Speech and language report, Autism?

[JustPondering]

Hi, I have an almost 6 year old who gets input from SALT. He has recently attended a social communication programme for 3 days.

When he was 3 I was sure he was autistic, but was told he probably wasn't as he was so happy and spoke to anyone, was affectionate etc. So last year i discharged him from the peadiatrician and from SALT as his teacher thought his speech was progressing fine. Then out of the blue i got a letter from SALT saying that DS needs to attend this group so i took him and have arranged a speech review.

The report that I have recieved from his speech therapist confuses me a bit and I am not sure whether this means he might be on the autistic spectrum or not.

Can anyone take a look and help me understand please? I'll copy it out:

Comments: DS tried very hard in each session; he did need continual reminders to wait his turn and not to speak when it was someone else's turn to answer; DS was very dominant in conversations and found it difficult to identify when he should stop talking and let others talk. DS was very keen to answer all the questions and comment on a range of topics. DS occasionally tried to direct adults by telling them what they should do.

DS has a very vivid imagination and created a fantasy related to a range of topics eg got bit by a dinosaur and his mole was a bruise, his car is as big as his house and that he met a giant and saw a beanstalk. This led to DS being very distracted from task and he needed continual reminders to return to the task at hand.

DS became upset when he had to wait until last for his turn or when someone chose something before he did. DS presented with difficulties with his speech, particularly clusters which sometimes made it hard for the listener to understand the words he was saying; DS also spoke with a fast speech rate which also had an impact on his clarity of speech.

He has demonstrated some learning strategies taught in the group and responded well to specific praise to recall the srategies idscussed in the group. DS participated well during the sessions and demonstrated some social skills throughout the sessions.

Strengths:

DS appeared to thouroughly enjoy the groups and was keen and happy to join in all the activities and games completed. DS' emotional vocabulary is developing and he was able to draw an angry, sad and happy face and comment on what made him feel angry happy or sad. He was able to match a situation to an emotion, eg. saw a spider- scared.

DS displayed some good listening skills during the activities but he did find it difficult to follow 3 part instructions. DS could racall all the group rules and used some of them during the session.

Skills developed:

As described above DS developed his looking skills during the sessions this week. DS did initiate conversation with his peers in the group and responded to questions if directly asked. He gave good eye contact when talking to peers and adults.

I am going to make an appt with my gp and ask them to send another referral for him. I still suspect that he is on the spectrum. He watches TV upside down or while spinning and looking to the side. He holds his hands in unusual stiff positions, he is over emotional but seems to lack some emotions like guilt or remorse. He still cant pedal a bike not even a trike.

But could he be on the spectrum and have an amazing imagination, his imagination is more advanced than most his age.

Thankyou for reading this long post!

Oh he was diagnosed with moderate to severe phonologiacl alnguage disorder mild receptive language delay and moderate expressive langiuage delay when he was almost 4 if that is relevant.

He still wears dry-nites for bed.

If you ignored the vivid imagination, he could be on the spectrum, certainly. But he doesn't quite seem to fit. Have you considered dyspraxia with verbal dyspraxia? The report makes him seem quite domineering in a group situation, not really having fully developed social skills in that area, yet. DC with ASD, especially HFA, can be friendly and affectionate, BTW, it's just the quality of their interactions aren't quite 'right.'

Does he have any rigidity of behaviour? Reliance on routine, having to be in control of games, obsessions?

TBH, he doesn't sound NT but you need a specialist prof to iron it out. Was his paed a neurological development specialist? Or a general community paed? There are private paeds who will assess. My DS's pead is a communication and interaction and epilepsy specialist and even she seemed to find some DC difficult to DX until they were 7 or 8 despite having them on her books since 2 yo.

Sorry, no real help, but if you are concerned about your DS, then I'd be trying to get him referred back to an appropriate paed.

yes, it is possible to be on the spectrum and have a great imagination in terms of story telling etc, as it's more social imagination that is the issue in terms of having a feel for what other people are thinking etc.

obv noone can diagnose online, but it does sound like your DS has some ongoing language/social issues, and it is worth exploring further with the specialists. sounds like a mixed bag, that SALT's report, as some is positive re:social skills etc and some is negative. Did the SALT say what (if any!) follow up there will be from this group, particularly given the receptive language difficulty they have pinpointed?

There are some things there the spinning for me rings bells. But he sounds huge fun and rather lovely. I also found over the years that hese reports always seem to pick out negatives which gets draining.

Ds has a great imagination and can pretend play too, in fact sometimes he has difficulty seperating fantasy from reality ie he will learn a fact and then put his own slant on it!

It was explained to me as children with ASD usually have difficulties with shared imagination, rather than just imagination itself ie incorporating the ideas of others into his. Difficulties with flexibility of thinking, rigid thinking ie it is very difficult for ds to change his thinking once he has an idea or to move on from his idea.

Hope that helps in some way.

Hi, I did think he may have dyspraxia but he doesn't have any problems with fine motor skills, although his speech problems seem to fit perfectly.

He can't always seperate fact from fantasy, he will sometimes get very upset when i tell him that what he is saying is not true or possible.

I'm not sure if he lacks social imagination, he always thinks people are his friend even those that bully him, he says no they are his friends when i tell him that they wasn't being nice to him. He goes up to children and says, 'Hi, wanna hear my funny guess?' then goes on to say a joke that is in no way funny and also doesn't make sense.

He always has to be in control of games and he has to win all games or he has a meltdown. And he doesn't seem to have a good grasp on emotions, in theory he knows all the emotions and what they mean, but he cant put them into practice. He never seems bothered if someone is hurt, and when his little brother is poorly and has to go to the docs, he has tantrums because he would rather stay at home and play. The other day my sister told him not to feed her fish as it had already been fed and it could kill him, he didn't seem to bothered and fed him anyway.

I have to tell him something about ten times till he understands what i want him to do, even simple things like close the door, he hears the words but doesn't seem to process them.

He has some great strengths though, he is the friendliest little boy i know, and has a very strong sense of fairness, for example if someone takes someones toy, he knows thats wrong and gets upset so i guess that is an exaple of empathy.

He does have some rigidity, he only wants to wear ben 10 clothes or goody green ones, only wants to eat of his ben 10 plate and lines up his books and shoes on his floor before he can go to sleep.

He is a baffling little boy certainly

How do i go about seeing a neurological pead? Can you only see one privately? It was a general pead that he used to see. Her thought were that he would pass ADOS so didn't send him for one and that he was very charming

He sounds very similar to my ds. Community Paeds told me for 3 and half years there was 'no way ds had autism' or 'he was too bright to have autism', in my opinion their experience of autism was limited (with hindsight). They seemed to want to see severe difficulties. All the red flags were there at the age of 2, but he didnt receive a dx until he was 5 and half.

I spent years being pushed from pillar to post, never seeing the same paed twice and being referred off in all different directions.

Our breakthrough came when we moved boroughs. The Paed we were referred to was part of the Child Development Centre and the ASD assessment team.

Where would the Paed have referred you to for ADOS?

The more examples you are giving, the more he sounds on the spectrum. DC with ASD are often very strict about 'rules' and 'fairness.' Processing delays could also be a sign, but can also be due to other things.

I was lucky that my DS was referred to the correct paed straight away. Can you go back to your paed and ask for ADOS? There are private specialists but is depends on whether you can afford them.

social imagination is about getting things right socially, taking his age into account, so if he's not initiating conversation appropriately or not realising people aren't his friends then it does sound like he has difficulties with this.

In terms of the NHS - if you specifically want him to see a neurological/developmental paed, I would work backwards - go online, check your local areas asd protocol, and if that doesn't involve the right sort of paed, phone up the hospital and either speak to the dev paed's secretary or their referrals department to find out more about how to get him referred.

I don't know where they would have referred him for ADOS, I never asked because she said she thought he would pass. Last week the speech therapists that ran the social skills groups he went to said that it's worth going back though as what can be normal at 3 isn't necessarily normal at 6.

He is initiating conversations but he has an odd way about it.

There's lots of little things about him that make me think hmm that's not quite right, but they just seem insignificant on their own. Today I have my friends 11 year old overnight and he keeps insisting on calling him Damien even though he has been repeatedly told he is actually called Kieron. He has also not stopped crying and shouting all day, which is typical every time someone other than family are here.

He also gets a bit confused if I nod at him instead of saying yes, he gets mad saying he doesn't know what I mean and why don't I just say yes!

I can't afford to go private without taking out a loan unfortunately although i am getting seriously tempted.

He has a doctors appointment next week so i will see what they say. I am starting to think he probably has got a form of ASD especially since my health visitor is monitoring my 15 month olds speech and social development as he has been failing her tests and cant wave or point yet. It makes me wonder. Although I think the lack of gestures could just mean a language delay or disorder.

I am going to do a bit of googling and see what i can find about developmental peadiatricians in our area

Hi, just an update

Ds has been referred to a peadiatrician after his latest speech therapy appointment. The SALT said that he seems to have problems with his receptive language and his social and emotional understanding, She said that he can say what is happening in a picture but cannot explain why or how they may be feeling appropriately. He also continues to present with cluster reduction.

He has also got some medication from the GP for bedwetting, it has been a productive few weeks!

The latest letter from Speech therapy says that DS will be having further formal assessments on his higher language skills, any idea what this means? What are higher language skills? Does it mean comprehension?

Hello Justpondering, you're son sounds similar to mine except that my son seems more extreeme. How is he in school? Role play, controlling and mood changes are like my son. He also often cannot snap out of role play, is charming, manipulative, bright and has variable eye contact. My son has a diagnosis of PDA , this is an autistic syndrome disorder ,but is quite different to others and often mistaken for other problems. My sons behaviour can be quite aggressive , he doesn't respond to sanctions or rewards but being negitiative , using humour and being very indirect is helpful. might be worth taking a look at the diagnostic criteria.

It's interesting to hear about PDA Walter4 I have never heard of it before, it sounds worth mentioning to the peadiatrician though.

My son isn't particularly aggresive though although he has emotional outbursts when he can't have his own way. He definately uses charm and manipulation to get out of doing things though. He calls me lovely mum and is really affectionate when he doesn't want to do something. Or sometimes pretends to be a rabbit I find that it is easier to get him to do what i need him to do by using manipulation myself and making him believe it was his idea all along and that he is in control.

Also he was very difficult at speech therapy at the last appt, he wouldn't co-operate and was pretending that he didn't know the answer to some questions that I knew he did. He spent a lot of the session fidgeting and rocking. He had a lot of bizarre answers for some of the picture questions that made no sense. Although one made me laugh, a girl had fallen down the stairs and broken her glasses, DS said that she was feeling happy, and when the therapist said that she thought she was feeling sad DS said no definately happy as she would be getting new glasses

He has started tip-toe walking since going back to school for the new term, usually in front of the TV, he paces backwards and forwards on tip toes while swinging his arms. I have took a video to show the peadiatrician.

He is OK at school I think although he doesn't have any real friends although he thinks he does. And I often catch the teachers rolling their eyes at him when he doesn't do what they ask of him, but that may be because of his language difficulties. He has problems with phonics and can't blend phonics to make a word. He usually comes out of class looking emotional and teary for no particular reason, maybe relief that I am there, I don't
know.

I don't know why I find it important to have a diagnosis zzzzz I guess it is because at the moment I feel he is misunderstood and isn't getting any help at all at school and I feel he needs it.

Not all children with PDA are physically aggressive, but this often happens if they continue to be misunderstood or constantly treated with tradional methods. My son is 4 and was diagnosed this summer, however , this is very early , they usually cope till work becomes more structured yr 1. My son also does not have real friends as he is so controlling in play, but thinks he has. My son also toes walks back and front when anxious. He can also often appear totally ' normal' on a good day! On a bad day it is indescribable and impossible. Take a look on the national autistic society page for PDA also the forum on PDA contact is so helpful and parent are extremely knowledgeable.

I think they do provide services for children with ASD as there were some children in his social skills group that seemed to have clear ASD. But I will ask about that at the next appointment.

I know what you mean about waiting years for diagnosis I have a cousin with aspergers who wasn't diagnosed till 8 or 9.

He sounds very much like my dd1, she has Aspergers, can talk for england and often talks quite fast making her hard to understand at times. She has great imagination, loves fantasy, loves role play but has to be in charge of most situations.