Do you see anything worth pursuing here (diagnosis-wise)? DS(6)

[NameChange3000]

I go round in circles re my 6 year old DS, and whether he has any potentially diagnosable issues, or whether it's just him.

Since he was fairly young, he has had some social issues. Not major ones - he has friends - but he doesn't always play brilliantly with them. He's quite introverted, and does like to set the agenda a bit. As he's grown up, this has evolved into him telling lots of tales in the playground about very minor issues (e.g. another child not following the "rules" of a game to the letter), not being quite sure about how to join in with other people's games (e.g. he won't just start kicking a football, he'll always ask to play, and if he's told "no" he'll get upset and run to a teacher), and complaining that "nobody would play with him" if nobody wants to play his game, his way. All of this said, he really wants to have friends, but obviously other children get annoyed with his approach. He realises that some of his relationships are problematic, and will get quite upset about it. He is fundamentally a very kind and caring boy (he can go a bit overboard with this) and simply doesn't seem to understand lots of the stuff that goes in in the playground, or why other children would be mean (sometimes the "meanness" is just a perception issue - i.e. his friends wouldn't play his game, when they were already happily playing another game - which he would just join in with). He often asks whether we can talk about "feelings" and seems fascinated when I try to explain about human nature and other people's motivations. He has no issues with expressing his own feelings (he can be quite over emotional -and is very sensitive).

He is very gentle, and whatever problems he has will usually seek to resolve them by involving an adult (never physically, and only rarely verbally without adult help). This is what school are now trying to tackle.

At home he plays fairly well with his younger brother (but the games are far simpler), and likes to do things on his own a lot.

Academically he is very bright. I know this term is bandied about a lot, but he really is - easily the best in his year group at both numeracy and literacy (he now gets additional support out of the classroom for these, as is working at a completely different level to even the top groups). He is very curious and loves to read. He gets quite geeky about subjects - space, geography, history etc - but doesn't have any "special interests" as such, rather a fairly broad range. He fully understands that other people do not always share his interests. He has an almost photographic memory for facts, and is astonishingly good with numbers in terms of mental arithmetic. He also enjoys fiction too, though.

He is very well behaved in class although can get over emotional about trivial things, e.g. lost property (not frequently though, just occasionally). He is very motivated by the rules and rewards of the classroom. He loves school, and the playground issues don't seem to spoil his enjoyment of the learning side.

His personal organisation is good (very good for a six year old, I think). He will remember to get dressed, pack his school bag, do his homework etc without prompting. He follows routines well, but is not tied to them and doesn't mind if they change. He loves sport although it's not his strongest point - hand-eye coordination could be better but he can hold his own in football / tennis, and could ride a bike and swim before he was 4, so overall his coordination is fine. He is good at art (although produces very detailed, literal drawings) and music (is learning an instrument).

He can get distracted and silly in non-school activities (school say they don't see this). Sometimes he acts up in music lessons - e.g. Playing the wrong piece (for a joke? He likes to make people laugh, although in a slapstick sort of way) and has an amazing ability to appear to be somewhere else completely, yet actually take everything in.

Overall I think he is probably ok, just a but quirky and not the most socially competent child, and yet I have this niggling worry that I'm missing something (albeit minor) that might become more of an issue as he gets older. He was unhappy in reception (different school), and school involved an EP who said that he was bright, socially not brilliant and therefore was genuinely getting bullied, but that she saw no signs of ASD (I asked outright).

He moved schools for year 1 - again school reports said very, very bright, needs to work on relationships in unstructured time (there were never any major issues though, nothing that we needed to discuss outside of parents evening).

He moved schools again for year 2 (unfortunately, we moved house). He loves his new school, and at parents evening 2 months in they saw no issues, but a month later the teacher did ask for a meeting both re differentiating academic work, and helping him socially (the SENCO is going to work with him on social skills, using social stories). To be fair, the school said that he is not the only child in the class who will be getting extra input here.

I just wanted some opinions really. I'd hate to be missing something 'big'. The fact that different schools have repeatedly raised, albeit fairly minor, social issues leaves me wondering whether there is something which we should be exploring.

Sorry that it's so long.

[AttilaTheMeerkat]

"He was unhappy in reception (different school), and school involved an EP who said that he was bright, socially not brilliant and therefore was genuinely getting bullied, but that she saw no signs of ASD (I asked outright)".

That person did you at that time a great disservice. EP cannot diagnose ASD because they are not qualified to do so; they can only advise on educational needs.

If a child is not overtly disruptive in class and can manage academically, children with social and communication difficulties can and do get missed by schools.

I would be asking your GP to refer your son to a developmental paediatrician and do not take no for an answer. It appears that your son does have ongoing social/communication difficulties and that does warrant further investigations.

[clairewitchproject]

Look, the EP didn't say the child was categorically not autistic, she said she didn't see any signs when she was directly asked, or are EPs not allowed to express an opinion now? EPs cannot diagnose autism as you say but they can and do recognise social difficulties in children and make appropriate referrals. The only reason EPs can't diagnose autism is because it is a medical diagnosis, not because the entire EP profession is never able to recognise an autistic child. Many EPs are 'qualified' in as much as they are ADOS trained or specialise in autism, and many sit on diagnostic teams. Of course some EPs are better than others but this suggestion that EPs aren't qualified is a bit misleading because it suggests that no opinion should ever be expressed and there are many children whose social needs were first recognised by the EP. That's like saying parents should never suspect their child has autism because they are not qualified to diagnose.

The EP may have missed something, you may want to pursue it. My own opinion is that a reason to make a diagnosis includes that there is a conflict with one's setting (this is the social model of disability I suppose). If you have a quirky kid who is managing well (I have one of these, and one with aspergers) , and school is already supporting the social difficulties, I am not certain what benefit would accrue at this stage from the diagnosis, but whether you want to investigate further is up to you. Francesca Happe (well respected autism researcher) says this in her interview in October's 'Psychologist': '..People quite often ask me if I think that everyone's a bit autistic, and it depends what level you're looking at. Behaviourally, you can certainly put everything on a continuum and it's all shades of grey, and you make your clinical cut off where somebody is impaired and asking for help. You don't just go out and start Asperger spotting'.

[NameChange3000]

Thanks for the replies.

I was happy with the EP when I met with her. I felt she understood DS well, and had a really good grasp of his strengths and weaknesses. claire is right, right - she didn't categorically say that he didn't have ASD, but that she didn't really see anything which made her think this, and didn't think that he needed a referral on the basis of what she'd seen and been told.

His school are very good on pastoral care and social skills - one of the reasons we chose it. However I'm aware that this could be a double edged sword - he can stay there for primary school but may not find the secondary school environment so supportive. That's a long way off though.

Perhaps it's best to let school implement their plans and see where things go, before rushing to the GP? I have to say that when I looked at the DSM 5 I couldn't see how he could possibly meet the criteria for an ASD diagnosis - he doesn't really have any of the issues in part B. Which is not to say that there isn't another possible diagnosis (ASD traits?) but my issue is whether he needs one, and I guess for as long as he is happy and well supported at school, maybe he doesn't?

[kleinzeit]

Hm. It’s all a bit uncertain isn’t it? OK, the EP didn’t see signs of an ASC, but that doesn’t rule it out altogether. And sometimes conditions can be what they call sub-clinical - some signs of an issue, but not enough of them and not strong enough for a diagnosis. One of my friends’ kids has ADHD that is sub clinical. The school were concerned and he was assessed, it was not serious enough for a diagnosis but the clinical psychologist did suggest some strategies for helping him to stay focussed (which have worked well and he has just flown through his exams!) So on the one hand it does sound as if your DS has some real issues with social and communication skills, but on the other hand they might not be (and they may never become) serious enough to qualify for a diagnosis.

It does sound as if, with his lively intellect, your DS is using his conscious brain to learn about social behaviour and to reason about other people’s feelings and motives, while most people do this more or less “by instinct”. My own DS (who has an Asperger’s diagnosis, and is also academically very bright) reasons about these things too. One difference between him and other kids though is that quite often he gets them slightly wrong or “off” (it’s hard to explain). I also really struggled to explain some social concepts to him – like what is and isn’t bullying. It wasn’t just that he didn’t agree that something was bullying, he couldn’t even see how it might be bullying.

It would be worth your while to read up on Social Stories to help your DS. I didn’t write Social Stories down for my DS, but I did use the same approach when I explained things to him. Social Stories were originally invented for kids who have ASCs though of course other children can benefit from them. It is also likely that some of the other kids who are getting this help will eventually get ASC diagnoses, and some may have them already. You might also like to have a look at The Unwritten Rules of Friendship which has lots of practical advice for parents of kids with many different kinds of social difficulties, and which I’ve found helpful.

I’m sorry to be so wishy-washy! I do understand your concerns. It’s good that the school have recognised that your DS has some social and communication issues. It sounds as if they are making an effort for him. It also means that if things don’t improve or if your DS really starts to struggle, and you want to get any investigations done later on, then you will very likely have their support.

[NameChange3000]

Thanks Kleinzeit. A lot of what you say resonates - it doesn't sound washy washy. It just all is a bit unclear. I can go for months thinking that there is clearly no issue , and wondering why we ever thought there might be, but then we seem to end up at the same point again.

I have had almost the reverse conversations with DS about bullying - he is very quick to categorise any behaviour that he doesn't like as being bullying (e.g. children being happy for him to join in their game of "score you're in", but refusing to change the whole game to "proper" football, just because DS prefers it). He really struggles to take on board that this is not aimed at being mean to him. Or at least, he'll take it on board for the duration of his conversation with me, then tell tales of similar issues the next day, with the uncooperative children again cast as bullies.

All this said, sometimes we have (the right) children over to play and they just disappear happily upstairs for hours together, only surfacing from their games to look for food.

I'm off to order that book.