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My 27 months old son - referral to be assessed

11 replies

Akorede · 25/10/2024 12:18

Dear team , can you please advise on my worries? Please see below email from nursery assessment.

Son , I have written up some information regarding his behaviours at nursery.
Within the setting, son comes in really well. It is normally Mummy or Daddy dropping son off, he separates from whoever is dropping off really well and will have a quick cuddle before going to explore the room. He will play a lot around the door as there are less children in this area. He will also usually find a car or a sensory toy to hold. He enjoys exploring different toys and cars by putting them in his mouth and exploring the textures of them this way.
Son will wander around the room throughout the day, and does not like to sit in one place for too long. At circle times and meal times, he will often stand up and walk around the room. During circle times when the children are all singing, he will cover his ears, however if the children are getting excited and singing slightly louder action songs, such as sleeping bunnies and sticky kids, this will make him smile and walk over to clap along.
Son is not able to communicate with us verbally, however he will babble and make sounds such as, “dadadada, mamama, eeeeeee and ooohhhh”. He will often experiment with making different sounds, we are constantly hearing new sounds from him. When he is really happy and excited, he will flap his hands and say “eeeeeee”- however, this is not often and appears to only be when he is excited or overstimulated, watching his friends doing action songs and noisy activities. When he needs or would like a cuddle, he will find an adult or a child and give them a big cuddle. He really enjoys giving his friends cuddles, and will often walk over to them playing and give them a big squeeze. When son is feeling distressed, he likes to be held and to be able to put his hand in the creases of the adult holding him, for example, he will scratch and slightly pinch your armpit or the crease of your arm, until he has calmed down. He prefers going to, and finding reassurance and comfort in his teachers.
Son will play on his own most of the time, and likes an adult to be around him while he is exploring the room, however he does not generally interact with them during play. He doesn’t mind the children playing around him, but does not seem aware of them being around him, and is object motivated. We do try to get him involved with small group activities, but he has a very single channelled attention, and therefore it can be hard to engage him in these. Son is making more eye contact that is less fleeting and not coincidental in nature recently, as previously he wouldn’t engage in this as much, however he will now look at you when you are speaking to him. Son will now also look at you/ for you when you call his name too, and will also come for a cuddle when you call his name and put your arms out to him. In terms of our routine, son is starting to gain an understanding of this, and will come to you when you call him for his nappy, and go and stand by the garden door when you get his coat on for garden time.
Son is rarely upset at nursery, however he does not enjoy meal times. He does not like to sit and eat with his peers, and he will become very distressed and upset. Son parents have made us aware that he prefers his food slightly pureed, very warm and with a lot of sauce, he then will need to be spoon fed. However, at nursery we find it a struggle to get son to try any foods, he will often take one mouthful and hold it in his mouth for a long time before finally swallowing. If he doesn’t eat lunch we will also try him with Weetabix, as this is something his parents have said he does enjoy eating, which again he has on preference on how it needs to be. He is still struggling with eating, and often son does not eat at all, or will only have between one and three spoonful’s of food with us at nursery.
Physically, son is doing really well and is very strong. He loves the outdoors, he finds a quieter area of the garden and will run backwards and forwards across the garden. With adult support, he will go on our climbing equipment and is able to climb up and down on his own. He will occasionally walk around on his tiptoes around the room, but is also able to walk on his whole foot and only tends to tiptoe when he is excited. He is happy to have his nappy changed when needed and will lay nicely when being changed. He isn’t able to communicate when he has a soiled or wet nappy.
We have been supporting son with settling into our nursery. He has now been here for a month and we will be putting together a support plan in place, to help with his development. We want to support son with his speech, social interaction and the meal times. He is a pleasure to look after at the nursery and overall is a very happy little boy, who gives some of the best cuddles. We are looking forward to helping to support and watch him grow.

OP posts:
PolaroidPrincess · 26/10/2024 07:57

@Akorede I can understand that you find this worrying, I suspect though that you had concerns already, before this report?

Are you in the UK? If so, has he been referred already for SLT and a hearing test?

Akorede · 26/10/2024 08:57

@PolaroidPrincess thank you so much for taking time to read and respond. Yes we live here in the UK and that report has just been sent to the NHS for adhd assessment. So we are waiting for them to contact us for an appointment for him to be assessed. No we have not done hearing test or SLT. Is this something we can do or make arrangements for on our own ? If yes can you please guide me on how to do that?

thank you once again

OP posts:
PolaroidPrincess · 26/10/2024 09:08

Akorede · 26/10/2024 08:57

@PolaroidPrincess thank you so much for taking time to read and respond. Yes we live here in the UK and that report has just been sent to the NHS for adhd assessment. So we are waiting for them to contact us for an appointment for him to be assessed. No we have not done hearing test or SLT. Is this something we can do or make arrangements for on our own ? If yes can you please guide me on how to do that?

thank you once again

Are you sure that he's been referred for an ADHD assessment and not ASD (Autism)? It's just that most Paediatricians won't assess for ADHD until the DC are around 7 years old, whereas they will assess for ASD much earlier.

As he's not speaking I'd ask to see your HV and ask for a referral for a hearing test and SLT. The waiting list might be long but it's worth doing as Glue Ear can present in a similar way to ASD sometimes.

You could also ask your HV for referrals to a Paediatric Dietician as his foods seem quite limited.

I'd also ask for an Occupational Therapy Assessment and a referral to Portage.

Your HV should be able to do all of these referrals for you.

She might also be able to put you in touch with the local SN support group, if there is one, any SN Playgroups or Nurseries and any groups for DC with Speech Delay.

I'd also head on over to the SN Children Board. It sounds as though your DS needs an ECHP and it's best to get this process started now, so that hopefully he has one in place before starting school.

The lovely and very helpful posters in the SN Children Section can guide you through how to apply for a ECHP and what therapies to include Flowers

TTCJJB · 26/10/2024 09:27

Akorede · 25/10/2024 12:18

Dear team , can you please advise on my worries? Please see below email from nursery assessment.

Son , I have written up some information regarding his behaviours at nursery.
Within the setting, son comes in really well. It is normally Mummy or Daddy dropping son off, he separates from whoever is dropping off really well and will have a quick cuddle before going to explore the room. He will play a lot around the door as there are less children in this area. He will also usually find a car or a sensory toy to hold. He enjoys exploring different toys and cars by putting them in his mouth and exploring the textures of them this way.
Son will wander around the room throughout the day, and does not like to sit in one place for too long. At circle times and meal times, he will often stand up and walk around the room. During circle times when the children are all singing, he will cover his ears, however if the children are getting excited and singing slightly louder action songs, such as sleeping bunnies and sticky kids, this will make him smile and walk over to clap along.
Son is not able to communicate with us verbally, however he will babble and make sounds such as, “dadadada, mamama, eeeeeee and ooohhhh”. He will often experiment with making different sounds, we are constantly hearing new sounds from him. When he is really happy and excited, he will flap his hands and say “eeeeeee”- however, this is not often and appears to only be when he is excited or overstimulated, watching his friends doing action songs and noisy activities. When he needs or would like a cuddle, he will find an adult or a child and give them a big cuddle. He really enjoys giving his friends cuddles, and will often walk over to them playing and give them a big squeeze. When son is feeling distressed, he likes to be held and to be able to put his hand in the creases of the adult holding him, for example, he will scratch and slightly pinch your armpit or the crease of your arm, until he has calmed down. He prefers going to, and finding reassurance and comfort in his teachers.
Son will play on his own most of the time, and likes an adult to be around him while he is exploring the room, however he does not generally interact with them during play. He doesn’t mind the children playing around him, but does not seem aware of them being around him, and is object motivated. We do try to get him involved with small group activities, but he has a very single channelled attention, and therefore it can be hard to engage him in these. Son is making more eye contact that is less fleeting and not coincidental in nature recently, as previously he wouldn’t engage in this as much, however he will now look at you when you are speaking to him. Son will now also look at you/ for you when you call his name too, and will also come for a cuddle when you call his name and put your arms out to him. In terms of our routine, son is starting to gain an understanding of this, and will come to you when you call him for his nappy, and go and stand by the garden door when you get his coat on for garden time.
Son is rarely upset at nursery, however he does not enjoy meal times. He does not like to sit and eat with his peers, and he will become very distressed and upset. Son parents have made us aware that he prefers his food slightly pureed, very warm and with a lot of sauce, he then will need to be spoon fed. However, at nursery we find it a struggle to get son to try any foods, he will often take one mouthful and hold it in his mouth for a long time before finally swallowing. If he doesn’t eat lunch we will also try him with Weetabix, as this is something his parents have said he does enjoy eating, which again he has on preference on how it needs to be. He is still struggling with eating, and often son does not eat at all, or will only have between one and three spoonful’s of food with us at nursery.
Physically, son is doing really well and is very strong. He loves the outdoors, he finds a quieter area of the garden and will run backwards and forwards across the garden. With adult support, he will go on our climbing equipment and is able to climb up and down on his own. He will occasionally walk around on his tiptoes around the room, but is also able to walk on his whole foot and only tends to tiptoe when he is excited. He is happy to have his nappy changed when needed and will lay nicely when being changed. He isn’t able to communicate when he has a soiled or wet nappy.
We have been supporting son with settling into our nursery. He has now been here for a month and we will be putting together a support plan in place, to help with his development. We want to support son with his speech, social interaction and the meal times. He is a pleasure to look after at the nursery and overall is a very happy little boy, who gives some of the best cuddles. We are looking forward to helping to support and watch him grow.

Is this the first time you or any others have expressed concerns with his development?

Akorede · 26/10/2024 09:28

@PolaroidPrincess Oh yeah you are right . I am mixing it up. Because the GP said it might be mild Autism before he made the referral . But we are now waiting for them to contact us following the response from nursery.

The HV don’t seem to be active here in Essex . So when we noticed he’s kinda behind we had to contact the GP who then made the referral. So maybe I will contact the GP once again for hearing and SLT referral? Even while I am still waiting for the ASD team to contact us ? Is this something I can I do ?

Can the GP do all the referrals you have mentioned ? The HV only visited when he was little and since then we have not been contacted .

I will definitely do all you have advised. Also one last thing . Have you seen a similar case and it eventually becomes normal ?

I am really worried for my son

OP posts:
PolaroidPrincess · 26/10/2024 09:39

Akorede · 26/10/2024 09:28

@PolaroidPrincess Oh yeah you are right . I am mixing it up. Because the GP said it might be mild Autism before he made the referral . But we are now waiting for them to contact us following the response from nursery.

The HV don’t seem to be active here in Essex . So when we noticed he’s kinda behind we had to contact the GP who then made the referral. So maybe I will contact the GP once again for hearing and SLT referral? Even while I am still waiting for the ASD team to contact us ? Is this something I can I do ?

Can the GP do all the referrals you have mentioned ? The HV only visited when he was little and since then we have not been contacted .

I will definitely do all you have advised. Also one last thing . Have you seen a similar case and it eventually becomes normal ?

I am really worried for my son

Yes the GP can do all of those referrals but it might be worth enquiring at the Doctor's surgery if they can put you touch with the HV first Wink

Akorede · 26/10/2024 09:57

Thank you so much

OP posts:
Sonolanona · 27/10/2024 23:53

That's a good report for going forward with assessments.
He needs:
Referral for a hearing test (even if there are other issues, glue ear is common and can really delay speech so that needs checking out)
Referal to SLT (speech and language therapist) The earlier the better . In the mean time look up PECS (picture exchange communication) essentially you teach a non verbal child to use pictures/photos to communicate... they want something, you teach them hand over hand to give you the photo of the thing they want. (It does NOT hinder spoken language... quite the opposite)
Paed dietition.

He is probably going to need an EHCP for school. Nursery can request formal assessment for this but so can you ... once the request is made, if it is agreed he needs assessment, then the various professionals put forward to reports, and in essence it details the support he will need in mainstream, OR special school.

He's only little and a lot may change, but realistically he is going to be assessed for Autism, and it sounds like the Nursery is being fabulously proactive and supportive :)
I have worked in Special Ed for 20 years (and have a now adult, son with autism) and have watched probably a hundred or more little ones who are similar to how you describe.
My son was one of them. He went to (my) special school, no speech til 5, delays in all areas. He's 27 now and he has had a full time job in retail for 8 years, where he is BRILLIANT because his autism makes him do everything exactly. When he was 27m he was flapping in a corner! He lives with us and will not be fully independent, but he is a lovely man in his unique way.
Some children make amazing progress, others will always need support, and there is no way of telling, but what I'm saying is... don't be afraid; not of having him assessed, not if they suggest special school ( ours is fab) because your little boy will be who he is and you will grow together to figure out the challenges ahead.
I've seen some wonderful progress over the years with many children :)

But my biggest advice is: get ready to fight his corner for EVERYTHING. You have a great start already... but education is short of money... you have to be clear that you expect these referrals to be made, you expect the EHCP process to be done in a timely fashion... you nag, you chase, and in the meantime, you enjoy your boy :)

PolaroidPrincess · 28/10/2024 06:16

All of that is such great advice @Sonolanona Wink

PolaroidPrincess · 28/10/2024 07:21

Just to reiterate what you're asking for:

Hearing Test to rule out Glue Ear

SLT referral as he's not yet talking

Portage Referral

Occupational Therapy Assessment to help him at Nursery/Home

Paediatric Dietician Referral as he may have Restrictive/Avoidant Food Disorder

And separately, you need to request an ECHP Flowers

Akorede · 01/11/2024 14:07

@PolaroidPrincess and @Sonolanona Thank you so much for your detailed information. I will do exactly what you have advised.

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