ASD behaviours or just social anxiety?

[Blossom4538]

Hi all,
So DD has some quirky behaviours and social communication struggles, along with other difficulties. No diagnosis as yet for ASD as may be too soon and Paed wants to re-group next year. She has Selective Mutism and anxiety.

So, she has a little friend who lives across the road from us. I know he feels sad sometimes when she can't chat to him or say hello. One day she will play and take the lead (control?) and others she almost appears to ignore but will do things to get his attention. Example, the other day she wouldn't come and say hi or acknowledge him, but started trying to do backwards rolls all over the grass, in her school uniform, knickers on display! She then went on to talk loudly about all the caterpillars which appeared in our garden (it was for his benefit but by this point, he'd gone off and wasn't listening).

Today, we had her hairdresser over to cut her hair. She couldn't speak the whole time and at the end as she was leaving, ended up crawling along the floor. Afterwards, once she'd left,she was hyper and v v talkative! A year or so ago, she would have probably removed most of her clothes with visitors or afterwards!

Does this sound a little like behaviours associated with ASD or just seem like social anxiety do you think? Do your children
Ever behave like this?!

Also, she always talks over H and I when we talk to each other orneed to discuss something. Or she'll do something to grab our attention, scream, sing loudly, do something to provoke reaction...! So hard for us to have a discussion. E.g. mundane things like this evening, organising when Someone can come to fix washing machine!

I didn't want your post to go unanswered. I diagnose autism.

Does she have any repetitive behaviours?

I'm not sure. The consultant paed seems to think possibly so. They are saying too soon to diagnose. Her Selective Mutism means they are unable to get a clear, full picture at present and they said issues with friendships will become more apparent with age, if she is.

She does have some sensory struggles.

Walked on tip toes a lot at home around age 3-5 and it has calmed but I do see it sometimes.

She has been physically aggressive towards us since around 18 months - she's now 6.

She avoids eye contact with people other than her Dad and I - this can also be a trait of Selective Mutism.

She can be quite "intense" id say, and "busy/lively" - but does sit still at school.

She has had a tics - a little cough which lasted about 4-5 months and the longstanding one - eyebrow raises but this isn't as prominent as it used to be, quite subtle that only her Dad and I would notice and it's occasional.

She only started to alternate feet going upstairs at age 4-5 and struggles coming downstairs. It doesn't come naturally to her.

She hates using cutlery and was a reluctant writer but has progressed a lot this past year on the writing front.

I know we should stop analysing but we can't help it!

She also doesn't like people looking at her at times - and gets agitated and says they're staring.

OR, she will behave in a way where she is trying to get attention it seems!

She's a complex little lady isn't she? I can understand the paed saying its a bit early I some ways but then she's six now and some of the things you say are not typical of social anxiety (eg sensory struggles). I have two daughters and if this was one of my girls I would absolutely want her to be assessed for ASd

Thank you for replying. She is complex and that's exactly what an OT said!

I think it's almost like "prepare yourself for ASD diagnosis" (we feel we can see Aspergers traits) but they are just not prepared to diagnose as yet. I know Selective Mutism often co-exists with sensory struggles, but realise there could be an ASD underlying, creating these difficulties.

She copes/masks at school but she is anxious over change of routine and anything can bother her and then the following morning we'll have difficulties getting her ready for school or even getting her to school, at its worst. We always manage it but she has been an hour and a half later before! School are understanding.

Taking each part of her presentation separately, it would be easy to miss the bigger picture that (to me as a diagnostician) sounds like ASD.

My impression is that, due to her complexity and the fact she is a girl (girls often present differently as you will probably have read), until you get to see a team experienced in diagnosis of girls then you may have a series of different professions describing her as complex or 'a puzzle' and taking a 'wait and see' approach because they don't have the skill or experience to piece together the different aspects of her presentation.

I would push for an assessment that includes a very detailed case history interview (I personally prefer the DISCO for diagnosis of girls). I use this in both my NHS and private work so its not something that is only available in the private sector. I'm pretty sure this would tease out the different aspects of her presentation and give you the answers.

She is indeed complex but that doesn't mean she should have to wait. On the contrary, I think complex children should be seen more quickly.

Just to add my DD sounds similiar - and was diagnosed with selective mutism at 4 and then ASD at 8.

We did have to push for an ASD assessment - CAMHS wanted to wait for the SM to resolve... (which wasn't likely and DD still most definitely has it at 12).

Do you have an EHCP in place? I know it's early days, but as she just about copes in school, I worry she will go under the radar a little (although I won't let this happen!) - I hear horror stories about transition to secondary school.

Does your DD cope at school? How is her SM? I feel so sad that she cannot speak to Grandparents. She is our only child. It's such a shame for her to not feel relaxed around them. We have the SM manual and are aware of strategies but it doesn't seem to help. She will now speak at school (won't read aloud) - won't always speak to everyone or if she feels overwhelmed orintimidated at all by another child.

DD does have an EHCP - we applied when she was in Y4 about 6 months after her ASD diagnosis because her anxiety was affecting her school attendance. Just after that DD became too anxious to be in class at all - we spent a few months trying to 're integrate' her but it didn't work.

So DD moved to a very small special/specialist school for DC with moderate additional needs. The LA named it on her EHCP. At that school DD spoke to teachers and TAs for the first time - and in front of (a tiny) class.

DD moved to a small mainstream independent secondary - there is no way she would have managed in a class of 30 in a state school. Her classes are 12 at the most. She has made a good transition and speaks to some teachers (obviously lots of subject teachers in secondary) and to her classmates.

As for outside school DD has never been very consistent about speaking to grandparents. At her most anxious she stopped talking to them. And she has hardly spoken to her aunts, uncles and cousins who she only sees occasionally.

DD is very mute with strangers - very little eye contact as well. That has got more difficult as she's got older - adults expect an older child to be able to speak and I don't always want to explain about SM and autism. And I don't know if it's the SM or autism but for example, today DD couldn't speak to the 2 instructors at riding (we're on holiday and went for a trek) and she couldn't shake hands with them.

Sound so alike. I think we are trying not to,
but both H and I are feeling quite down at the moment. We have v challenging behaviour at home - avoidant, aggressive, defiant and blows up so easily. I know it must be so hard for her.

She sounds a lot like some children we see in clinic with a diagnosis of PDA-type autism.

We see a lot of children with PDA in our private clinic because, by nature, they are harder to diagnose or properly assess. I think you should pursue that. The PDA society has a great website.