Can ASD really present like this?

[clutchingatstrawsk]

Can a 4 year old present as NT almost all the time, and the only indicator of autism be violent outbursts?

Sorry if I sound a bit tone deaf, I don't know a lot about asd and the traits I'll list below I am aware not all autistic kids won't have, but it's the ones I keep seeing online

He's 4
He doesn't really meet any of the 'red flags' in the social tab on the page I'm reading online. He has lots of friends, tells stories, engages in pretend play, has a great imagination, he can communicate well with us and with others etc. the only slight thing on the list that fits is doesn't share well, but he can sometimes, but sometimes he doesn't like to share and gets very upset.

He doesn't meet a single red flag on the language and communication list.

He only meets one thing on the repetitive and restrictive behaviours list in that he will line toys up, he lines all his paw patrol cars up before they go on their missions etc

He eats well, he sleeps well, he gets dressed, goes to bed, goes to school well (on the whole, occasional tantrums but not out of realms of normal I don't think) he is generally a very loving, sweet child. He's funny and smart and has good relationships with friends and family.

He just has these violent outbursts, not daily but around 3/4 times a week where he will scratch hit or bite us. He has immediate consequences, apologies and shows empathy after. But the behaviour never totally stops as it keeps happening again. Tried one thing new this morning which was time out and had to hold him to stay in it and he lost his shit so bad he bit himself three times.

The only other thing is he shouts and screams a lot, randomly, I hate it it sets me on edge. He's aware he's doing it he just goes hyper and will make weird noises and shout and scream and act a bit odd for lack of better word

Can this be autism?!

Today was the first time he's ever bitten himself but the hitting/biting/scratching us does happen fairly regularly. It did stop completely for a few months but has restarted in the school holidays so far.

I'm not an expert at all, but from your description I would assume not autism and look at ways to help him manage his emotions. Have you read The Explosive Child?

Are there any sensory processing issues, eg liking to strip, soft texture on skin, retreating to small dark spaces, noises or bright lights an issue? Does he get overwhelmed from busy environments, partiss etc, does he stim? Any little habits like stretching fingers out when stimulated. Can he cross the midline in exercises. What do nursery say? Who mentioned ASD to you.

Also not an expert, but I think it's going to difficult at age 4 to differentiate between underlying SEN and other causes.

Time out obviously didn't work for you, difficult to suggest what will but it might be worth trying ignoring all bad behaviour and praising the good every single time until you are bored of the songs of your own voice. The explosive child book is a good recommendation too.

Do you think he could have a food intolerance? Alternatively, I have heard of preschoolers who go crazy when they need the toilet, could that be the case?

Meant to also say: he's struggling with something, so ultimately it doesn't matter right now the 'why', but trying things that work with ASD kids might help with a lot of children, it doesn't mean he will be diagnosed in future.

It does sound like some kind of SEN (weird noises, violent outbursts, self harm) but I'd not be absolutely sure which at this stage. What does school think?

Can be shy for the first 5 mins at parties, does snap out of it usually and joins in, same at softplay. Was a bit funny about his school top at first as had a collar but got used to it. He doesn't stim

The noises/screaming etc are when he's bored mainly so I've always shrugged it off

He can be a bit inappropriate with space and gets right up in his little brothers face all the time but only does it to us really and only sometimes

When I Google the outbursts it suggests ASD but everything else doesn't seem it

Regardless of ASD it sounds like he could benefit from being exposed to resources that help him self regulate. Look into 'OT' occupational therapy and try some of the simple ideas to build his experience of knowing what he likes/dislikes for various types of regulation, sensory and emotional could be draining him if he doesn't have a go to "thing". You can find tailored approaches here https://www.nhsggc.org.uk/kids/child-development/interactive-child-development-questionnaires/

Thanks will look into it all.

Just had a roast and he was all excited for it and was jumping about and getting loud but when you ask him why he says he's excited, or he's being silly etc and he can easily stop. I find it so hard to know if it's normal kid behaviour or not? And if the scratching and lashing out at times is making me look at everything too closely?

It could be ADHD - also associated with meltdowns but not with social difficulties quite so much (well, being overly boisterous, chatting too much, making odd noises etc can obviously cause problems but in a different way to autism)

And the “goes hyper and makes weird noises” certainly can fit with ADHD, as well as getting in peoples space.

A sensory assessment with an OT could be a helpful start

Thanks I'll look into it. I wondered about ADHD but it's not all the time, it's not even the majority of the time so I ruled it out. Just feels like everything I Google online about it people always bring it back to some sort of diagnosis so perhaps it's time I pursue one for him rather than just trying different parenting techniques. I'm skeptical though.

Your gut feeling is there for a reason. Don’t ignore it, have a look at low demand parenting approaches for neurodivergent children and then go from there, you don’t need to worry too much about diagnosis right now but you will be looking at ways of supporting your child right now as he is clearly very distressed at times.

I'd keep a diary for a couple of weeks with regard to the violent outbursts. Note the time of day, what and when he'd eaten/drunk, how his sleep was the night before, who was there, what was happening immediately before hand, what was he doing/playing with, what had you asked him to do. Plus anything else you think is relevant. You may spot a pattern, as sometimes it's hard to remember the specifics when you're in it dealing with the behaviour.

You could start to explore assessments for ADHD/autism, the NHS typically has long waiting lists so if you suspect something it's probably a good idea to get the ball rolling. Ask school (is he in Reception) if there is anything that they've noticed that they might not have mentioned to you, and maybe ask for a meeting with the SENCO. Has he had a violent outburst at school ever?

Outbursts always caused by not getting his way or being told no. Sometimes he takes it fine but sometimes just goes nuclear. Used to take him forever to calm down, he calms down within a few minutes now. They also used to be multiple times a day and now only a couple of times a week - so definite progress! He's good as gold at school on the whole, he had a couple of biting incidents but both were after a kid bit him and he bit back

Thanks. Honestly my gut feeling really tells me that he doesn't have ASD/SEN. I think he just struggles with his temper and loses control sometimes. It is just literally everything I read about violence at 4 suggests them. I've watched so many videos searching 4 year old autistic and he's just so different to that. I know it's a spectrum but I just don't see it but I don't want to not seek help because I can't see it when perhaps I'm just wrong.

We had a bad morning, he's been great all day since. I was just saying goodnight to him and he said "I love you mummy. Have I been kind today?" And I said yes you have, since this morning you've been very kind and he said "I did a naughty thing this morning, I won't do any naughty things tomorrow. Unless there's a bad guy who tries to steal our pizza, if there is I'll bite him, but no one else" 😂 he's just so aware of his behaviours, and he can go weeks without issue, it just doesn't tally up with the constant of a diagnosis of something. I dunno. It's all so hard to figure out.

It sounds like he's dealing with a lot of big emotions and struggling with how to manage these, id focus on helping him with this. From someone who works with children with ASD it doesn't sound like your son has this diagnosis to me but without meeting him no one can really say. If you are genuinely concerned you could speak to his school or a GP or health visitor they will be able to give you some reassurance. At this age they have a lot going on

Also stay off Google, you will drive yourself mad and Google cannot diagnose your son

As a mum to a 32 year old with autism I would say no.

Just probably temper tantrums.

And my son didn't have behaviour problems or violent episodes.

Managed to get a GP appointment for this afternoon obviously won't get answers but atleast it's something

Half hoping having me, his dad and the doctor sit down and discuss his behaviour in front of him will make him realise how serious it is and rectify it 🙈