How Do I Help My Niece?

By Dr. Marie Hartwell-Walker

From the U.S.: I babysat my now 5 year old niece a lot when she was an infant and toddler. Early on her behavior didn’t seem quite normal. Other people speculated she might be autistic.
It’s tough to describe the problem as most children get upset about things. The issue is that odd things make her upset. She doesn’t like it when things get moved. She doesn’t like loud noises like the vacuum. She won’t let you move a puzzle. She wants you to draw something or make something with playdoh and if it’s not right she flips out. She’s fine with strangers outside the house, but when someone comes over she flips out. Sometimes even if it’s someone she knows.

There was a time when she would bite her finger a lot, mostly at night. When my sister took her to the doctor for an ear problem and the doctor asked about the finger, my sister lied about it. The doctor made a comment about not being potty trained this old could mean something else is going on. My sister acted incredulous about it, “she’s so smart” she says to us like that’s what is in question.

She did not get potty trained until about four, not the least bit interested in it. She had books about it and we were very positive about it. It was the teachers at preschool who actually made progress with her. I knew that she waits as long as she can to go, but I just found out tonight she gags when she pees. The act disgusts her to the point that her gag reflex starts going off every time she pees. I’m very angry that my sister doesn’t see that as an issue.

My mother, who watches her the most, found out that she does a lot better when she eats. But she doesn’t want to eat when she’s in those moods, so mom literally spoon feeds her to help her snap out of it. I looked up a list of things that defined autism but it didn’t seem to fit her. She will interact a lot more than what the criteria implies.
How do I get my sister to believe my niece might need help? Do you have an idea of what she might have?

A: I can’t diagnose a child on the basis of a letter, of course, but I can tell you that this little girl needs an evaluation. I understand why your sister doesn’t want to think something is wrong. No mother does. But what you report is not usual behavior in a five year old.

Within the diagnosis of autism is a huge range of behaviors. That’s why it is called an “autism spectrum disorder.” One thing kids on the spectrum seem to have in common is sensory issues. Many react strongly to smells, sounds, sights, etc. that wouldn’t bother other kids. Often there is some element of what looks like obsessive-compulsive type behavior. (It’s unclear whether this is really OCD or an artifact of autism itself.) Your niece’s “rules” about puzzle pieces and how you need to make things with play-doh to be “right” may fit. On the other hand, there may be something else going on. Kids develop unusual behaviors for all kinds of reasons.

All I can tell you for sure is that you are right to be concerned and that this little girl needs to be evaluated by a qualified clinician as soon as possible. Early intervention is key to helping kids with autistic leanings to learn how to master their own behaviors. If she is on the autism spectrum, every month that she goes without treatment is a lost opportunity to help her. If, on the other hand, she is acting out some other kind of hurt, it’s important to know that so that you can provide the right kind of support.

I hope you can talk candidly with your sister. I understand completely why she doesn’t want to hear that something is wrong. But loving her daughter means getting the information she needs so she can be helpful.

I wish you well.
Dr. Marie

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Last reviewed: By John M. Grohol, Psy.D. on 17 Apr 2014

APA Reference
Hartwell-Walker, D. (2014). How Do I Help My Niece?. Psych Central. Retrieved on September 21, 2014, from http://psychcentral.com/ask-the-therapist/2014/04/17/how-do-i-help-my-niece/