Does this sound like ASD or SN?

[nanbread]

My almost 4 year old:

Has some sensory issues, won't wear certain clothes and hates certain noises

Doesn't have a great imagination - likes playing with play food for example but his ice cream is always the same flavour, he doesn't come up with his own ideas much

Very verbal from an early age, copies quite a few adult phrases verbatim eg "see you soon, have a good week"

Behind on gross motor skills - he has low muscle tone

Will play for long periods by himself especially with Lego. But will seek out attention and play from adults too.

Hates nursery - it's a very nurturing place and they are amazing there - and says he has no friends.

Doesn't want to see other children we know his age really, with one or two exceptions who sadly we only see very rarely. Says he doesn't like them. Wants to spend his time with me, mostly. Not interested in playdates with those we could see more regularly... So I've sort of given up recently, which may be a mistake. He really doesn't have friends. When we used to arrange them he seemed to play ok together, although often quite independent in his play.

Can be very shy and clingy and doesn't like big parties, conversely he can sometimes be a bit overfamiliar with children / adults he doesn't know eg will go and talk to random grown up in the vicinity

Struggles with transitions or new things and to let go of old e.g. we painted a room and he didn't like the change and took weeks to accept it

Had regular big tantrums where he can't calm himself down

Makes eye contact but sporadically

Ditto with responding to name. He hears but chooses not to respond.

Lashes out physically - hitting, biting, scratching

We had a home questionnaire assessment for him by HV about age 3 as his tantrums were so bad but he was on great form during assessment.

I thought he might be Highly Sensitive Person but now wonder if he may have some social communication issues too or be on AS.

I wondered if this resonated with anyone? Would really appreciate some thoughts.

[LightTripper]

It does sound a bit like my DD (5.5) who is autistic but does very well. She actually does have friends but I do think she's a bit more "on her own agenda" than other kids her age - and if the game isn't going her way she'll tend to just do her own thing if simple persuasion/negotiation doesn't work. She definitely socialised later than other kids. I found quite often playdates worked better if I organised a structured activity (craft or cooking or a treasure hunt around the house or something) at least to kick them off while everybody relaxed.

It's funny I've just picked up the Highly Sensitive Child book again as, for all their insistence that they are not talking about autism, there does seem to be a lot of overlap to me.

You might find he prefers school to nursery as the environment will be a bit more structured and he'll be learning more. Does he have any interest in letters/numbers etc yet?

I suspect whether he is autistic or not you'll find that parenting techniques for autistic kids will work well (lots of notice of changes, talking through feelings a lot - if he'll tolerate it! so he can learn to navigate his own and others', visual prompts, maybe some scaffolding for play skills - or just practising playing turn taking games or slightly more "social" play with somebody he feels very comfortable with - e.g. you!)

With all this stuff if you can centre it on his special interests you'll probably find that helps. Have you seen "Lego Therapy"? It's basically a team approach to building Lego to help practice social skills. Might be worth a try? It's designed for 3 children to do together, but you can kind of improvise something similar between an adult and a child.
network.autism.org.uk/good-practice/case-studies/using-lego-therapy-autistic-pupils

This book is also quite good for ideas - we got it from our local library.
www.amazon.co.uk/Activities-Children-Aspergers-Processing-Disorders/dp/0071623361?tag=mumsnet&ascsubtag=mnforum-21

[nanbread]

Thanks this is really helpful. Yes the nursery have said he may prefer school as he struggles with the free play aspect at nursery.

He's just started taking an interest in letters and numbers, he wants to try to "write" words with magnet letters etc (always the name of a TV show or one of our names) but can only recognise one or two so far. He has poor pen control partly due to his muscle tone I think.

He's so empathetic, which throws me.

Can I ask how you got a diagnosis?

[BlankTimes]

Hi, sorry about the questions, but some of the answers make a big difference, so it's worth your while to observe him when these things happen to try and determine why he's reacting as he is.

Had regular big tantrums where he can't calm himself down

Is 'had' a typo? Does he still have them, sometimes or hardly at all now?
What about when he's in a completely different environment?

There's a vast difference between a tantrum and a meltdown.
A tantrum is when a child can't have what they want and giving them the desired thing will stop the tantrum in its tracks.

A meltdown has an external cause like sensory overwhelm where the child cannot process all the things that they are feeling that are making them react, e'g. too loud, too bright, too soft, too tight.

Lashes out physically - hitting, biting, scratching again, the 'why' of this matters, is he just bad-tempered or is there a cause for his behaviour? Is he reacting to something someone did to him, however innocuous that action may seem to you or is he overwhelmed by something?

Keep a diary of his differences, list everything he does that's different to his peers, for at least 2 weeks if they are full-on, maybe a month if not so much so you can see any patterns.

Once you have enough evidence, include everything you put in your first post and anything else you notice, then make an appt with your GP and ask for a referral.

[BlankTimes]

He's so empathetic, which throws me
Lack of empathy in autistic people is a myth.

For poor pen control try different pen grippers, there are loads of different types available, google pencil and pen grippers.

How is he with a knife and fork? Kura Care Junior cutlery helps some kids a lot. Video here, www.nrshealthcare.co.uk/eating-drinking-aids/cutlery-aids/kura-care-childrens-cutlery-set?gclid=EAIaIQobChMIjrS6uKfv5gIVybTtCh0AjgpBEAAYAiAAEgJ55fD_BwE widely available from different online retailers.

[Ellie56]

Quite a lot of what you say resonates with me.

Lack of empathy in autistic people is a myth. Yes. My autistic son is more empathetic than a lot of NT people I know, and he has always been affectionate.

[nanbread]

Re tantrums and hitting / biting etc: he'll get into a state, sometimes for a reason eg he had an hour long cry this morning because he didn't want to go to nursery, sometimes he'll want dinner but it's not ready, often it's because I've set a limit or he has to stop what he wants, occasionally there will be an external factor eg he got overwhelmed at a party, changes in routine, or no discernable reason. He'll say something through his sobs after a while like "I can't stop crying!" And after some time he'll eventually calm down enough to have a cuddle.

I said "had" as they have got less intense and shorter, at one point they were multiple daily lasting 30-90 minutes each.

I think we have got better at managing them which is partly why it's improved eg I massively stripped my schedule down. We basically do nothing except stay at home when I'm not at work. We also removed some things from his diet. However in an attempt to make some friends and socialize I've just signed up to a group.

One more thing is he's really sensitive to bad things happening in cartoons etc. Anyone in danger such as a character falling or being chased even in a slapstick way upsets him.

He doesn't have tantrums like he does with us when he's at nursery or with childminder.

[nanbread]

Oh I forgot - because of his sensory issues he would have big tantrums over clothes, if he put on something he didn't like the feel of he would scream and cry and it would sometimes take more than half an hour to put his clothes on as a result. recently I feel like this has improved but I wonder if part of that is because we now make a big effort to make his clothes soft and dress him in the same few items. Occasionally he will start to accept new items of clothing after a few weeks or months.

Also apologies if I have offended anyone over the empathy remark, I understand that it is a spectrum with no particular type

[AladdinMum]

I agree with previous posters about the lack of empathy, total myth. However, at times children with autism struggle to read faces and hence tend to not always react appropriately to the situation (giving the impression that they lack empathy) - though as soon as they understand the situation (or they are told that the child that they are playing with is upset) they tend to show great empathy.

@nanbread A few things you mention are very common and not concerning at all , i.e. really sensitive to bad things happening in cartoons - very typical, children cry over cartoons all the time. But remember that autism is a social communication disorder so that is the area that will give you the greatest insights. Does he point to share interests with you, and did he point since 18M? (like a plane in the sky), does he look at you from a distance when he is cautious or unsure (social referencing), does he look at you when he does something that he is proud of? (praise seeking), does he show/give you interesting things that he finds, or used to do this when he was younger? (like an interesting rock or leaf from the ground), etc - autism really tends to distort these areas of social communication.

[LightTripper]

We got a Dx really because we have a nanny and she noticed that despite having a big vocabulary DD wasn't asking for things (e.g. drink, TV, a toy she couldn't reach) - and similarly wasn't pointing to show things (like the aeroplane example @AladdinMum gave), even though she got the concept of pointing (e.g. if you asked her to point to something in a book she could and would do it). She also noticed she tended to make a beeline for activities that didn't have other kids playing with them. She did do social referencing and joint attention with us, but less with others (and less than typical I think ... but if you're a parent and it's your first child it's very hard to know what "typical" looks like in this kind of detail).

So we ended up at SLT when DD was about 2.5 I think (which at the time I thought was a bit ridiculous, given how verbal DD was), and she'd already been seeing physiotherapy due to late walking (hypermobility and low muscle tone is common in autistic people too according to some stuff I've read and casual observation from YouTube/Twitter autists) - and in my area once you are in for two different services you can ask for a more general paediatric review, which eventually resulted in an autism Dx.

None of this registered with me in the early days because DD was my first and because (I now realise) I am very similar to DD and may well be autistic myself. But of course like many parents I had no clue of that then and thought autism = nonverbal and constant meltdowns (i.e. I was clueless).

Luckily we pursued it and DD has her diagnosis and is doing really well with minimal support (so far), but a lot of understanding and - like you - we probably do quite a lot to accommodate her without even thinking about it. Parents have been doing this for years I think: I remember my mum saying if she bought me new clothes she would always have to hang them in my wardrobe for a few weeks before I would try them on let alone wear them - I just had to get used to the idea of them first. But now we have the internet and a better understanding of autism we can hopefully find these accommodations with a bit less trial and error!

On empathy, if you read/listen to autistic adults many of them say they feel empathy which is actually kind of overwhelming and can be hard to process. I think the misunderstanding about empathy is more about how emotions are processed and responded to, rather than autistic people not having empathy.

If you want to learn more from autistic adults then Autistic Not Weird (Chris Bonnello) is a good place to start, and also Purple Ella (they are both autistic and two of Ella's 3 children are autistic too). They both have websites and Purple Ella has a good YouTube channel. There are a lot of other autistic adults making videos for YouTube and I have learnt a lot from them.

I think the lack of imagination thing is a bit of a myth too actually - there are plenty of diagnosed autistics who are fantastically creative (Gary Numan, Paddy Considine, Ladyhawke, Joanne Limburg, Hannah Gadsby, Anthony Hopkins, Dan Ackroyd ....) - but maybe in different ways. DD doesn't do much of the "make believe" play like feeding dolls etc. but is very imaginative in other ways (lots based around magic and super heroes at the moment, or just imagining different ways things work or could work). She loves "made up" stories and often gives me the plot which I then have to embellish and tell back to her at bedtime!

[nanbread]

He never really pointed much, I do remember him about 15 months old saying "bird" and waving his arm / finger in the direction of birds he could hear. Apart from that he rarely pointed from what I can remember. I put it down to his low muscle tone, he could barely lift a cup so maybe it felt like too much effort to point.

He does say "mummy I've made a xxxx" when he's made something he wants to show me.

[nanbread]

despite having a big vocabulary DD wasn't asking for things (e.g. drink, TV, a toy she couldn't reach) - and similarly wasn't pointing to show things (like the aeroplane example @AladdinMum gave), even though she got the concept of pointing (e.g. if you asked her to point to something in a book she could and would do it).

Wow I think this could be like my son. I can't remember him asking me to get things down or out for him etc. Except perhaps food! But then I wasn't looking for that as a problem so maybe I just don't remember. He will ask to play make believe games with me, like superheroes or animals, where nothing actually happens, but doesn't really ask for a specific toy or to do a specific activity.

[LightTripper]

Do you think he'd read books on making friends? DD is quite logical and likes to "know the rules" of stuff, so quite likes those. Has worked quite well for her so far though obviously it's all about to get more complex and we'll probably be back to square one... But for now she does get a lot out of her Friendships and is a kind friend in return.