02;59;10 – 00;03;00;09

Dr. Mona

Or.

 

00;03;00;09 – 00;03;14;22

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;03;14;26 – 00;03;33;14

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;03;33;14 – 00;03;50;21

Dr. Mona

You know, the repetitive play, the lining of the toys, the the speech, the struggling in 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;03;50;21 – 00;04;04;04

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;04;04;10 – 00;04;28;23

Andi Putt

I think a lot of the times it would be a, a concerning sign. You know, a lot of the other speech therapist will not agree, but those kids that are getting those diagnoses later, they will have been in an early 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;04;28;23 – 00;04;56;27

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.

 

00;04;56;28 – 00;05;03;21

Andi Putt

So it’s really nuanced, and it’s really hard for parents to follow all of those pieces.

 

00;05;03;24 – 00;05;22;15

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;05;22;15 – 00;05;25;29

Dr. Mona

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

 

00;05;26;02 – 00;05;46;19

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 where your, provider is supposed to go over the follow up questions.

 

00;05;46;20 – 00;06;08;15

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;06;08;15 – 00;06;10;03

Andi Putt

And if you say no to all.

 

00;06;10;03 – 00;06;10;16

Dr. Mona

Of them.

 

00;06;10;16 – 00;06;25;19

Andi Putt

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;06;25;19 – 00;06;37;24

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;06;37;26 – 00;06;54;06

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;06;54;06 – 00;06;58;26

Dr. Mona

What should parents know when they’re answering that question? Or their pediatrician ask that asking that question.

 

00;06;58;29 – 00;07;26;21

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;07;26;21 – 00;07;45;18

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;07;45;18 – 00;08;01;25

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 stem 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;08;01;25 – 00;08;06;02

Andi Putt

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

 

00;08;06;05 – 00;08;21;09

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;08;21;11 – 00;08;41;15

Andi Putt

So this one’s 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 their next to them maybe? Are they imitating the other kids play?

 

00;08;41;15 – 00;09;08;24

Andi Putt

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. 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.

 

00;09;08;24 – 00;09;15;07

Andi Putt

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;09;15;10 – 00;09;27;07

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;09;27;07 – 00;09;33;17

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.

 

00;09;33;17 – 00;09;56;05

Andi Putt

Name? 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;09;56;05 – 00;10;19;00

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;10;19;02 – 00;10;25;03

Andi Putt

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

 

00;10;25;06 – 00;10;42;08

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;10;42;10 – 00;10;54;15

Dr. Mona

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

 

00;10;54;19 – 00;11;00;15

Andi Putt

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

 

00;11;00;16 – 00;11;00;27

Dr. Mona

Right.

 

00;11;01;03 – 00;11;04;01

Andi Putt

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

 

00;11;04;06 – 00;11;23;27

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;11;24;00 – 00;11;43;25

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;11;43;28 – 00;12;02;15

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;12;02;15 – 00;12;21;12

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;12;21;12 – 00;12;36;16

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;12;36;16 – 00;12;39;17

Dr. Mona

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

 

00;12;39;19 – 00;13;02;13

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;13;02;17 – 00;13;31;29

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 to say, oh, if you’re concerned, then let’s just go, you know, let’s just go on.

 

00;13;31;29 – 00;13;58;23

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;13;58;23 – 00;14;09;01

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;14;09;04 – 00;14;14;24

Dr. Mona

Yeah, that’s a great point.

 

00;14;14;26 – 00;14;36;06

Dr. Mona

And that’s your follow up. Just a small dose of the real relatable and eye opening conversations we love to have here. If you smiled, nodded or had an moment, go ahead and download, follow and share this episode with a friend. Let’s grow this village together for more everyday parenting wins and real talk. Hang out with us on Instagram at the PedsDocTalk podcast.

 

00;14;36;13 – 00;14;51;25

Dr. Mona

Want more? Dive into the full episode and more at PedsDocTalk.com. Because parenting is better with support. And remember, consistency is key. Humor is medicine and follow ups are everything. I’m Doctor Mona. See you next time for your next dose.