Could DD be 'on the spectrum'... sleep and behaviour issues becoming increasingly difficult!

[OhWhatAPalaver]

Firstly, apologies for the giant essay... I posted last week about general disobedience but feel I need to go in to more detail, especially after speaking to other family members.

My DD is 4 and is going through one of her more challenging phases at the moment, probably due to some big family changes - house move, school in September and baby on the way very soon! She went through a similar phase around a year or so ago when she changed from a childminder to a day nursery. Some of the main problems we have been having are:

Sleep issues - she goes to bed totally fine, but we have noticed a pattern whereby if something a bit stressful or unpleasant has happened during the day she will have what we thought for ages to be night terror type things. They are worse when she is poorly or if going through a period of change. She will wake up and scream, shout, throw things and be really physically and verbally aggressive towards me or DP when we go in her room. She tends to repeat the same things over and over, eg. 'I can't get comfy!' or 'Go away!' 'I'm not your friend!' etc. She scratches herself lots as well.
Occasionally she will just have what I would describe as a noisey sleep where she doesn't really wake properly and has shorter bursts of noise. Lately however, she doesn't calm down and we have to go in as she will be screaming at the top of her lungs and crying incessantly. It is incredibly hard to calm her down and at worst DP will have to carry her downstairs kicking and screaming to completely remove her from the situation.
We thought she didn't know what was going on as she always said she never remembers anything but last night, after a particularly bad episode resulting from our creaky bedroom door waking her up, I asked her if she remembered coming downstairs last night, which she said she didn't but when I asked her if she remembered what woke her up she said 'the creaky door'. So I am now wondering if she is in fact awake and fully aware of what she's doing but for some reason can't control herself.

Problems in the car - Another thing that is making me think she is fully aware of her behaviour above is that she has started behaving in a similar manner in the car. She doesn't seem to be able to cope with the hot weather (no air con in our car unfortunately) and she screams and shouts about being too hot and throws things around the car. She does the same repetitive shouting things as well. It's getting really dangerous to the point of where I'm actually considering selling our car to get one with air con. But then she still gets annoyed at the sun being in her eyes, even when it's not hot! It's like she can't deal with it or tolerate it. I have shades on the widows, she has sunglasses, a hand held fan, front windows open and blowers on and she is STILL not happy. She will scream 'get me out, get me out!' 'I'm too hot' or 'Go away sun!' etc etc.

Generally being difficult - I'm not sure if she is taking advantage of me being 36 weeks pregnant but she has started to run off when we're leaving the park or run away when I'm asking her to do something she doesn't want to do. This has only happened outside a couple of times but it really bothers me that I feel like I'm lacking in control and I think she knows it. I'm terrified of her going to close to a road by accident or something even though she says 'i wasn't going near the road mummy, i was just playing on the grass.' She is usually very aware of roads and cars etc and will cling on to me if we are crossing a road so I know it's not lack of awareness that's the problem.

She is usually a very bright spark, constantly asking questions, brilliant listener and really keen and eager to learn things. We reward her good behaviour with a star chart type thing and when she's overstepped the make she gets a toy taken away or gets a tv ban for a day or something. If she has a particularly good run of behaviour she gets a treat. She is openly very loving, she's really excited about the imminent arrival of her baby sister and she loves our new house (although does still talk about the things she misses from the old one, which is fine). She is extremely well behaved at nursery and 'the SENCO didn't seem to think there's a problem when I asked her to observe her last year when she had the similar phase. I'm hoping that is it just a phase but my mum i adamant she is on the spectrum somewhere.

Thank you so much if you have got this far! Now what do you all think?

In order to be on the spectrum you need to have difficulty in three areas; these are called the Triad of Impairments...these are, Social interaction, Social communication and social imagination.

Does DD have these? Does she play imaginary type games? Does she interact well with peers?

Yes she plays really well with her friends at nursery, she has a very vivid imagination and will play role play type games all the time. The only thing she might struggle with socially is understanding when she needs to tell the teacher something, I don't know if this is just due to shyness though. Eg she wouldn't tell if another child did something wrong towards her or sometimes she holds in her wee or poo because she doesn't want to go at nursery, she'd rather go at home, not always though, just every now and again.
She's very good at nursery and enjoys it hence the teachers are shocked if they ever see her misbehaving with me (she would never misbehave when I'm not there!) Her challenging behaviour only comes out when she's somewhere she feels comfortable... More often than not she is worst when just with me.

Haven't read your other thread but what you are describing doesn't really gel with my own experience of my DS's ASC. The disruptions you are talking about are all big ones, whereas my DS tended to react strongly and immediately to little changes such as going home a different route, or stopping at the shop on the way home, as well (or even more than) big changes. He reacted as strongly to "nice" changes - an extra trip to the park - as to boring changes like an extra trip to the shop, though the reaction might not set in til after the "nice" thing had finished and then he would be hell to get home. And DS was very straightforward in certain ways - if something made him uncomfortable he would fuss til whatever it was stopped. Though of course children with ASCs do vary a lot, and my DS's biggest problems were social and communication ones which only really started showing when he was a bit older. Your DD might have some sensory issues, which can occur by themselves as well as with an ASC, such as hyper-sensitivity to certain noises and to heat. Try looking up "sensory integration dysfunction".

As for the car, it may be that she is making a fuss for attention because she is feeling generally unhappy, or it may be that she is genuinely too hot. Is the trouble only in warm or bright weather? I used to keep a cheap 2 litre bottle of water unopened in the fridge, wrapped it in a towel and gave it to my DS to cuddle at night as he used to complain about being too hot in bed.

The running off is a tricky one. My DS went through a phase of doing this and I found that whatever happened I must not run after him - that only made him run further and faster. If I stayed put he would soon stop. I kept him in the buggy or in reins if we were on narrow pavements where he could quickly get in trouble. It may help if you make it clear in advance where she can and can't go - e.g. she can run as far as the park gate but if she takes so much as half a step outside there will be a penalty. I also found count-to-three and consequence worked quite well at that age. By the time I had spelled out what I wanted DS to do, what the consequence would be of not doing it, and counted slowly but steadily to three, he was ready to do as asked. The running off may be a response to a "sudden" request.

Thanks Klein, that's really helpful. My DD won't tend to react strongly to minor changes like the route home but she does often point it out that we are in fact going a different way, or when we are in traffic she can get annoyed and demand to go a different way! Obviously I don't give in to that unless I actually think it would be beneficial though.

I think the running away thing is probably normal for her age, I know she is aware and wary of cars and roads, I just don't want to run the risk of her running off, out of my reach. She's a very independent girl who wants to do everything herself, she often actually gets annoyed if I try and help her with something. Eg. she likes to take the lids off the yogurt pots herself, if I do it for her without thinking she would get upset.... which I guess is a little odd but I just thought of it as a quirk whereas DM would probably think it's a sign she's 'on the spectrum.'

Mostly it's the aggression I'm concerned about. Having your 4yo hitting, kicking, shouting, screaming and throwing things around aren't really compatible with a newborn baby!

Part of me is wondering if it is a reaction to a feeling of pressure being put upon her, ie. when we say to her 'when the baby arrives you won't be able to behave like this, you could hurt or scare the baby' it may actually be making her worse....

Also, am I right in thinking that, if she did have ASD that she would behave like that in any situation and not just at home? She doesn't tend to have the sleep issue when she stays at her dad's and she's only ever done it at her nana's once when she had a temperature.

She doesn't seem to complain about the heat as much in her nana's car either....

My DD has just been diagnosed with ASD at age of 8. She is highly imaginative and makes friends easily. The Imagination thing from the triad of impairment is actually 'flexibility of thought' which includes empathy and coping with change.

We didn't think DD could have ASD as her behaviour is much better out of school than in it. I've just attended an ASD course for parents and many reported their childrens teachers had not identified a problem but the children were dreadful at home. My DD can cope sometimes but not others. It depends on what other demands are on her and how tired she is. We were told 2/3 of people with ASD have sensory issues. My DD has a particular problem with noise.My DD was a runner until the age of 4 and still tries to dash off if highly stressed.

If you are concerned I would suggest getting some advice. Waiting lists are long so it might be worth exploring now. If she grows out of it you've lost nothing. Lots of strategies for ASD children are really great for NT children too.

Interesting, Scone thanks. I'm not sure what age children develop empathy but I'm not sure DD has lots of it just yet... she finds it hard to understand when other children don't like a particular food and she does, she doesn't make a big deal about it, she just doesn't get it. She talks about various ways in which the children at nursery are different to her, which I'm fairly sure is normal as she learning and getting to grips with the fact that everyone is different.

DD used to hate loud noises too but she seems to have improved in that area recently. Maybe she has just learned to cope with noisey environments. She still worries about what some noises are though, particularly at bed time.

I have a health visitor coming to visit in a couple of weeks so I'll have a chat with her and see what she thinks. Although we have already had a health visitor and the nursery SENCO observe her at nursery and she was deemed to be totally fine. That was over a year ago when she had only been at the nursery a couple of months though. I don't know, it could all be stress/pressure related but I didn't think 4 year olds usually get this stressed?! She does ask a LOT of questions and she worries about things like, what would happen if something set on fire. We always explain things to her and reassure her. I just hope me and DP aren't inadvertently stressing her out in some way.