normal.... anxious.... autistic... or spoiled? 9 yo dd

(38 Posts)
hodgehegs Tue 06-Nov-12 23:25:22

Feeling confused about my dd's behaviour and wondering whether to speak to our GP but don't want to be seen as making a fuss if these things are "normal".

Hard to put it in a nutshell but she has sensory issues about clothes and will not wear anything with applique or buttons that she can feel. Trousers must be elasticated only, no zips as she hates the feel of them. Refuses to wear tights as they are "uncomfortable", so finding clothes is challenging. She prefers to wear her old clothes that are too small for her eg tracksuit bottoms swinging 5 inches above her ankles! Also hates to change clothes, likes to keep her socks on for days and tells me she has changed her underwear, but hasn't, and it is often stained when it reaches the washing basket. When I have tried to talk sensitively as possible about personal hygiene she gets angry and storms off.

Cleaning teeth - nightmare, she hates the taste of all toothpastes, and will not clean them unless I nag, then makes a big deal about it. Also can/will not stand still at the sink to get ready for bed, has to be swinging about on one leg, flicking light pull etc

Has food issues - refuses dairy, can't stand butter, so sandwiches consist of dry white bread with a slice of ham. Not a great deal of variety, says she doesn't like most of what I cook, even though we have made a menu together of least-unacceptable meals (I am a decent cook btw!). I have a whole other thread on this, as she is currently underweight, possibly due to eating habits, or possibly genetics, since I am size 6 and weigh 7 and a half stone no matter how much chocolate, cake or takeaway I eat. Was sent home from school today at lunch (has happened a number of times before) saying she feels sick because of the food.

Can be quite controlling - a friend's mum said that she had noticed how much dd controls play when they are together. At home if things don't go her way she gets v angry (I don't pander to this, so put up with much anger directed at me when she can't have/do what she wants). Being moved down the reward chart has little effect, she just gets angrier!

Strange responses to events sometimes eg seemingly neutral when pets die. See v little sadness, mostly anger, and takes things v personally eg when there's a tangle when I brush her hair she says I have hurt her deliberately. Likewise, extreme rection to being brushed passed, says "ow, that hurt!" v loudly to only the lightest touch. I can't tell whether she genuinely feels some touch as pain or if she's putting it on to make some sort of point.

With homework, has meltdowns. Asks for help, and when I try to breakdown what she needs to do or explain, gets v worked up, tearful and angry at me til she's in such a state she can't do it.

Dad is v similar - controlling & vindictive towards people who don't agree with him, and divorce 4 years ago was acrimonious, and still is, with regular allegations from him to social services that dd is at risk. She is not, and SS go away happy every time they investigate. This is purely an attempt to have her removed from me and continuing punishment for me leaving him.

Sorry this is so long, there are so many factors involved! There are unusual (ASD type) behaviours on both sides of the family, plus the stuff she witnessed during the marriage and his ongoing manipulation of her, so she may have emotional issues, but the sensory things make me wonder about ASD.

Just wondering what to do next - whether this behaviour is normal (doesn't feel it), or because she is used to getting her own way with him and feels it is her right to dictate life and throw a strop when things don't go her way.

BTW raised concerns at parent's eve, but school not noticed anything. She is v quiet there and always well behaved.

hodgehegs Thu 15-Nov-12 17:42:27

Thanks All

Checking out all the book links, I'm going to have a lot of reading to do!

Will try and remember to keep bedtime routine the same and only remove computer/TV time etc.

Thanks for your perspective, Primrose. Some things are improving, like fussiness with food (she knows she won't get pudding unless she eats it), but the attitiude is getting worse. Maybe she'll grow out of it, it's just impossible to tell at this stage. What really worries me is that she might end up abusive, like her dad, and whether that's through learned behaviour or the way she's wired it's something I need to work on. A diagnosis probably won't help with that on its own, but it might help me to understand where it's all coming from. Plus if the problem she has with homework persists or gets worse as expectations go up and the level of the work gets harder, it would be good to have something in place, or at least some understanding from the school that she has difficulties rather than just being stubborn.

Goldmandra, I like the worry board idea, and no I don't think you're crazy, the bucket makes sense! Thanks to your dd too for her perspective.

I made a "shortlist" of the little things I have been noticing - ended up 4 pages of A4! and took it with me to the dr today. Only managed to mention a few bits before we ran out of time but she has taken it and said she will have a good read of it all, and also copy it and send it to the paediatrician that she is referring us to for a general assessment! So, first bit is done, and I feel a lot better for bringing it out in the open. Just got to wait for our hospital appointment now and see how it goes from there.

Goldmandra Tue 13-Nov-12 21:50:05

What you have described there sounds like an evening in my house when DD2 has had a bad day at school. Usually something has happened which was stressful or upsetting and she doesn't know how to talk about it. It happened tonight because she wanted to leave a 'whole school in the hall' activity because of the noise today and the TA made her stay in for an hour.

To be perfectly honest I don't think you're doing anything wrong at all. You are being calm and consistent in your expectations and you are explaining the consequences of her behaviour.

There are only two things I would do differently. If I felt that the behaviour was due to stress I would explain that it wasn't acceptable but I would keep sanctions to the bare minimum. I also wouldn't make the sanction a change of plan because that just produces more stress and kicks things off again.

The other thing I would do is keep up a running commentary about emotions. I would use sentences like "I understand that you are feeling angry about having to get washed but I feel upset if you speak rudely to me". This could help her to understand her own emotions and yours. Both of my highly intelligent and articulate DDs still need this although DD1 at 15 needs it less these days. Making links for her between her emotions and her behaviour will help her to learn to manage her anger more appropriately.

Do you have a worry book, white board, etc where she could write down things that are worrying her? Sometimes starting the conversation is just too difficult but writing a sentence on a piece of paper can start the ball rolling.

I have just shown your post, nothing else, just that one latest post to DD1 and asked her to tell me what she thought. She said "That girl has AS like me. She doesn't realise that her mum will still be angry when she comes back in the room." She also said that the little girl's stress bucket is overflowing.

I don't know if you've used the principle of a stress bucket with the children you work with. DD1's ed psych introduced her to the idea and it works well for her.

Basically everybody has a bucket inside them where they store worries and stress. We all have some and we keep some for a long time while we deal with other things quickly and they get taken out. When we've got a lot of stress in our lives our bucket can get quite full. That means that on bad days it can get right up to the top and one tiny little thing can make the bucket overflow. That's when the shouting and door slamming comes in.

When your DD goes away and calms down the stress level drops to just below the top of the bucket but it only takes a tiny setback to make it overflow again.

Understanding this has really helped both my DDs. DD1 has a little duck floating on top of her bucket and it has started turning red before the bucket overflows. This is her beginning to recognise that the anger and other emotions are becoming unmanageable and she can now tell us before it all goes wrong.

What you need to do ids find the key to getting some of the other worries and stresses that are filling up your DD's bucket out into the open and dealt with.

I do hope this makes sense to you and everyone isn't sitting there thinking Goldmandra has finally lost it! blush <clicks on post message with eyes shut and fingers crossed>

Primrose123 Tue 13-Nov-12 20:40:45

Hi Hodge, my DD had some similar traits to yours when she was younger, and although I worried about her then, I don't think she has AS or anything else.

She screamed constantly as a baby, was (and still is) extremely fussy about food. She was very sensitive to clothes, regarding elasticated sleeves, labels, any sort of lacy trim, of if the material was too stiff, she just couldn't bear the feeling of them next to her skin. She wouldn't let me near her toenails to cut them.

She is quite bright, but was a very early developer, loved books, and didn't really like playing as a toddler. She liked drawing and crafty stuff, and pointed out letters constantly, and nagged me to teach her letters and numbers at the age of 2. She could read and write relatively early. She hated mother and toddler groups, but liked to see friends on a one to one basis. She wasn't great with social skills at school, but this has improved the older she got.

At the age of 4 - 5, she was well behaved, but could get unbelievably overexcited and hyper. She would get hyper if she ate certain biscuits or chocolate, but has now grown out of that.

She was quite clumsy, and couldn't ride a bike until she was 8. She wanted to give up, but we persuaded her not to!

She can be a little OCD about some things, and is very very well organised about schoolwork and exams.

There is probably more that I have forgotten to mention, but she is now 15, and is bright and happy, and doing very well at school. She has grown out of most of the things I mentioned above, apart from the fussy eating. She is not the most sociable person (but then neither am I) but she does have plenty of friends.

My second DD was completely different, much more laid back and easy-going, and I often felt that there was something 'wrong' with my elder DD.

It is possible that your DD is very oversensitive, and could grow out of it as mine seems to have done. Do you think her issues are getting worse or better with time?

adoptmama Tue 13-Nov-12 19:56:32

My 5 year old can have epic hissy fits with a great side line in indignation and 'it's not fair' just as you describe.

Stick to your guns on insisting on an apology. When she has done wrong she needs to apologise.

One thing I would suggest is not to take away something like a bed time story - easier said than done in the heat of the moment, I know myself. Try to only withdraw 'privileges' from her - computer games, play date, after school club etc but not normal routine things like the bed time story. All children like routine and by withdrawing this very special one-on-one time you are going to get a kick back from her.

As she sweetly reappears like nothing happened and asks you for something, now is your chance to reinforce your message. Simply tell her no, she can't have it. When she asks for a reason tell her you don't like the way she spoke to you earlier. Yes she will likely blow up and you may well be in for some epic battles, but you will win eventually and she will become more respectful. I also have a very controlling, strong willed (smart) 5 yr old and she can be very hurtful and a bit of a smart arse smile I recommend Have A New Kid By Friday - lots of common sense, easy to use techniques to get control back off your kid. Very readable and very much advocates the consistent approach.

Cahoots Tue 13-Nov-12 18:25:39

Oh dear, it is hard work isn't it. You have to keep on repeating yourself and enforcing good behaviour. Continue with clear and consistent punishments and try not to loose your rag.
I don't think there is a magic answer.
Good luck.

hodgehegs Tue 13-Nov-12 17:52:27

Had an awful 24 hours with dd, just want to post it on here partly so I can get it down in writing before I forget and for feedback incase there's something I'm doing wrong, or could do differently...

Last night dd wanted to have a bath without me in the room (happening more often these days, which is fine by me). Came out riding on toy dog about 2 mins later and smirking. said "You might not think I've had a bath because I'm very dry, but I did, I just dried myself off very well" I felt her hairline, arms and back and they were bone dry with a couple of damp patches here and there. I also noticed she had some paint on her leg which didn't look like it had been near water.

When I pointed the paint out and suggested she go back and try again as she wasn't completely clean, she got very angry and shouted "You don't believe me, you think I'm lying!", then stamped her feet, slammed the door and got back in the bath, alternating between muttering and shouting things like "I hate you! It's not fair!".

She was so rude to me that I banned her from the computer today and she lost her bedtime story.

Earlier this evening she asked to help cook dinner, which I agreed to. She then tried to get round her computer ban by saying I had only banned her from her favourite game, and therefore she could still use the computer for other things. I said that I had meant no computer at all. She started "It's not fair!" again. I explained, calmly, to her that when she said "I hate you" that was very hurtful to my feelings and rude, which is why she was not allowed to use the computer.

She then became very aggitated and started shouting that I was hurting her feelings by saying that, and I upset her like I had upset her yesterday. I reiterated that I hadn't been rude to her, I had just asked her to go back and make sure she was clean, since she had paint on her leg.

Cue full on foot stamping to her room. "I hate being here!", slammed her door, shattering her hanging ornaments, followed by banging and crashing noises and more shouting.

I went downstairs to start dinner and 2 mins later she came into the kitchen like nothing had happened and asked if I was making dinner. When I said yes, she again got angry and demanded to know why I hadn't told her. I said that, because of all her shouting and slamming doors I no longer wanted her helping me in the kitchen.

You can probably tell what happened next ... she shouted "It's not fair!", "I've had enough of this!" stormed out of the kitchen, slamming the door, stamped up the stairs to her room etc

She absolutely refuses to apologise for anything she has said or done after an incident like this. If threatened with a sanction such as loss of computer or pudding she will sometimes do so through gritted teeth, utterly insincerely, and refusing to look at me, but usually she just argues back that she has done nothing wrong and I have upset her (by expecting to be treated with a little respect).

I feel at such a loss. What am I doing wrong? How could I have handled this better?

As I am writing, she has just come into the room (she can't see the screen), again like nothing ever happened, sweetly asking for some paper and card. I just don't get it, I am still feeling shocked from the earlier outburst!

hodgehegs Sat 10-Nov-12 15:31:18

Yes, looks like it. At our school if children feel sick we usually get them to have a drink of water and monitor them, but not usually send home, and we are aware of those with anxiety issues. Would be interesting to be a fly on the wall in her class to see what she says to the teachers that means they think she is bad enough send her home before she is sick and with no temperature.

Her teacher is the SENCO, so she is aware I have concerns from our discussion at parents eve, but said they hadn't noticed anything yet. Perhaps they will look a little closer now, esp after her days off, and depending on what the dr says.

Goldmandra Fri 09-Nov-12 13:39:37

So will they just keep sending her home when she says she feels sick?

Clearly this is working well for her at the moment in that her anxiety going up triggers nausea which, in turn, triggers going home.

My worry is that they will start telling her she is lying and refusing to call you. They need to recognise that the nausea is an indicator that there is a big problem here and start looking at how to help her.

Have you had a meeting with the SENCo about this?

hodgehegs Fri 09-Nov-12 13:11:17

btw I did Baron-Cohen's AQ test on myself. I scored 32. The blurb says control group scored an average of 16.4, and 80% of people diagnosed with autism (or other disorders) scored 32 or higher. Not conclusive, but certainly interesting.

Also tried Aspie-quiz (Rdo's blog?) with 150 questions and came out aspie: 108 out of 200 and neurotypical: 96 out of 200, so mixed on that one.

hodgehegs Fri 09-Nov-12 13:03:07

Tangle teezer now added to christmas list!

She was sent home at breaktime again this morning saying she feels sick. She had mentioned to my BF last night that she was worried about Big Maths today as it is quickfire questions with a time limit and she gets less done than many of the other kids. Also has still not done her news recount homework. She asked her teacher for extra help yesterday and reported back to me that the teacher had read it through with her. DD was unimpressed by this, saying she needs help with doing the work, not reading!

hodgehegs Fri 09-Nov-12 12:47:48

Thanks all.

I have a Mason Pearson bristle brush for her hair, as I find them pretty good. I also have a very sensitive scalp and find anything other than a bristle brush is too painful for me. I had always assumed it was a physical problem with me and my skin was over-sensitive for some reason, but perhaps it is my brain that perceives it that way instead. I am learning to look at things in very different ways since coming on here!

Interesting that you mention dyspraxia - I had discounted that since I thought it only manifested as clumsiness, but now realising that many of these conditions have other symptoms apart from the most obvious ones, so I guess I should not discount any of them til we have had a diagnosis.

I have reposted the same question on the special needs page under the heading "sensory issues & controlling behaviour is this normal or should I seek help? (moved from development/behaviour thread)", but am still getting more replies on this thread than that one. Checking both though.

Cahoots Thu 08-Nov-12 21:22:05

You really need to see your GP and get a referral if you are concerned.

tricot39 Thu 08-Nov-12 19:39:46

I have not read the whole thread as i am short of time. Sorry to hear you are having a bad time. Hope it gets better soon. Wrt to hair brushing - maybe one of those "tangle teaser" brushes might help diffuse things. They seem expensive tho....

BCBG Thu 08-Nov-12 18:00:08

Forgot to say that your DD has the symptoms of Dyspraxia rather than ASD to me (just my opinion, of course) and you might like to google Dyspraxia in girls. Many people think it is 'clumsy child syndrome' whereas in girls it is particularly hard to spot but produces the sort of frustrations and behaviour that your DD is showing.

BCBG Thu 08-Nov-12 17:57:10

Haven't had time to read the whole thread, so apologies, but def agree with the sensory processing disorder idea: my ten year old DD is very dyspraxic (as well as dyslexic) and has a recognised SPD that her school are brilliant with, otherwise she would be just like your DD. Everything you describe, the hair brushing over reactions, the toothpaste/teeth brushing, swinging legs, fidgeting, outbursts, organisation, clothes, textures, noises, food - you name it, we've been there. The good news is that once you undertsand what the problem is you can make a huge difference to behaviour very quickly indeed. DD also sees an OT every week which has given her school exercises for DD to do every day to 'warm' her up and desensitise her - for example sending her for the register while the classroom is filling, sitting her at the front on a wobble cushion, avoiding noisy environments (she wore ear defenders at the school bonfire night grin )and so on. HTH

Ineedalife Thu 08-Nov-12 17:45:54

Hi Hodge, your Dd also sounds alot like my Dd3, she was diagnosed with ASD last year when she was 9.

I would recommend keeping a diary of her issues/difficulties, what causes them and how you deal with them. Make notes about when she was little because some assessments ask for a detailed history and when you get your referral you will be prepared.

I do think you should join us on the sn childrens board it is really friendly and supportive.

Good lucksmile

hodgehegs Thu 08-Nov-12 14:09:08

I like your ideal school idea, I will try that and see what happens.

I realised yesterday after trying the soft approach to getting her to go to school and saying the teachers would call me if she felt poorly, then when that didin't work, trying, "well, you need to try", and finally "you WILL go in!", which resulted in flat refusal and meltdown, that it wasn't going to work. Of course my own anxiety gets mixed in because I panic when I realise if she says no there's absolutely nothing I can do to make her go, and then I can't go to work and support my little boy with autism there, so I feel guilty about letting him and my school down, and the possiblilty that if she cottons on to the fact that I can't make her go she might start doing this more often.

Have just been on the phone to my mum talking about my difficulties in processing and organisation and she had no idea that I and my youngest brother saw the world that way and struggled with things that she thinks are straightforward and simple. It caused a lot of conflict when we were growing up and I would like to avoid repeating that with my own daughter. At least I am starting to get on the case with it now, rather than 30 years time when it's a bit too late to do much about it.

Goldmandra Thu 08-Nov-12 09:42:10

Can I suggest that you spend some quiet time with your DD talking about school and how she experiences it?

I spent an illuminating morning with DD2 once designing her perfect school on a big sheet of paper. She took the lead and we drew the school she would attend if she could wave a magic wand. Many of the things she said gave away difficulties she had which she had never mentioned.

I used the information I gathered from this and from some reading about sensory processing and ASD to bring a list of suggestions to the school about how they could better support her. They didn't respond very positively until she started to refuse to attend, at which point they put lots of the things in place and she found school a lot easier to cope with until they got bored and started forgetting to do things.

It is entirely possible that your DD is experiencing high levels of anxiety in school whilst appearing to be happy and relaxed.

Don't make the mistakes that I did and try to force your DD to attend at any point. Use your normal behaviour management techniques and nothing more. If they don't work there is a problem in school which needs to be solved in order for her to feel able to attend.

One big positive I have found is that, when school provision is more appropriate and their anxiety levels have dropped, my DD's sensory issues and need for control and routine have also dropped significantly. This makes life much easier and more pleasant for all concerned.

hodgehegs Thu 08-Nov-12 09:20:42

The school is small - mixed year groups and the only rooms that aren't the main 3 classes are the dinner hall and staff room, so they don't have much space. She asked to be moved from her table a couple of weeks ago as some of the other children were distracting her too much, so I think putting her on a quieter table is about all they can do.

They already have one boy in the class with SEN who has no volume control and calls out regularly, but she says she tries to ignore him as best as she can. They are generally really good and have had lots of involvement with us over the problems with her dad, and seem very understanding and as supportive as they can be. I think if I asked, they would do what they could to accommodate her needs. At the moment they don't seem to think she has any, so support from the GP or a diagnosis would be really helpful.

Goldmandra Wed 07-Nov-12 23:30:29

The more you describe her the more she sounds like my DDs!

We have had very similar issues with homework and not being able to summarise. The teacher tried to help at one point by telling her to use different words to those in the book. We then had meltdowns because she couldn't use 'the', 'and', 'to', etc because they were in the book! So frustrating!

Sensory processing issues make it very hard for my DD2 to complete work in the classroom. She now takes it to a quieter room. Do you think the school would be willing to provide a space and support for her to do that?

hodgehegs Wed 07-Nov-12 23:15:54

Yes, I try to be conscious of my thought patterns. It has been scary to see similar behaviour in her as in him, but they are separate people and I can't tell whether it is learned behaviour or a consequence of underlying factors such as ASD, so only way to go is get it checked out and see where that takes us.

lingle Wed 07-Nov-12 23:10:59

all sounds positive - and much more constructive than thinking she has negative characteristics like her dad - I'm sure you self-monitor those thoughts anyway......

hodgehegs Wed 07-Nov-12 22:45:56

Thanks Goldmandra

I just thought she was difficult - right from birth (screamed unless physically on me, and even then I wasn't allowed to sit down, had to walk with her constantly), and that there must be something wrong with me that I found it so hard.

Has only been since working with autistic/aspergers children the last 3 years that it has slowly dawned on me, and sitting in courses realising that what they were saying applied to her as much as the kids I worked with (and me too, to some extent). Plus my brother, who is undiagnosed, is classic aspergers and has food issues v similar to my dd. Growing up we just thought he was "weird" and awkward, and my parents thought his personal hygiene and eating issues were just laziness. When I spoke to my dad recently about investigating the possibility of ASD in my dd he said she was just manipulative. My new partner thinks her food/clothes/homework issues are spoilt behaviour and laziness, and my Mum says she is difficult and rude (to me) and I need to discipline her more effectively, all of which made me doubt myself.

Coming on here has given me more confidence to follow my instincts, and I have a close friend with a child with ASD who has also mentioned she sees those traits in dd, which prompted me to come on here.

She's also a hoarder - forgot to mention that in my list. Hasn't got a particular obsessive interest other than to acquire more "stuff" and never let any of it go, despite not playing with it and her room being full to bursting. Mostly it's a mess in there but sometimes she tidies - she made it into a library recently and every book had to be in alphabetical order and grouped by category, after which she freaked out when the cat went in, incase he knocked her books out of order. Also had obsessive tidying phase earlier this year where nothing was played with, only tidied and continually rearranged.

The social story worked when she was not acknowledging people who spoke to her and not looking at them. I managed to do it in an cartoon strip way. Perhaps a visual timetable in the bathroom would help our mornings.

Her homework was tricky - they had to watch a news report and summarise in a recount style. There were guidelines given to make sure they had the who, what, when, where, how, and why, and I suggested we take one part at a time and write one sentence about it, but converting that information was too much for her. She wanted to write the whole news story word for word copied off the computer and then anxiety took over and we had a meltdown.

She was sent home from school yesterday after "feeling sick" during lunch. This has happened quite a few times, she says it is the smell and the taste of the food. This morning insisted she was still feeling sick, though had normal temperature, and when I said she needed to try going in she point blank refused then got so hysterical she gave herself a headache and was in no fit state to go. Discussed it with the head this morning who will chat to the teacher and see if there are any anxieties that may be causing it. Think homework and food sensitivity could be the cause.

She is a great reader and finished the school scheme early, but I have doubts about her comprehension and the amount of work she gets done during a lesson is below what I would expect for someone in her year. She comes across as bright, and met her early development milestones well, but is in second to bottom group in her class.

Thanks for the link - I will just go check it out.

Goldmandra Wed 07-Nov-12 21:24:51

As other posters have said, your DD clearly has big issues regarding sensory processing and she needs to be assessed by an OT ASAP.

I think I would also be pursuing an assessment for ASD because apart from deep interests I think your posts tick most of the boxes.

How she presents in school shouldn't be taken as a reason not to diagnose. A really skilled observer might see lots of social communication and social imagination difficulties which are not apparent to teaching staff. Many parents of children with ASD are told that their child appears to be neurotypical in school. The problems come when keeping up that front causes the child so much stress that the end up in meltdowns on arriving home.

I have two DDs with AS and the homework issue is very familiar to me. Can you ask the teachers to be very specific about the tasks for her, giving examples or extra guidelines to help her with the open ended ones? TBH I gave up on homework for DD2 (9) last year and only let her do the occasional worksheet.

Don't stop the social stories because they seem patronising. If she has difficulties with rigid thinking some messages will take an awful long time to sink in and become part of her everyday processing. Also use visual timetables and prompts if they are needed to help her complete tasks even if it is counter-intuitive because she is able and articulate. If they help that is indicative of problems with executive function which is relevant to a diagnosis of ASD.

If you think she may have difficulties with auditory processing ask the school to arrange for a SALT to assess her. I was surprised how much was picked up in DD2's assessment and so was her teacher.

Lastly Google Tony Attwood and listen to some of his interviews about girls with AS. You might recognise your DD in his descriptions.

I will also PM a link which you may find useful.

Just to be clear and stop me from being flamed, I'm not saying she should be diagnosed with ASD because it isn't my place. I am just suggesting it might be a good idea to pursue an assessment.

adoptmama Wed 07-Nov-12 19:11:27

Good luck. Don't be fobbed off. Your GP is not an expert. Insist on the referral.

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