Joey is a 6-year-old boy who was reported to have achieved early developmental motor milestones within expected age ranges and his early developmental language milestones were within normal limits as well (e.g., first words at 12 months, two word phrases at 15 months). However, his parents reported that between 15 and 18 months he gradually stopped playing with his siblings and became quieter. Also at this time he developed sleep difficulties and extreme tantrum behaviors including banging his head. By 2 years of age, he was no longer talking and appeared to be "in his own little world."
Joey began receiving speech/language therapy at age 2 years and his speech/ language therapist suggested that he be evaluated for autism.
At the time of his diagnosis, shortly after he turned 3 years old, Joey had no speech and was not pointing or gesturing to indicate his needs. His parents would need to hold things up and give them to him to try to determine what he wanted or what was bothering him. Joey would not imitate actions of others around him, nor did he engage in any pretend play or play with other children.
Joey made little eye contact and his parents reported that if they held his chin to try to force him to look at them, he would look away. Joey did not offer comfort to others and would not accept comfort. He had a limited range of facial expressions (smiling, scowling, and a "blank" look). Joey had no interest in and did not respond to the approaches of other people. He would sometimes take his mother’s hand and lead her to what he wanted and put her hand on it. He used her hand as a tool in other ways as well (e.g., when he would be upset and crying, he would use her hand to wipe his face instead of his own).
Joey would repetitively pluck the fur off of his stuffed animals (going through two to three stuffed animals per week) and pluck the fibers from carpets and afghans. He frequently went around the house and collected everyone’s shoes and lined them up. He frequently mouthed objects and also liked to lick windows and glass. Joey had odd hand mannerisms, twisting his hands in front of his face and eyes. He was also frequently observed to walk on his toes while flapping his hands and spinning in circles.