Would you hint this might be ASD?

[Princessrani]

My friend has a DD same age as my DD (5) and we meet regularly for playdates.

I have a strong suspicion that her DD has ASD and 'screams' for professional help but I don't think the parents realise that and treat it as 'every child is different and society puts too much pressure on kids to be in a certain way'.

For instance their DD is not in school as she hated it, as well as her nurseries, and so she goes to a childminder a couple of times a week instead. She has severe meltdowns over small things so they constantly walk on eggshells to prevent that. She has severe sensory issues with clothes (too small, too big, too itchy...labels/seams a problem), it takes them an hour to get her dressed/undressed and sometimes she goes to bed in her day clothes as it's impossible to make her get changed. Noisy soft plays are a no too, she cries in agony. And the list goes on, every time we meet she asks me if we have the same issues with DD at home and I say no!

She loves playing with DD because she is easy going but I can see now we are meeting more often and she's familiar with us, she's starting to boss her more, something that the parents have noticed themselves and apologized for.

We are slowly decreasing our playdates but I can't help thinking that this child needs professional support and the parents need some clarity on what's going on as I feel they are oblivious.

Would you make a subtle hint at this or just leave them to it as it's their own battle?!

My dd sounds a lot like that little girl. School came to me with their fears two years ago. Still on the waiting list for assessment. I would say that maybe they know that any support would not be forthcoming even with a diagnosis. Does she know about PDA? Having knowledge of it will change her view on parenting so would help with how she deals with the meltdowns. I would maybe just listen to her and then when she says something about not knowing what to do, subtly suggest some reading on sensory difficulties, it will lead her to autism and she can make up her own mind.

Sorry to hear that you are still waiting for an assessment. I know lists can be long.

I don't know how much she knows about PDA or even ASD. She just gives me the impression they are overwhelmed and that their DD's behaviour is becoming more challenging as she grows.

@Shinyandnew1

It’s Sheffield. They have a whole building devoted to ASd and ADHD as well as other disabilities.

Ive just been gobsmacked tbh. Immediate phone calls back, email pyschologist when we need to. She even came in on a meeting with DD’s school to fight her corner. They don’t transfer to adult services until they are ready and continue to get individualised support until they are old enough to go. My dd was diagnosed at 16. She will stay with children’s services until she’s 19. They’ve just been fantastic.

CAMHS aren’t involved in any of the assessments. They are all done by a senior pyschologist and a SALT. Perhaps it’s CAHMS lack of input that makes it so successful🤔

When Dd self harmed, pyschologist fitted her in 3 days later. CAHMS did nothing of course.

I would say it. I have an autistic kid. The person who told me did it in a really positive manner, noted his strengths, things he did differently to others that suggested a different neurotype to his peers. If we continue to not speak about Autism then autistic people will continue to be marginalised.....the silence perpetuates a tragedy narrative.
Also, that child deserves appropriate supports. We should all be responsible for the wellbeing of all children.

Stims like flapping hands and jumping are things a lot of kids do to regulate. I've seen a big increase in mainstream kids having Stims of this type, as well as screaming and screeching way, way more as if it's a form of communication but these are the Covid nursery generation. ASD esp in girls is so complex as often girls are highly verbal skilled communicators and adept at mirroring peers but the burden of masking can be overwhelming at home at meltdowns, controlling behaviour and even alter ego's can crop up. If you're not an expert in the field it would be impossible to spot these girls. Then others presentation is what you'd see on a Google checklist of ASD features (mostly based on boys). Could you try asking her which aspect of the DD's behaviour is worrying her what is she worrying about, does she think it's something that support could be found for, maybe that would enable her to open up. I wouldn't ever mention ASD just the presenting behaviours, quirks etc.

Don't understand why you can't talk to her about it and help her rather than backing away (reducing play dates).
Just ask her - have you ever thought she may have some form of ASD?
Tell her about the hand flapping experience etc maybe she does need it pointing out if she asking you for advice. Help her!

We are reducing playdates as her DD is becoming quite bossy towards DD and also making up issues (i.e. she said the other day DD hit her, which we all knew wasn't true). She wasn't too bad at all before but I think we are becoming a bit too familiar. I don't think DD minds it so much now but I don't want to encourage this dynamic.

If you're backing away anyway then why not mention it. Say you think dd might have ASD and have been looking at some of the signs and noticed sensory issues and x y and z seemed to be common and you wondered if they had considered it with their dd.

What surprised me at first is the fact that they never say no to her, she rules their lives. She used to go the bed close to midnight, they let her stay in the bathroom for 2 hours, sometimes giving her dinner whilst she's having a bath as she'd not come out until she's ready, staying out for ages, sometimes it'll be totally dark in the playground and they'd not move, I realised later it's to avoid meltdowns, which she says can last for up to 2 hours.

OCD behaviours like they come into the house and she'd say you've not held my hand the right way so she'd start screaming, so they all have to go back out of the house, all the way to the street and walk back in a certain way she decides it's right.

Severe issues with clothes so they keep asking me if DD has them like: something doesn't feel right on her arm, or her back, or too small, too big/ not the right colour etc. Apparently the childminder has also mentioned she keeps twitching and complains about her clothes not feeling right on her. She keeps buying only certified organic cotton as she thinks it might help, but don't think it does.

And generally very tantrumy and miserable. I only recently found out how challenging her behaviour is at home, she doesn't display too much of it with us though. My friend is sharing a lot more as I think she wants to find out whether this is typical behaviour for a 5 year old and I can say it isn't.

I was thinking to say something along the lines of: did you think of going to the GP or ask for a professional opinion about her sensory issues with clothes, noise etc. Not going too much into ASD but just to mention that perhaps she can ask for a more qualified opinion.

@Princessrani

www.stephstwogirls.co.uk/p/what-is-pda-pathological-demand.html?m=1#:~:text=The%20main%20features%20of%20PDA,recognised%20by%20parents%20early%20on)

Thank you. I didn't know much about PDA. It all sounds like her from what my friend says.

It's difficult to say whether some of the behaviours you have mentioned are due to ASD or the girl's isolation (for lack of a better word) and not having many peer interactions. To put it bluntly, I feel that peer interactions, not necessarily through mainstream school, are great for ASD kids as it builds their understanding of social interactions, not speaking about their niche interests for hours, turn taking, it builds their tolerance of frustration and disappointment. In my opinion, and I realise it is not popular, the current movement which demonise 'masking' are not realistic in terms of helping our children to function in society. We all mask. I, neurotypical I think, mask every day. There is a difference between disinhibition and masking, yes, but presenting yourself in a slightly more agreeable light, giving way in terms of what you want and what others want, letting others talk are things that we all do.

OP the next time your friend asks about your DDs behaviour in comparison to her own DDs, why don't you say something along the lines of "this is a few times you've asked me about this, do you think that there might be something going on with your DD that you're worried about?" Then see what her response is.

It's also important to be sure that the child isn't being mistreated, especially if you don't see much of this behaviour. I'm not saying that means it doesn't happen but your description suggests the mother has difficulties too.

But the effort involved in masking for ND comes with huge problems. ASD burnout which destroys mental health. It’s not quite as easy as being the same at masking as a NT

Stay out of it. She knows already - I speak from experience. She clearly doesn’t want to talk about it and her questions around comparing behaviours are likely to be an attempt to understand her daughter’s difficulties and how they stand in relation to other children of the same age. You are also not a developmental paediatrician and in no position to make an armchair diagnosis. There are several conditions that can look like ASD including attachment problems and Developmental Trauma Disorder. If you are a good friend you can be quietly supportive and ready to talk if/when she does decide she wants to open up. Please do not decrease play dates as that will be devastating for your friend, especially if she is already struggling.

You are also not a developmental paediatrician and in no position to make an armchair diagnosis.
There are several conditions that can look like ASD including attachment problems and Developmental Trauma Disorder.

Hmm, I’m not sure how I feel about this. For several reasons:

1. If it looks like a duck and quacks like a duck, it’s a duck. I wasn’t aware you had to be a paediatrician to make an educated guess about the possible cause of a child’s difficulties.

2. Autism is considerably more likely than attachment disorders and trauma.

3. It worries me that attachment issues and trauma are the new “refrigerator mother” - something levelled at mothers to blame them for their child’s autism.

However I do agree with you that children with trauma and attachment issues (children who have been adopted for example) are perhaps wrongly included in the autism stats, ultimately does it really matter, if the end result - SEN support at school etc - is the same?

Say something. She’s wondering about it. Her daughter’s behaviours aren’t normal and are consistent with asd. Why wouldn’t you say something? You can be tactful!

OP - how do you know the child's parents haven't pursued a diagnosis?

My child has ASC but I don't tell everyone we come into contact with. She's different, her behaviour is often challenging, she struggles with school attendance and she is learning at a different pace to many other children. I expect there are many parents who come into contact with us that have opinions about what she 'should' be doing but frankly, unless she behaves unacceptably towards them or their child I don't think I owe every one of them an explanation for my child not conforming to their expectations of how she should be.
Also, can you be sure they don't already have support in place? My child has very limited support for her ASC and it isn't a panacea. Even with support she still experiences challenges as a result of being ND. Support doesn't magically mean she is willing to go to school, brush teeth, wash, generally
Co-operate or get on well with other children. It's challenging and support makes a minimal difference, very slowly. Again, I'm sure there are people who may observe my child's challenges and feel concerned that she needs 'support'. But assuming support will just neutralise the challenging aspects of a disability is a bit naive and privileged. We have strategies to manage her ASC but that's they all they are. She still has meltdowns and struggles. It doesn't mean I'm in denial or that she isn't supported. Just that her ASC is something we have to live with and it can't just be eliminated with ' support' to make other people feel comfortable.

I don’t even know where to start with your post.

Yes, something can look like a duck, quack like a duck but not be a duck. It also may blow your mind to know that you can have autism, attachment issues AND DTD. All at the same time! Equally you can have autistic traits but not meet the official criteria for an actual diagnosis of autism.

It is also extremely ignorant to link attachment disorders and/or trauma with parental neglect. Obviously that CAN be the cause, but generally it is far more nuanced than that. There is growing medical evidence about stress/trauma that the mother experiences during pregnancy which then transfers to the baby in utero. A child can also have extremely traumatic early life experiences which have nothing to do with the love and care that their parents provide, eg admission to hospital/medical treatment, any enforced period of separation from a parent etc. I speak from personal experience, sadly.

As far as appropriate SEN support at school is concerned, it is important to have a correct diagnosis so that the support is as effective as possible. If you knew anything about attachment and/or DTD you would realise that the approaches for these conditions can look very different to those for autism. There is also evidence that it won’t do an autistic child any harm to be treated as if they also have attachment/trauma issues but it can be damaging to treat a child with attachment/trauma as if they are autistic.

Google the Coventry Grid and a comparison of ASD and reactive attachment disorder and how
much they overlap - it will be very enlightening for you.

I agree with everything you have written (my DD has likely ASC and diagnosed ADHD).

It is naive and patronising to imagine that the vast majority of parents in OP’s friend’s situation won’t know or at least strongly suspect what challenges their child has.

It also needs to be remembered how long NHS diagnosis can take in the UK, a family can be waiting for years for their child to be assessed. Quite rightly, they will not want to publicly share any details in the meantime until a formal diagnosis is received.

My daughter has just been diagnosed with autism. We started wondering when she was 4. She is now 8. One of my friends suggested it to me when she was 2 (due to sleeping issues) and I completely dismissed it because she was extremely vocal and had what we thought was great communication skills. No-one else (including nursery or school) ever raised it with us, and it was this that caused us to doubt ourselves and not put in the referral until she was 6. Hers sounds similar to, but more subtle than your friends (my daughter masks very well). I really wish other people had pointed out the signs to us if they had spotted them. We knew she was much harder to handle than her peers but we had no idea why - the signs of autism in girls with high IQ are v different to the signs that are listed when you google.

I think what is concerning is how many children are being diagnosed with asd these days. Some of the children diagnosed with it in my daughters class appear perfectly ‘normal’
what will a diagnosis achieve? Will it cure her?
her parents definitely need to stop pandering to her every little annoyance asd or not.
your friends child sounds like she needs some proper routine or she’ll end up a very messed up adult. They tried getting my daughter assessed for it because she would line up her toys. I refused and she stopped doing that when she was 8. She’s now completely normal.
a lot of 5 year olds are hard work, especially ones with no structure or discipline.

This is great for identifying female ASD.

My Dd was a real chatterbox when tiny. Plenty of eye contact and smiles. But she fits nearly everything on this list.

https://autisticgirlsnetwork.org/wp-content/uploads/2022/11/Keeping-it-all-inside.pdf