4 year old with some autistic like features

My son 'A' was born quite premature at 29 weeks gestation. The premature birth was triggered by an infection in me, which the hospital attempted to treat with antibiotics (oral and IV) eventually resulting in an emergency c-section. I was given steroids to speed up A's lung development approximately one week prior to the c-section and on the day of birth I was given a large injection of i think magnesium phosphate to protect him from cerebral paralsy. A was in the neo-natal unit for about three and a half months. During this time the only real set-back Aadam suffered was that he aspirated into his lungs during a reflux episode and consequently had to go on constant oxygen for the ensuing months. The oxygen was not of high strength and came off in the minimum time possible. He also had two blood transfusions due to becoming anaemic. A had reflux and was on reflux medication throughout his time in the neo-natal unit and for 2-3 months after coming home.

A did not miss any milestones nor were they seriously delayed. He required some guidance to start rolling over on the carpet. Thereafter, he crawled and took his first steps before he was 1 year of actual age (we have 2 ages for him actual, from when he was born, and corrected, from when he should have been born) .

A also had surgery under GA before 1 year of age for a hernia developed in the neo-natal unit.

A babbled a lot as a baby. His pediatrician at one of his reviews pointed out that A was not saying Mama or Dada like words (i think he was over a year old) and referred him for speech and language therapy. Speech and Language Therapy Department refused to assess him as he was very young and margin for prematurity was being given.

It is important to mention that during all this time and till A started nursery, we never put him in a creche, nursery or any toddler groups and rather kept him in a bubble of his family members (his parents and elder sister by 6.5 yrs - we have no other family whatsoever in our country of residence). This was essentially because of A's weak lungs at the time of discharge from the neo-natal unit. He was on oxygen 24/7 and we were told that we should make all efforts to keep away from repeated infections from viruses/ bugs (especially the RSV virus) as that would impede his lung growth, weight gain and prolong the need for oxygen. He received special RSV vaccines over one winter due to his weak lungs.

We had his 2 year development check by the health visitor. He was playing puzzles well and his gross/ fine motor skills were deemed to be developing well. A was still not talking but had started making some relevant sounds from books read to him and said mama, daddy and apa (his elder sister). The health visitor thought it appropriate to give Aadam some more time. We have a bilingual home (English and Urdu) and we were advised to drop one language to create clarity for him. Other professionals have recently stated that we should have continued two languages. We spoke only in English to and around him and he started developing more words.

By this time, A loved music, nursery rhymes and developed a love for the alphabet. He was able to place the ABC in order and say the ABCs. By December 2014 Aadam could spell small words like me, cat, dog. He was not communicative at this point. He could understand what was said to him.

We went on to a stage of some words. He could name family members in photos. He could say single words (all after directed efforts to teach him). There was repition of what was said to him. We employed the choice strategy, with the less preferable choice said last and in time he made his choice and not simply repeat the last words said. In this time he developed a passion for numbers (which is still there today). He can count to 100 and backwards.
A speech therapist said to me that it was her assessment that A will learn language and communication differently, in a structured manner and not naturally by just hearing people speak around him. The process would not necessarily be a long one but she felt a slow one.

A had a stage of not liking crowded, loud places when we visited back home. However, when around a few people he would happily try to engage with them with smile and gestures. We tried to toilet train him at this time but he just would not go in the toilet. The health visitor told me he is not ready and to hold off.

A was eliglble to start nusery in September 2015 (about 3 years and 3 months years actual age/ 2 years and 11 months corrected). We proceeded with it eventhough we could have waited another year in an effort to get him outside of hs bubble, reliance on me knowing his every need, being away from me and his family, being around other children and hopefully get him talking).

He was obviously very upset about being left and would cry immensely when being collected (just wanted to run out to me and not waiting for his name to be called). He settled in quickly for being dropped but for collection time he was still troublesome. Slowly. He now sits happily and waits for his name to be called. We undertook the last speech referral to through the school at my behest. I would say his first three months at nursery were his settling down period. He always looked a little lost in nursery for the short time i was there. But Aadam has always responded to my instructing him.

His teacher asked to see me in January after we returned from a trip back home (where he was very happy attending a family wedding). Her concerns were that A had started covering his ears when they would get loud in the classroom with clapping of cheering after a song, he was throwing toys, would just stick to activities of numbers and alphabets, not engage with other children, be very reluctant to try other activities like play doh or blowing bubbles with a straw out of a tub, arts and crafts and would attempt to do something soon after he had been asked not to the same. I said that he the same at home and i am in the process of teaching him not to throw toys, which sometimes ends up in scolding and he covers his ears to block me out. Also at the wedding there was a very loud drum which did scare him for a while, after which he started covering his ears when he heard a loud sound. I affirmed that he loves his numbers and alphabet, which we use to elicit a lot of speech from him and numbers and alphabets are EVERYWHERE so how do i deviate him from it. Instead try to curtail it at times, try something else and then let him continue. He was still not two-way communicative in a fluid way so i was not expecting a lot of engagement with other children. I was advised to get him used to play doh and bubbles, etc. His sister and i worked with him and after initial reluctance and a bit of encouragement and firmness he now asks to play with play doh at home, blow bubbles and take baths (he was also reluctant to play with the water tubs in nursery). He is now placed on time out at nursery for splashing the water too much out of enjoyment.

Aadam currently is as follows:

Vocabulary: no, yes, water, food, chicken rice, cereal, cheerios, banana, apple, egg, milk, outside, inside, garden, ipad, comupter, game, numbers, alphabet, mama, daddy, apa, dado (granny), nano (other granny), abu (my dad), dada (my father in law), carpet, car, chair, table, upstairs, downstairs, bed, pillow, blanket, sleeping bag, clock, pants, shirt, head, ears, hands, tummy, popo (bottom), pepe (private part), legs, feet, eyes, teeth, tv, bicyle, scooter, phone, video, airport, aeroplane, cup, plate, jumping, walking, running, creaming, shouting, i love mama/ daddy/ apa, shoes, shoe rack, jacket, socks, jumper, pamper, wipes, wee wee, toilet, spoon, fork, yogurt, crackers, chips, nuggets, eat, drink, sleepy, hungry, music, sunny, cloudy, windy, rain, hat, helmet, bubbles water gun, candles, blow, balloons, door, mirror, cross trainer, exercise, on, off, press, push, together and maybe some more i am unable to recall.

His instinct is to use one word commands for what he wants, but on prompting and sometimes of his own accord he can put sentences together (some said fluid and some in a taught manner): mama can you put on song number __, hello/ salamalaikuum, how are you?, i am fine, you ok?, what's this?, what's this number?, so many cars, so many birds, go daddy's bicycle, go outside, mama/ daddy come outside in garden, drink water, can i have water please?, mama can you give me ___?, mama/ daddy lie down carpet/ bed, let's go downstairs, let's go car, mama/ daddy/ apa you know you are very cute, cutie pie, go to naughty spot and some more, faster daddy!, apa wait for me, mama hold my hand, mama hold my book bag, mama fix shoe, come on guys, let's go upstairs, mama help me.

When asked a question he understands, Aadam will respond. What color is it? What is your name? What is this animal? What do you want? You want to go outside? What do you want to eat? (a choice usually has to be given to get a true answer) How was your day? (usually a rehearsed answer of 'good'), Where is Daddy? and the like. Sometimes he can properly answered what happened? When given choices, he now makes a determined choice and not just repeat the last word. He still has some of echolalia, usually when he is being told something new or told off.

He plays happily with his family, now recognises and knows the names of all his class fellows, his neighbours and their children and is keen to play with them, is looking for interaction with them, he sings songs at home that he has learnt in nursery, repeats instuctions in context given to him in nursery (no screaming, no shouting, no splashing, i am not happpy, no throwing, tidy up time, line up, cross your legs, hands in your lap)

I am still trying to achieve concepts of you, me vs. Aadam, mama. When you ask him 'why are you crying? what happened?' he just says 'i no crying' (probably because we said that to him to calm him down). Questions like what did you do in school today?, who did you play with?, what happened? are usually the same rehearsed answer. If you ask him where are we going (and he recognizes the route) he will himself answer accurately: usually between train station, school, home and sainsburys.

Aadam is very active, energetic and physical boy. He has a tendancy to flap his hands when excited. He does not walk on his tip toes but does stretch on to them a couple of time when excited. He sleeps a sound sleep both in the afternoon and at night. He walks just fine, balance is fine, runs fine, jumps fine, can eat finger foods well, uses a spoon to fed himself, can drink from a cup. His eye contact is fine. He has started putting his shirt and fingers in his mouth. Never took a dummy despite repeated efforts :) Eats three meals a day and no bottle of milk. He can climb ladders, go down slides, ride his scooter and is learning to ride a bicycle these days. He initially shows reluctance to new things but if steadily encouraged to try with attention he will try it. He can pay attention to activities he likes or decides to do. He can (not always as he may not be in the mood or would be distracted be a more appealing activity) sit and build blocks, make shapes out of play doh, build a lego duplo train, sometimes sayiing help me when needed, tidy up till it is all done, read a book, watch his favorite shows/ cartoons. He can blow bubbles. When angry or frustrated he just says jargon until calmed down and assertively asked what happened (maybe more than once) and he does eventually say it (blocks fell down, balloon popped).

He now says hello to people walking by and to class fellows. But if anyone he is not too familiar with talks to him he gets very excited and starts laughing and not responding. But with people he familiar with he stays calmer. Also he is very adament. You have to tell him numerous times not to do something, before he will even think about not doing it.

He has recently started feeding himself very well with a spoon.

A hearing test has been done at the request of the nursery. The report is all clear.

He is now toilet trained.

It may be important to mention that Aadam has as of the last few months started to develop the ability to read. His teacher has also noticed this (he started reading a book The Little Red Hen in nursery and an information board for the parents).

He definitely needs to improve his attention and listening skills. He gets distracted very easily. Taps his lower jaw sometimes, sometimes grinds his teeth and chews on his shirt at times. As i said he is very energetic, likes to move around or do something all the time.

He is quite thin, tall and dark eyed & haired. Has a couple of light brown spots on his back. His father has many moles all over him and a large birth mark on his torso. His sister is now spurting similar moles and has a large birth mark on her leg. I am also developing light brown moles.

He has a skeletal ridge down the middle of his forehead (his father has the same).

His face is not pale but on his arms you can see his veins.

Aadam has a tendency to sweat on his head only to the point of soaking his pillow. He still naps well during the day.

We have a history of C***** (a word i am not permitted to use in this forum) on both sides of the family. My mother had one in the breast and my father in law in the connective tissue. Diabetes and tuberculosis is also in the history.

He used to battle with constipation. That is not issue now, however, he does get anxious prior to and while passing a stool. Quite often he tries to hold it in.

He is not scared of the dark. The only real fears he has are of hand dryers in public toilets and being on his father's shoulders. He is fine on my shoulders.

He catches colds quite easily, but is not difficult to handle when unwell. He just tends to gag on food when his throat is irritated. Colds usually go straight to his chest resulting in a bad cough with phlegm coming up.

He does eat sweet things. Does not like eggs but will eat them on my insistence. His preference is for chicken curry and rice, buttery things, salty things. Only drinks water and one cup of milk in his morning cereal.

I give my children a teaspoon mixture every morning of crushed raw garlic, raw honey and brahmi or gotu kolu. Fish oil supplement, vita min d and a multivitamin.

He is a loving boy with his family. On his own initiative when in a moment will look at you, caress you and i say "i love you mama/ daddy/ big sister".

Any recommendations on improving his attention span, flapping, chin tapping, chewing shirt, social skills and language development would be highly appreciated.

I have considered carcinosin after reading Amy Lansky's article. My apprehension is that i do not want to regress any natural improvements he has made over the last year.

Kind regards...