3yr old possible ASD - what should early monitoring look like?

[BusMumsHoliday]

Potentially beginning SEN investigations for my DS (3), who we suspect may have ASD and/or ADHD - I know it's too soon to really diagnose the latter. Prompted by worsening behaviour at nursery in terms of hitting/biting staff and lengthy meltdowns, but there are other signs (special interests, social skills behind other skills, family history). Keeping an open mind at this stage.

I wanted some advice about what I can expect of nursery in the early stages. I'm concerned about keeping them to task because I asked his room manager to keep a diary of his behaviour and possible triggers, only to find out two weeks later that this wasn't being done after an especially worrying episode of aggression. They have now promised "ABC" behaviour monitoring, which I believe is the first part of their "assess-plan-do-review" sequence, and we are trying to see their behaviour specialist/SENCO this week (again, I asked for this meeting to be set up a fortnight ago and there's still no date).

I wanted to know what reasonable timescales were for assessing his behaviour and trialling a plan to try to reduce aggressive episodes and improve emotional regulation? DS is in nursery 3 days a week. Should I ask for meetings at each stage of the "assess-plan-do-review" or at regular intervals? Can I ask for more support in the classroom for him now around transitions, play skills, and friendships?

I'm also setting up an appointment with the HV, and we're trying to find a private psychologist for advice and initial screening about whether he should be formally assessed (we can luckily afford this). Is this the right thing to do? Should we be doing anything else right now? He is due to start Reception in September 2024, and I'd ideally to have some idea what we're looking for when choosing a school this Autumn/Winter, because he's very bright but it sounds like he might need extra support socially and emotionally.

I think this varies hugely. The private nursery we tried at a similar age were not very good, but school nursery has been excellent. We moved to school nursery at 3 to facilitate support for reception and it has been for us a good experience but I appreciate that’s not universal.

First, is he happy in the setting?

second I would join your local parent support group and use that to guide school choice. The question is if he needs an EHCP, you will get the best advice on that from nursery SENCO and an early years teacher.

one consistent piece of advice I’ve received is to use money for support not assessment. My little boy needs speech therapy and that is not available in abundance - he has his first appointment with the NHS next month after a nine month wait. In the meantime we have had lots of support privately. There’s no treatment as such for ASD so an early diagnosis doesn’t really expedite things.

finally my little boy changed a lot in the last year and his self regulation is far far better. He is also much better in a more structured environment. So it’s difficult to see the future.

good luck

Thank you for this advice. I'll look up local parent support groups.

We're not sure how happy he is at nursery. He complains about going but nursery say that he seems mostly happy while there. He has a couple of friends. I would like to investigate other settings with smaller class sizes or a more structured day, but DH worries that another transition might be worse for him. The move up to the 3 year old room in September was a challenge and where the behaviour issues seemed to really start.

Unfortunately the school nursery of the state school we assumed he'd attend only offers either mornings or afternoons which is not a pattern we can make work otherwise I would definitely think about moving him there now to smooth the transition to reception.

Hope your son's speech therapy appointment goes well.

Nursery should be providing more support, other than the ABC charts what support are they providing? If they need more advice have they asked the Area SENCO for advice? They can apply for high needs top up funding if they need more money in order to support DS’s needs.

Often assess/plan/do/review cycle last a term or half a term, and that’s roughly how often many places meet with parents, although if needed it will be sooner.

If you think DS needs an EHCP you can request an EHCNA yourself. Unlike JustASquareMoreChocolate I wouldn’t rely on teachers and SENCOs to give you the best advice on this. Sadly some give incorrect advice &/or repeat the LA’s unlawful policies. Instead I would look at IPSEA and SOSSEN’s website (they both have advice lines too) and read the SENCOP.

Support in nurseries and schools is based on needs, not diagnosis, so don’t feel you have to go private. If you apply for an EHCNA and the LA agrees to assess SALT, OT etc. can be part of the EHCNA without the need to sit on the normal waiting lists and if an EHCP is issued ongoing therapies can be part of the EHCP again without sitting on the normal waiting lists.

Thank you for this advice.

DS is very bright and very verbal so if it is ASD, it would be more like what used to be termed Asperger's. I don't think he is having difficulty accessing the nursery curriculum and at the moment I don't think he needs speech therapy. Issues are behavioural and, honestly, I'm still not clear whether these are because of sensory overload/struggles with demands/anxiety around transitions, or because it gets him one on one adult attention (or both!). I'm hoping the ABC charts shed light.

In terms of support, could I ask for eg 1:1 help with transitions, or dedicated support around emotional regulation, and friendships and play? He does like other children, especially 1 to 1, but tends to mimic their play exactly - even down to falling over if they accidentally fall - rather than joining in a game by elaborating on another child's play. Can SLT or OT help with play skills? Sorry to sound clueless but I'm not really sure which therapists do which.

SALT is about far more than the physical ability to speak. If ASD &/or ADHD are suspected it is likely DS would benefit from SALT. SALT can help with social interaction and social communication as well as self regulation. As can OT, which can also help with sensory needs.

The nursery can provide support with transitions, interaction, play and emotional regulation (you could ask if they offer emotional literacy support &/or have anyone who can support Zones of Regulation work). Without early years inclusion funding or an EHCP prolonged 1:1 is unlikely.

So we had a meeting with the Senco and we have a learning plan drawn up. I'm mostly happy with it, with one concern. Can I request amendments?

The target to reduce his hitting has been worded as "I want to understand that my actions have consequences." I agree that this would be ideal and hopefully stop him hitting if he realises it hurts others. But right now, I just want him to stop hitting and I don't really mind why! My concern really is that support for this is phrased in terms of staff speaking to him after/during incidents, when I'm not sure that this attention isn't partly why he's acting this way (he prefer adults to children and I think he sees the 1:1 attention and conversation as positive). Can I ask for it to be added for staff to monitor him closely to attempt to a) find triggers and b) divert him to other ways of expressing anger? Maybe I'm wrong but I think replacing the behaviour with something else is likely to be more successful that starting with feelings for him.

You can request amendments, although that doesn’t mean they will necessarily be made, but bear in mind targets/outcomes should be SMART.

Spotting triggers will be helpful and giving DS alternative strategies is also helpful - this is what Zones of Regulation can help with if they have anyone who can support that. Prolonged 1:1 without an EHCP or early years inclusion funding is unlikely, so the close monitoring/supervision might not be what you envision.