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DS (3) - query ASD?(10 Posts)
I have noticed some aspects of DS (very nearly 3)'s development which lead me to query ASD - possibly Asbergers. I have worked with (older) autistic children previously, but not in a professional capacity - so this is something which I am aware of but do not know much about. DH is very dismissive of any concerns, so it may be that I am just over-thinking this. My queries are:
1. without looking for diagnosis by internet, any first thoughts as to whether the things I'll outline below are issues at this age; and
2. whether there is any benefit (if there are issues) in raising concerns with a health professional at this stage, or whethre a "wait and see" approach would be better. I suspect that if he is on the spectrum he is very high functioning, so am not sure if any intervention would be indicated.
DS is clearly very bright - he knows a lot about a lot of things, and communicates very well. The more unusual aspects of his personality / development however are:
- "fascinations" with certain things - some "normal" (e.g. cars - he can name pretty much all makes of car from their badge), some more unusual (really keen on windmills / wind turbines / clocks just now!). These are fascinations rather than obsessions, i.e. he is easily diverted and does have a wide range of other interests. He likes to point out these things wherever he sees them, and incorporate them in his play, make (with a lot of help from me!) models of them, try to draw them etc. He is also very interested in numbers, and is very numerate (i.e. can actually count, not just rote-count, to about 50). He likes to know the "numbers" of things, e.g. friends' houses, tracks on CDs.
- established pronoun reversal in speech. His vocabulary is very very good for his age, but his speech does sound a bit odd due to pronoun reversal about 80% of the time (I/you - i.e. largely refers to himself as "you" and to me as "I", and your / my). I have started giving him a little nudge when he does this (e.g. "whose shoes?") and he will very quickly correct himself. He doesn't revers pronouns nearly as much at the start of sentences (will say, e.g. "I going outside" spontaneously. There is also a degree of echolalia in his speech, and he likes to repeat favourite phrases (although usually in context) - this is decreasing with age, however. It was very very pronounced at about 18 months.
- some very odd social reactions. He is absolutely fine with children, will actively seek out their company, parrallel play well (not really got as far as co-operative play yet), copy what other children do (e.g. if one child puts the sandcastle bucket on his head pretending it's a hat, DS is likely to find this funny and do the same). However adults are a different story. He has a select group of familiar adults who he is happy with, but unfamiliar adults (e.g. people coming to the door, mums he doesn't know that well, people in shops) are often met with shrieks of "I do not like that lady! Will mummy not talk to the lady!". Sometimes this makes it impossible for me to hold a conversation. On other days he is better. Once he has taken a dislike to something (this has happened with a couple of classes we've attended) he will be adamant that he is no longer going.
He also displays lots of what I would consider to be "non-autistic" traits, e.g.:
- no issues with eye contact or affection with people he knows (very very cuddly and loving towards me, and very interested in and caring towards his baby sister).
-no issues with sleeping or eating, and no particularly unusual sensory issues (a few minor ones, e.g. likes food to be fairly cool, but I think they fall well within the "normal" toddler range).
- no motor development issues, fairly well co-ordinated, will throw / catch a ball, dribble a football, rides a balance bike well.
- good communication (apart from pronoun reversal), can hold a meaningful conversation, answers 90% of questions appropriately, inititiates conversations.
-engages in some (possibly limited? But I'm not sure what's age-appropriate) pretend play. Hates dressing up, but will e.g. pretend to speak on the phone (lots of things become "phones"), pretend that the laundry basket is a boat (or recently put it on his head, and spun round crashing into people saying he was the brush from the car wash), pretend to be a "scary monster". Plays with other toys (cars, trains, duplo being favourites) appropriately (although still puts things in his mouth a bit). Will try to involve me / DH in his play. Will go round the room handing out toys to people ("this one's for mummy, this one's for daddy, this one's for baby" etc).
- has a definite sense of humour. Loves peekaboo / hide-and-seek games. E.g. found him in bed this morning hiding under his covers, giggling away at how funny he was being hiding from mummy. Finds "slapstick" comedy hilarious, e.g. things being spilt, dropped, people falling over. Will often take the role of the comic and try to make us laugh by doing these things.
- not attached to routine - he is pretty adaptable, e.g. staying away from home has never caused an issue.
Any thoughts would be very welcome. On writing this down I appreciate that much of his development does appear normal, but the social issues are getting very pronounced and affect what we do in a day, and the speech issues do make him stand out from other children. I have (in a roundabout sort of a way) raised these queries with his nursery (he goes 1 day a week) who appear unconcerned.
My DS2 has ASD and I would say that my DS3 age 9 is a bit quirky, possibly on the spectrum but not enough to be DX. Your DS sounds a lot like my DS3. He had some strange obsessions/fascinations with numbers and groups of 4 'teletubby' colours etc. He didn't have much problem with 'you and I' but only very recently got 'he and she' correct, despite knowing if someone was male or female. He is also very bright and a bit sensitive. Because I already had DS2 whose issues were much more pronounced, I have never really worried about DS3 and haven't sought a medical DX. His school are aware of his quirks and his brother also attends so they know his family history and I've been happy with that.
However, if your DS's behaviour is concerning you and impacting on your lives then I can see no harm in asking for an assessment. These things take time, sometimes waiting lists are very long, and it's better to get in the system earlier rather than later. A medical DX doesn't have to be disclosed to schools if you would prefer, but would get your concerns taken more seriously and open some doors to support in school if necessary. I would go to your GP, describe your concerns and ask to be referred to a developmental Paed if you are still concerned. If things improve you can always cancel.
Your DS, if on the spectrum, is obviously very HF. He may well just be a bit quirky and sensitive/shy.
Thank you EllenJane for taking the time to read that essay and reply! I think you've hit the nail on the head with "a bit quirky". That's exactly how I'd view DS, just not quite like most other children, but usually (with a few exceptions) not in a problematic way (his behaviour at home is pretty good / easily managed). I suppose I'm just wondering when "eccentric" becomes autistic, or if it is even as clear cut as being able to draw a line. Eccentricity does run in the family a bit - I suppose with older generation there was less concern with attaching a medical lable to it and so these people have just been accepted as eccentric (the relatives I'm thinking of all have / had functional relationships and very successful careers, so these personality traits didn't hold them back).
The slight issue I have with going to our GP (or HV) is that we live in a very small community (2 GPs, one HV, all of whom we know socially) and if my concerns are dismissed I may be forever labelled as a neurotic mother and not taken seriously in the future!
Usually on here people have got obvious issues and getting early intervention is really important, but having DS2 and DS3 I can see both points of view. If your DS is bright, likely to manage well at school, has no friendship issues and you can accept his quirks as minor eccentricities, then, given your description of him and your GP/HV situation I'd be inclined to 'wait and see.' It's not what I'd recommend if you had any more serious concerns, but you are looking out for issues, if he gets self esteem concerns or his fear of new adults becomes more problematic, then you can review the situation.
Hopefully some others will reply and give you a different perspective.
I have a DS who is 9 with fairly severe AS, DS2 is nearly 5 who will be assessed for HFA in September and DS3 who I am fairly certain when compared with the other 2 is NT! If I didn't have DS1 there are certain areas of DS3s behaviour that would concern me, but when I compare him to DS1 I am fairly certain he is NT but just has odd traits.
He will be three in September, very vocal (like DS1 was), has massive obsessions (like DS1 had). However, his language has a different style to DS1s, he is much happier to talk 'off the cuff' and be led in conversation, whereas DS1 always had/has to be in control even going to tell you what you must say. He is obsessed by horses and dinosaurs and has been for 2 years now. His play will always involve one or the other, but unlike DS1 he is playing rather than just reciting facts about his favourite things. DS1 was obsessed by tudor history from age 2 (until now!) but he just read books about it, did jigsaws about it, or looked around old houses. DS3 pretends to ride a horse, or turns objects into horses, or plays with playmobil horses etc. DS1 even now has never turned an object into something that it isn't, in fact it was only a couple of months ago that I actually heard him pretending to use a toy phone!
Another difference between DS3 and DS1 is that DS1 doesn't make eye contact, even now he doesn't know if you are talking to him if he is in a room with other people if you say his name, and will answer if you have looked at someone else before you speak. DS3 not only makes eye contact but if he points at something he checks I have looked before continuing with what he needs to say.
Given your DSs problems I personally wouldn't get him assessed unless things became more of an issue as he got older. I believe that they tend to be able to dx AS when DSs are older, as it becomes easier to see what is stroppy toddler and what is AS! Believe me DS3 can throw mega tantrums when things don't go his way, but definitely toddler not AS tantrums!
A dx won't lead to any interventions. But it may lead to peace of mind. You can stop thinking is he / isn't he - and just get on with continuing to enjoy him and bring him up.
You might want to parent him slightly differently (especially 'bad' behaviour) if you know whether or not he is on the spectrum.
pronoun reversal in speech can be a trait of ASD but also of hearing problems have you checked his hearing? just incase as can be also linked not just to echolalia as in ASD but sensory issues, personally if your happy /hes happy i wouldnt worry to much yet a lot can happen by say 5 but a trip to chat at a drop in centre for SALT could stop your worries too.
Have to say that while much of what you say sounds great and normal, some of the obsessive/repetitive behaviour and language you describe sounds similar to ds around that age. He was dx with ASD (high functioning) at 3.5.
With normal language development, the echolalia which (though you say is decreasing) should be virtually absent by the age of 3. Ditto pronoun reversal.
Might well be absolutely nothing to worry about. He may grow out of these quirks naturally but he might not. But my instinct (with hindsight of course) would be to seek further advice.
Actually getting any kind of formal dx might not be the most important thing (certainly made no difference in my ds's case), but acknowledging that some of his behaviour and development might need specific help would be beneficial.
What's important is that if you recognise any area which he is struggling with, best to start helping it immediately.
Hate to sound like a voice of doom, but having um-ed and ah-ed about ds (whose symptoms at 2.5/3yo were much more subtle than they are now he is 4), I wish I'd done something earlier rather than do what I did which was bury my head in the sand and hope he would 'naturally' grow out of things.
Ds always had great vocabulary, eye contact, highly sociable, great sense of humour, no major problems with routine, no sensory issues. We dismissed much of his 'unusual' interests (eg fans) as quirks, and thought he'd grow out of the echolalia (he did). Now in hindsight we realise that despite his great vocab, and good use of communicating for his own needs, there was a big lack of social communication - eg just making conversation (which we've been doing with dd since she was 18 months old).
But in our case, having subsequently had dd, it is clear now that the development of a (so far!) nt child is so, so different.
I do think if you have an instinct something is not quite right, it is worth looking at ways to help.
FWIW we chose to start an intensive early intervention programme with ds which was the best thing we could have ever done
I hope I haven't scared you - just think it is best to trust your instinct, and seek expert help if you think something is amiss.
Sorry, just seen that you said he has good conversation, and great interaction - forget my ramble about all that then
Thank you everyone for taking the time to reply, I really appreciate it. There is lots to think about in what people have said. Bialystock the possibility of looking into early intervention is one of the main reasons that I would consider seeking a diagnosis. He is pretty interactive and conversational though (lots and lots of questions! - "what's that?" "what are you doing?" etc) so that's a positive.
I think on balance I'll wait and see for the next couple of months. He has days where he is so fine that I wonder why I ever wondered... then days which are so awful that I have very little doubt! The social issues, which are probably my biggest concern, may be due to other things (new sibling and a recent separation from me when DD was hospitalised) - I have been testing him a bit recently, he will be absolutely awful with e.g. the checkout lady in the supermarket when we've popped in to get loo roll, but fine with / happy to speak to the man in the village shop when we've gone to get him an ice-cream! I'm not sure if some of it's just attention-seeking toddler stuff (in a slightly extreme way). It's been so useful to hear all of your experiences, and I'm trying hard not to take the "head in the sand" approach, but to keep an eye on it and seek advice if issues persist / develop.
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