Sensory issue or not?

[Moonmoose]

My child is nearly 3. He's on the waiting list for autism assessment, his main symptoms being speech delay and sensory issues around noises like hoovers, lawn mowers, blenders.

But something has thrown me today. We had a gardener round who used a strimmer for about 15 minutes right by our front window. All our windows were open and we were sat in the front room playing on the floor, so the noise was very loud. I was sure my son would hate it. But he just looked up to the window and because of the angle we were at sat on the floor, he couldn't see anything. He then just played very happily the whole time.

Then the gardener went round the back, which my son could see from where we were sat. As soon as he saw him with the strimmer, he started getting upset even before the gardener turned the strimmer back on, which was also much quieter than when he was in the front garden.

It made me think that the actual noise of the strimmer didn't cause him any upset or discomfort, but the sight of it did.

It also then occurred to me that whilst he had a brief phase of hating me hoovering, he soon got used to it and doesn't mind it now. But he hates it he sees an unfamiliar hoover used in someone else's house.

Surely this would indicate that it isn't actually bothering him in a sensory way? As being bothered by the sensation of hearing the noise seems to be context-dependent?

It is also on my mind that whilst there is no autism in mine or my husband's families, anxiety disorders very much do run in both of our families. Could it be that he's just a very nervous/anxious character? Of course, there's every possibility my son has both autism and an anxiety disorder so one doesn't rule out the other. In any case, he's a quirky little soul - very very lovely and brilliant, but definitely quirky.

I don't know much about sensory issues and google is leaving me a bit confused, so I'd love it if someone who does can help explain whether this sounds like it's actually sensory or not.

I wouldn't draw any conclusions from a single episode. Sensory issues can appear "context dependent" eg a child will push through a difficult sensory experience to do an enjoyable activity, or have less bandwidth to deal with it at the end of a long day.

If he saw the strimmer, and then got upset, it may be that the anticipation of the noise was the upsetting factor.

The difference between autism and anxiety is that a core diagnostic component of autism are delays/differences in social communication (which might appear as: not understanding social cues, not using gestures, not turn taking in conversations etc). Without these, you can't be autistic, which would guide drs towards a different diagnosis.

In either case, the best way to help your son is to guide him through strategies and offer ways to help the distress. Eg, seeing the strimmer is upsetting so we'll go in another room.

Thanks so much for your very helpful reply @BusMumsHoliday, I really appreciate it!

I will have a think about that going forward.

I also really appreciate the clear point you've made about social communication. As his speech is delayed I'm finding it hard to tell. It all feels a little confusing for me right now because we have some health care professionals who seem very convinced he has autism and others that are very sure he doesn't. At the moment I'm just trying to fully engage with the process to ensure he doesn't fall through the cracks, but I'm wondering/worrying that some of his symptoms are being misinterpreted.

Taking one example, lack of pointing which his HV in particular was very concerned about. He'll point if you ask "where's XYZ" but he never points to interesting things. But IMO he is displaying an interest in joint attention - if he sees something interesting he will say its name (like a dog in the street or a bike) and he won't stop until we've acknowledged it. Surely the actual intent of joint attention is more relevant than the physical act of pointing? It's just so confusing as everyone we see so far seems to have a totally different opinion about him and his behaviours.

I feel like it sounds a lot like I'm minimising because I don't believe/don't want to believe he has autism, but I do actually think there's a reasonable chance he has it. I made my peace with that a while ago. I'm just trying to figure it all out I guess, I want to make sure I'm understanding him properly.

He's certainly a quirky little soul in any case. Treating each individual issue as something we need to help him cope with regardless of the cause is a great point, thank you.

Like all autistic traits, difficulties in social communication can present at scales of severity and in different ways. So some autistic children will struggle to follow any adult's attempt to direct or gain their attention, and some will make bids for joint attention in potentially effective but atypical ways.

Obviously, I can't diagnose your DS, but my DS, now 4 and autistic, did exactly the same thing with joint attention as your son when he was about 2: sharing interest by saying a word over and over again until acknowledged. The deficit for him was that he could have also turned around to see if we were looking at the same thing, but he never did. He also pointed on time, but he didn't - and still rarely - co-ordinates pointing with eye contact. My theory is that he couldn't/can't use eye contact and gesture to confirm shared attention, so he had to do it verbally.

I don't know if the same if true for your son, but the fact that he is sharing his world and that he's come up with a strategy to do that which works for him are both hugely positive, regardless of whether he's autistic or not. And the absolute best thing you can do is tune into his ways of communication and respond to them, whatever they are - and it sounds like that is what you are doing.

I do understand your fears about misinterpretation, but a through assessment by experienced professionals can tease out these differences and it will also explore other potential reasons for behaviours and delays. I really thought my DS could go either way until his ADOS, which pinpointed exactly what he struggled with,and I knew within about two tasks that he was going to get diagnosed. I think you're right in pursuing assessment, and I hope you get answers soon.

Sensory sensitivity does seem to be massively influenced by context IME. DS can cope with big crowds at a sports match when he has a special interest in the sport, massively more than he can cope with a much smaller crowd somewhere he doesn't really want to be. That doesn't mean he's made it up.

We use the bathtub or stress bucket model a lot. You've probably come across it - you have a certain capacity to cope but there's too much stress mounting up and not enough ways to dissipate it, you get overwhelm. In my head a difficult sensation is bearable when there are enough other factors there to mitigate but if you have added stress factors instead, the exact same noise is unbearable. Factor in expressive communication difficulties and you get a situation that can feel unpredictable. But as you get to know him better and he can tell you more over time, it will get a bit easier I hope.

Re the pointing, I'm not sure but I think there is a well established difference with autistic children not pointing. Leading an adult by the hand to the item is common in autistic children and I suppose it's still kind of sharing it, but it is intuitively different and perhaps less demanding of their social & communication skills, expressive and otherwise.

In hindsight (child diagnosed at 9) I certainly explained away too much when he was little. Eg his vocab dropped from maybe 100 words to just colours. I could see he was choosing to code everything as colours so he had to say fewer words, and put it down to maybe he just wasn't very confident speaking. That insight kind of got in the way of me reacting enough to what should have been a red flag. It didn't feel like he was losing words, because I thought I could see why he was doing it, but actually every child has reasons behind their behaviours. Lost language is still lost language. It's right to give them grace because they are all individuals and still so very little, but don't let that get in the way of spotting the flags. Personally I needed help with this, I find it impossible to judge in my own child.