Communicating Concern about Early Signs of Autism to Parents.

Dr. Peterson smiled at Elizabeth, a 15-month-old who was in his office for her well-child check. He made small talk with Elizabeth's mother for a few minutes while Elizabeth played with a doll from the exam room's toy chest. " Do you have any concerns today? " he asked the mother. Elizabeth's mother smiled. " Not really, " she said. " She's been a little slow to talk—her brothers were both talking much more at this age—but I think she's catching up. " Dr. Peterson noticed that Elizabeth was flapping her hands slightly. " Does she do that often? " he asked the mother. " Oh, once in a while. " He continued to observe Elizabeth play as he asked her mother a series of questions. Elizabeth continued to flap her hands throughout the interview. To Dr. Peterson, it looked like " stimming, " or self-stimulation, behavior that is frequently associated with autism. Elizabeth had poor eye contact, although she did respond to her name and come to her mother's side when called. She also rocked back and forth on her knees, singing to herself lightly. The hand-flapping, rocking behavior, and poor eye contact gave Dr. Peterson reason to consider autism. He hesitated. According to Elizabeth's mother, Elizabeth had met all of her developmental milestones, although recently it seemed that her speech development was not on track. There were plenty of signs that she could be developing normally: she played with the doll attentively and demonstrated affection toward it, she responded to her name, and was well-behaved. Her mother—who had two older children—hadn't noticed anything out of the ordinary. Dr. Peterson considered his course of action. He knew that Elizabeth would undergo routine screening for autism at her 18-month visit and didn't feel that he saw anything severe enough to warrant an extensive evaluation at the moment. However, he wondered if Elizabeth's mother had a right to know that he was concerned. He was apprehensive that conveying his concern to the mother involved a certain degree of