Doctor suspects child has autism

DEAR AMY >> I am a physician and live far away from my family.

My niece has a 3-year-old daughter.

Between distance and COVID, I have seen my grandniece only rarely.

About six months ago, while I was visiting, my family united at my sister’s house. Our cousin is a speech pathologist and is familiar with signs of autism.

She recognized specific signs in my grandniece, but she refused to share that with my niece because of a lack of intimacy between them.

My family debated whether we should bring this up with my niece, and ultimately her mother (my sister, “Annie”), told her about our concerns.

It did not go well: it was viewed as an invasion of privacy and as ill-intentioned negativity.

Since then, we understand the child is in speech therapy (with a very young therapist who we fear may not have enough experience to recognize the broader issues).

Otherwise, we are not aware that there is any effort being made to address the issue, and both parents contribute to the denial and wall of privacy.

In family gatherings, when my grandniece doesn’t engage, it is brushed off as “She likes to be in her own world” or “she wasn’t interested in what you were doing.”

Since I am a physician (but not with relevant experience), I struggle with whether I should discuss this with my niece and her husband, and if so, how to approach them.

We are all concerned that the window of opportunity to intervene in a meaningful way in the child’s development may be closing.

— Concerned Uncle

DEAR CONCERNED >> Your family’s concern — and your sister’s choice to convey it to her daughter — has not backfired. The parents may have reacted poorly and defensively, but the child is seeing a speech therapist and that is a positive first step.

However, you family members should not put these parents in a defensive crouch by judging their child’s behavior and diagnosing her during brief holiday visits.

As a physician and the child’s great-uncle, you are in an ideal position to continue to express interest in this young girl’s development.

You can do this through gentle and supportive questions posed to the parents. You start by noting positive aspects: “Look at how well she’s growing. Six months makes such a big difference!”

Then you can consider taking it further:

“My sister said she’s seeing a speech therapist. What’s that like? How do you think it’s going?” You might then add, “Have you ever run this past cousin Rachel? You know that she is a speech pathologist.

She might be helpful if you have questions.”

You can also say, “We doctors don’t always communicate so well; is your pediatrician good at answering your questions?”

If you present yourself as a supportive, interested and objective family member, these parents might lighten up and utilize you as a sounding board and resource.