Can a child be diagnosed as on the ASD spectrum if they meet almost all the criteria?

[Aliceinboots]

My 3 yr old has severe speech delay, appears oblivious to other children, appears a lot of the time to be in a "world of her own" and is emotionally aloof.
She does not however have any issues with routines or rituals. In fact you can take her anywhere surrounded by anyone and she just does her own thing. There are no sensory problems or tantrums either.
Could it be that she still fits somewhere on the ASD spectrum or is it more likely she to have a more non-specific learning difficulty?
I realise only a paed can only answer this but ours seems clueless.
Can ASD present as just a communication and social disorder?
Any thoughts, theories, comparisions gratefully accepted.

well dd2 got her dx of autism at 3 years and i was unsure about the routine thing, but its more to do with the rigid thinking and need to do things the same i think. DD1 is run by routines, dd2 is getting worse the older she gets :(

you may well get a dx of pdd-nos instead

Thinking about it, she is quite limited in what she will eat. I know there is "something" not right. That much is a certainty. Whether a specific label would help, I'm not so sure.
She starts Reception in 2012 aged just turned 4 and without 1:1 support I can't see how she'll manage to learn anything!
Am worried she's going to be overlooked and left to her own devices as she is "no bother" to the teachers.

girls with autsim present very differently to boys with autism, so anything you know about autism, delete it and reread research especially for girls.

How does se manage at nursery?

DD has most f not all of the classic symptons of Aspergers but down't present them badly enough to warrant a diagnosis.

The nursery are stuggling to engage her in the social aspects. The SALT have fobbed us off with "we can't work on her speech until her social and attention skills are improved.
A bit of a brick wall. We have a follow-up paed appointment next month where I believe they want to go through a detailed history with us without DD being present.
Need to check this though. Info all a bit flakey!

At 3 my DS had no sensory problems and he didn't have tantrums - he is worse now at 11 for tantrums! She could have ASD on that basis although as you say we can't as we don't know her.

However, the thing that springs to mind for me is that she might have hearing difficulties. She sounds a lot like a little boy I used to know who when he was eventually tested had a horrible case of glue ear and made massive improvements just from having grommits fitted. Do you know for sure that your DD can hear you or that she doesn't have some sort of impairment? As a mother with a son who has AS I would have sworn the little boy had it too but being able to hear has transformed him.

She's had her hearing tested thoroughly. She was resistant to most of their attempts with games/puzzles but she has passed the technical assessments with flying colours.
TBH I was hoping it was all down to a bit of glue ear!
No such luck...

Oh well It was just a thought and worth looking into if the hearing test hadn't been done.

I really understand your frustration. I knew there was something wrong with my DS too but he doesn't present a text book case either. Get the paed to refer you to a clinical psychologist. They can do the proper assessments and give a diagnosis if needs be.

Thank you "BigBoobied*. Will bring up the possibility of a clinical psychologist referral at our next paed appointment next month.
Unless DD makes a MASSIVE improvement in speech and particularly the social skills in the next year I am sure she is going to need 1:1 support for starting Reception.
She is a happy, lovely little kid but because she doesn't have meltdowns or angry outbursts that she could be ignored and not given the appropriate help. Can a clinical pyschologist diagnose? Do we need a diagnose to apply for a Statement? Does the school apply for this on out behalf? DD is currently in MS preschool attached to the primary school she will 99% go to.
Sorry, a lot of questions...

God grief! Sorry for all the typos! Am rushing this out on a knackered old laptop and it's been a LONG day!

I read your thread earlier on my phone Alice but had to go out so just popped back to add my bit.

My Dd3 has recently been Dx'ed with ASD she is 9. It has been a long hard battle to get her dx. She actually has Atypical Autism but the psychiatrist who did the assessment felt that an ASD dx would get her the support that she needs. I mention the Atypical because she didn't clearly meet all the criteria for ASD. We thought she would get an Aspergers Dx but she doesn't [apparently] have all consuming obsessions. I would debate that but we are happy with the Dx so whats the point.

As people have said, girls present very differently to boys. My Dd is very passive at school and doesn't ask for help or even tell people if she is ill, despite good verbal skills.

She lets all her anxieties out at home where she is safe.

FWIW I think you should apply for a statement for your DD, she doesn't need a dx, there are people on here who know all about how it works, if you post a thread about statements someone will be able to help you. I do know that it takes 6 months so I would recommend that you do it soon.

Good luck..

Our SALT made noises about not being able to work with DS2 until his attention span and focus improved. I repeatedly demanded (in writing) that they work with him NOW as they suspect he has ADHD, and I don't see his focus and attention span improving any time soon. I made a rather clear statement about it being their job to work around his attention span and focus - basically it's your job to engage him in whatever is needed to help him.

I think they realised I wasn't going away and finally started working with him. It is frustrating to have to push so hard for it.

Yes, you can apply for a statement yourself - contact the IPSEA for advice - I have never managed to get through but other people on here say they are great. They can help you out. We don't have a statment for DS so I am not clear on the process but you don't need a diagosis either but it is easier if you do have one. The process is about to change so to avoid getting caught in the cross over period I would start sooner rather than later.

Around here the paed is just the person who does the initial assessment of a child and then uses that to refer on to the experts. They aren't qualified to dx themselves although I think there are a few developmental paeds around who do dx, there just aren't any here. If you have a look at the NAS website it says that clinical psychs and psychiartrists dx and paeds help with the dx but from what I have seen on here that isn't always the case. I would ask if you think the paed really is that flaky, just for the peace of mind!

Your DD shouldn't need a statement to get one to one help at school either. A decent school would be doing something to help from day one. Presumably you are looking at schools now? I would be making appointments with the heads of the schools you are interested to speak to them directly about their approach so that you can make the best choice. If the pre-school struggling and haven't got the SENCO in to help maybe you need to be looking elsewhere but obviously only you can be the judge of that. The normal open days aren't going let you get a feel for the schools when your DD's needs different from other children.

I have asked DC's keyworker (preschool) about the statement process. She seemed to think 1:1 support was dependent on a statement.
Also that the school had to demonstrate they had done everything possible to "bring the child on" before a statement could be applied for.
I am in the process of applying for DC's primary school which up till recently I assumed would be the one attached to her preschool and the one attended by her elder sibling.
Now I am studying the booklet and wondering if I should pick one with an autistic unit attached to it.

It's all very confusing as I assume DC would need an official ASD diagnosis.
ARGGH...

I am also tempted to put in writing my wish for DC to recieve SALT now. If her social skills are linked to her speech delay then surely she requires SALT.
I feel a bit like we've been abandoned.
DC goes to preschool each day, is in her own little bubble, doing her own thing and it appears apart from us (her parents) she is having no intervention.
Surely it's not "normal" for a 3 yr old to have virtually no language (although she understands most things) and to have no social skills?

It is very confusing.

You shouldn't need a statement to get 1 to 1 help - my DS has had it and he is only on SA+. It wasn't a huge amount though to be fair but if you can't get a statement in time then anything is better than nothing and they should be offering it without you having to force them. If the school is doing their job they do what it takes to help the child. Unfortunately, some schools don't do that and won't be forced to do anything without a statement. They are the kind of schools I would avoid like the plague though. Their attitude is all wrong imo.

You might get into the mainstream side of a school with an autistic unit but you wouldn't get a place in the unit without a statement - places are far too limited so they go to demonstrably the worst cases. However, a school with a unit should be sensitive to your DD's needs much more than a school without one.

CAn you afford to pay for some SALT intervention even if it is a consultation and the SALT giving you a plan of things to work on with your DD yourself? SALT waiting lists can be horrendous especially if they have already decided that they can't do anything to help yet. TBH that all seems just bizarre. Surely the SALTs work with children on the ASD spectrum all the time? They should know better than most that social skills aren't going to improve any time soon but language can't wait?

Your best hope is that the paed takes things in hand and starts getting some action. Go prepared with what you want to happen and ask them how they are going to achieve that. The whole statementing system is recognised by everybody as being extremely adversarial at the moment and there are moves being made to change that but be prepared to fight for everything. You might not need to, as we haven't when dealing with DS1's problems (well not until he started secondary this term but that is another story) but I think we are lucky. Our situation should be norm but sadly it isn't.

Good luck.

Bertha, thank you. I agree that the paed (who who suggested at our first meeting with her that DC may have a "social communication disorder) might be the best person to move the process along.
A social communication disorder is just another term for ASD, right?

Yes, social comm difficulties are a symptom not a diagnosis so other disorders such as some sorts of language impairment might come with social comm. difficulties but they will be different from ASDs.

It is a difficult area to get a handle because each child with an ASD is unique and they don't all have all the symptoms you would expect. I have read books on AS and not recognised my son at all but there is no doubt he isn't like other children. At the end of the day the label to me is just a flag that there is something that requires help. The help the child receives shouldn't be dictated by the label but by their own individual needs. In an ideal world of course.

My DS is quite good with some aspects of change,but whilst we thought he wasn't locked into routines we realised how much we help him by structuring his life. I think if the ADOS shows marked difficulties in some areas and only mild difficulties in others a diagnosis is still possible.

The help the child receives shouldn't be dictated by the label but by their own individual needs. In an ideal world of course.

Totally agree with this Bertha. I don't recognise my DD in any of the descriptions of ASD I have read (and there have been LOADS) but obviously I'm very concerned about her. I am only interested in a label if it i a gateway to more understanding from the school and practical help.
My DD is only just 3 and I realise that there are still "normal" 3 year old's who are unsociable and not great at interacting with their peers. TBH DD is very happy. It's not as if she wants to join in and can't. I believe her speech delay (which is at least 12 months if not 1 months behind) which is the key area she needs therapy in.
Am incredulous an experienced SALT can't do any work with her. They have basically left it to th nursery staff (and us of course) to socialise her.
I thought in the States especially SALT can be given to children as young as 15 months. Surely my DD is entitled to some.
If she never gets any more sociable than this will she just be crossed off the SALT's list?

Aliceinboots

"A social communication disorder is just another term for ASD, right?"

A very debatable statement. There are many forms of communication disorders, most of which can contribute as part of the multiple issues experienced by those who are included on the Autistic Spectrum.

International researchers are still trying to unravel the issues which contribute to ASD. Some of the issues are already recognised as individual and separate conditions, which on their own would not be considered as ASD.

ASD is currently diagnosed by subjective observation of behavior, which has to meet at least 6 from 12 behavior traits and from in specific combinations of traits. As yet there is no what is called "Scientific Diagnosis" of ASD. progress is being made in providing many "Scientific Diagnosis" processes for the individual conditions which can combine ( or be co morbid, co exist) to cause the ASD behavior traits, but there is still a long way to go.

It is recommended to identify ASD traits etc as early as possible, from 2 - 3 years of age. The individual or contributory issues, can be considered part of natural development, as we all develop different cognitive skills and abilities at different ages and at different rated until the age of maturation 6 - 8 years of age. And until this stage of natural development children can still grow out of these types of issues. However if there is a family history, the genetic link, of these types of issues, siblings, parents, grand parents, aunts, uncles, cousins etc, then there is more support that these issues will not be grown out of between the ages of 3 - 8 as part of natural development, and that there may be a life long disability which requires a clinical diagnosis, and support.

So ASD is not the only route, but is the route that most are aware of.

alice, your DD sounds very much like mine (will also start school in 2012, severe s&l issues and autistic traits). she did not receive salt until recently and I wrote quite a big complaint letter (to PALS). within days of sending the l letter the head of speech and language services was on the phone, apologised and DD is now receiving therapy. the squeaky wheel gets the oil? I think it is appalling not to offer Salt to your DD.

she she on an IEP at nursery? has an EP been involved? I think we were quite lucky with our nursery. very proactive, DD gets loads of 1:1, is on an IEP, the EP saw her recently and nursery are now applying for a statement.

if your nursery is not that proactive, definately think about applying for a statement yourself. the whole process takes at least 6 month (often longer).

Alice do you think your dd might have a language disorder like APD? If you look this up it tells you that quite often the condition presents some autistic traits but not all the classic ones hence could explain the lack of social interaction? If she has severe language delay it could explain it. Might be worth exploring.

Thank you for the information. Have just caught up with this thread.

Am off to look up ADP.