What on earth is nursery teacher talking about? ... ASD?

[Jean24601Valjean]

I'll try to make sense as I'm a bit all over the place. DH just got back from dropping our boys off at nursery and he said that the nursery teacher pulled him aside for a chat. He can't remember most of her exact words but he said she used the phrase "I don't like to use labels but..." and then went on to talk about some occasions when DS1 has been particularly stubborn and single-minded about things. This has been a bit of a persistent theme since joining this nursery (and for his entire life really but they are the first people to have brought it up formally - he has been to 2 nurseries previously due to house moves). We've had a few meetings about it and they have been trying certain techniques to make things easier, which they themselves have said improved things.

To give an example of the behaviour she is talking about, a couple of weeks ago DS1 wet himself but we'd forgotten to replenish his spare clothes supply so they only had other clothes to offer him. He flat out refused to put any of the other clothes on. This has happened once before and they called me to bring more in. However this time I couldn't answer the call as I was in a meeting and didn't have my phone with me. By the time I called back (maybe 45mins later) they said he'd agreed to wear the clothes they offered him. Other than this, the behaviour tends to be things relating to not wanting to transition from one activity to another.

I'm just really thrown by this "labels" talk! The only label we can think of that she might mean is ASD. I honestly don't know a lot about ASD but I thought that there was an important element around sociability and empathy. DS1 is really very sociable, takes a bit of time to warm up but loves playing with other kids and is very fun and playful with adults. He's also got a decent amount of empathy for a 3.5yo. E.g. I got upset about something once and then had to do his bedtime. He could tell I'd been crying (I'd stopped actually crying by that point) and said "Are you sad Mummy?" He's really sweet with his little brother as well, he'll give him a cuddle if he falls over and things like that.

So I guess I'm asking two things. Firstly is there any other "label" that the teacher could be talking about that we're not thinking of? Secondly does anyone who knows a bit more about it than me think based on my description that DS1 could be ASD, or is the nursery teacher being a bit overdramatic (she does have form for this, but not on such a serious topic) and DS1 is simply a stubborn and strong-willed toddler? We'll obviously have more of a conversation with her about it to clear things up (DH was caught a little off guard and was trying to get DSs into nursery at the same time) but just thought it would be helpful to have some input from the wise minds of Mumsnet to help us think it through.

Honestly, you or your DH need to go and ask to have the conversation again. Tbh I'd be annoyed that your DH didn't particularly listen or ask for any clarification at the time.

There must be more to it than your examples for the nursery teacher to get to the point of saying something about this. Although the label talk could have just been the label of ‘stubborn’

I don't think there's enough information here to really comment. Some of what you've said could be ASD traits, but could also be normal behaviour. I will say that ASD can be misunderstood and plenty of people with ASD have empathy and can socialise within parameters. (Eg when a child socialises with adults the child tends to get to control the rules of how that works)

But this might not be what the nursery is saying. I'd listen to them though and try to keep an open mind. They deal with lots of kids and if there is some form of neuro divergence it good to know so you can work with him.

An ASD diagnosis is not the end of the world. It impacts people differently. I say this as an autistic person! This may be absolutely nothing or might be something, but please try and wade through the (understandable) shock and find out what nursery is seeing that is unusual. Then you can go from there.

[Edited for typo]

It’s impossible to tell from the information you have given and the nursery teacher won’t be trained to diagnose either, but could be worth listening to as she will have worked with a lot of children. Things that I noticed with my dd were sensitivity to certain things, lack of sensitivity to others, love of routine. I guess the nursery teacher is identifying rigid behavior which can be a sign of asd. I will say though that my dd is also very sweet and empathetic, and I think it’s a bit misleading to think that all people with asd have no sensitivity to other (not suggesting you do think this btw).
Essentially your ds is still very tiny but now someone has mentioned it I would be watchful, it may be nothing, but it’s worth having at the back of your mind as he moves into primary.

There are lots of incorrect assumptions about people with autism. For example there are often assumptions about people with autism being unsocial, avoiding eye contact, not doing humour. However autism is known as a triad of impairments based on three themes - rather then a sliding scale from being autistic to not being autistic. In addition there are endless comorbid diagnosis which can run alongside an autism diagnosis too. What I’m trying to say is that each person with autism is as unique and very different to the next person with autism. One person with autism will be very social and understand humour, cope with change well, while the next will struggle with these things and have other strengths. A good place to read up is the national autistic society website.

Transition difficulties are often but not always an autism trait. There’s lots that can be done to support transitions regardless. Maybe start with a visual plan, try sand timers, verbal prompts that the activity will change after x,

There are many many "labels" that are not autism.

ADHD
Sensory processing difficulties
Dyspraxia
Etc etc

It may or may not be ASD.

You both need to go back got a proper meeting. I have two children with ASD and it's very hard to get seen to get a diagnosis so whatever happens, it would take years and no one is just incorrectly slapped with that diagnosis. A diagnosis in education comes at a provision cost and no one wants that on their budget especially at school. So it's rare they bring this up as a possibility normally.

Go back and ask who they going to bring in to start observations and advise if they suspect this. Where I live, diagnosis is via camhs and a head teacher at a advisory outreach ASD school told me on Friday that diagnosis is taking four years now. My county is massive and borders London. So IF it is a nuerodiversity your better off exploring this now with a willing nursery than waiting to start at school who are very cash strapped to deal with SEN.

Do you think when she said that she doesn't like to use labels, what she means is that she can't diagnose because that requires comprehensive assessment by appropriate health professionals, but in her experience it is something to keep in mind?

As others have said, it might be within the range or normal behaviours or it might not. An early suggestion to monitor is wise.

I'm just in a meeting so will get back properly as soon as I can but just wanted to say thank you to everyone for all your helpful and thoughtful comments! Really appreciate it!

Thank you - that's true I hadn't thought of that. It's possible I'm leaping to the wrong conclusions.

@Staringoutofthewindow @AppleCrumbleTea @Gladespade @IncessantNameChanger

Thanks so much for sharing your experience. I'm the first to admit that I don't know enough about the condition. I've had a look at the National Autistic Society website and it looks really helpful so thanks for that suggestion. It seems so complicated to get your head around as a newcomer as it can affect such a range of different characteristics and to such varying extents!

As several PPs have suggested, we will definitely ask for a proper conversation about it and see where it goes. Thanks for your point @IncessantNameChanger about making the most of a proactive nursery. I hadn't thought of that.

You need to have a direct conversation with her. Ask specifically what she means by “labels”. If she’s using the word “label” to infer neurodiversity then that’s a problem right there. If she means autism, autism is not a “label” and it’s unprofessional of her to say it.

Some of the inflexibility you have described around your son’s experience sounds familiar to me and I have two diagnosed autistic children. It may be worth exploring as a possibility.

Firstly autistic children can be both social and extremely empathetic.

Secondly, this doesn't sound like a conversation that should be had ad hoc at pick up time, when staff are mentioning potential additional needs this should be done by someone senior and when the parents are prepared in a meeting situation, not wrangling their child at pick up So could just be a case of an over eager staff member whose had a bit of new training.

Many autistic and other traits of additional needs are the exact same as normal development in young children, it's when they extend beyond that normal age that indicates a problem, ie DD hating the noise of hand dryers at 3 was totally normal, still hating them and thinking they are the devils work at 14 is not so normal.

A stubborn three-year old who has had a couple of big transitions sounds entirely normal to me. I'd keep an eye out though and write down any quirky or unusual behaviour and keep it somewhere safe. If you do need to go for assessment further down the road it is useful evidence for the Development History part, trying to remember what your child was like as a toddler is difficult when they are a teenager.

If they've noticed behaviour they need to agree to do early help meetings with you and talk you through through pathway they think needs to be taken.

Fwiw both my son and I are diagnosed, he's soon to be 5, and just started big school from nursery and he's always been an incredibly empathetic and sociable person. Too empathetic go a detriment of his own wellbeing even.

I on the other hand do have empathy, but I struggle to show people outwardly that I am empathetic, although socialising I could take it or leave it.

In assessments they do obviously look for these qualities, but the assessments themselves are not perfect. A lot of it relies on the very rigid image of what an autistic person should be like, but as you can tell from my anecdote, we're very different, because we're just human. My son is the least rigid person and needs spontaneity, I need strict routine and structure. My son is fine for plans to change or last minute plans to be dumped on us, for me it's the end of the world. My son can't cope with the transition when people leave, I for one embrace that transition wholeheartedly.

I would follow the pathway if multiple agencies had brought this forward. It's a demonstration that his behaviour is the same in multiple settings which is one of the things they look for.

I would however perhaps sternly mention that nobody likes the use of the word label, and it's somewhat insulting to those with a special need or disability because it's not a label, it's a diagnosis and we won't be stigmatised from the get go.

Thanks to those bringing up the use of the word "label". I hope this doesn't come off as a terrible drip feed but we do live abroad and the nursery staff (kindly) communicate with us in English. So I do agree with the points you are making but I'm not sure it's the best idea to bring it up with them specifically as they probably would have put it differently if using their native language.

Thanks so much for your examples, @Jimmyneutronsforehead and @Singleandproud. Really useful to help me understand the nuances of the condition.

@Jimmyneutronsforehead This is the first time it has been mentioned in this way. I guess I'm also wary because as I alluded to, this teacher can be a bit overenthusiastic with pointing out potential issues. She's told us several times to go to the GP for certain things which the GP then dismisses as non-issues. So I agree with everyone that following a more formal path is the best way to get meaningful insights and next steps.

@Singleandproud thanks so much for the advice around the Development History. Very useful! And your explanation of how different behaviours can be interpreted in different ages and contexts is really helpful too.

I have an extremely empathic child who's on the ND pathway. She is way more empathic than me and I'd say more than average.

Firstly, nursery teachers are not experts in child development. They don't generally have qualifications in autism/ neurodevelopmental disorders (unless they are specialist practitioners - but most aren't). You can work in a nursery with a Level 3 qualification in childcare.

It's odd that she said 'I don't like to use labels...' but then didn't actually tell you what 'label' she was talking about. It is a strangely coy and vague way of communicating with a parent as a professional. If she has a concern, she should tell you directly what that concern is.

This type of communication is not particularly professional so, based on what you've said, I wouldn't have a huge amount of faith in her or her knowledge/ experience of whatever 'label' she's talking about, due to her lack of professionalism in the way she communicates.

If it were me, my next step would be to ask her to clarify exactly what she means and what her concerns are about your child. If you agree with those concerns, perhaps have a chat with the GP.

But you don't have to agree with the concerns. Some nursery workers think they are experts on autism and are diagnosing every child they see. If you don't have concerns yourself then just take a mental note, wait and see how it goes when your child gets into primary school.

DS who is 4 (and waiting for an autism assessment) has been described as stubborn, but in his case it's usually anxiety based. He's a very well behaved compliant child when it's something he feels capable of but if he's anxious then he just won't do it.

Anyway I think it's worth going back to nursery and asking them what steps they recommend. E.g. were they recommending speaking to your HV or GP about a developmental assessment, or just drawing your attention to some atypical behaviour for you to be aware.

Best of luck OP.

I also agree with the pp that said its not really OK for them to just make a fly by comment about it, when people are busy or are trying to leave, or their headspace isn't there to process the information.

It's what my sons nursery did to me, but in our case we'd already been put on the pathway by another medical professional so it was less of a shock to hear, and I didn't need to actually process it because that ship had sailed.

I don't know if your relationship with the nursery is otherwise good, but the more I think about what they've said and how they've said it the more I think they're the ones with the social, communication and interaction issues, and if I was a nervous child in their care and they were clumsily wording things when I was just getting to grips with understanding language as a whole then I'd probably be resistant too. They need to tell you more about what's happened before, during and after an incident, as well as explain why they have their concerns rather than just a passing comment.

Yep echo everyone else. You need a proper meeting.

But don't be scared. Your DS is your DS no matter what 'label' (which actually means diagnosis) he may or may not get.

My 14 year old was diagnosed at 3 with autism. I was distraught when it was first raised. But it's fine. If this is what happens then it will become your normal. And it may well be that it makes no difference to anything. And you will be fine. Promise. He's since been diagnosed with ADHD, dyspraxia and tourettes just for starters (and is being investigated for a condition that might be life-limiting but we will cross that bridge if we come to it). There is so much info out there (and for me MN has been a life line) so you will find plenty of support.

Oh yeah and the no empathy thing is bollocks. DS is incredibly empathetic and kind. I have a million different examples but trust me he demonstrates his courtesy and care for others every day of his life.

My son once refused to change a pair of pants when he peed himsel. I got them off him and he went and fished them out of the washing machine and put them back on. He just flat out refused to do stuff sometimes. Both at school and nursery.

He's not neurodivergent. He's just really strong willed. He's at school and is still a wilfull boy but it's not a symptom of anything other than that. So I'd say don't panic. It might just be his way.

I think what she was saying is that she isn't trying to label or diagnose your child (so that you/DH don't panic or become defensive and miss the actual point she is trying to make about her observations) but as a professional that works with many young children it is her duty to raise with you behaviours she is seeing over a period of time that DS may need support with/for. I have these conversations often and I'm not labelling or diagnosing, but parent sometimes think I am so its considered best practice to reassure or mention positives first so the conversation is as productive as it can be. We are often the first people to raise a possible concern with parents (I know you've said she isn't the first, but presumably she doesn't know that) and they can be blindsided, I dont think she's making any assumptions about what, if any, diagnosis/label may be appropriate down the line, she's telling what she sees. You could ask for a formal meeting with observations/documentation around behaviour and see what step the nursery might advise. It could be personality, a stage they grow of, or something like ASD, but where I live I often advise parents to start asking for referrals because to only be starting that long process in a couple of years when the child clearly does need support can be detrimental whereas if the behaviours have been grown out of by time they are called for assessment no harm done.

Both of my kids are autistic, one is highly empathetic, cuddly, kind, makes eye contact. The other not so much. Autism is a spectrum. They may suspect autism (please don't use ASD, autism is not a disorder its a neurotype), maybe ADHD (bear in mind this doesn't always present with hyperactivity, it's completely different to what I originally thought).
Look around you and your partners family, any quirky characters, pedantic people, very bright with fixations on certain topics etc etc?
Does your son line up his toys? Is he a flight risk? There are so many signs and for us both of my kids are so different it took us quite a while to realise they were birth neurodiverse.
Good luck with next steps.