I am concerned that my young grandson may have signs of autism, but I am uncomfortable bringing this up with my son and daughter-in-law. Do you have any suggestions about how best to approach them?
Answered by Peggy Halliday, MEd, BCBA and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

We appreciate your question as this comes up often. It is natural to be unsure of how to share your concerns with your grandson’s parents. As is the case with many concerned family members, you may worry that such a discussion will not be well received. You may fear that it can cause some discomfort or tension in your relationship. However, if an autism diagnosis is a possibility, you would not want to delay screening which could result in a referral for an evaluation and services. Waiting may waste valuable time during which intervention can be most beneficial for your grandson. Even knowing that better outcomes can come from early diagnosis and intensive intervention, it still may be difficult to talk to your son and daughter-in-law if they have not expressed their concerns to you directly.

As a grandparent, you have already raised at least one child and have years of lived experience, so you probably have a good sense of what may be typical development or behavior and what is not. You possibly feel that your grandson is not making expected gains or meeting certain milestones. To you, he may appear delayed in some areas such as communication or play, compared to other children his age. Also, you may not have day-to-day contact with your grandson, so slower development of skills may be more obvious to you. These impressions may create a sense of urgency for you.

There are several important considerations in planning for this discussion. Perhaps the most important one is to weigh the pros and cons of talking to your son and daughter-in-law vs. the pros and cons of not talking to them. Although it may seem prudent to wait, the risk of delay in diagnosis and treatment is potentially much greater than the risk of harming the relationship.  Please do take a moment to reflect on your own parenting perspectives and values and how they may compare and contrast to those of your son and daughter-in-law.

The way in which you approach your son and daughter-in-law will depend in large part on the quality of your relationship and on the nature of how you communicate with one another. In your relationship, you may already discuss difficult issues frequently and easily. On the other hand, this may not describe the type of relationship you have at all. If it is possible that your son and daughter-in-law already view you as meddling or intrusive, we invite you to consider if these perceptions are at all valid. If this is the case, be sure to approach this conversation with greater caution, sensitivity, and a clearly communicated intention to share support, rather than to be critical.

Regardless, it is important that you bring this up from a place of love, transparency, and concern, rather than judgment and blame. Many parents who have been carefully and respectfully approached by a relative later admit that they already had concerns of their own, and it was a relief to discuss them with someone else close to their child, who clearly wants what is best for them.

We would like to offer some concrete suggestions that may increase the likelihood that your discussion will be positive and constructive.

Planning Ahead

    1. Plan your discussion ahead of time. Take some time to think about what you want to share and how you want to frame your concerns. It may be helpful to preview a screening tool such as the M-Chat so you have specific points in mind.
    2. Find a time and place when you will not be interrupted. It may be best when the child is sleeping or with another caregiver.
    3. You might begin by commenting on the child’s strengths and acknowledging the parents’ love and dedication to their child. It is important not to appear judgmental or focused only on concerns.
    4. The role you take in the child’s life depends, of course, on geographic proximity, but be poised to offer concrete, practical help whenever possible. For example, you might offer to babysit siblings while parents pursue evaluation of the child or offer a respite weekend of childcare so that your son and daughter-in-law might have time to discuss the situation without interruption.
    5. Whatever assistance you offer, the important thing is that your grandson’s parents perceive it to be helpful, it will be important to gauge their reactions carefully by reading their body language and tone, as well as checking in with them about what was offered.

Having the Conversation

    1. Try to keep the conversation free-flowing. You may want to ask a few questions that will allow the parents to express their concerns if they have them. For example, “I noticed that Billy became very upset when the phone rang. Does the phone ringing bother him?” or “Does he seek you out when he is upset?”
    2. Avoid labels and technical terms, which may trigger fear or upset from the parents. Focus instead on discussing milestones, which are observable indicators of a child’s development and accomplishments.
    3. In some cases, it may be beneficial to think about the discussion as a series of tiny conversations. This approach would be more appropriate if you have frequent contact with your son or daughter-in-law. It may then be helpful to share some observations that provide a backdrop for later discussion. For example, “Peter seems overwhelmed by loud noise.” or “I have noticed that he does not seem to know how to use words to get his needs met.” Be sure that this does not sound like constant criticism by peppering it into each conversation you have with them. Rather, lean on asking questions about how you can help your grandson in tough situations, such as, “How should I respond to him when he repeats the same question over and over? I just want to do what is best. Have you asked anyone for advice?”
    4. It may also be helpful to discuss observations surrounding problematic or absent social interactions with peers or siblings.
    5. Emphasize the need to simply get any concerns checked out to “rule out” anything serious or to get some guidance and support in how to promote skill development. You might follow this up by mentioning that the earlier a potential problem is recognized and addressed, the easier it is to help the child.
    6. Finally, it is often helpful to share relevant resources such as those listed below so that your son and daughter-in-law can explore them on their own.

Other Considerations

    1. Most parents start to become concerned that something may be wrong with their child between the ages of 12 and 18 months. If the parents are beginning to realize a potential problem exists, you want to gently urge them not to delay screenings and/or evaluations. It may also be helpful to have contact information on hand within your local state/town. Often parents can feel overwhelmed due to not knowing what the first step would be. Having this information ready for whom to contact and how to schedule a screening may reduce some of the stress in hearing the news.
    2. You should never take for granted that developmental concerns will automatically be addressed during routine visits to the pediatrician. Sometimes they are not. Refer parents to good quality resources they can explore on their own, such as our website. We emphasize the word “good” as there is a tremendous amount of misinformation about autism both in the media and on the Internet, particularly many false promises about autism treatment. We share some of these resources below. The most helpful websites at this stage are typically the ones that discuss developmental milestones. Parents often know when to expect their infants and toddlers to sit up or take their first steps, but they do not know when they should begin to speak in two- to three-word statements, point to things they notice or want, imitate gestures, or show interest in another child.
    3. If the child is in daycare, his teachers and directors often have relevant information about how he is doing and what they are observing. They may be keeping records on how the child is developing in different areas such as social interaction, communication, etc. Your son and your daughter-in-law may find it beneficial to touch base with these providers.
    4. If your son and his wife decide to have a conversation with their pediatrician, encourage them to write down their questions so they can make the best use of their time. Furthermore, they should seek clarification if the doctor’s responses were vague or confusing in any way.
    5. If your grandson is over the age of three, the local school can be contacted as well.

We invite you to explore the full array of offerings on our website. In addition, there are some other websites that include milestones checklists, booklets, charts, and a wealth of other helpful information.

    • Centers for Disease Control and Prevention: The Act Early website contains an interactive and easy-to-use milestones checklist you can create and periodically update for children ages three months through five years, tips on sharing concerns with the child’s doctor, and free materials you can download or order, including fact sheets, resource kits, and growth charts.
    • First Signs: The First Signs website contains a variety of helpful resources related to recognizing the first signs of autism spectrum disorder, and the screening and referral process. There is a directory of local resources for at least eight states, and that number is likely to increase over time.
    • American Academy of Pediatrics (AAP): The AAP website contains information for families, links to many other websites, information about pediatrician surveillance and screening, and early intervention. This site contains great tools for pediatricians, as well as parents. Please note one page in particular that details what to do if autism is suspected.
    • Autism Speaks: The Autism Speaks website includes an Autism Spectrum Disorder Video Glossary of clips designed to help parents and professionals learn more about the early signs of autism, information about how autism is diagnosed, and a resource library. They also offer a free 100-Day Kit designed to help families of newly diagnosed children make the most of the first 100 days following a diagnosis of autism.

In summary, we think it is commendable that you desire to share your concerns in a sensitive way with your son and daughter-in-law. We hope that this advice has been helpful to you, and we wish the best for your grandson’s future. If your concerns are well-founded and your grandson receives a diagnosis of autism, we recommend that your family learn all they can about applied behavior analysis, the treatment for autism that has the most compelling scientific support. The ASAT website, of course, would be an excellent resource at that point as well. No matter what the outcome, your caring presence in your grandson’s life and unconditional love will continue to be invaluable.

Citation for this article:

Halliday, P., & Celiberti, D. (2018). Clinical Corner: Discussing concerns with family members. Science in Autism Treatment, 15(2), 14-17.

Please visit our Clinical Corner section to read articles related to young children with autism:

Please read an overview of early intensive behavioral intervention and visit our Research Synopses section to learn more about early intervention research. A few links are shared below:

Finally, here are few other articles/pages that may be of interest:

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