To ask you if my almost 4 year old has autism

[WorriedMum11]

I feel like my almost 4 year old daughter has autism. I’ve name changed and also I have an older daughter and I try not to compare them but I look at other 4 year old girls in my almost 4 year old DD’s nursery class and think she is possibly on the spectrum. My husband thinks IABU and these are typical behaviours for a soon to be 4 year old. She’s 4 next week.

I have read that AuTism can present itself differently in girls to boys.

• labels and sleeves these scratch her and feel tight. She won’t wear her nursery jumper because of the cuffs. I have to lie on cold days and say the teacher says you have to.
• at night will only wear shorts doesn’t like material on her legs
• won’t wear certain colours e.g green. Is adamant she doesn’t like certain clothes - I have so many clothes I have bought her thinking she would wear them and she doesn’t. It’s the same old skirt and top she’s happy to wear.
• I almost feel like she tries to fit in at nursery. I sense the exhaustion in her at home. When she’s home she has her meltdowns.
• she has one best friend and obsesss over her all the time.
• she struggles to be out of routine. She’s still in pull ups at night and likes to wear knickers over her pulls ups - if she doesn’t get knickers it’s a meltdown
• she does pretend play but it’s like she feels she has to play like that rather than wants to and does a fake American accent (maybe too much barbie and an older sister)
• goes to ballet with a group of girls in her class and doesn’t sit or talk with them
• does stuff if she knows it’s a rule. E.g at ballet wouldn’t stay without me until the ballet teacher said no sticker for her and then because she knew she would get a sticker would stay with out me.
• refuses to any other class other than ballet
• will only do swimming lessons one to one
• copies her older sister - hasn’t found herself
• if people don’t play her way has a meltdown - conversely she will generally easily share
• obsessed with one little toy rabbit to sleep with
• can write her name but refuses to learn other letters or sounds
• feels she must be compliant and so should others e.g will have a meltdown if she feels her old sister is doing something ‘wrong’ or not the right way

All her teachers / learning assistants say she is fine interestingly her group leader at nursery has said she knows when DD is about to have a meltdown and so she said she’s built up different ways to distract her if she does as she’s realised she’s sensitive.

So am I worrying about nothing? She plays dolls, shops, likes her scooter and playing in the park. She wants a pink butterfly and diary bedroom like her big sister.

If you do feel I need her checked out/assessed who do I speak with? Can I get it done privately?

Sorry for the long post but I need to speak to DH and he’s not having it and thinks IABU and she’s a regular almost 4 year old girl.

All sounds so like my dd who is currently waiting foe her assessment as initial CAMHS assessment indicates ASD traits. Interestingly the first GP we spoke to re referral felt she was just "too smart for her age" and essentially dismissed my concerns. Months later in our CAMHS assessment it was evident her idiosyncratic behaviours were much more than her just being clever- although she is, but at 6 still not reading or writing fluently, held back by her own anxieties and rigidities. You know your dd, so swek the referral, and best of luck.

Io have ds who is 3 with asd. Only just been fully diagnosed. My advice to anyone is that if you suspect there isn't something quite eighth with ur child and you suspect autism then push to get tested. I became aware at a young age my son was different and managed to push from there age of 1 1/2 to start getting tested and has taken this long for diagnosis. We haven't been told low function/high function etc as out S.a.l.t and community pediatrician told me that they don't use those terms anymore as it is of no help. Maybe different health boards are different though.
It's a long drawn out process and you need to be strong and push for the tests and keep on top of reminding health visitor/doctors about your child being put on various waiting lists for various tests.
Good luck with it all xx

I can tell you what would happen with my 5yo DD - all hell would break loose. And it wouldn't be because she was being "naughty" or "spoilt" but as a result of genuine, deep distress.

The same would happen with my son but being able to say to the GP that this is what would happen if we didn't make the adjustments we were making was helpful in getting a referral so it's something to consider as GP/HV is likely to ask.

What also stood out for me op was when you say that you have always known.

That was exactly how I felt.

My wonderful ds is almost 16 and is in year 11, doing his GCSE's this year and he was diagnosed aged 8yrs 8months but I knew from around the age of 2.

He was diagnosed with Aspergers and we were advised to tell him about it due to his age which we did.
He is doing amazingly well, is targeted grade 8's in several of his GCSE's ( A* ) and grade 4/5 and above in all of the others ( C and above ).

When he was diagnosed, the doctors said to me to "play on his strengths and work on his weaknesses" and I've always done this. Diagnosis took a long time though.

I've also got a dd who is 8 next month and feel she is fitting in the ADHD box.
However, it is all too easy to read up on traits and think that your child has them all. I've done it myself, I think in the past I've convinced myself she has ASD because it's so bloody easy to see things that may or may not be there.

Always always trust your gut instinct.
When ds was in nursery I took him to the doctor who told me that school would flag up any concerns if there were any.
This was so bad as school didn't pick up
on anything for several years. It's worse with girls as they're known to "mask" it better.
Very best of luck

I've known since my DS was 5 that something was up. I've been fobbed off by teachers and the Senco (who was rubbish, sadly) for years as he's high functioning.

We asked for a referral through the Drs when he was 8, and a year later he's now been diagnosed as autistic.

School told me it's always best if the school refers your DC because it gets delt with much quicker than a doctors referral.

It's not quicker if the school are being crap about it though.

My daughter has asd and it is different in girls often. But from what you post whilst yes there's possible indicators none are stand out to me - many kids are fussy about clothing and are "best friends" not always equally reciprocated. Keep an open mind and possibly look into parent strategies for autistic children as they cannot hurt. Once she's at school a few months you can reassess how she's doing and raise concerns. As a mother of a dd with autism, I know that having the bit of paperwork hasn't made much difference until later secondary years so even if she is, pushing for a diagnosis won't trigger anything to change after nursery aren't saying she is.

Morning folks on the train to work and looking at this with fresh eyes.

I do definitely think I will speak to NAS and voice my concerns. Your guidance has been great thank you and also thanks for sharing your stories.

She will pretend play - pretends to be Barbie. I would not say her vocab is outstanding. She often gets frustrated and will lash out. What I will say is that when she tantrums I know she's not being naughty - she's 3 almost 4 and struggling to explain herself she seems genuinely distressed and often inconsolable.

At times she's incredibly compliant - generally rarely breaks rules.

She takes compliments well and follows instructions. E.g. I asked her to switch off the television using the green circle on the remote and she was genuinely so impressed with herself for doing it and loved the praise that came after.

She now lets me help her brush her teeth. She will also generally try most foods and encourages her older sister to do the same.

However can be fussy.

For me it's just that feeling and also I know we work around a lot of stuff to stop her feeling a certain way.

I would say in contrast to pp comment about the paper work not making abit of difference till high school. I would say different, my son is 3 and since getting the diagnosis and on the process we have been given an extra staff member to help him in nursery as he needs 1 on 1 attention, we are now getting an occupational therapist to help us out with things we can do in the house, access to s.a.l.t ( speech and language therapist), access to a.s.l services. Then obviously to help with things for your child now get d.l.a. Money has nothing to do with it but it helps with such things like buying dummy's as he chews threw 2 a day at 5 pnds a box of 2, nappy's, various sensory things for around the house ect. I'd also say that I wouldn't change my son for anything he's incredible in his own way you want to be able to get the best help at a young age to give them the best start to help them through life and as Iv been told many times it can be a scary world for anyone living on the spectrum. Xx

Look up the Triad of impairments!!!

. Social communication

People with AS may be very good at basic communication and letting people know what they think and feel. Their difficulties lie in the social aspects of communication. For example:

they may have difficulty understanding gestures, body language and facial expressions

they may not be aware of what is socially appropriate and have difficulty choosing topics to talk about

they may not be socially motivated because they find communication difficult, so they may not have many friends and they may choose not to socialise very much.

Some of these problems can be seen in the way people with AS present themselves. For example, classic traits include:

difficulty making eye contact

repetitive speech

difficulties expressing themselves especially when talking about emotions

anxiety in social situations and resultant nervous tics

1. Social understanding

Typical examples of difficulties with social understanding include:

difficulties in group situations, such as going to the pub with a group of friends

finding small talk and chatting very difficult

problems understanding double meanings, for example not knowing when people are teasing you

not choosing appropriate topics to talk about

taking what people say very literally.

3. Imagination

This can be a slightly confusing term. People often assume it means that people with AS are not imaginative in the conventional use of the word, for example, they lack creative abilities. This is not the case and many people with AS are extremely able writers, artists and musicians. Instead lack of imagination in AS can include difficulty imagining alternative outcomes and finding it hard to predict what will happen next. This frequently leads to anxiety. This can present as:

an obsession with rigid routines and severe distress if routines are disrupted

problems with making plans for the future, and having difficulties organising your life

problems with sequencing tasks, so that preparing to go out can be difficult because you can’t always remember what to take with you.

Some people with AS over-compensate for this by being extremely meticulous in their planning.

Your 4 year old sounds like a 4 year old !!!!

I have an aspie Ds and an Aspie DD and she sounds like parts of both of them.

Having the diagnosis has helped Ds at school because he needs some accommodations. He doesn’t identity as having ASC.

DD doesn't need any accommodations in education but it’s helped her understand herself. She would say “ know why she is weird “. It’s almost given her permission to be herself IYSWIM.

The diagnoses also help us be more patient. Most of the time .

I knew very early that DS was ‘different’. His Y1 teacher was very sceptical, but in the first term of Y2, his teacher was unsurprised when I mentioned he was undergoing evaluation, and by the end of the year, she said he needed more support than the school could provide (despite her best efforts).
My DD is now in Y1 and starting to show signs of ASD - she sounds very like your DD, but if I hadn’t had all the education that came with DS’s dx, I wouldn’t have recognised it as such.
It’s worth a) reading up on ASD parenting techniques because they work very well for ‘sensitive’ children and b) starting the long tedious process of referral now, because things are likely to get harder for your DD if she does have ASD, as her emotional development gets more out of sync with her peers.
The process is not particularly tough on the child, and any information and insight gathered will be useful to supporting her, whatever her needs.

I saw this video a while ago, which I thought was quite informative

NOTE: this isn't intended to offend or concern anyone!

Ps you sound like you’re doing an amazing job, being sensitive to her needs and supporting her. Even if you don’t pursue a dx, just paying this much attention to her should mean you’re better able to be the parent she needs.

She sounds a bit like my 4 year old ds who is being assessed for asd. She sounds more like me when I was 4 though and I have dyspraxia.

Hey OP, you've had lots of input and great advice on here so I'm not going to repeat anything. For context, I've got an autistic son and a daughter who I am just starting the potential process of diagnosis with too (both aged 9 - my son was diagnosed at age 3). I also used to run a local support group for parents of children on the autistic spectrum.

The only thing I would absolutely say is listen to your gut. It's bloody hard to get a diagnosis - despite what some might say, it's never easy to get enough professionals to agree sufficiently to get a diagnosis issued. However, I urge you to go and see your GP now - please don't wait for your daughter to start school. The reason for this is once your child is in school, you may need the agreement of the school to get your GP to make a referral to a paediatrician for an assessment for autism. Crazy, I know. I know some parents who were certain their children were on the spectrum but the school was rubbish and wouldn't support them by agreeing a referral was needed. The GPs said they couldn't refer for autism assessment without backing from the school!!! To be fair to schools, with 30 children to look after and with the fact that some children can mask their symptoms really well, it's not always easy for them to spot the signs. However, some schools just aren't that switched on. If you go to your GP before she starts school, the referral for assessment can just be made without any outside agreement. Much easier!! One parent I knew only managed to get in front of a paediatrician in the end because her daughter also had a sleep issue. When she saw the paediatrician she mentioned all the other symptoms and the paediatrician immediately started the process of assessment for autism - the child was later diagnosed as ASD. If they hadn't been referred for sleep issues, they wouldn't have their diagnosis...

Also, I don't think anyone else has mentioned it yet but is she coping OK at nursery? Is she needing extra support? If so, you might want to talk to them about applying for an EHCP.

Finally re your comment about the point of having a diagnosis - it doesn't change anything but it is useful. Having a "label" that's been officially issued opens doorways for when extra help is needed. Without a diagnosis you can very easily be dismissed as a neurotic parent - when you've got an official diagnosis you can access certain services more easily and people tend to take you more seriously. My son is in a special school as he can't cope in mainstream but his twin sister is managing in mainstream. If she gets diagnosed as autistic, it will give me some clout to negotiate a more appropriate secondary school for her. Right now, I can't see her coping in most secondary schools. If she is autistic my concerns about her ability to manage will be taken more seriously. It shouldn't matter but it does.

Oooh nearly forgot! NHS diagnosis is preferable if at all possible.It can take some time but some professionals get sniffy about private diagnosis. I've got friends who have gone down the private route (private paediatrician who's widely renowned for specialism in autism) and it's been fine most of the time, but occasionally it's not accepted as an official diagnosis.

Always happy to chat if you ever want to pm.

Thanks and thanks everyone. Yes I need to make time to see a GP.

Sorry I've been at work all day and now on my way home so have been unable to respond.

I just know in my gut. I know that she's extra sensitive and we work around stuff now to make life easier for her - she's so clingy as well.

We called her (jokingly of course) Velcro baby.

She's also quite stubborn and likes things her own way and perhaps we do give in as we don't want the ensuing meltdown.

If you have concerns, this is the perfect time to address them. It is WAY easier to get a diagnosis and then help at school if you start the process before they are five. Also they won’t remeber much about the testing etc. You just say, we are going to talk to Doctor Wendy (orwhoever) and play some games. But mainly if you can catch it early you get in the system while they still have budgets for early years interventions - it thins out later IME. And you can get them the help they need before the functioning differences have time to “harden” into mental health problems. So yes, follow your instincts.

She sounds lovely by the way. So do what you can to fight her corner and get her some extra support if she needs it.

She's amazing amazing little person! In absolute awe of her.

Love the way she sees the world. Little superstar

Thanks everyone.

So just to reiterate to get her seen by the GP or request a referral myself for her . What about the HV? Should I take her to the GP?

Thanks again!

What I did was just speak to my lovely GP by myself. He was amazing and said “mum, I know you and if you’re cincerned I believe you” and started the referral then and there. So he never saw DS in a diagnostic capacity, although he knew him a bit as a general patient. But the GP was just the gatekeeper who then made the referral to undergo assessment. So the referral is what you’re after. (Don’t go through the school, always another advice I would add.)

I always post in mouthfuls! So anyway, just to be clear, I never took DS in person to the GP. (I love how you talk about your child, you have such a good handle on her needs.)

Didn't want to read and run, but I have been in your shoes. No one would verbalisé their suspicions but lots of 'hints'. I took DS (3) to the drs to put it to bed, I knew he was sensitive etc and that something wasn't quite right BUT I had explained everything away.

Anyway, to summarize, I had to push and push, but DS is now 9, in a specialized school and soaring. I am so proud of him. Early intervention was key for us, and I see nothing but a bright future for him.

Good luck x

I'm so pleased to read all these positive stories.

We know our children don't we!!

I will book with my GP. She's very very understanding and been my GP for almost 10 years.

@RedemptiveCrocodile it's true what you say. We do make adjustments to make life much easier for her - e.g. clothes and social situations.

With her birth party coming up in a couple of weeks I'm concerned it may be too overwhelming for her it's what she's asked for - a hall party - bouncy castle etc. But I just wonder if it's too much. We will be able to give her time out so it might be ok.