Q: My 2.3 years old son is having various problems like he responds very little to his name or social cues and he make very little eye contact unless he is in need of any thing. His was a caesarean delivery and the birth weight was 2700 grams. He passed the hearing test at the time of birth and we are sure he is fine. His over all growth is normal and walked and scrolled on time, etc. He cries a lot and makes tantrums whenever his mother is out of his sight specially when he goes to toilet. He is an active baby and always wants to experiment with things. He watches cartoons and movies for his age with good concentration; his reactions to good things is admirable and he express excitement by jumping, and hand flapping. He likes music and rhymes and a variety of video clips and whenever we run those clips he leaves whatever he is doing just to watch them, even if the volume is very low. He hides himself whenever he sees something dangerous like fighting in the movies or feels vulnerable,. He doesn’t sit at one place and is constantly active unless tired or sleepy. He sleeps during the daytime and doesn’t sleep easily at night, usually around 2.30 AM. He was very allergic to dusty and dry weather conditions, which caused him severe allergy, chronic bronchitis and enlarge adenoid, since he was 5 months old. At the age of 1.6 years, doctors advised us to go for adenoidectomy, after which he has improved a lot in-terms of sleeping pattern, running nose, and clogged chest, bronchitis, etc. He has not started speaking yet, except saying mama. He plays with his elder sister at home but when we go out he plays with mud and wants to see things around him rather than playing with other kids. We have consulted a doctor and he has asked us to go for CBC and ABR test, which unfortunately could not be done as he was very nervous, upset and crying a lot despite 3 doses of sedation. Please advise.

A:I can suspect what must be worrying you! The combination of delayed speech, not responding to his name or social cues, and poor eye contact makes one suspect a pervasive developmental disorder or autistic spectrum disorder (ASD). This combined with tantrums, anxiety, hand flapping, playing with water and sleep disturbances, amongst other symptoms, further point towards the above disorder. As you know, the diagnosis of autistic spectrum disorders is entirely clinical and there is no test that confirms or excludes the disorder. I am sure his hearing is normal. My suggestion would be to contact any centre in your city dealing with children with ASD. The earlier the intervention, better are the outcomes. If there is no facial dysmorphism, frequent vomiting, abnormal urine odour or failure to grow, I would not bother about lab tests. I would recommend a sleep EEG to see for epileptiform activity. Intensive education with a 1:1 teacher child relation; particularly with one who is trained to teach such children. Behavioural therapy, speech therapy and occupational therapy should be instituted. If he is very hyperactive, has tantrums, sleep disturbances that are not controlled with behavioural therapy, then medications, of which there are many, the best results I see are with risperidone given early at night.