Should I be worried? Social and communicational skills in 5 years old.

[Mackonadragos]

We took our son (will be 5 in April) for psychiatric assessment (we went quickly privately) - disturbing signs of OCD type behaviour. We collected data from teachers (used the NHS questionnaires), and based on what the teachers wrote, the psychiatrist's opinion is that he has problems with social interaction and relating to his peers. Therefore she would look into the area of high functioning autism.

According to the teachers, he plays along with his peers, but not joining in as such, he does not have friend, he holds hands when a walk, but does avoid close physical contact with others,also does not seek comfort from adults when he is hurt at school (at home he is very happy to be comforted, stroked, cuddled, etc). Also he is unable to modulate his voice, he speaks loudly.

On the other hand, he very happily talk to adults, he has a good sense of humour (it was noted both in the kindergarten and at school). At home he is very happily playing with his siblings, I know that he happily chats to children at playgrounds, and he smiles at strangers.

He had not had any weird habits (up to this point, when alarming OCD symptoms started very suddenly, last 2,5 months), was fixated on anything, he was a laid-back child, but since started school I noticed anxiety (chewing jumper excessively).

So, my question would be - based on your experience, is it not normal, that a child at that age does not have a closed friendship and too much interaction with other children? And based on that solely, would we need to go down on this autism spectrum path? I am somehow not very comfortable with the idea, I feel we are barking on the wrong tree here, but again I might be wrong.

(We live a relatively isolated life here, not friends and no opportunities to meet children outside of school really, so my idea would be, that interactions too need to be learnt and practised.)

Social interactions are a mixture of development and learning. If your DS doesn't have much social experience but he is ready to learn then I would expect him to pick up social skills quite quickly when he started school, and to enjoy it. It wouldn't necessarily make him anxious or obsessive.

Autism-spectrum is very much the kind of problem that causes both obsessive behaviour and social anxieties. So it would make sense to explore that. I am not sure whether your DS would be diagnosed with an ASC at all based on what you have said, but that does seem a logical thing to explore first. (For what's worth my DS who has an ASC also had a great sense of humour and got on very well with adults but much less well with children his own age.) The assessment for an ASC covers a wide range of things so he may well be given a different diagnosis eventually. Or no diagnosis at all!

I am also a bit puzzled about why you went to the psychiatrist at all. Chewing his jumper to shreds doesn't seem very bad to me, at least not by itself. So do you think you might have jumped the gun a bit by going straight to a psychiatrist - usually they would only see kids with quite severe behaviour issues or other mental health issues. Or did the teachers come to you to tell you that your DS had a problem getting on with other kids, or an unusual problem with obsessive behaviour?

(PS what I said about the psychiatrist applies to the UK - things may be different if you're in a different country.)

Thank you for your quick reply. A bit more info. We based in the UK, so we use the system here (though I am not British, hence we a bit more isolated, husband, who is British, busy with work).

Why psychiatrist? OCD behaviour started suddenly (not eating food when someone caught, started hand washing (but it disappeared), instead came the scrutinising of food, washing hands, scissors, food in water before eating, but often smashing food on floor, not eating food if he thinks the grandmother touched it, got very aggressive around food time (now eats separately) smashes plates, food, drinks, if he thinks that it is not good enough to eat it, often demanding bath before going to school, in the evenings he wants to eat in the bath. When asked he says it is the germs. (He normally is hungry and thirsty at some degree all day long, and this does not help with aggression.)

So this is itself was enough to see a paediatrician who referred us to the psychiatrist.

I agreed on things with her that he is anxious, it needs to be explored, he has speech problems (started to talk at the age 1,5, fluent, bilingual, but cannot pronounce letter "r", he says "l" instead.). Also that we can explore that autism thing as well, no harm in it. I just feel that this is not my main concern, although, it might be linked. I never had concerns about him before, regarding ASD, and I still think that he just need more time to form friendships with children. I have been filling in forms for the NHS, and really there is no other signs than the underdeveloped friendships that are slightly unusual.

(My daughter, who is going to be 7 in March, was lot worse. She went to kindergarten only for 4 months, before starting reception year, and she did not talk to anyone until around Christmas time, now she says that she was scared when she started school. She is in year two, had two good friends, who, moved away, but she plays with other children, and talks to adults, although, she is generally an anxious child. She can be very particular about things sometimes, so to me she would be a candidate for ASD, but she seems to be fine. My son is completely different. I never worried about him over these issues.)

So my question remains the same - is it worrying, unusual if a boy of 5 years does not play with his peers at reception year (but plays alongside them and talks to them sometimes, but not too much)?

(He only went to kindergarten for 1 year, 3 hours a day. So not much, but some of the children carried on with him in reception year.)

Also, as far as I am concerned, children first do not play with each other, but play alongside and later they start to interact with each other. (My son plays nicely with other children, he did it during the summer holiday when there was an opportunity).

My DD was like this at school. She was fine at home but like a zombie at school. Wouldn't talk, join in, ignored kids asking her to play, wouldn't eat etc, the list was endless!
We went to psychologists too who said she would grow out it, and at nearly 6 she is starting to come out of her shell and is much happier.

OK, I see now, there’s much more than just the jumper-chewing!

is it worrying, unusual if a boy of 5 years does not play with his peers at reception year (but plays alongside them and talks to them sometimes, but not too much)?

I’m not expert in child development but my understanding is that this is related to age and development rather than experience or practice - roughly, kids under three play alongside, kids over three play together. So by 5 it might be a developmental issue. And combined with the other very anxious obsessive behaviour you have described then I can see why the psychiatrist would want to look into an ASC. To some extent the exact diagnosis at the end is less important than the detailed assessment process, which will (hopefully) pin down what is triggering the anxiety and obsessive behaviour. It does sound as if something about starting school might have set this off - maybe the social demands, maybe sensory overload, maybe he has subtle communcation issues which only become clear in a bigger group or with people he doesn't know well.

It’s interesting that you were more concerned about your DD. Autism-spectrum can look very different in different children. I would not have recognised it at all in my DS if his behaviour had not suddenly changed when he started school - in fact at first I thought my DS might have some kind of OCD and it was only when his communication was assessed in depth that I realised how many issues he had. And we know other young people with ASC diagnoses who my DS says himself are the exact opposite of him!

Thank you for the replies.

Regarding my daughter, I even raised the possibility of ASD with the kindergarten staff, I myself saw that something was not quite right here. But she got better year by year, and by now she looks more or less average. However, I know that she is still a very anxious child (collecting awards at sharing assembly, she looks like as if she is going to the guillotine, very different from her peers who look lot -lot more relaxed.)

I think, I too was an anxious child, but over the decades I become more confident. So I tend to think that many issues are personality traits rather that some disorders. On the other hand, because I live with these children, their behaviour seems to be the norm that I am accustomed to, therefore I am in danger of normalising things, which for an outsider, looks somewhat unusual. And I sort of need to get the balance right.

These answers help me to articulate my thought. Somehow, I was not fully convinced about what the psychiatrist tried to tell me. The OCD-like symptoms are so oppressive right now, that his underdeveloped friendships were not really on my radar, and didn't put much thinking into that.

I also talked to a nurse lately, and she said that often it is when starting school that many ASD related issues come to the surface, due to increased pressure. I also though that my son is very playful, maturing lot slower than my daughter. He is in my opinion is no school material just yet, he is happily playing, and that is what he likes to do.

I keep lamenting if children would start school 2 years later (in my home country they start at 6+) would we encounter the same problems with them or not.

Hi OP- I know this is an old post. But I'm wondering, if you are still around, how are your both DCs now?

I have some concerns about my 6 yo DD.

@Mackonadragos