DS1 age 3 SPD? ASD? PDA? Advice please

[skidd]

Hello,

I am worried about my DS who is 3.3 and started pre-school in January. I have always had some niggling concerns about him but not enough to really worry. However, since he started pre-school his 'symptoms' seem to have become much worse. Any advice on whether he sounds like a very shy normal (hate that term but don?t know how else to put it) little boy, or whether this sounds like there is something wrong is much appreciated...

At pre-school he is extremely anxious and more than 2 months in has not settled. He mostly does as he's told I think and is not disruptive but he seems unable to interact with his peers, plays alone, spends a lot of time just standing staring into space (from what I?ve seen), and does not really participate (won't try fruit/milk at snack time, won?t use toilet there, doesn?t respond to other children when they try to interact with them) or seem comfortable/happy there.

Having said this, he does WANT to interact with other children, he just doesn't know how to. I can tell the other children think his behaviour is strange and don?t want to play with him (one girl told me they call him 'ghost' because he just stands there and never smiles )

Other than pre-school, some issues are:

very reluctant to do what we ask of him - complete battle to get him to go to the toilet, sit at the dinner table, get dressed etc. DH does the ?if you don?t sit down, you can?t ?? and even that has no effect ? he either plays with his fire engine, or just flops on the floor, or cries. Sometimes I have to pin him down screaming on the toilet when he hasn?t been all day and I think his bladder will explode!

toilet issues - has been out of nappies for a few months but wakes up every morning with a dirty nappy which looks REALLY unhealthy (seeing GP about this)

VERY picky about food, and gets very upset when dinner is not what he wants it to be. Will not tolerate anything on his plate which is green or black. He also has this breakfast ritual where he has to spoon a spoonful of cereal onto his porridge or else there is a meltdown

Engages in role playing (always Firemen Sam themed) to a worrying degree (I think!). Talks about Fireman Sam and characters almost constantly and often completely out of context, e.g. when I ask him how school was, he will reply, 'Mandy Flood doesn't have a fire extinguisher because she's not a firefighter' or something similar. This has been going on for months now

His coordination is a little bit odd - has a funny wonky run and is noticeably behind his peers in motor development (e.g. has just started jumping, started climbing stairs at 2.5)

His language is OK, bit behind his peers but talks in sentences and people can understand him at least 50% of the time I reckon. He quite often appears not to hear me ? I can go right up to him, hold his shoulders and say his name really loudly and he will not react at all. Other times he reacts immediately so I don?t think it is a hearing problem

More positively: his eye contact is fine, he is affectionate and loving, he is well-behaved generally and non-aggressive

I have spoken to his teacher who ?understands my concerns? but says he is still very young. She is happy to me to discuss further soon.

Sorry complete essay as I anticipated ? what do you think (if you?ve got this far)? Worrying? Fine? Thank you.

If you have concerns your best course of action now is to see the GP and ask for a referral to a developmental paediatrician. Do not take no for an answer!. From what you have written I would say he does warrant further investigation by such a person.

Has preschool got a SENCO on site; this person should be aware of your DS and there should be extra strategies now in place to help him. Ask about this, are they looking at getting extra funding for him?. Is this already in place, is there someone within the preschool helping him specifically i.e 1 to 1?.

His preschool teacher is not trained to properly recognise any social/communication difficulties.

BTW this is NOT your fault this has happened and is certainly nothing to do with your parenting. I just state that in case either thought had crossed your mind previously. He is still your little boy regardless.

What you need to be also for him now is his advocate because no-one else is better placed than you to fight his corner for him.

Completely agree with attila. Wld in addition look for salt referral, although you say he speaks in sentences, if most of them are quotes from fireman sam rather than appropriate to the situation that can be a sign of a language delay and possibly difficulties understanding language.

What do pre school propose doing to help him feel happier there, leaving him to stare into thin air isnt helpful, the needs of passive kids can be overlooked.

Definitely agree with the others. Your DS does seem to have a range of developmental concerns which need looking into. Get a referral to a developmental paed via your GP or HV.

In parallel you can be looking for some help along the educational route. Ask to see the SENCO and start getting him some help at pre-school.

We can't DX your DS but some of the concerns you listed sound very familiar to me and my DS has ASD. Your DS may just be very sensitive and shy but the sooner you know one way or the other, the sooner he'll get the correct help for him to continue to progress.

I agree, an appointment can take a while to get so best do it now and get started as early as possible.

The fireman Sam is reffered to as scripted language which my DD2 has and shes 3.6years now. She has Autism. Its a good sign he has good enough language to get though the day but he may need some extra help from Speech and language as he will no doubt find it furstading (I cant spell) and this is normally the cause of meltdowns in our house.

Please go sooner rather than later, with the support and help we have had since sept our dd has moved on loads.

I don't have anything else to add other than I agree with the other posters.

sorry all punctuation seemed to come out as ? for some reason (perhaps reflecting my current state of mind!) - thank you for reading through it all patiently!

And thanks for your replies. I forgot to say - very importantly - that I have actually taken him to the GP who has (slightly begrudgingly) agreed to a referral so we are waiting to hear. I can't believe I forgot to say this in my initial post - sorry

I am both happy and sad to read that his symptoms sound as if they are cause for concern. I am having difficulties with DH as he doesn't agree that there is a problem - just thinks he doesn't yet have social interaction skills - but my concern is WHY he doesn't yet have them. Have been getting a lot of 'oh he'll be FINE' from well-meaning friends which I also find frustrating.

Thanks attila for your comment re not being my fault. He is my middle child and I do have a lot of guilt about that - thinking that because he is so placid and his older sister is so domineering confident that he has been doubley-ignored

Thanks also for advice on SENCO and SALT (is this language therapy?) - SENCO is my DD's teacher so I can speak to her. His teacher doesn;t seem too concerned atm but will arrange another meeting. The school is fantastic generally, very welcoming, caring, inclusive. There is a little boy with ASD in DS's class who gets 1-1 support so it is definitely something I will look into - although I assume he first needs a diagnosis/statement - not sure what the difference is as new to all this.

Oh one last thing I am curious about - he does that tiptoe walking thing a lot, especially when he's excited. I know this is associated with ASD/SPD and wondered why? My DH thinks it is ridiculous as he thinks lots of children do it and can't see how it could be connected to a cognitive disorder.

Thanks again for your replies

forgot to say lisa123 - is it scripted language even when the sentences are novel - i.e. he doesn't just repeat sentences verbatim (although he does this too) but rather makes his own sentences which are always about Firemen Sam. Thanks

yes, salt is speech therapy, when my DS was doing a lot of scripted talk, it turned out his receptive language was behind for his age, which I hadn't realised, and was obv v important for me and nursery to know.

in terms of novel tv talk - it may be a)a stepping stone for him, that he wants to talk/reply, isn't sure of what to say, so falls back on language content he is confident with or b)he may be talking to himself and enjoy talking to himself about fireman sam.

re:tiptoes - you are sort of both right - on it's own it's not at all concerning, but together with other language problems it can form a pattern of their being some sort of sensory issue.

thanks total - very helpful.

This struck a chord with me: "or b)he may be talking to himself and enjoy talking to himself about fireman sam" That is exactly what he does although I never thought of it like that - he often talks and talks and talks about Fireman Sam and doesn't need any response/audience - I think he just loves talking/thinking about FS and finds it really comforting

Also interesting re receptive language - would I ask for a SALT referral through school or GP?

My DS was referred to SALT through the Health V but as you are already seeing the GP I'm sure it wouldn't matter which. There can be a (very) long waiting list for this, around 6 months!! Best to get a referral now as you can always cancel it if things improve.

My son had some of the same issues, he is now in P1 and he got referred to the Occupational Therapy and they have said there are sensory issues there. Maybe this is another route you could go down. The picky eater, not seeming to hear you call him etc was some of the diagnosis.
Also, he can not tolerate loud noises etc. There is a good site I referred to before I went to see the OT so that I was prepared for the meeting and I printed off and high lighted all different sensory problems that he had and had his teacher go through another one to see what she saw as well. The OT said it was a great help to the diagnosis. The best site that I found on sensory problems was www.sensory-processing-disorder.com/sensory-processing-disorder-checklist.html
It's long but worth the reading.
Good Luck xxx

Sorry me again, I would also ask the teacher to refer your son to see the Educational Psychologist. Apparently, this is one of the best things that my son's nursery did. Every referral that comes from nursery is apparently bumped up the cue but if you wait until P1 you right at the back waiting months if not years.
I hope this helped

skidd

The list of issues you listed tend to have multiple co morbid underlying deficits or disorders.

There is one disorder or disability which is common to most of those you listed and that isAuditory Processing Disorder (APD), which is a listening disability, or not being able to process what you hear.

This would be the cause of his not processing what you say to him.

Those who only have APD have problems processing verbal conversations, and verbal instructions, and processing all other sound based information. On a good day when our coping strategies are working, (lip reading, reading body langauge) we are able to cope as if we have no communication disability, but on a bad day when we are not able to process what we hear can become very isolated.

thanks mummycanhandleit - good idea to go through school too. Have a parent consultation next week so will ask then

dolfrog - that leaflet is really interesting - From reading the adult leaflet I think I might have (mild) APD too! I have always wondered why I could never hear when there was background noise and everyone else could - perhaps that is the reason... which I guess would make DS's chances of having it greater too...

He played (fireman Sam!)with a little boy in his class after school today for the first time ever. The little boy gave him a hug to say goodbye and he just stood there all embarrassed but was clearly delighted - so sweet