3 and a half year old DS: ASD?

[ChangyMcNamechangerson]

Hello, sorry to barge in!

I think I've written before on other threads about some issues with my son- he has pronunciation problems and so goes to a speech and language group every week with two other little boys. (Added to this he has glue ear which of course is not helping and may be the cause of the speech problems.)

At this group, he behaves appallingly: takes ages to settle; doesn't interact much with the other children; very distracted, fixates on something (this week it was the blinds) etc. etc. He hates unfamilar situations and so gets anxious, I think- he is like this at many (most?) new places I take him.

The therapist wanted to talk to me at the end and says she thinks it may be more than a personality quirk. From the way she was talking, it was very obvious that she was suggesting autistic spectrum disorder although she wouldn't say it (I had to do that). I had him screened by a paediatrician less than a year ago and that was ruled out but the therapist thinks it might be a good idea to get another assessment.

I will do this of course but I am very torn. I have gone through the various checklists that they do to screen and he does not appear to have ASD, although he does have some traits. For example:

• very attached to familar routines;

-inflexibility of thinking; -likes other children but can sometimes parallel play rather than interact; -very upset if routines get disrupted; -doesn't like crowded and noisy environments; -hates singing and dancing; rarely sings, and hates it when we do (apart from bedtime when I sing to him).

(The last one is a big red flag for me; maybe I am wrong...)

On the flipside: he loves other children; has friends; has theory of mind as far as I can tell; has imagination; does not do things repetitively (although does occasionally like to line things up).

Obviously I want him to have all the support he can get, especially with school approaching next year. I know he is a bit more difficult than other children, but I did not really think ASD (I have some specialism in SEN issues.)

His father is quirky in the same way; perhaps he is just similarly quirky?

Any thoughts appreciated. I know we are at a very early stage with any investigations but my mind is whirring. Thanks in advance.

Deafness (including glue ear) can produce behavioural problems that present similar to ASD. (we spent a long time fighting for an assessment after being repeatedly told that) That said however if you feel that there is something more push for an assessment. Better to have an assessment and be told he doesn't have ASD than to ignore that niggling feeling that something's not quite right and find out later.

Thanks. Yes, I wonder if the glue ear/hearing issues are translating into the behaviours or if there is somethingelse going on? But you're right, the assessment is the key thing. SALT will take it forward, so now begins the wait.

As an alternative viewpoint, my friend's profoundly deaf DS wasn't DXed with Dyspraxia until he was 14 because while his fine motor skills were poor, all his social deficits were put down to his deafness.

My DS has ASD and this was first spotted by a SALT when he was 2.9, who was too professional to mention it but she did persuade me to have him assessed by a paed. He was DXed at 3.5 by the paed and the SALT together. I would definitely get him reassessed, as you say he might not tick all the boxes for ASD, but it sounds as if something is going on. How old is he?

Oops, just saw thread title!

Thank you. Yes, he's 3 and a half. Much, much improved re: behaviour and speech is generally very good apart from pronunciation, but something else is going on , I'm sure- the question is, what?

Thanks; this is helping me think it all through.

None of us can or should speculate - but I have to say from your list it sounds like he has as many characteristics that would rule out ASD as ones that would qualify for a dx.

he loves other children; has friends; has theory of mind as far as I can tell; has imagination; does not do things repetitively

Those are all massive plus-points. Even if he is eventually dx with ASD, if he has these qualities at 3.5 he is doing really well.

But take him along for assessment in any case.

In the meantime try, if you can, to forget about an ASD label. Concentrate on helping him in the areas that he needs help. It sounds like compliance is a bit of a problem - try reading Robert Schramm's book (it used to be called Educate Towards Recovery but has changed name, sorry can't remember what but google should find it). It's about ABA but has a very useful section on the 'controlling child'.

I agree also that s&l difficulties will almost certainly cause problems in other areas.

Speech problems can present as ASD but the ASD symptoms can reduce when speech improves. Someone who worked at a S&L school told me they often get young children in and don't know if its pure speech problems presenting as ASD or is ASD and its only over time when the speech improves that they can tell which also have ASD.

But I also know many children with ASD traits who have never been diagnosed with anything and it is quite possible to have some ASD / sensory / dyspraxic traits but not the full bundle.

Nothing you would use with for ASD is harmful. Trying out different behaviour methods etc is not going to do any harm. Desensitisation programmes to change his behaviour / routines can help e.g. rewarding him for tolerating even small chunks of other people singing etc - we do ABA and have worked on DS becoming more flexible and tolerant to things just like this

Its important to figure out if its behavioural or sensory reaction - it sounds as though its a rigidity. DS is like this he invents rules e.g. only I am allowed to sing that song o do it in a certain way - and then we have to break down his rituals otherwise they would just take over and we do this by rewards e.g. earning tokens while tolerating something he finds hard and building up the time - then he gets a reward e.g. computer time / favourite toy when he has earnt the tokens. You can start by having a board with just the last token off - singing for a few seconds then he gets the last point and reward - praising all the time he is tolerating it esp if being quiet / sitting nicely - label the behaviour you want e.g. 'you are listening really nicely' - so he knows exactly what behaviour is being rewarded and will hopefully do more of it! Then 2 tokens etc. That way you can gradually work on the intolerance. just work on one thing at a time though.

We have done this with songs, food, routines, places, clothes, haircuts, nail cutting etc and usually DS will become more tolerant and often it stops being a problem at all. You also get more alert to when rituals are starting and can nip them in the bud more quickly by insisting on changing them before they get entrenched.

It doesn't have a good evidence base yet but you might want to read up about RDI as well as ABA, that is supposed to work on flexibility.

bialystockandbloom- Thank you. I will get that book (now called 'Motivation and Reinforcement: Turning the Tables on Autism '). I am trying hard to forget the ASD label, particularly because I am not totally convinced he fits; but it's a hard thing to get out of your mind once it's there.

Thanks AgnesDiPesto- I sometimes wonder if it's sensory (bad reaction to certain clothes, hates noise, occasionally doesn't like lights (mornings), doesn't like being wet).

I like the ABA approach so will investigate further.

We have worked well on listening and specifically praising that, and it has improved- perhaps now it's time to try singing, and then move on to something else. We tried going on a different number bus yesterday and to my great surprise it was fine! So things can change.

I do need to get DH onside though as he is totally unconvinced that there is an issue.

Thanks everyone. I can't telly ou how helpful this has been.

Have you looked into sensory integration disorder? Sensory issues are often a feature, an possibly even a causal factor in ASD, but it is possible to have sensory processing problems without the social communication problems of ASD.

Sorry, hadn't read properly- now realise the sensory thing has already been mentioned.

Thanks , EBDteacher- yes, I have had discussions with people re: SID and I will follow this up further after we've had a paed consult. Not sure we can afford a private assessment for SID at the moment (I understand that it is not totally recognised yet byt the medical profession).

Have a look at PDA - it's an atypical ASD and not very well known so could easily have been missed.

One thing I have learnt over the last two years (since we knew for sure that ds had ASD) is that rigid behaviour (including tantrums if routines are messed up - like the singing thing you mention) is often down to a need for control.

If a child can't make sense of a lot of what is happening, whether because of eg language difficulties, impairment in social imagination, reading social situations etc, there might well be an increase in control as a way to reduce anxiety. Things like having to have the same route home, only singing the same songs, repeating rituals, saying the same thing, repetitive play - all these familiar patterns are reassuring. I think we all do it, even as nt adults, to some extent! But of course if it takes over and stops normal functioning then it's a problem.

As agnes says, if you can break down each new step you want to teach him, and reward, reward and reward for doing things outside his normal patterns it will help enormously.

The Schramm book is great on this - explains it much better than I do!

Thanks silk: I had never heard of that. Will read more.

bialy yes, that sounds familiar. He sticks to familiar things because they are reassurring.

But today I decided to work on the bus thing in the way that you and agnes suggested. He usually likes and insists on the #XYZ bus, but the #XY came instead. He was about to get upset but I reassurred him and praised him for getting on (he paid the driver!) and he sat beautifully all the way, looking at all the other bus numbers out of the window.

So I will work on buses now, and singing next.

Thanks so much. Can't wait for the book! I actually feel more like I can DO something now and it isn't just my shitty parenting causing this.

One thing just struck me- he ins't bothered generally by noise- can happilly go to stations, busy shops, nursery....just seems to be us singing and very crowded public places (although the latter may be to do with the people rather than the noise).

He likes music on the radio/TV/CD/computer. Puzzling.