AIBU to ask my doctor if she thinks my 4 year old may be on the Autistic Spectrum

[FirTree31]

Hello, I'll try to summerise.

My 4 year old started school this summer, before this he was in a private nursery 3 days per week. During his last year at nursery I had to attend meetings every fortnight regarding his behavior, I also had to call in a Social worker (I do not have social work involvement) and HV. His behavior could be awful and they threatened to not allow him back due to safety concerns of the other children. His behavior did improve approaching the end of nursery through hard work of nursery and I. School have phoned once regarding his behavior also. Nursery seemed to insinuate that he may have autism so I took him to the GP who said this was not the case due to his being able to keep eye contact, he isn't repetitive and usually answers when his name is said.

However, I'd like advice on more subtle signs if possible. His tantrums continue to far disproportionate to what is happening, he punches people's, says threatening things, hits me with things, often does not listen, stamp, throws things, slams doors, and demands. His elder brother (9) has recently had two panic attacks during DS2 tantrums because of the way he hits me and shouts and screams. DS2 also used to have ticks (coughing and clearing throat) but this seems to have calmed down in the last few weeks.

I don't want to pathologise bad behaviour, but I don't know what to do. I am on edge often and absolutely dread if I have to reprimand or say no to DS2.

Can you push for the school to refer? Can you speak to the senco? The GP isn't a specialist and it sounds like he is fobbing you off. I would try to work with the school on this one
And yes, you may need to be pushy...

It would need to be the school who refers round here. CDC won't accept a referral from someone who's spent two minutes with the child. It's a hefty referral and will need lots of info.

I doubt gp will give an opinion but if you list the areas of concern they can refer to a developmental paediatrician if they agree it is out f the norm.

He's a bit old but if you google the M-CHAT (modified checklist autism toddlers I think) and complete it thinking about when he was that age it might help. It gives you a score with likelihood of autism. You can use as basis to push for referral.

grinds teeth - lack of eye contact is only one of the possible signs of asd many people within the spectrum have "normal" eye gaze in conversation & some people who do not don't have autism
www.autism.org.uk/professionals/health-workers/gp-info.aspx
gp should have looked at other criteria as well - look up this website & check other bits of info that are relevant to your dc - or not. There are other conditions that may lead to some of the behavioural issues. How is his hearing (& vision!) - have them rechecked - its amazing how many educational & behavioural issues can be caused by these 2 things. Pathological Demand Avoidance (PDA) is something that does spring to mind as well from your description (check that out on this site) Or ADHD - read up talk to teachers & go back to surgery but ask to speak to different gp if pos & take a list of schools observations & make a log of behaviour before you go

Talk to the school sendco. Tell them your worries. From my experience, I had the Ed Psych, Paediatrician and ASD specialists (and other professionals) attend the school for observations so they could build a case for diagnosis and EHCP. This was only after school refererred.

Thank you, that's great advice. I will call the school tomorrow. Can these tantrums and awful behavior be an indication? He also runs off a lot, in supermarkets or anywhere, he just expects me to turn up wherever he is I think. He's not my first child so I do know that children can be difficult, but this is extremely difficult, it makes my life miserable. Conversely, he can be an angel, especially one to one, its like night and day.

Gp,s often don't have much of a clue about autism , is he still.under the health visitor can you ask for a referral to the community paediatrician ?

you dont need to ask your doctor. If your child is school age, it will be something the school/nursery can refer you to paediatrician for

We were told by the paed that m chat is outdated and they refused to look at it, a hv can also refer if you still have contact.

I would not go by the GP’s opinion. My sister took her daughter to be referred for the same thing (being that her son was already at an SEN school and autistic so she knows what she’s talking about) and the GP just turned around and said ‘well she doesn’t look autistic!!’ What an incredibly stupid thing to say! I would speak to the school senco for starters. Good luck

Sorry if M-CHAT is outdated advice, I was recently told by a friend she was asked to consider the questions on it with her toddler who may be on the spectrum. Don't mean to give the wrong advice!

Mylittlepony374 still good advice, I'm definitely going to have a look at it later, thank you so much.

Around here the GP can refer but needs reports from nursery and HV etc first as well as a cogent list of your concerns. Talk to your HV about your worries and what their advice might be .

I have two on the spectrum who would never have been referred based on your GPs advice!

But if you look closer, they didn't exhibit joint attention (pointing something out for you to look at) when they were younger, and their imagination wasn't social, so although it was a brilliant imagination involving dragons and knights and all forms of other creations, they didn't take on the part of those knights iyswim. Also no playing doctors and nurses, or any kind of dressing up games, and although they had friendships, they were a bit odd.

I would get either GP or school to refer asap, if only to put your mind at rest.

They are at the higher functioning end of ASC though, so symptoms were rather subtle and really needed the input of people who know what they're doing (sorry, that generally doesn't include GPs in the case of ASCs).

The GP sounds pretty clueless about autism to be honest. I would make an appointment with the class teacher and senco in the first instance, and then you can go back to the GP with something concrete from school.

The problem is all of those things could be signs or might be nothing.

My DS spoke early, eye contact was fine (slightly reduced) and had no issues with new situations, people, places etc.

However I knew something was amiss as he just seemed ‘different’.

The school were excellent for us and he got his diagnosis in the last term of Reception. All in all about 18 months from referral by school Cahms practitioner to diagnosis I think.

Write down what happens when he has his "tantrums" @FirTree31. Keep a log of what was happening, what you think caused the meltdown, and what happened as he calmed down.

Also lots of advice on the National Autism Society website about behaviour. Keep things consistent every day, routines help lessen the anxiety of what is coming next. Keep voice low and calm.

ASD and ADHD can go hand in hand too, so look at ADHD for behaviours as well.

GP is not able to diagnose, DS needs to see someone qualified to do so, which takes time, not a 5min chat! Ask to be referred or contact school about getting a diagnosis.

School is an excellent place to start.

My go referred my ds to camhs who referred to developmental paeds who referred to camhs. I had to email camhs direct then to refute their refusal to see him. When we did get to assessment school and I pretty much write the same things!

Schools will have more knowledge of what to look for with asd as they spend more time studying developmental norms in children.

Be prepared to fight though. Be sure what it is you want (assessment) and why (what you do that's recommended parenting wise and how this does or doesn't work - excellent advice above about keeping a diary)
How is it affecting his life and that if the family etc.

I've just been reading about Pathological Demand Avoidance and i feel he fits this. I literally had to hold him down whilst my eldest distracted him/made him laugh to brush his teeth, he'll ask for chocolate at night to which I'll explain that we shouldn't have chocolate right before bed and he screams, punches me, throws things at me...but when he calms down and back to being light again he'll often say sorry when it's been a really bad one.

Make a list of everything that concerns you and ask you GP for a referral.
However, do keep in mind that people with asd all show different things. My child is on the lower end of the spectrum.

not much speech, effectively a toddler in a adults body, they have always had pretty good eye contact, generally good with change and have never displayed behaviour such as hitting, punching, or any of the ‘bad behaviour’ that you have described. However they were given a diagnosis of autism at 2 years old as it was very obvious.

This is just to say, don’t automatically assume he has autism, it takes a long time to have assessments by qualified professionals so try and get the ball rolling now and see what they say.

We live in Scotland meaning upon starting school HV no longer involved ( I believe) ours wasn't great as we kept getting different ones or periods without due to funding. Can I ask, what is Senco?

I was reluctant about posting as I didn't want to offend anyone, I understand no all children on ASD spectrum display bed behavior, I think my son does this because he doesn't understand perhaps and is part of not being able to emotionally regulate. It could all be because I'm a bad parent

He sounds very similar to my dd. I hope it's the case for you but the tantrums and the hitting side of things seems to have improved over the last few months. I think that is at least partly because we have developed different ways of approaching things, and use tactics that work better now she is older (she's 5). With toothbrushing for example we talked about bugs on her teeth (we got that idea from a book about toothbrushing which I read to her a lot). So now instead of saying "go and brush your teeth" or "it's time to brush your teeth", we will say, "I think I just saw a bug on your tooth, you better brush those quickly!" And she will run and do just that. Reverse psychology helps too with a lot of things.

Sorry I've gone off on a bit of a tangent...but we suspect asd, because of that and other behaviour. She does make eye contact sometimes but not always, she responds to her name sometimes. When we first spoke to the gp he didn't seem overly interested but said we needed to talk to the school. We spoke to her teacher about it, and the teacher wrote up a letter listing behaviours shown by DD and whether they are considered in the normal developmental range for her age or not (I can't remember the exact phrasing). We took that letter back to our gp and currently are on the waiting list for her to be assessed.