Possible ASD

[helenfagain]

My son is 22 months and I've suspected for the last 6 months that he may have ASD. Everything seemed fine (apart from the absence of pointing) till about 15-16 months when he stopped waving which he used to do all the time. His speech also regressed. He started walking at about 17 months and the health visitor believes he regressed due to concentrating on that. He's since made a few developments in speech (now has about 10 words) and joint attention (since I took him off dairy but don't know if that is a coincidence) but still no pointing or waving.

He can follow some commands like kick the ball and high 5 and brings lots of things to us and he waits and looks at us till we say thank you or if we don't shout goal when he kicks the ball against the radiator he will look at us (and sometimes shout goal himself). His eye contact is hit or miss and he doesn't always respond when you talk to him (usually if he is concentrating on tv etc). He also tantrums quite a lot (over food running out usually) but it seems to be calming down a bit. There is no imaginative play either and he isn't interested in trying to identify items in books. He loved a story or a song though and if you finish a book he will go back to the page you started on and tap the page for you to start again but when you are reading he wants to turn all the pages too quickly. He also picks up our hands and claps them if he wants pat a cake.

I might add that he failed his newborn hearing test and we've been trying to test it since but he won't concentrate during the test and just tries to run off. We know he can hear at least at some level though. He's been referred to salt but I know we will have a long wait. The he doesn't seem at all concerned about ASD and I feel like I'm being ignored. It seems to be the norm here not to diagnose till at least 6/7 but I keep reading that early intervention is the key. I'm confused as to what I should do. Do I keep pushing, or go private?

Has a referral been made for him to be seen by a paediatrician? It's really great he's gaining skills but for some of the stuff in your op (the lack of pointing and waving plus the no imaginative play) I'd say there's enough concerns there to warrant a thorough assessment. Not all HVs are knowledgeable about ASD, and as there's also a question mark on his hearing I would be pushing on for him to be seen by a paediatrician.

I've no personal experience of the private route. I'd say if there's a long wait for SALT a private assessment may be helpful in terms of getting strategies and advice you can use to help extend his skills.

6/7 years seems very old to assess, but that said, under 2 is also very early.
I think the hearing assessment might be key though. When you say "We've been trying to test it since" who is 'we'? Is that the paediatric audiologists? Many children can have a significant hearing loss without being completely deaf, and, even with a mild loss, it can make a huge difference to both speech and also social interaction at a young age. Then there is the possibility that it is more to do with processing than the physiology of hearing. Or, of course, that there is no issue - but it's something most assessments would want to rule out even if you did get a referral, that would take it one step further down the process.

Does he go to Nursery or any playgroup ? What do they say? Have you shared your concerns with them ?

From what you've written, it's not screaming ASD to me, however nobody can make that assessment or even form a strong opinion from a couple of paragraphs on the internet.

He's been back and forth to audiology since birth but the first couple of assessments he had fluid in his ears (he was a very quick delivery and had pooped in the womb). The next one he was asleep but had a cold so was snoring so loudly they couldn't test. His last 5 or so he just wouldn't sit blooming still and he won't let them put the things in his ears to do the electronic test.

He goes to nursery 3 days a week. They have noticed similar things to me but have commented very positively about his recent improvements.

If he failed his hearing test,you need to look into that, 22 months is not an age where you could say hey he has Asd because that age is a funny age for toddlers anyhow. I would not expect a 22 month old to have imanigitive play to be honest, if you said yes hes 8 years old and cant do that then fine, It sounds like your trying to force too much on him,hes only young.

In a few years if he has not caught up on all these things then question it, your child will have a 2 n half year check soon, the health visitor will test him in various ways then tell you if she thinks hes delayed, but quite frankly its probably his hearing. get his hearing checked again, if he has hearing problems it will be sorted out quickley, what made you question Asd?

And if nursery had concers they would get the early years ed pych in, they havent done that so dont worry xxx

I would ask the Nursery to fill in a developmental profile now then, and then they can put a plan in place to particularly focus on any areas he is struggling with, and then review it before the end of the Summer Term. It will give a more objective measurement of his development either to reassure you, or as evidence for you to get the referral to a Paediatrician if that is felt to be appropriate.
The Nursery SENCo can also ask their Area SENCo (or Inclusion Officer, or whatever name they go by) for advice, and another (experienced) opinion.

Thanks everyone, I think I will talk to nursery again.

We have been trying his hearing every couple of months but he won't sit still for the test. They can do one under general anaesthetic but are loathe to when it is obvious he has at least some hearing. He got ok results on normal sound level during the sleeping test but they couldn't test 30 decibels due to his loud snoring interfering. It's very frustrating! I'm really hoping they can test next time.

Things that make me think ASD are as follows
Doesn't always respond to name
Poor eye contact (this is improving)
Behind in speech
Loss of waving skills around 15 months
Loss of words around 15 months but these are coming back
Has never pointed
Head bangs (this does seem like it may be associated with teething though)
Bad tantrums
Unusually high pain threshold
Can seem disinterested where other children are interested, for example if dog walks past etc.
Will very rarely follow a point.
Nips and bites a lot (and finds this funny)
Flaps (only when excited though so not sure if this is 'normal').
Very nervous in unfamiliar environments. Can cause tantrums, again this is improving.
He has issues with walking outside, particularly on hard surfaces but this is improving a bit.
Eats a lot, and tantrums when food is done. I believe overeating can be a sign as well as undereating?
No simple imaginative play like talking on a pretend phone etc.
Puts everything in mouth and chews books etc to the point of destruction (again this may be teething related but he's getting his last 4 now so should find out)
Often doesn't 'check in' while playing.

I'm sure I've missed a few but these are the main ones.

I forgot to mention that his tantrums are self injurious, he throws himself backwards and bangs his head off the floor. These seem to be reducing in frequency though.

Hmm, that list does seem to point to an assessment being a good idea. The Nursery should be able to refer if they have the same concerns - doesn't have to be a HV.

Helen - he sounds like my son. Also regressed and then picked words up again. Bad tantrums and eye contact is hit and miss... the flapping when excited is another one too.

I think I would certainly push for an assessment (my son is 2.4 and is going to be having his ados soon)

It could well be nothing, bit as you say - early intervention is key. So no harm in pursuing an assessment.

You have very good reasons to explore things further - self Injourous meltdowns and regression of speech are red flags I was told.

Have you done the M Chat online?

Yes, I've done Mchat, comes up high risk but I wondered if he is perhaps just a little too young for it to be meaningful yet?

It's designed for their specific she group, so unsure it would be ?

I think - from experience - the best thing to do is speak with a paedatrician about your concerns and see if they will do an assesment. An assessment will determine if he has ASD or not.

I am not saying your son does. He may just be a wee bit delayed.

Age*

Sorry - my previous post made little sense :

The M Chat is specifically designed for younger children - pre school. So I don't really think your son could be too young for that to be a meaningful Indication an assessment could be helpful?

But as I say- it doesn't mean your son has ASD, only an ados assessment could determine that.

My son got high risk too.

Many adopt the wait and see approach - for good reason. However, we know that early intervention is key with ASD. NICE guidelines state as much. So with this sort of thing I think getting assessments done asap is sensible. The way I see it is if my son was showing signs of a physical condition , would I wait and see? Or would I get it addressed asap? With ASD I feel it's even more important to get an assessment early due to early intervention being vital.

Early intervention can also be done whilst waiting for the assessment. You can start floor time , Makaton, pecs , etc now - we have with our son, it's helped a lot