Does it make Asperger? Please help as assessment is coming

[Worriedandlost]

Hi everybody, I am new here, so do not judge me too strictly!

My DD1, 5yo, has social communication problems (does not play with children, does not know what to say, does not reply when asked, though happy to be around and keen on going to school, occasionally can kick a child or kick/bite an adult when frustrated). She is watched by child development team. Her pediatrician admits a problem, but cannot fit DD1 into ASD, as DD1 only has communication problems, but has pointing gesture, can make eye contact, does not have floppy hands, etc. She is also clumsy and academically ahead of her peers.

First suggested diagnosis was selective mutism (DD1's first language is not English, though she is fully bilingual now, I think this was confused for mutism). The the next version was social anxiety in spite of the fact that DD1 is confident in unfamiliar places with unfamiliar people.

My personal feeling based on various reading is that DD1 has Asperger - question is - can it be dagnosed with only one ticked box - social problems? Did anyone have child diagnosed without all the rest - floppy hands, absence of pointing gesture, etc? We have next assessment coming and I started to think about second opinion now...

Worried hello and welcome! It is difficult to say based on a few paragraphs, but I think your gut is pointing you in the right direction. ASD in girls can present differently and be more subtle. They don't fit the Classic Autism picture (in fact Classic Autism is a subtype all its own, although subtypes are about to go out of the diagnostic manuals). So to diagnose ASD in girls you often have to look more closely to how the 'triad of impairments' expresses itself.

My dd2 is awaiting formal assessment and we are pretty sure (well, hopeful) she is going to get a diagnosis. She does not flap hands (did you mean flap or flop?), can make eye contact and is socially very motivated, but the triad is there, you just have to be a bit more canny to identify it. Diagnosis (or rather under-diagnosis) of Autism in girls is a big issue. Have a read around the subject.

Having said all this, high functioning Autism and Aspergers can often be difficult to distinguish from other problems until children reach Key Stage 2 at school, when the social interaction of other children becomes more sophisticated and the Autistic child's discrepancies become more apparent. So given that your dd1 is 5 there may be merit in a bit more watching and waiting. Are you keeping a diary of her behaviours and triggers? Is she inflexible and restricted in any of her behaviours? Does she have a good understanding about the motivations and beliefs of others? Is she able to cope when things don't go her way at home? Does she have any siblings? Are there any sensory issues?

You could start thinking about a second opinion, although that can be difficult in the NHS. Is the next assessment a formal ASD assessment? If it is then it should shed some light. If not, you could ask for one outright. Sometimes you have to get assertive and start thinking of yourself as The Lead Professional in all of this (which in fact you are, just think of all the experience of your daughter and all the knowledge you have). You might also want to push for referral to Occupational Therapy if she is clumsy. ASD is often accompanied by Dyspraxia.

Above all keep reading and posting on here, there is a wealth of information and experience here. There will be more insights and suggestions here I am sure.

Morning worried. No judgement here, just trying to do the best for my DS, knowing I'll never get it perfect but hoping to get some things right.

My DS was diagnosed at 7.5y with High Functioning Autism/Aspergers.
He would have had none of those "symptoms" (flopping hands, absence of pointing etc).
What he does /did have was an absence of social imagination the triad of impairments. So he has difficulty understanding that what he wants/his interests are not the same as others. He can't 'see' social rules.
He has associated movement problems, very uncoordinated, clumsy. And has HUGE sensory processing problems.
If you think this is the path you are on, try to diary all the 'quirks' your Dd has, all the mannerisms that are just her.
There is great support here, you're not alone in this.

I have a Dd with Asd/aspergers and would agree with Handy and Porridge, many proffs are still not recognising Asd in girls and it is massively undiagnosed.

Keep coming on here for advice and support

Do you have any eccentrics or autistic types in your families? If so, mention these to drs as autism is usually genetic so that would be evidence.

Just to confirm what has already been said.
ds2 is currently assessed for Asperger and doesn't have any of the hand flapping, lack of pointing etc...
However, he is also bilingual, also had problems with communication that were all put down to the fact he is bilingual.

Ime, if the problems your dc has are present in both languages (eg struggling with the social side, no friends etc...), then it's more likely to NOT be linked with the bilingualism (and how difficult it is for these poor children to learn 2 languages at once...).
I would look at how good she is imagination wise, difficulties with routines (or the opposite difficulties in dealing with what lies ahead), sensory problems (Look at all the details. The usual are lights, sounds, labels but I found ds can cope with that but with other things such as sand on his feet. Also can come out with what is a lack of sensitivity such as not knowing you have a tooth infection) etc...

I would have a read around AS and then with that in mind keep a diary of what she does that looks unusual.

The other thing that helped a lot was an evaluation from a SALT privately. It cleared the fact that ds2 doesn't have any issues with english as such but also highlighted spikes and issues with communication (eg difficulty in relaying information). That was a good starting point of discussion with other HCP.

It is interesting you say that about relaying information Labels. Our private SALT also said my dd2 is poor at that dedpite good functional use of grammar etc. We mused about it, wondering if it has something to do with not realising other people do not know what you know (theory of mind).

Interesting pov...

I think part of it is his inability to answer 'open' questions. Part of it is the issue of relaying information that doesn't 'fit' (So OK for general class info for a day trip but not OK for a personal thing that he has to do).
And a big part is just a plain inability to express his pov clearly, which I suppose can be part of the theory of mind as he is very good at starting his explanation with 'It'.

I've found people with AS tend to be very emotionally literate/perceptive/ expressive about their own feelings, just less so re those of other people's.

Dear all, thank you soooo much for your replies, reading them gave me some piece of mind, and I agree - it is so much of support here (which I saw before as I was reading discussions for some time).

Handywoman, I meant flap hands, sorry! did not remember spelling :).

Regarding the questions-DD does not seem to have high functioning autism, I looked at it too! saying that HFA definitely fits better than mutism or soc.anxiety! DD had some sensory issues, though I think she may ovegrew them (is it possible?)-she used to be scared of loud music and crowd-like she would scream if I took her to funfair, or she hated musical and speaking toys. She can handle the change of routine but some things have to be told in advance, like if we go to the store and it is closed she may get extremly upset. Or when she was at nursery and they changed sitting places in a restaurant she refused to go. About her understanding motivations and beliefs of others - I am not sure, she seem to get it to some degree, but how far I am not sure...She has a younger brother which she treats no different to other children, hardly notices him but quite happy that he exists!

Our next assessmnet is not a formal ASD assessment, we already had a formal one where mutism and anxiety came up. Assessment she has is unplanned but was offered after I moaned at meeting with Pediatrician and school's senco backed me up. I also looked at Dyspraxia before, does not quite fit in there. I will google for occupational therapy (so much I do not know yet!) and thanks again for your answer-it cleared my head a lot!

porridgeLover thank you for sharing your experince, it made me more confident in my view of diagnosis now :) Yor DS sounds very much like my DD, apart from sensory issues which were not that huge problem.

Ineedmorepatience, thank you!

SilkStalkings, as far as I know, no one in the family has autism. Saying that, at some point I satrted to think about my husband as DD and him have similarities in certain things. However I now think that he is just a man :), so probably not... but I read discussion about Asperger husbands-very interesing reading!

LabelsGalore, thank you, yes the same problem was when DD went into her second country for a short period of time, and yes, I forgot about clothing labels, and seams of course-she is very sensitive to these. I also started to think about private assessments but after reading the answers here I feel that I have to dig more into subject before doing something- quite a few things were mentioned of which I was unaware.

Thanks again to all who contributed to the discussion, a lot to think about and google!