15 month old autism concerns

[BeRubySquid]

Hi all,
I’m hoping for some advice or reassurance from other parents as I’m feeling a bit unsettled after a nursery experience yesterday with my 15-month-old.
She started nursery a few weeks ago (she was 14.5 months at the time) and goes one day a week so I can work and also to support her social development. Yesterday was her 3rd full session, and when I arrived she was crawling in a corner crying. A staff member said she had only just started crying, but also mentioned she’d been quite upset and unsettled for much of the day.
They said she only had a 40-minute nap (she normally has around 2 hours at home) and that she hadn’t wanted comfort from any staff. I wasn’t too surprised about that as she is quite wary of unfamiliar adults, and each time I’ve dropped her off it has been different staff members rather than consistency with the same key person, which I do find a bit odd.
The staff then mentioned they had observed her “flapping” and tapping the back of her head on the wall and asked if I had noticed this at home. I explained she does sometimes flap when she is excited or upset, but it isn’t constant, and the head tapping isn’t something I’ve seen at home. I asked if they were concerned and they suggested I speak to the manager.
The manager then came over and said she was “stimming”. I asked directly if they were concerned and whether I should speak to my health visitor, and she said no, she wasn’t concerned yet and to just monitor it for now and not speak to my HV at this stage.
I came away feeling a bit confused and upset, especially as I had previously mentioned some behaviours to my health visitor who said they were completely normal for her age.
When we got home she didn’t show any of the same behaviours at all. She played normally, had dinner, a bath, and went to bed early as she was very tired.
I’m wondering if what nursery saw was just her being overwhelmed, overtired, and struggling with a new environment?
For context, she is generally a very affectionate and happy child at home. She will come for cuddles while playing, enjoys books, and I’m her main source of comfort. She does sometimes look blank if asked for a kiss, but is otherwise very engaged with us.
Some other behaviours I’ve noticed:

• Sometimes ignores her name
• Acknowledges me, smiles, laughs and crawls over, but will sometimes completely ignore her brother
• Not walking yet, but very strong on her legs and will stand if supported
• Can follow simple instructions (e.g. “come to mummy”) but not more complex ones yet
• Enjoys repetitive play like opening/closing cupboard doors but will move on easily
• Says “Dadda” consistently and appropriately, has said “mama” once
• Often stands on all fours and looks through her legs
• Loves spinning/turning objects but doesn’t fixate for long
• Very interested in sensory things (lights, textures, sand, rice, etc.)

On the positive side, she has good eye contact, loves songs and anticipates actions (especially tickling parts), enjoys peekaboo, and gets excited waiting for it. She will interact with us, watch other children, smile at strangers, feed herself well, and sleeps reasonably well aside from a current regression. She also gave me a toy yesterday when I asked, after a pause, which felt like a big moment. I suppose my question is: has anyone else had concerns like this around this age? Were you advised to wait and see? Is there anything I can be doing to support her development? I am planning to call my health visitor on Monday, but would really appreciate hearing from other parents who may have been through something similar. Thank you so much for reading

Dd was referred to paediatrician at 12 months and had autism diagnosis week of 2nd birthday. I wouldn't be terribly worried if I'm honest but I wouldn't be sending your dd to nursery if it wasn't needed either as she doesn't sound very happy and she is finding it really stressful.
Your dd doesn't need social opportunities just yet and if you want she could get those opportunities at stay and play or mother and baby groups with you alongside to support and give her confidence.
Dd went to reception very part time and only into full time school at the latest point quite happily. She benefited enormously from the undivided attention I was able to give her.

She's so little i don't think it's something you need to worry about for at least another 18 months

Everything you've described can be completely normal behaviour. The head tapping sounds like self soothing, which makes me feel really sad tbh. I'd be worried that she was just crying on her own. Is this definitely a decent nursery?

It’s hard to say; 1 word is a little slow by that age in my experience. Does she point to show you interesting things, like a plane or dog?

Please try not to worry, 15 months is so so young and lots of what you’ve listed are completely normal behaviours for her age.

DS5 was diagnosed with autism at age 4, I had concerns from about 12 months but it just became more obvious to me the older he got, for us a clear indicator was that he wasn’t able to understand anything for a long time including single words/ basic instructions etc until he was at least 3/4. The fact that your daughter has a couple of words and can understand basic instructions is great & very developmentally appropriate for her age. DS2 only had a couple of words at 15 months and now at almost 3 he does not stop talking all day!

Keep It on your radar incase you have any concerns for the future as it doesn’t hurt to be well informed but I would focus more on helping her to settle in the new nursery environment/ keeping an eye on how she’s feeling there. I definitely don’t think you need to be worrying about autism at this stage based on what you’ve said.

I think the nursery are being OTT to be honest bringing this up after 3 sessions with a baby.(As a nursery nurse). They should just be observing her behaviour, ensuring she is safe and helping her settle! They can mention any behaviours of course but more in a curious way "oh we noticed she is doing X, is that usual for her?"
On a personal level my ds has ASD, LD, PICA and at that age he was completely typical. The only difference was he was an irritable/clingy kinda child. He met all the milestones. Even started talking age 2. But his speech never progressed past single words, and since he was 4 he's gone from 200+ single words to completely non verbal (we get the odd mama or daddy but rare, he just walks around saying EEE. Fyi, no professional is concerned about this. Allegedly it's common...I digress).

I had an inkling at 16 months something was different with my youngest. She put a red brick on a certain floor tile and ran around it in circles. On walks she would sift through stones and hold the right one between her thumb and finger for hours. No words at all but meeting milestones.
I waited until her 2 year review and raised it. She was referred to SALT at that point and it was agreed she should go on the wait list for autism assessment as the list is long. It was becoming far more apparent by 2.5/3 she was finding things more challenging. Diagnosed at 3 years 11 months. She’s now 7, working at greater depth, fluently talking, but very sensory and high anxiety. Now on adhd wait list, as identified by her paediatrician. I guess only you know if you think something needs attention/ investigation. At 2, this seemed like a good time for us and we’d already collected some potential ‘evidence’ at this point. Maybe start observing now towards that point?

OP as others have pointed out, 15 months is quite young for a diagnosis. Also, my nephew who is now 7, had some of these issues (flapping, bagging his head in frustration etc.) between the age of 1 and 2.5 yrs. He is a fairly neurotypical child at 7.

Do you mind me asking if there was any speech delay for your DS? And if so, what age did he start speaking?

We (parents and nursery) had suspicions my son was autistic from about 9-12 months old. By 18 months we were certain. He was referred on his 2nd birthday (the earliest a referral would be accepted here) and diagnosed 3 months later.

Your health visitor is the right person to talk to, if I recall there is a 15-18 month ages and stages review? I could be off on the timing there, it was a while ago!

He didn’t have any speech delay at all. When he was diagnosed at 5 they actually wrote ‘Asperger’s Syndrome’ on the letter even though it wasn’t on the DSM as a recognised diagnosis by then. He has advanced vocabulary, Hans Asperger referred to the children he studied as ‘little professors’ and he fits that profile. His cousin is non-verbal however, so there is so much variation even amongst the same genetic pool.

They have had your daughter for 3 sessions so they have no idea wether your child is autistic or not. Little one is 15 months, if she is not walking by 18 months speak to the HV. Are you "allowing" her to walkm by that i mean not going to get toys she wants or do you always take things to her? Some parents don't realise they are doing this, same with talking, parents often "talk" for their child, if the child points at their cup some parents ask oh do you want a drink instead of asking the child what it is they want, sometimes they need to be "forced" into walking and talking. As for not sleeping at nursery, they are noisy places, other children aren't quiet just because your child is asleep. Hand flapping, all children do it at some point.
Personally i don't think that nursery sounds like a good fit for your child. Find a better one.

200 words to nothing and as a parent you’re supposed to shrug your shoulders and say ‘autism’?? Really??

She sounds a bit like my DD who is autistic but was diagnosed at 9, is at a mainstream school doing really well! She's a talented dancer, academically fine (in middle sets at her secondary school) and just needs a bit of support socially. Even if she is autistic which it's too early to tell she can still thrive.

I feel like I really have to comment as my background is in Early Years Education and SEND and I feel as though they have been extremely abrupt and unprofessional...I would be more concerned that the nursery staff flagged this the way they did when it was only early on in the settling in process. Some children at 15 months do stim (hand flapping included) to regulate emotions. This can be when excited, stressed or simply disregulated. My own DS did at this age.

Nurserys main focus should be on getting to know your child. During this process, they are required to carry out a baseline assesment charting the childs age and stage of developement.

If they observed slower than expected development from the childs baseline assesment and/or a consistent pattern of restricted or repetitive behaviours then and only then should they be having this discussion with you.

I would in the first instance email the manager, this is to keep an audit trail should you need. Ask who the settings SENDCo is for future reference. Also ask for them to send you their concerns about your child as you would like to pass these on to the health visitor. (Again, this is just for you to keep as an audit trail).

I would also ask if your child has been assigned a key worker yet. This is purely because if she doesnt have a familiar person to go in to nursery to on a morning, then this will make her more stressed.

I would also consider (if there is the option) to change settings if you are not happy with the way this situation was handled. I did a few tours of different nurserys until I found one I felt was right (understand though this isnt always possible).

My view on babies and toddlers that display traits is that unless they require local authority funding for urgent support such as a 1-1 TA or specialist equipment etc then yes push for a diagnosis as this starts the process of getting the right support.

However, your child sounds like she is coming along lovely and is simply struggling with settling in. She needs time and understanding bless her. Hope you get this resolved. Im saddened that they approached the situation like this and I think its down to their lack of training and awarenesss.

Several SALT and a paediatrician have told me this. I'd never heard of it before. They are positive that speech will return, but after several years, I'm not so sure. However, When I say 200 words, I do mean single words and learned phrases, many not in context. Very little functional language, only "want chocolate" "Wana drink" "toilet". So the severe language delay was apparent from age 2 1/2, but it was a surprise that he became non verbal, and actually devastating tbh. I'm told to focus on the positives, that his understanding and attention span have improved (responds to name much better and can follow 1 step instructions) but it's a slog. Anyway I won't hijack the thread anymore but there's my story. ASD is such a massive spectrum.

I have also just read you are a qualified childcare practitioner...so please have confidence in your knowledge and take what they have said with a pinch of salt and know that they havent acted as they should have in discussing this with you so early on.

I would look to move setting if at all possible. She should have been allocated a key worker who should do handover each day. The aim is for your daughter to develop a bond with the key worker and feel safe to go to her. The fact that not only is this not the case, but it’s been entirely different staff in the room every time, is unusual and against the early years framework and must be very unsettling for your daughter.

What behaviours did you raise with health visitor

Key workers are mostly for admin purposes in my experience

Flapping doesn't automatically mean autism - as you have correctly pointed out, it is a standard human reaction to stress and agitation (to the extent we actually have phrases around agitation like "stop flapping" or "she's in a flap") - picture a neurotypical person who has just won the lottery up on stage, jumping up and down with emotion and flapping their hands.

Hi OP

I wouldn’t be too concerned at this stage. You know ND is in your family , so your child has an increased chance of being on the spectrum.

I complete assessments and nothing on your list is really what I would be looking at in an assessment (or the things you have said would be very minor points on a much larger list of things we would be looking at). 15 months is very young, your child’s had a massive change recently so I don’t think anything you’ve described would be ‘best’ explained by autism at this stage, although that’s not to say your child doesn’t have it.

the fact that the nursery worker used the word ‘stimming’ to me suggests they have very little understanding or knowledge and probably very basic training, people working in the area don’t really use that terminology and it’s inappropriate for an unqualified person to label something when they do not have the qualifications to do so. It’d just as likely a soothing response your child is having to the significant change in environments (which may or may not be related to autism).

Thank you, this is what I thought. I too am not qualified in this area, so would never have labelled her at such a young age. Don’t get me wrong, I have observed her myself against other children her age and thought that she seems very “baby like” compared to them and wondered if there was something more. She has regressed in some areas, for example she used to give a high 5 when I asked, but she just ignores me now. She loves singing though and interacting so I’m just holding on to that right now. I did complete the MCHAT assessment online and it said she is “high risk of having autism” but that’s obviously from 18 months, so I’m going to redo it when she’s a little older. Thank you for your advice!

I think it is inappropriate for a nursery to comment in this way firstly considering her age and secondly how little time they have observed her. To be fair to them they said they’re not concerned, but then why bring it up? All they have done is made you worry and it’s unnecessary.

IME hand flapping and other ‘stimming’ behaviours at 15 months are very common and not indicative yet of autism.
The other behaviour you describe is also very typical for her age.
I would monitor it OP but also don’t look for it. See what you observe and if you’re concerned in a few months then speak to a HV.

My partner said the exact same thing, why bring it up now? It’s like it was a drama! My health visitor is lovely so I’m going to call her tomorrow and see what she thinks. Thank you for your advice!