Referral for 3 year old - Recommended from Nursery

[Happydays1987]

Hello all, might be a long post but could do with some advice regarding my 3 year old DS. He started Nursery in January this year after turning 3 in December. Initially he was full time but reduced to half days quite quickly as he was struggling with separation anxiety from me and they couldn’t manage his distress. Anyhoo, the nursery teacher has met with me and my husband to express that she has concerns in several areas regarding my son and has requested we ask for a paediatric referral and get the ball rolling for input/diagnosis..

I don’t want to be a delusional person and profess nothing is wrong but my overthinking has spiralled out of control on this and I am questioning everything. How much is him just being a 3 year old child and what are identifiable issues? So some background.

DS was practically a covid baby but hit his milestones and there were no concerns at his 27 month check

He is a funny, bright and cheeky little man. Generally happy, caring, affectionate

He struggles with transitions and finishing an activity/ moving onto something else. Will sometimes scream and cry - meltdown

Loves water and playing with water table at nursery

Very fussy eater

Struggles to regulate emotions and nursery says once he has hit at certain point they can’t bring him back down

At times is echo laic and when he he talks will randomly go high pitched or drag a word out

Can be easily overwhelmed. Arrives at Nursery and sometimes has to clear the tables and teacher says it’s almost like a compulsion he isn’t being ‘naughty’

If there are particularly loud noises at nursery then he may for example squeeze a carton of milk, do something in retaliation (loves fireworks
though and noises at home don’t bother him)

Nursery said he generally needs to be 1:1 otherwise he gets up to mischief and that’s when they get the best out of him

I do see some behaviours at home/in community but just have always accepted that’s just his personality and being small still. I have never overanalysed it before but unfortunately now I am.

Has anyone been in the same boat? I actually work with adults with autism adhd but it’s different when it’s a little one and your own child

Please be kind xx

The bit that stood out to me in what you’ve said is that when he gets emotionally overwhelmed they can’t get him back down again. That seems out of the ordinary. The clearing tables too. You’ve said he’s happy, and that is absolutely the most important bit for now.

Getting a referral is a good thing. Waiting lists are long - what you really don’t want to happen is to do nothing now and then in 12 or 18 months you suddenly realise you’re struggling and need a referral and it takes years. This way you’re on the list. If there’s something to diagnose, you’re in the right place, if there’s nothing then they won’t diagnose anything.

There’s no harm in accepting a referral. There will be no one rushing to diagnose your child with anything. The process is long and most paediatricians adopt a “watch and wait” approach at the initial appointment.

So my advice is, yes there might be a few autistic traits there (for clarity: I have an autistic boy, diagnosed at 5, and preschool raised concerns at 3), and you’re better off being in the system sooner rather than later.

Try not to panic or catastrophise. It’s hard to see traits and behaviours when they’re just your child and you’re used to their quirks.

I’m sorry, it must be tough.

But the nursery staff will have seen literally hundreds of children between them, and his whole cohort will have been covid babies. If they’re saying they’re worried, I’d listen.

The nursery teacher can't diagnose anything, but she will have a good sense of what is 'typical' in that age group.

Providing 1:1 is very difficult in nursery so the fact that they need to do so indicates that he is really struggling and needs a lot of extra support.

It's really hard to hear that someone thinks there might be something 'wrong' with your child, but getting professional input or even a diagnosis isn't going to change anything about who he is - it will just mean a better understanding and hopefully more support for him.

Fundamentally, any kind of assessment or diagnosis won't actually change your child and all the qualities that you love about him. But what it could do is help him manage at nursery and later at school.

My youngest is currently on the waiting list to be assessed for ASD, having started to really show signs in his Reception year. In retrospect there were some signs since he was quite small, but nothing that was significantly outside the norm. Same with his time at nursery. But he just couldn't deal with a busy classroom of 30 pupils, with only 1 teacher and a TA, especially when expectations moved beyond free play.

Do you feel confident that the nursery can manage his behaviours? I would think they should be looking at things like a visual timetable for him, maybe a safe space just for him if he gets overwhelmed, a tactile fiddle toy just for him etc etc.

It will help so much at school and nursery when he's diagnosed.

Individually all those behaviours are fine but together highlight autism. So I'm guessing they want to refer him for an autism assessment?

Dd was diagnosed at 3, ds when he was 7. Dd has so much support in nursery.

It’s actually strange in some respects as I work in the learning disability field and have done for 15 years, having worked with some really complex and challenging adults and young people. But the little people field is totally new to me! I am not adverse to the referral at all and obviously want to do everything I can to support him etc. He is also my first so nothing to compare it to as such! Xx

Do you have any personal experience?

Do you have any personal experience?

You’re definitely not the first parent I’ve spoken to who works in the field and hasn’t noticed traits in their own child. To be honest, professionals can be the hardest to convince that there might be something going on, when they’re used to a certain presentation of autism and aren’t used to seeing more subtle behaviours.

@Happydays1987 Only personal experience of having a three year old (another almost lockdown baby!), and a good friend with a DS the same age who is in your position.

From my perspective - and his childminder and HV - he seems to be struggling with communication, socialising and food. My friend can’t see it because she’s so convinced that he just needs longer to get over lockdown. I suspect she’s finding it tricky accepting he might need help (he’s a lovely boy! So it’s sad to see him distressed at things that other kids are taking in their stride).

So, no professional experience at all, but you struck a chord.

Aw bless your friend, hopefully in time she may find it easier to recognise and accept. It’s a very difficult thing to hear, even though you want the best for them it’s like a total blow but probably because of the unknown x

My son was diagnosed autistic at 2.

From a practical stand point, he will likely need additional support in preschool and reception and to get the funding you'll have a better chance if he is known to the system.

He doesn't stop being any of those lovely things you said if he is autistic! My son is so smiley and adorable. But it would be foolish for me to say he doesn't need significant additional help.

I know it's hard to come to terms with initially but it does get easier.

Hi, I read above the signs that you noticed in your son and my son had just turned 3 and does all the exact same things…. To a T!!

do you have an update at all? My sons nursery are gathering everything to go ahead with early help. He’d already been assessed by SALT and they’re putting in towards the referral too.

thanks x

I'm going thought the same at the minute, have a paediatrician going in to nursery to monitor him next month. Do you have an update?

Hi!

This past ten months has gone so quick :) to be honest nursery went as normal until around end of may. My son then started getting into the habit of biting when he was disregulated and this caused for a risk assessment to be put in place. After this had been done which only took a week when there was an incident of him biting a teacher, we started the process with nursery for an early help care plan.

Then we had quite abit of paperwork to fill out like parental statements, what our expectations were from this etc. the nursery also had to fill out quite abit. They then arranged for SALT to come and visit the nursery, also arranged for a specialist teacher to come in and watch him for a session. They then also filled in statements.

everything was sent off and he was accepted for EHCP. It was now waiting for an appointment with paediatrician, however he actually got offered an appointment 3 weeks after this. It was ALOT quicker than expected since you hear about waiting lists being a year plus long. I’m not sure if it’s because my son got slightly more aggressive when unsettled or just whether the waiting is quicker in my county.

essentially the assessment was about 90 minutes long, there was a salt advisor as well as the paediatrician and the salt advisor played or tried to play with my son! (He has no interest what so ever) they asked us questions more in depth, but honestly it wasn’t anything that was already written down they just wanted us to elaborate more. At the end of assessment they gave him the autism diagnosis. It did take about 4/5 weeks for the report to come through in writing however now the next steps is waiting to see how his last year at nursery goes and whether he will be in mainstream school or a more specialist supportive school.

his troubles are with other children and not wanting them to be near him/being uncontrollably hysterical when disregulated and lashes out, his speech being very behind etc.

Thank you for this! It sounds exactly like my son. Hes been evaluated by the speech therapist and is on a waiting list to start going regularly, he is really behind on speech, only a few regular words and picks up a new one here and there. He started nursery in April and became quite aggressive with the other children if they got upset or had a tantrum around him, we had a risk assessment for biting too but since they introduced some chewy necklace toy for him he's become a lot more settled. It's more reassuring to know that he's not just being a bad kid and on his way to a diagnosis

I’m so glad you’re getting the support, I know how difficult and overwhelming it can be. It’s reassuring to know your feelings are validated though!!

yeah that’s exactly like my son with speech, mostly picks up things off shows and then quotes them even if they aren’t used in context. For example he’s associated when he’s upset with George from peppa pig crying when his dinosaurs stuck up a tree 🥲 so when he’s upset he’s saying the dinosaurs stuck up the tree!! I’m hoping we get the salt sessions soon, I had the zoom call last week so hopefully it’ll start to be in person as that’s the only thing that’s kinda naff is that they still do it over zoom currently and my son won’t have any interest at all in watching.

I have seen those chew toys actually and I have been thinking of trying one. They also do ones made of like t shirt material which I think might be good for him as he loves biting his clothes at the moment.

font hesitate too in applying for DLA, you can apply for this without a diagnosis. Of course when you have the diagnosis there’s pretty much a definite approval but you don’t actually need one to apply!

Oh bless him, at least he has a way of communicating that he's upset. My son talks a lot but the speech therapist thinks we just don't understand it yet as he's trying to talk in phrases rather than simple words.

I did look in to the DLA but the form seems so daunting, I think once I've spoken with the paediatrician I'll give it a shot.

The chew toys have been a god send. I got a pack of five from Amazon for about £7.99 I think.

I understand what you mean, it’s very similar :)

i just finished filling out the dla forms today, the nursery teacher actually helped me fill them out as they are super daunting!! A lot of repeating yourself and it’s almost in a way to ‘trick’ you. You have to do it from the worst possible day too, but to be honest each day is pretty difficult!!

they are also local charities like DISH who can help you fill out the form, the nursery can also help, I think scope also can help. Once you actually start filling it out though about 70% is just ticking boxes and 20% is for nursery/salt/health advisor/paediatrician to fill out. The other 10% is you filling out the rest which could be how long it takes to get them dressed etc.

I hope your son receives all the support he needs :)