ODD

[Aimeeleighb]

A family support worker has suggested my 3yo may be on the autistic spectrum, more specifically odd.

My concern is that it isn't diagnosed in the UK so unsure what level of support we will get or how he will be diagnosed at all?

He is incredible clever and affectionate. His fine motor and gross motor skills all on point, speech is great etc.

Concerns were raised for a few things; firstly he is extremely sensitive - every emotion is magnified and there seems to be little middle ground; secondly he shakes with a lack of control when he is angry and lashes out violently; thirdly when he is asked not to do something he seems to have a compulsion to do it more, quicker, harder etc.

These behaviours have been seen and noted but waiting to hear back from his referrals.

Me and dad are at breaking point trying to manage him best we can.

Any constructive advice welcome.

Autism is diagnosed in the UK, in fact, babies as young as 18M can and have been diagnosed - there is over 700000 people diagnosed in the UK. It starts with going to your GP, and after a few referrals to rule out other things they are referred to a development pediatrician or child psychiatrist which is able to asses and diagnose if necessary.

The behaviors you describe sound challenging but they are not generally linked to autism (in the way you describe them), and by themselves would not be sufficient for a diagnosis. Autism is a social communication disorder so deficits in that area need to be present. Some of these deficits normally present by a child not pointing to share interests by 2YR old (so pointing to a plane), poor eye contact, lack of social referencing, general lack of joint attention, etc. Other behaviors not linked to social communication may also be presents; violent and long meltdowns over trivial things, inappropriate use of toys, lack of interest in other children, repetitive and/or ritualistic behavior, etc.

Hi aimeeleighb

ODD isn't usually diagnosed in the UK, but autism-spectrum conditions are. Your DS's issues might be the result of an ASC. The support he gets will depend on exactly what his needs are and (I'm afraid) also on the resources avaiable from the NHS and education authority in your area. My DS has an ASC diagnosis and he could also lash out. He had an individual TA in school (this is unusual nowadays!), and sessions with a social skills group. The biggest benefit was that the assessments made it clear what he found hard so that we - parents, school, clubs - could adapt to his needs, and the lashouts happened much less often. DS's speech and langauge appeared very good but when paediatritian and the speech and langauge therapist talked to him they found that he couldn't manage the non-verbal bits of language - voice tones and facial expressions, recognising the signals about other people's feelings, knowing when someone was joking, etc.

The compulsion to do what he is told not to could be a bit of rigid thinking or a processing delay. What worked for my DS was giving him positive instructions and a bit of time to change direction. Like "Walk near the houses" instead of "stay away from the road". To stop him splashing in a puddle I might say "three more splashes and then stop - three, two, one, and done!" I also used a lot of "count-to-three and consequence" with clear instruction, a small clear consequence, and a slow steady count. I think the count actually helped more than the consequence as it gave him enough time to think, though I made sure that if he hadn't started doing whatever by the time I said "three" the little consequence happened. I kept instructions clear and concrete, I repeated in the same words or shorter, and did not try to explain or justify (unless he asked why) because adding extra verbal information overloaded him. We also used some visual timetables and reminder cards and kept to a routine, so he knew what to do when and he didn't always have to be told.

One other thing was that although DS's lashouts could seem to come out of nowhere, quite often there was a build up of stress behind them that didn't show in his face or demeanor. They could come from a mix of frustration and confusion that would get him into an irrational panic. DH and I did a lot of work on just keeping things calm so he could think straight and communicate - despite having a fine vocabulary he would go non-verbal under stress.

One book I found very helpful for my own DS is Ross Greene's Explosive Child. It's aimed at ODD-ish kids and I found it especially helpful before DS had been assessed, and I used the strategies in combination with ASC-specific stuff afterwards.

Hope you get some answers and support soon.

AmaryllisNightandDay out of interest did your DS struggle to read the tone of voice/facial expressions etc of everyone, ie including you and his dad?

My DS 3.7 can definitely read even subtle cues when it's me (asks mummy why are you cross just from the slightest look) but I've heard that children with ASC can usually still read their mothers/parents well, its people not so close that they struggle with. I don't know if DS has an ASC or not.

did your DS struggle to read the tone of voice/facial expressions etc of everyone, ie including you and his dad?

I do think DS was very "tuned in" to me and DH, and he understood us better than other people, but at times he still didn't get the subtleties. So if I got a bit stressed and used a rather short cross tone of voice he'd react as if I was really furious with him and his usual response to that was to get angry and defiant. So then I'd get more cross, and you can imagine how that usually ended up!

And he could get very confused if anyone tried to give him a mixed message, like giving a bit of a scolding in a joky voice. That was never DH or my style, we're plain speakers and that suits DS. But it's very hard to tell if a child has an ASC or not, I didn't realise just how much DS was struggling til I saw the language therapist trying things methodically and how he reacted.

Thank you for your response that's useful. I know who knows. It's such a minefield. Most of the time I don't think DS is on the spectrum as we don't really have the same struggles with outbursts etc, and he displays all the usual communication (IMO), joint attention etc. It was more the social skills with peers side that I was concerned with, but he seems to have come on well with that recently, so I don't know. I've done all I can and pushed for a referral but it's a long 9 month wait just for the first appointment.