How fine is the line between Terrible Twos and autism?

[emmafield82]

I have a two year old, 27month old.

He has limited speech although he can say things like "i want..." parrots words, can name an animal if you point to it. I honestly don't know how delayed his speech is - we are waiting for an assment. But thats not my concern as there is dyspraxia and severe stammering in all the children (4) and my husband so im expecting speech issues.

My concerns are his negative behaviour. He gets very angry fast when you say no or he cant have what he wants. He will scream, throw things on the floor. He hasnt yet been violent although i saw he almost bit his own hand in rage when i tried to put him in his car seat last week.

He doesnt co-operate in public places like supermarkets, shops, post office, school pick up etc. If hes in the buggy he can last no more than ten mins (unless he falls asleep). I bring snacks but when they end he screams bloody murder.

If hes on foot, and he decides he doesnt want to come my way or leave he will dissolve into a screaming monster puddle on the ground.

I have plenty more to discuss about my son but im overwhelmed by everything at the moment so just starting with this.

Normal two year old, bad parenting or possible red flag?

Briefly, i suspect my two eldest kids 9 & 7 may be on the spectrum, my eldest has learning difficulties and severe stammer and as of yet hasnt been diagnosed with asd but i strongly suspect.

I think distinguishing between the terrible twos and autism is really hard.

To me, you've just described a bad patch of terrible twos. Particularly when toddlers have older siblings, I think they quickly pick up how to put their own foot down in a very, er, determined way!

Also, I think any speech delay or impediment makes it much much more likely that he will lose his temper. It's very frustrating if you cannot convey what you want.

Lots of kids hate the buggy. I guess I would be wondering if for example he just decides he doesn't want to go a certain direction or whether he cannot cope if you go home via an unfamiliar route.

I think one of the reasons I found 2-4 years really hard was that I had no idea how to differentiate what was autism and what was naughty/terrible twos. It has gotten a lot easier as he is getting older.

With my ds at that age it was all about working out triggers and trying to distract him before he noticed something that would make him upset.

I also found that telling him what we were doing several times before doing it sometimes helped as well as countdowns to transitions.

Maybe you could try and use some visual supports as well. Showing him an image of where you are going or what you are doing next?

Score an MCHAT autism checklist you will find it online. The key to it being autism is the social interaction and interest in others. Does he do back and forth. If you played peek a boo or horsey horsey type rhymes with him facing you on your knee would he join in and enjoy the social contact. Is he more interested in things than people. Does he bring things to show you or point things out. If that's all ok then it's probably not autism but could still be ADHD, dyspraxia, sensory issues etc. You could also find and score a sensory profile and try eg ear defenders or a blanket over the buggy which will cut out some of sensory input if struggling to process everything. Hanen books and courses have good ideas on communication also lots info on a website called teachmetotalk.com and first signs which have info on developmental levels etc

Great advice from @Liv Potter

Have you tried the MChat-R/F online screening for two-year-olds? It may give you a few clues.

I'd be at the GP, with a big list of each one's presentation, a short summary of co-morbid conditions and a precis of any existing assessments, asking for all three dc to be assessed, the sooner you start, the sooner you'll know for sure and have the right strategies to help each one.

emma has he had the 27 month review yet? Ours included the ASQ assessment.

@Viewoffriday
Funny you say that, yes he goes bonkers if I go almost home but deviate for whatever reason. I didnt think he would recognise our road bit he does!

He doesnt flap or rock but its hard to tell about all the other things. Will check out the online test.

Thanks everyone

Yes he had the 2.5 check up yesterday, it went so badly (group setting) she is coming to our house to try again. He wouldnt stand on the scales or be measured...
She wants to check hearing and possibly refer..

But was there a developmental aspect to it such as the ages and stages questionaire? This asks questions such as can they copy you and draw a vertical line, can they thread beads, does he get something to stand on to reach things? That sort of thing?

I agree it's so hard to tell but definitely red flags. I have an 11 year old with mills ASD and her younger siblings have been difficult at times but noway near as hard as she was, and she was very similar to how you described your son. I'm not sure if it's a recent thing you are experiencing so my comparison may not help as we haven't hit the terrible 2's yet, but 23 month old is always happy to go in his pram, the only similar thing is if I let him walk he only wants to go his way and won't usually follow the way I want. All of mine have been like this though. Sometimes he will totally lose control if he doesn't get an endless supply of biscuits or whatever, but its only a couple of times a week and the devastation is dramatic but soon forgotten. After my daughters diagnosis and observing friends I think I'd everything just seems so much harder than other children and you are comparing a lot, then something probably is different. Push for help as much as you can. Good luck.

Hi my little boy is now 33 months so nearly 3, he has been referred for an autism assessment at 22 months he was given a diagnosis of global development delay, my little boy has no communication so we are waiting for SALT, we literally can't go shopping with him he will scream and cry and cover his ears and rock if we do this is as soon as we go in a shop we have noticed it gets worse near fridges and freezers in supermarkets, he spins and looks out the corner of his eyes, walks around with one eye closed, he does not try to join in with other children although most days he will tolerate them playing around him but somedays he will scream if he feels they get too close, he likes to sort things so only the correct things are in a box of his toys e.g. if you put a Lego brick in with his blocks he will want to remove it if you put it back he will go back and remove it again, he is very sensory and will eat his own poo and spread it just to get the feedback he needs, if he has a meltdown he can get violent and will scratch himself if you get near him he will scratch me, dig his nails in to me, pull my hair, I wouldn't say he has a massive issue with eye contact I'd say he will make eye contact but won't hold it for long.

I would second the MCHAT. It is very hard to differentiate the 2. However we knew when our ds was about 18 months, as did family. He would hoard, bite his own arm and others, constantly throw, fixate on wheels, and had limited eye contact.

Even now we struggle with what is normal 4 year old behaviors and what is asd. It's tough!

My DD is autistic and also didn't have those particular behaviours. But I've realised that autistic children can be very very different to one another (E.g. Hypo versus hypersensitivity to certain stimuli, or more social issues versus more sensory issues). It seems enough to start getting into the process so you can access help if needed, but as others have said at this ages it's very hard to tell what is terrible twos, what is frustration due to a Speech delay, what is sensory issues related to autism, what is sensory issues not related to autism, what is some digestive or other physical issue that they can't communicate yet, etc etc etc.

Thankyou everyone, it appears i was over worrying. He may have some crazy loud tantrums but he is not asd - in the last few days i obsrved him giving me kisses when i asked, runs up to daddy saying "daddy!!'" When he came home from work. He brings me lego creations showing me what he made, he points to his brother having his teeth brushed and said "brush teeth" whilst pointing. The list goes on.

I did the online test and he didnt fit.

Its so weird that ever since I started worrying i am seeing more positive reassuring behaviour day by day.

I still have a home visit by the health advisor for his 2.5 check up so will discuss then.

That is really reassuring. They do all just have leaps and pauses. Sounds like it's all good but good to discuss any worries with your HV. Hope the tantrums tone down a bit as he is doing and communicating more, I think that's often how it works!

My son was always calm and happy. He never had tantrums, happily played alone and in general was “too easy”. My first red flag that things weren’t right we’re around 14 months. He never walked anywhere, just jumped and hummed. By 18 months it was obvious. He wasn’t overly interested in us or anyone. Never sought us out at all, never pointed, didn’t have any speech and no understand8nf etc. The assessment started at 19 months and he was diagnosed at 3. Still impeccably behaved until puberty hit! He’s 20 now.

I think you just know when there’s more to it.