Feeling like nursery are really pushing to label my son

[Dumbledormer]

This is a difficult post. First of all I hugely like and respect my DS’s nursery workers but I’m getting a lot of mixed messages and I feel like I’m going crazy.

DS is two (literally just turned last week) and was born 5 weeks premature. He’s been going to nursery two mornings a week since he was 1. Nursery flagged a concern with me that he wasn’t responding to his name at around 18 months and that he walked on his tiptoes a lot and that these can be early traits of autism. Contacted HV who came out to assess him and was not hugely concerned. Advised to “watch and wait”.

Did my own research, panicked a lot then calmed down and looked at things to do to help. Managed to get a private speech therapist a couple of months ago who found him to be speech delayed on meeting him but didn’t think he was autistic (although mentioned later that she now wasn’t sure as nursery had a different view when she spoke to them). Anyway shortly after this, we broke up for the summer and he’s come on in leaps and bounds. Always responds to his name, follows instructions, has a handful of words that he uses functionally. Points to request and points to share excitement at something he’s seen. Really enjoys being around other kids, although doesn’t play with them unless they chase him or he chases them but will try to copy what they do. Eye contact is great and loves people copying him. Still walks on his tiptoes but this has got less and less. Doesn’t appear to be phased by changes in routine at home, eats well although can be fussy with new foods which I think is fairly typical and he sleeps well.

Nursery’s concerns before we broke up for the summer was that he wasn’t happy when they changed the layout of the room one time and moved the toys back to their original place i.e. struggles with change. He’s never done this at home and we are in the middle of renovating so stuff is moved round a lot. Obsessed with water play and struggles to engage with others when water is about (it’s fair - he still loves it) and that he’s very sensory seeking, he won’t sit down for story time and wants to be off playing with toys and no spatial awareness.

He’s been back at nursery a couple of weeks now and is doing two full days. The most recent comments are that he’s just picking at his lunches (which are free at nursery) when all the other kids are eating their full meals and I’ve been emailed a list of SEN toddler groups to take him to as they think it’ll be good for me to get more support with him as he’s clearly struggling.

Spoke to HV yet again, who is still unconcerned but has agreed at my insistence to now refer him to SALT and talk and play.

He’s not perfect, he’s a toddler and the things I find difficult are the frequent tantrums when he doesn’t get his own way and when being made to wait. He really likes to be very theatrical and throw himself to the floor and scream but these last seconds and always end as soon as he gets what he wants or is distracted by something else. His new thing is crying if strangers speak to him and most recently covered his eyes when an elderly gentlemen tried to talk to him. Again, all quite normal I think and he usually warms up to strangers eventually if they give him some space initially.

Basically, I’m trying to be as open and as realistic as I can about my son’s strengths and weaknesses, I’ve thrown myself into researching kids on the autistic spectrum and I just really don’t see it in my DS.

BUT nursery do! Am I just completely in denial? How can I question their collective expertise but it just sometimes feels like they are talking about a different child. They haven’t always got it right either, I remember them flagging concerns that he had PICA when he was a lot younger and shoving everything he touched in his mouth. This also made me worry like mad but he just grew out of this behaviour like most kids do.

Sorry for the absolute essay but just wondering if anyone else has experienced this with a nursery before?

OK, OP, so now you've said more about what nursery is doing, I still think they might be right to suspect neurodivergence, but if you feel that their approach to DS is not as positive and supportive as you would like, YWNBU to consider moving nurseries. You should still go ahead with any assessments or referrals that are suggested, though.

Nursery are raising a concern, they are most likely noticing it and seen it many times. Btw please don't use the word 'label' I have two children with autism and it's highly offensive to consider them 'labelled' children. It's a disability, many have it, every single person with autism is different and without further investigation you'll never know. What the worst that can happen? They don't get labelled! I tell you what really boils my piss, kids in yr 2/3 clearly autistic and struggling and parents not wanting to accept they need a diagnosis and support.

Already apologised upthread but I wasn’t sure how else to say it. Nursery are pushing their opinion that my son is autistic when other professionals are not in agreement and is that not giving an undiagnosed child a label?

Other professionals? HV doesn't count.
Any professional worth their salt - including SLT and others - should be saying that they can't diagnose and can't tell you either way, because an assessment must be done by a multidisciplinary team, and it is very early to be diagnosing, too.

This also happened to one of my DC.

Another one only said 2 words by his 2nd birthday. Both are NT

I agree, keep your mind open to both outcomes

Well I wish my nursery had been this diligent about my son. I pushed them for ages as was convinced my son was ASD, and they denied it every time, adamant he's neurological. He's now in Receptipn, really struggling, and the HV says she has no doubt he's neurodiverse. I would be grateful that your nursery are doing something- it's easier for them not to.

Oh and kids can present very differently at home compared to school/nursery. My son is an angel at home but struggles with the school/nursery setting. It's only there that his neurodiversity is really obvious.

Nursery are pushing their opinion that my son is autistic when other professionals are not in agreement and is that not giving an undiagnosed child a label?

Nursery are 'pushing' their opinion? Again, like 'labelling', this sounds very negative. It sounds like your son has a nursery that is concerned, and expressing those concerns (as they should). It's much easier for them to ignore.

Also, if your child was suspected by a doctor as having diabetes, but a different doctor disagreed, would you blame the first doctor for 'pushing their opinion onto you and trying to 'label' your child? No - they'd be raising it from a place of concern and duty. Just as the nursery is.

I'm a teacher and it's amazing how my parents refuse to listen when we raise concerns that their child may be ASD or ADHD or dyslexic... poor kids could have really done with support much earlier.

Look at it this way - which could be more harmful... listening the the nursery and investigating the possibility of neurodiversity? Or ignoring them? Which might you regret more?

My now 14 year old son is autistic. I was in denial about it for years. I’m not saying your son is but equally if he is he is and being in denial won’t change it. He’ll be the same person no matter what. Try and think of it not as a label but if there is a diagnosis of something that will help your son access support if he needs it in years to come

Based on your update I’d be looking elsewhere too OP. I mentioned upthread that nursery had incorrect suspicions about one of my DC and ASD. But their approach was very kind and understanding and I felt they always accommodated him well and gave me as much positive feedback as they possibly could as well as raising the things they were concerned about. Having concerns about a child does not need to mean giving you constant negative feedback about him.

I completely agree and again I’m sorry if my use of certain words like “labelling” and “pushing” are causing offence. It’s difficult to describe my feelings about his nursery without using negative language as I suppose I feel generally quite negative about them at the minute for various reasons, some which were mentioned earlier. I certainly don’t have a problem with them raising concerns but it just seems at odds with what I’m hearing from others. I’m finding it difficult because it’s leading to him being treated differently already.

I’m sorry to hear your son is struggling and that you weren’t listened to. I hope he’s now getting the support he needs.

I work in a nursery - I think sometimes it's is easier to see the signs in a nursery setting, seeing how children react in group environments, around other children, with change and routines etc. There has not been one child we have been concerned about that hasn't been diagnosed.

It's such a big thing to get your head around but you need to accept it's not about labelling your child, it's recognising there are some things they are finding harder and a diagnosis let's you access things to help your child and help them day to day in the setting.

I would be inclined to give nursery (who presumably have a lot of experience and know your child well) more credence than the HV who just sees a snapshot.

FWIW my DS is autistic and while I had the odd concern (it’s hard early on because there is so much crossover between ASD traits and just being a small child!) it was preschool that flagged it within six months and they were 100% right. I’m glad they did, and I’m glad I listened.

OP please don’t feel as if you need to keep apologising. Sometimes I think people forget how this can all feel at the beginning. It’s not easy.

Well, first of all don’t panic. Autism is a tricky one sometimes and I think you can tie yourself in knots looking for traits. Nursery may or may not be right but it’s been raised so it’s worth bearing in mind. Toddler ages are tricky because they all develop at different rates and they all have their quirks.

Fwiw, 15 years ago my godson’s nursery said they thought he was autistic as he liked to line up cars at nursery. He’s not. Most recently my friend’s nursery have said they think her nearly 3 year old son may be autistic, similar things to your son actually but there are other home factors that can explain things like his speech delay and also he was a covid baby so not much socialising etc. Her HV also says she doesn’t think so but I guess time will tell. My point is, sometimes nurseries are right, sometimes they’re wrong but keep an open mind.

Maybe move nurseries and don't tell the new one where he was before so they don't transfer notes, you'll soon see if they notice anything or if he flies in a new setting. That way if they do raise concerns you know it's not due to prior labelling.

Nursery aren’t pushing to label your child they are pushing to get some help and support to assist in giving your child the best possible start in life.

at our nursery, the keyworker will speak to the lead key workers before speaking to a deputy then the manager who all have input in speaking to parents before asking for outside help to support some children.

it’s not done on a whim and it’s carefully handled too. Take all the help given.

id listen to the nursery over the HV any day.

Hi OP, In my limited experience (3 DCs), there are lots of mild developmental delays, including speech and language delays, that fall outside ASD and are resolved by age 8-9 with appropriate occupational or physical therapy or SALT. E.g. hyper mobility and poor proprioception can cause toe walking and the treatment involves orthotic inserts and physio.

So it isn't necessarily a case of a binary autistic vs not-autistic outcome. The fact that the nursery staff are leaping towards that conclusion would make me question the depth of their medical expertise. It might be a case of a little knowledge being a dangerous thing, plus confirmation bias now that they're looking for signs of ASD in your DS. Nursery staff can have quite a range of qualifications – or very few.

Also the segregation might be causing him more stress and hampering his social development.

When reading about your son I was thinking about a boy in my nursery and saying "yup, just like Jeff"(not real name) all the way through. It was very obvious to all experienced nursery workers that he almost certainly had ASD of some kind. Took Mum 2 more years to accept it. He's currently doing very well and getting the extra help he needs.
He had delayed speech, walked on tiptoes and like turning round and round while looking up, very picky with food and eventually was on an all sandwich diet, struggled with change, liked sensory play a lot, wouldn't sit for stories, didn't like new people and had major meltdowns. We once had a new member of staff who I asked if she could see anybody in the room with possible SEN issues. She confidently guessed Jeff in around 10 seconds.
Some bad nurseries like to label/diagnose at the drop of a hat. Many good nurseries are very good at spotting issues. (But will not diagnose anything because we're not qualified to). And some health visitors make you wonder if they've ever met a child before. If you believe the nursery is any good please take things further, maybe with a second HV possibly visiting him at nursery. Going to a SEN toddler group would be great. We have suspicions about a younger child too. Delays and social issues, but we treat him as him rather than any label, but then we catch ourselves treating him a lot like we treated Jeff. You may find you go to the group and realise that many children there are behaving a lot like your DS.
I hope it goes well and ideally he's all fine and NT, but if not there is lots of advice, help and support out there. Although sometimes you have to fight to get it.

"Do you think autistic people can't get degrees abroad?!

🙄"

This!

There is no negative to being aware that your child may be autistic.

Trust me, you'd be far more upset if he reached his mid 20s and only found out then after struggling through school without the necessary support.

I would thank the nursery for being so aware and raising this to you. They aren't trying to 'label him' they're trying to make you aware of a potential learning disability.

Take some time, keep watching and listening to the professionals.

Thanks everyone. Just a bit of a further update: we attended our first SEN playgroup today on the advice of nursery and which is run by the portage service in the area. They observed my son and I for an hour and a half in the playroom, asked loads of questions and at the end said they weren’t concerned at all and that they couldn’t see anything that was not typical behaviour for a two year old. They did mention the nursery he currently attends as being very busy and suggested he may be getting a little lost if he was one of the quieter ones. So it may be the case that the nursery is not the right fit for him anyway. Not sure what my next steps need to be. Do I just look around for a new nursery and once they have availability do I then just inform old nursery we are moving and the reasons why? It’s a shame, it’s been rated outstanding by OFTED and he loves his key worker but I feel a bit shaken with all this and he’s obviously not thriving in his current setting.

Here's hoping they are right and nursery is wrong. I am skeptical because nursery see him regularly so I think they're more likely to spot the subtle signs than someone observing him as a one-off. However if you have no concerns atm as his mother then that's good. The only thing I would advise is to keep an open mind and to keep an eye out for any signs that he's struggling with anything. It might be there's nothing or it might be that he does have something, but it won't become clearer until he's older. This is why professionals often say that this age is too young. It's too difficult to tell the difference between "normal" behaviour for a 2/3/4 year old and more atypical behaviour indicating neurodivergence.

People who work in nurseries are just people. They’re not qualified to diagnose anyone with anything. Yes they see a lot of kids but that doesn’t mean they are always right about the implications of what they see. A child who doesn’t interact much with peers might have ASD. Or they might have hearing issues. Or they might have suffered a trauma. Or any number of other things.

When my DS was at nursery one staff member told me she thought he had ASD because he preferred to talk to the adults over the kids. He had no other “red flags” of any kind, had developed completely normally and I had no other concerns about him, and there were lots of good reasons why he was reserved around his peers, but when I posted on here I had a million replies saying that not only was it likely that he had ASD, but that I probably did too and that’s why I hadn’t spotted it!

Fast forward 18 months and he’s in year 1 at school and most definitely does not have ASD.

That is not to say that your son does or doesn’t have it, obviously, and you’re right to give it some thought, but at the end of the day if you think the setting is not the best place for your child then you should take him out.

My DD did this at 2. She is now 14 and absolutely does not have any ASD or anything else. She was simply a shy kid. Today she's very social with lots of friends but she's still quieter than most around strangers but now has maturity to politely respond.

Agreed. Both my kids went through a shy phase at around 2 and this is exactly the kind of thing they would have done.

They don’t have ASD. Being shy is within the normal range of human characteristics.