Is the child psychologist in the wrong?

[almostalwayslaura]

We have started seeing a child psychologist with my 11 year old daughter. Has major issues with health related issues, manifesting in many ways but mainly wobbly teeth. For example, if she has a wobbly tooth she completely shuts down, can’t talk or open her mouth - sounds extreme but I’m not exaggerating - it is extreme. I have been managing this myself at home however this presented itself at school and teachers/school nurse got involved.. hence the child psychologist referral.

today was the first appointment LG attended, the first two were parent only. At the first appointment we were told we would be seeing a student psychologist. The student today, after a few awkward silences and speaking to her about a few different things turned to us and bluntly said ‘have you ever considered she has autism?’ I was flabbergasted at the bluntness - obviously I am aware she has a few quirks and sensory processing issues (examples include food and being unable to touch her own neck… strange I am aware) but I just can’t believe he just came out and said it in front of her??

was he in the wrong? Am I over thinking this? I don’t know what to do or whether to return to appointments?? I am completely lost on how to support her as due to her age, periods will begin soon and i cant even begin to imagine how her brain will cope with this - she had a femur break and was in traction in hospital for 6 weeks and i do think this is the root cause but autism? I’m shocked. Any advice on what I should do would be greatly appreciated.

Thank you

I think it was wrong to suggest this in front of you.

I also would not put any faith in school's ability to pick up possible autism. My daughter actually had a diagnosis and her year 6 teacher refused to believe it! Teachers often have their own ideas about children and their own ideas about autism. Also they tend to be concerned about the children who act out - if your daughter is not causing the staff problems, it is possible they will overlook her difficulties.

I agree with not relying on the School to spot ASD, especially in girls.

I’m so sorry that the Teacher didn’t believe your DD’s diagnosis. That’s shockingly unprofessional of them.

Funny you say this as I actually relayed this appointment and conversation with the deputy head of the school and she was shocked and said ‘your child does not have autism’ and told me to complain and ask for a different psychologist.

Him mentioning it may well be the prompt needed to get ON that waiting list though.

Not telling your child about autism doesn’t stop her from having autism OP, it just stops her getting any support.

I think you're being a bit insulting to people with autism tbh. It's not a life sentence or an ailment. Just a neurological difference. Yes it can be difficult to live with but it's not something shocking to shield a child's ears from.

If she is autistic, she is autistic, there's nothing to be done to cure it, it isn't something that will 'hang over her head.'

What's the point of waiting until the next appointment? She'll still be autistic and there still won't be any cure or treatment for it. At least planting the idea now will give her some relief from the anxiety that there is something medically wrong with her. Children take these things much more in stride than adults and it is anxiety inducing to know the adults are talking about you but won't let you in the meeting. A child her age should be involved.

A psychologists opinion is generally going to be more accurate than a deputy heads in knowing the signs for autism. In my own situation I was told by multiple professionals who were not qualified to assess that my son couldn't possibly have autism. To me it was blatantly obvious he did but it took a long time to be taken seriously by anyone. Please try and get whatever assessments are available just so you have answers and can get your daughter whatever help and supports are available.

Seriously, teachers are not trained to spot autism. It requires a proper assessment for starters, not just someone's impression. How well does the head even know your daughter?

Girls can be really good at masking, only everyone starts to complain about something or other.

My daughter has a particularly social type of autism. Even the camhs psychologist who assessed her thought at first she didnt have autism, and was astonished when she completed the assessment and discovered she did!

If you can, get your daughter assessed by a good speech and language therapist for now. There is a lot of cross over with autism.

OP doesn't want an autistic daughter.

You should be complaining about the deputy head. How dare she?

Silly response really - Does anyone want their child’s life to be more difficult than it should be?

I am a child psychologist and I would have raised this more subtly. I probably would have talked about some people with the same experiences as (child's name) turn out to be neurodivergent, which means they have a rarer type of brain, for example they might turn out to be autistic, and is that something that any of you have ever wondered about or considered. And my advice would be to think about investigating this to see if it might help explain some of the things that (name) is finding tricky in their life.

It does need raising, but he does sound like he approached it rather badly, particularly given the child was present.

If you wanted to feedback, maybe something like "whilst we respect that the issue of possible neurodiversity needed raising, we did feel it could and should have been raised with us as parents in the first instance. As it was, the way the message was delivered left us all a bit shocked and taken aback".

But you seem to be missing the fact that whether you call it autism or not, doesn’t change what it actually is.

You can never get her assessed if you don’t want to, but that doesn’t mean she’s not autistic. You’d actually be the one making her life more difficult than it has to be by not exploring and potentially getting a diagnosis that can then give her the support she needs.

Of course they don’t, but the facts are your DD is showing signs of possible autism. She needs help and support and your refusal to hear the facts won’t change them. Nobody is suggesting you take a child with absolutely no indicators of ND to be assessed here, your child is already struggling. You have taken her to a psychologist already.

https://www.mumsnet.com/talk/thirty_days_only/5363391-high-functioning-autism-have-you-regretted-diagnosis-for-your-child?utm_campaign=thread&utm_medium=share

Oh dear. Has she received any formal training in supporting people with ASD or assessing ASD?

We were told emphatically, by many Teachers and even the school SENCO that our DD didn’t have ASD.

When we eventually managed to get her assessed she was diagnosed as AuDHD.

Unless the Deputy Head has previously worked assessing DC with suspected ASD and then changed careers into teaching, I would take her comments with a huge pinch of salt.

In our experience the evidence needs to be pretty overwhelming before you get anywhere near the Pathway. If you are being offered a referral for assessment i would grab it with both hands.

Afterall, is she hadn’t got ASD then she won’t be diagnosed.

I think the bigger picture here is going through the ASD diagnosis framework to be told no is very unsettling and a waste of everyone’s time and energy. I am not against a diagnosis however I know the school will return their part of the assessment as a clear no so I’m not sure how else it works to be given this diagnosis?

It may be worth doing some research into people who receive a later diagnosis of autism and how difficult not having the diagnosis made their formative years.

That’s certainly the case for my DC - no one ever suggested or suspected autism until they were under the care of a psychiatrist following a pretty much catastrophic break down in their mental health in their early twenties. That was really fucking difficult for DC.

Although they are doing better now I could cry every time I think of how difficult their teenage years were and how close we came to total disaster. Getting a diagnosis of autism was not just life changing but also life saving for them. They now understand why some things are so much harder for them, why they react to things in certain ways etc. I would give anything to have been in the position of someone suggesting autism 10 years earlier.

The bigger picture is your child’s mental health. It’s no waste of anybody’s time to investigate what’s going on. If it isn’t autism it’s something else and you would likely be signposted in the right direction at some point along the assessment process. Point blank refusing an assessment isn’t going to help your child in the longer term.

without sounding insensitive can I please ask how receiving a diagnosis and putting a label on it changed anything? Obviously there is no medication for autism so how does this change how your child deals with anything? I understand it’s understanding how your brain works, but how is my question?

That's not how it works. School will be given a series of questions to answer and the info will be used alongside a parental questionnaire, several sessions with the yp etc.

It isn't quite the same but my other daughter was assessed for adhd.

The first paediatrician we asked about it said it was unlikely but he would assess her and send the school questionnaire to school. We later got a reply to say she didn’t have adhd.

2 years later we saw a different paediatrician but she had our daughter's file and in it she found the 2 questionnaires - not completed. First guy hadn't even bothered to assess he thought he could tell by looking at her.

So questionnaire was sent to school, and I had to fill one in too. This paediatrician was smart, she sent 2 to school, one to the class teacher and one for the class TA.

The class teacher didnt score her high on anything but the TA did. There was a huge gap between the two. This is because the TA had a lot more day to day involvement. Class teacher bought all the masking that was going on.

I would be really wary of anything a teacher tells you tbh. My asd daughter is 26 now, so we are way through the system. My daughter was diagnosed in year 5. Two other girls were diagnosed later - one at the end of year 6 and one when she got to uni.

Lots of boys were diagnosed at primary. But they didnt pick up on the girls.

Why are you so afraid of exploring a diagnosis for your daughter? No, there’s no cure, but if she is autistic then it will help her make sense of things she struggles with. It’s not a death sentence or a dirty secret.

For my DC it meant that there was an explanation for how they reacted to things. DC is bright and for a lot of their childhood they were able to work out what they should be doing and almost “copy” that so they seemed like every other kid.

That worked really well for about 15 years but as teens grow the “rules” become more confusing - think about when you were that age and how different various groups of kids were at your school for example. They couldn’t always get the hang of “fitting in” and got quite isolated. Add in normal teenage insecurity etc, stress of exams to that mix and self-esteem and mental health can go through the floor.

Also as they become more independent the (in our case unconscious) support and accommodations that family and school bring fall away. School brings a huge amount of structure and that typically isn’t there at college, uni, work etc. That can create major stress for them. The extra effort involved in working out what to do can lead to anxiety, depression, self harm etc. The normal “bumps in the road” for growing adults can throw an autistic teen/young adult a lot more and their reactions to that can be intense.

For DC they’ve been able to understand now that there are certain things they need (eg some kind of structure for familiarity - that’s not necessarily what you may think of - they don’t have screaming meltdowns if plans change like you may be imagining autistic people do). They travel around the country and overseas independently regularly and whereas a few years ago a change in eg train times would have sent them into a panic and also made them feel enraged - they now know to take some breaths and logically assess the situation. They also know that if there is an “open ended” task, whether that’s an assignment, a deliverable at work, planning an activity or social event they need to put some structure that is meaningful to them around how to approach it - a deadline isn’t enough. These sound like kind of trivial examples but imagine most things you do creating stress because you find it hard to approach it - over time that becomes unbearable.

They also know that after a particularly draining set of social interactions they need to plan some downtime in and that that is ok. So for example when they were doing the “multiple gig economy jobs” they would offer up shifts that meant the one in hospitality was only done for a couple days and then they much more solitary one was done for a couple days. The autism diagnosis helped DC give themselves “permission” to do that.

It is hard to explain and also you have to bear in mind I don’t hear all of the things DC got from their follow up sessions as they were an adult when diagnosed. But having had a diagnosis of anxiety and depression as a teen they are now on much less medication for that than they were and in a much safer place.

Prior to their diagnosis it was obvious there was something wrong but it wasn’t being treated correctly (medication DC had wasn’t helping as they didn’t have the chemical imbalances that eg anxiety meds treat). An autism diagnosis followed up by a number of sessions to understand what that meant for them made a huge difference. I guess one analogy would be how therapy or CBT can help someone.

I get it can be a shock to have autism suggested but please don’t dismiss it out of hand. If it was just a label then that wouldn’t help but when a diagnosis comes with the right support for the individual it can be hugely positive.

From my pov, it's because autistic people tend to struggle at points in their life and if their autism isn't known and understood, they collect other, less accurate and more damning "labels" such as rude, arrogant, weird, crazy, depressed, defiant, lazy, obsessed, snobby and standoffish....

This can leave people with a deep seated feeling that they don't measure up. They are a bad person or an unacceptable person. Feeling chronically misunderstood can lead to trauma and "burnout" - a sort of nervous breakdown. This can happen where people's autism is identified as well, but it's pretty common in undiagnosed, masking females.

As a psychologist who works with children this is not how I would have gone about raising autism with you. It doesn't matter how positive we are about neurodiversity, it's a big thing and as parents I would want to gauge your thoughts and understanding and open the conversation carefully. You need to consent to assessment so it's important to go at the family's pace. I might have asked a more general question about what you had heard about neurodiversity in front of your child but ideally I'd have my first conversation about this with you alone. I agree it is crucial to involve children in their own needs and own decisions but ultimately it is a parental choice at her age as to whether you want to pursue assessment so it is fairest to raise it with you first.

That’s a much better explanation than my rambling stream of consciousness 😀. All of that applied to my DC!