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

Thank you, I said the same regarding the key worker. As I said before I have worked in settings for many years and one thing we were is consistent. We had the same staff members in each department each day and we all knew the children and they all knew us! She has a key worker but I’ve only met her once and she’s never been in the room since. People are doing observations on her because they update the app, but still I would prefer to see a familiar face when I go there. I am toying with the idea of moving her, maybe to a smaller setting. The nursery she goes to is in an old school and the room she has is an old classroom, so you can imagine how big and overwhelming it is for a toddler, especially one that isn’t walking!

Thank you so much for this, I will definitely take a look. I’m trying not to spiral and also analyse every movement now, but it’s so hard. Now that it’s been mentioned it’s like it’s all I can see. Whereas before I just noticed her little quirks! She’s so loved, I just want to support her as much as she needs.

Well I’m starting to wonder now. I think I’m going to start the ball rolling with a different setting because after I saw her crying on her own, it has left me really upset. She’s my baby and I’m trusting them to look after her and make her feel safe.

I don’t really like to use the word “slow” because she isn’t. She’s just doing things in her own time. She doesn’t point to show me things but she will look at me whilst playing as if to say “look at me”

I thought this aswell.
I think I’d be looking elsewhere, based purely on the fact the staff have been inconsistent at this early stage of her settling in - I’d have expected them to plan consistently so she has an easy adaptation tbh. I also think the manager sounds a bit flippant. When kids are older I think these small details are less important, but when they are babies I have a high bar and think id be losing my confidence in the nursery tbh.

shes 15mo and sounds like she is doing just fine- I wouldn’t listen to what they’ve said. All children are different and I think your perspective on her development and being concerned / not concerned is absolutely spot on. I wondered if the staff were very young / inexperienced when I read the post tbh.

My son was diagnosed at 2. It became more and more obvious from 18 months that his development trajectory and behaviours were different. I don’t think anything you have shared is cause for concern. It sounds like she was stressed. In these early days I would probably keep her at home if she isn’t well but appreciate that might not be possible with work.

Being affectionate isn’t something included in our diagnostic process btw…. My son is incredibly tactile and wants to touch and have deep pressure. He also maintains eye contact actually.

for us the signs were things like this though I will probably forget some things:

no mimicking or copying of sounds
repetitive behaviours eg would play with sand over and over for 2 hours
no interest in other children
no interest in toys
no attempt at spoken language
hand stimming
we lost foods he had once eaten until he was highly restrictive
struggled with transitions
wouldnt go with anyone except mum and dad

I think the nursery manager might want to take a bit more time before wading in. It was her third session!

I would be VERY sceptical about anyone claiming they could “spot” autistic behaviour in a child that young, particularly one they hardly knew.

This sounds like a nursery issue to me, it sounds like your dd was stressed and trying to find a way to soothe herself. Would another nursery (smaller with more consistent staff) or a childminder be an option?

I’m starting to agree. Yes it absolutely would be an option, but finding a nursery with availability is quite difficult. Most where I live have a 2 year wait list. I’m going to explore a child minder I think. I think this kind of setting may be more beneficial. I.e a home environment with one consistent person etc

Thanks for this, it’s so interesting how broad the spectrum is! Then manager ask me if she was affectionate at home because she didn’t want comfort from them, but she doesn’t know them?! To be honest she does a lot of what you listed except she does have a big interest in toys and can move from activity to activity on her own. However, I dare say she would play in the sand or water for hours given the chance! Thank you for your message 😊

Thanks for this and I agree. I never want to be that mum that’s like “well I have my childcare qualification and we used to do it like this” because I think it can come across as patronising. However, in my experience, consistency is absolutely key for children, especially ones at this age. It’s usually the first time they’ve been away from their safe place for any period of time and it’s a huge transition and I don’t think they are managing it well. I’ve paid until the end of the month so I think I’m going to give notice and get her in with a child minder. Thanks again!

The thing is, everyone talks about early intervention, but my experience is there is barely any support even when you have a child who would be deemed severe. Once you get a diagnosis it doesn’t even necessarily mean that you get access to help, it absolutely depends on what support the child actually needs. I’m not saying don’t pursue a diagnosis in due course, but realistically even if you started on the pathway now, nothing would change in your day-to-day life

I chose a childminder for this reason, my dd was much happier with one main caregiver in a home environment. She was more ready for nursery when she was 3.

My granddaughter is, the school thinks, autistic -- her parents haven't seen the benefit of an official diagnosis right now but taken the school's advice on getting a therapist who can help her cope with the things she finds difficult: mainly to do with being overwhelmed by a lot of people/noise. She spoke late but was obeying three-stage commands from a very young age so we knew it wasn't hearing, is very loving, has many friends, good at problem solving and maths. She went to a nursery we knew to be really child-centred and excellent. She needs a regular routine, even down to the food I give her when she's at our house - it's always the same meal! I think you know your own child, can see what they find difficult and it helps when nursery/school listens and adjusts accordingly.

I appreciate that but she is technically behind the average for this milestone, that’s all I meant. So it’s obviously something to keep an eye on. In any event the lack of speech is less concerning than the lack of pointing - plenty of NT children are not speaking by 15 months but it’s more unusual for them not to be pointing either. Overall she isn’t really talking or showing joint attention in a clear way, and is flapping her hands and banging her head. Which doesn’t mean ‘autism’ but she doesn’t sound non-autistic either.

I know it’s tempting to feel defensive and dismiss nurseries when they give this sort of feedback but in my experience they’re usually pretty good at spotting things that sometimes we are too involved to see. I would be trying to learn some basic floor play techniques to bring on her communication a bit.

It’s not just a nursery issue and I find it frustrating then when an OP posts with some emerging signs of potential autism, everyone jumps to reassure them it’s normal and obviously because of nursery. A 15 month old that has 1 word and doesn’t have joint attention is not typical. You would expect them to have a few words at that point, some gestures, and be a little further ahead than in this case.

I don’t have any experience or advice to offer for autism but going one day a week is not enough to get used it quickly. It will take months! I have 3 kids and only when they went to pretty much full time nursery they got used it. So makes sense your DC is so unsettled still.

As @Walkyrie says, not pointing is a big flag for neurodiversity. I have 2 ND kids, one with a diagnosis and one not diagnosed yet, neither one pointed until they were nearly 2. With DC1 no one actually told me how much of a flag that was though.

OP you say your daughter enjoys songs and anticipates favourite actions, but does she actually copy/join in with the actions or just enjoy you doing them? And you say she will bring you a toy if you ask her to, which shows great understanding, but does she ever bring you things without prompting?

FWIW my eldest (diagnosed ASD at 4, now age 8) has cracking eye contact, is a fab sleeper and was a great eater until he was 3. Honestly I doubt you'll get more than a 'wait and see' from the Health Visitor at this stage, but worth talking it all through anyway and getting your concerns noted. You should also ask for a hearing check if she sometimes ignores you, as it's standard to rule out hearing issues like glue ear before anyone will investigate potential ASD.

@ImFineItsAllFine i also remember reading a paper about how a lack of index finger pointing was strongly correlated with speech delays. She does sound like her speech is slightly delayed. Does she have understanding OP? If you say ‘doggy’ does she look at the dog? Or ‘where is the ball’ does she look for it? Is there any sign she knows the actual words or does she seem to pick everything up from context (such as knowing to fetch shoes because you’ve taken her to the front door and put her coat on)