Neuro Diverse 4 year old?

[Lostatsea10]

Looking for some advice/previous experiences really as at a bit of a loss with my DS whose (almost) 4.

He’s always struggled socially and when smaller would be very shy in new company etc. for some context until October this year he was an only, I’m an only and he has no cousins on DH’s side. Of course because of covid he lost all toddler groups etc from 2 so didn’t mix with any children during this time.

He started pre school at 3 days a week in Jan 21 and was absolutely fine and settled until May when he started to react to other children by hitting or pushing- reactions that were understandable- either rough play that had gone too far or being hurt himself. Pre school had no concerns and it was all very much children being children.

Went back to pre school in Sept after summer and all his friends had gone to school as they’re the year above him so he had no friends and didn’t know anyone really in his room. Additionally DS2 was born in October this year. Since Sept his behaviour at pre school has gotten more and more erratic.

He needs a visual timetable for the day and finds transitions between activities very difficult without talking it through, he struggles to play with other children and much prefers the company of adults. He throws toys in anger, tantrums and finds his own anger difficult to manage when asked to do something he doesn’t want to do. He also needs support to share and turn take. He does play with other children but they find him too much sometimes and he doesn’t want to sometimes either. He has no friends.

However- at home/soft play/friends houses I have no problems at all. I’m not exaggerating, none.

I called the HV who has done at home observation of 2 hours and an ASQ SE2 where he scored 35 (85 is the point for referral/monitor) and she also saw none of the behaviours mentioned- just a happy, typical little boy. Pre school scored him 135. I’m waiting for the HV to pick the form up and give me a ring to discuss what’s next. I’m just lost as to what’s going on- whether there are some underlying needs or he just needs more time with other children.

We're moving this thread over to our SEN topic for the OP.

@Lostatsea10
Hi I know this was a while ago but saw it had been missed so thought I'd respond in case you are still needing help. If prevschool are concerned they are in best position to support with referral process. Usually this will involve a referral to see a paediatrician who will get a report from setting and hv and anyone else involved. They will see you with child and determine if an further referral is needed at this time ie asd pathway. If a referral is done there's a wait list it was a year pre covid it may be longer now.
There's a few possibilities here 1, is your nursery a good one? Are they managing your child successfully? Because if he's great at home and other environments such as soft play, friends houses then the problem could be nursery not your son.
2, it could be he does have social issues due to covid etc and needs additional support in developing these skills. Could nursery apply for some funding to give him a one to one to help him at the setting.
3, he could have a neuro diversity such as autism or sensory processing, it's likely there would be signs at home too though such as echolia, stims, need for routine, sensory issues.
Unless you are really happy with setting you could consider moving him and seeing how he does else where or if you agree with nursery you could go down assessment route and see what outcome is.

Who you are referred to for assessments is area dependent. In some areas it is a community neurodevelopmental paediatrician, but in others it is CAMHS. It is not unusual for DC to present differently in different settings, so don’t worry about that.

Thank you so much for your thoughtful and detailed replies. In the 6 weeks since I posted this he is more settled at pre school however still needing adult support. We have left it with the community nursery nurse that we will speak in Jan and discuss next steps going forward.

DH and I are of the mindset that we will ask for the referral to be done as the waiting list is so long and see where we are when it comes through. We’re not in a position to go private for any diagnosis so are at the mercy of the waiting lists.

Once DS is 4 Caudwell Children offer free assessments if your household income is below £45k, if you would be interested in that.

If the nursery need additional funding to provide more support they can apply for early years inclusion funding. And you can also apply for an EHCNA if you think he needs an EHCP.

Thank you for your advice, I’ll definitely look at Cauldwell Children though fairly sure we’re slightly over the threshold.