Regina

Regina is a three and a half-year-old, Hispanic child. She is the first born of two children of professional parents. She was referred by her pediatrician due to uneven development and atypical behavior. According to her parents, Regina’s delivery was difficult and she needed oxygen at birth. Her physical appearance, motor development, and self help skills were all age appropriate, but her parents have been uneasy for quite some time about Regina’s lack of response to social contact and usual baby games. Their fears are recently increasing due to comparisons with their second child (Chris, who is two years and five months old), who, unlike Regina enjoyed social communication from early infancy.

Regina appears to be self-sufficient and aloof from others. She does not greet her parents in the mornings or evenings when they pick her up from daycare. She has been in daycare for three months, but continues to scream for up to an hour after drop off each morning. The daycare Director has recently requested her parents consider another program given the program’s limited resources meeting Regina’s needs and little progress helping her adapt to the classroom system. Regina shows little to no interest in other children and ignores her younger brother. Her babbling had no conversational intonation. At age three, she could understand simple one-step instructions. Her speech consisted of repeating some words and phrases she’d heard in the past, with the speaker’s accent and intonation. She could use one to two word phrases to indicate simple needs. For example, if she said, “Do you want a drink?” she meant she was thirsty. She did not communicate by facial expression or use gesture or mime, except for pulling someone along and placing their hand on an object she wanted.

Regina appears to be fascinated by window blinds, and stares at them or attempts to touch or open/close them any opportunity she gets. She usually puts her face up close to the blinds and smiles, laughs, flaps her hands, jumps up and down and appears giddy whenever she is able to do this. She displays similar behavior while listening to music, which she has liked since infancy. She is intensely attached to a hair brush, which she holds in her hand, day and night, but never used to brush her hair or in any other way. She does not play with any toys other than jigsaw puzzles, which she is able to assemble rapidly with one hand (while holding the hair brush in the other) even if the picture side is hidden. From age two, she collects kitchen utensils and arranges these in rows (always from right to left, always starting with a fork and ending with a spoon) all over the floor of the house. These activities, together with occasional aimless running around, constitute her whole repertoire of spontaneous activity.

Regina’s intense resistance to any attempt to remove her hair brush, collect the kitchen utensils, or prevent her from touching window blinds results in what her parents call “meltdowns,” during which Regina engages in screaming, kicking, and biting herself or others for up to an hour. The only way to stop these tantrums is to allow her to continue what she was doing or playing music has also worked on occasion.