what should a nearly 4 year olds language and understanding be like

[Hayleyjane83]

Hi, my nearly 4 year old daughter has a language delay, she saw a speech therapist for an assessment in march and she diagnosed her with a language delay. Nursery have concerns about her understanding and wanted to do a referral for an ASD assessment which I have agreed to and started. But other then speech and language I just don't see it, she doesn't have any sensory issues other then not liking hand dryers she hates them, but then so did my son and he's NT, she doesn't have meltdowns, she does get upset quite often but quickly comes out of it or is easily distracted on to something else, she is not bothered in the slightest about routines, she's loved going to see her new teacher and classroom for starting reception this week she ran in and just said bye mum, her nursery key worker had a couple of days off sick a few weeks ago, and she had a stand in and all she asked was where's Mrs ___ and just got on with it as normal. She's very sociable loves being around people rather then being on her own, she's always been like that since a baby, idolises her big brother she thinks he's amazing, and wants to do or copy whatever he's doing. Nursery have said she's got a variety of different friends at school, and that she's very sociable, when were out at the park she'll always go running over saying hello what's your name? sometimes she's a little to enthusiastic, and excited it can scare some children off, but most of the time it works. She asks a lot of questions like what are we doing today? where are we going? what's that? where's mummy/daddy. She can also answer a lot of questions like what would you like for lunch? What did you do at school? who did you play with? She can also tell me when she's upset and why, if were reading a story and I ask her what's happening she would be able to tell me, if we play games like Simon says she gets it and is able to follow the instructions. What she does have trouble with are the sort of questions like what do you want to be when you grow up? or what does a doctor do? why do people go to the doctors? or its like she's memorised things like if you ask her how old are you its always answered the same way, she always says im 3 years old, never oh im 3, or 3 nearly 4. Was just after some advice on what a 4 year olds understanding should be like, or if any of you have children with autism what there understanding is like.

From what you've said it doesn't sound very ASDry (though it's worth bearing in mind no autistic person has all autistic traits). Certainly nursery are not in a position to make that call. I think it's worth taking the assessment though, as if there is anything different it will put you in the best position to support and understand her needs.

It is certainly possible to have a speech delay without being autistic, but no harm in going to the assessment and seeing what they think!

Thanks for the reply, I think she acts differently at nursery to at home they say she has trouble with understanding and transitions, where as when she's at home or out and about with me I don't see any problems with transitions, don't get me wrong if I say come on pick up your toys now its bath time she'll have a little moan, but she does do it, it does take her a while to do it, but she doesn't get really upset by it. I do agree with the understanding part though, that's why I agreed to the referral. I often hear a lot of children mask at school and explode at home where as she seems to be the opposite. It's just this not knowing is a killer, and I worry about if she does end up having an autism diagnoses what her future is going to be like.

I know it's really scary.

My daughter is autistic. When it was first suggested when she was 3 it hit me really hard. It's a hard age anyway as they are all so different, and developing so fast so things change all the time and you desperately want a crystal ball that tells you she will be OK. She didn't have a speech delay but it sounds like your daughter actually communicates her needs more and socialises more than DD did at the same age (one thing I've learned in this process: speech does not equal communication, and communication does not equal speech!)

I would say 2 things.

First, autism probably isn't what you think it is (partly because it is a million different things, partly because it is so poorly understood even by experts, although there is a lot of good research going on now).

Second, autism isn't a disaster. Remember that girls with less obvious traits would never even have been diagnosed until 10-15 years ago (and many still aren't). If you look at women who have been diagnosed as adults (try e.g. speakers like Sarah Hendrickx, Agony Autie and Purple Ella; authors like Rachel Lucas, Laura James, Katherine May, Joanne Limburg, Jack Monroe; YouTubers like Invisible i, Sew Many Books ... if you look any of them up on YouTube with "autism" you should find good videos/interviews), many of their problems stem from lack of understanding and support when they were young (and despite these problems they are all brilliant admirable people that you would be proud for your daughter to grow up like).

But I really believe that we can do even better for the next generation of girls, who will be understood and supported from a much younger age.

So even if your daughter does get a diagnosis, the fact that she is sociable and manages transitions with you well means that you already know that she CAN do these things, so she WILL be able to navigate the world. You will just need to find the right settings and the right supports so she can thrive in nursery and at school in the same way she does with you.

It is also quite possible it will turn out she's not autistic - but if nursery think she is struggling a bit there it is worth working out why (maybe just the speech delay, maybe ADHD, maybe a hearing problem, or maybe just a slightly different development track of some other kind) so you can put the right supports in place for her, or maybe find a nursery that would fit her better. And all of this stuff is much better done before school if you can - so although it doesn't feel like it you are actually in a good position, try not to worry. The not knowing is infinitely worse than knowing even if it's not the answer you wanted.

Thank you so much for your kind words, you hit the nail on the head I just wish I had a crystal ball to see what her future will be like. I never had any concerns about her other then speech before the nursery brought it up, and since then all I've done is worry, im quite sad and angry at myself as I know I should be enjoying these early years as I won't get them back, but I just find myself analysing her all the time now, and its not fair on her. The moving nursery one is a bit trickier as its a nursery that is attached to my sons school, and the school that she will be attending in September, she is one of the youngest and is 4 in august. The school have said that when she starts in September she will have weekly speech sessions so im really glad about that as that will help her out loads. Thanks for the YouTube suggestions I will look them up. I have wondered if its more ADHD as she does seem to switch off and not listen, when I went to watch her do sports day, she was to busy chatting to her friends, waving at us, and just fidgeting rather then watching what she was meant to be doing, she did love doing it though

There are a lot of links/overlaps between ADHD and autism. I know it probably sounds mad as I wouldn't have been ready to hear this 2 years ago but the world of neurodiversity is actually amazing and it's very satisfying to learn about e.g. sensory stuff and then support your child with what you have learned, and see them grow in confidence.

I know exactly the feeling about over-analysing and not enjoying enough but you will get back there, don't worry - it just takes a bit of time to process your feelings. Just let yourself do that. The more you let yourself feel and read and learn the quicker you'll pass through this stage and be able to enjoy your DD properly again.

Sorry jumping on this thread. I'm in a similar position with my DS age 3.6 although it was me pushing after negative feedback from playgroup - but the HV observed him and agreed to refer him to a community paediatrician (we have no idea under what suspicions although I think it must be ASD).

The transitions thing. I think DS had some problems with this at playgroup, although they never came out and used the word transitions. It was things like not wanting to get in line to come inside after playing outside, and not wanting to wash his hands after snack time.

Does that count as transitions? I don't really get it to be honest; how do you know if it's a struggle with a transition or just being difficult as they are not getting their own way? Like your DD OP I don't see this sort of thing at home or out.

Yes, they do count as transitions. It’s the change from one activity to another or one place to another, that sort of thing.

It’s very difficult for young children to stop what they are doing and enjoying to go and do something different and often less favourable. They aren’t being naughty they are just still quite self directed and find it hard and they usually grow out of it. Children with special needs can find this particularly difficult, often for longer than a neurotypical child.

Approaches to help with this are timed countdowns and timers - so ‘dd in 10 minutes we are going to stop doing x and do y’ then ‘dd in 5 minutes...’. Visual aids can help too, particularly if the child’s receptive language (understanding) is not well developed. A ‘first, then’ board is good for this.

Thanks openupmyeagereyes. How on earth do you tell if it's a problem because of SN or just a child being 3? I guess you can't, you just have to wait and see? It's such a minefield.

If a child has special needs then there will likely be additional concerns, not just issues with transitions.

Using techniques to support transitions is good for NT children as well as those with special needs.

I think this is why most children don't get diagnosed until they are older than 3! It's hard to tell.

But as open says strategies for helping with transitions are good strategies for that issue regardless of whether there is a special need there or not.

Thanks for all of the advice, my DDs nursery have been using a sand timer to help her out which I think has worked quite well. I always say to her in 5 minuets were going to stop and do this, but like I said she's not really like it at home. She understands now and then, like if she asks for an ice lolly I'll say well you have to eat all your dinner first then you can have an ice lolly, and she gets it, or if she asks to get a different set of toys out I'll say to her tidy these ones away first then you can get those ones out, and she does it. Its so hard because a lot stuff she does or acts was just like my son and he's NT so its hard for me to see what they see

Just to put your mind at rest about the questions perhaps OP, I've found the following about speech by 4 years old (don't know how to hyperlink it sorry):

www.talkingpoint.org.uk/ages-and-stages/3-4-years

The questions you mention seem quite complicated in fairness; maybe not the why do we go to the doctor one but the one about growing up. I just asked my DS age 3.6 who doesn't have a speech delay the 2 questions (although there is a question mark over whether he has anything else going on) and he could answer the doctor one when I simplified it (I said why do you go to the doctor and he said when you're poorly) but he totally didn't get the grown up one.

Well exactly that's what I thought, but that's the sort of discussions they have at her nursery in little groups of children, and the staff there said she had trouble understanding, even though they know she has a language delay. I think a lot of it is to get them ready for reception. But then I said the other day to my DD that we had to go to the chemist and she said to get medicine, I think a lot of the time she understands a lot more then she lets on. But then other times I really worry as the other day messing around with the kids I said DD tell your brother off, and she literally said Noah tell you off

In isolation that sounds like it's quite picky of the nursery, a child wouldn't know what they want to be when they grow up unless someone has had the conversation with them. I think sometimes children surprise us with the things they come out with purely from their own logic (not long after my DS2 was born, so DS1 was about 3.2, he said "DS2 pushes REALLY hard to come out of your tummy" - no one had told him how the baby would arrive, I guess in his head, that's how it would happen! He often surprises me with the things he comes out with) but otherwise it's from what they've learned through books, talking to people etc.

Have the nursery specifically said ASD is what they're referring for? That surprises me too to be honest. The best thing you can do (and I need to take my own advice here) is keep an open mind. And raise your concerns with your DD's SALT, if she has one?

*pushed not pushes

But I agree with Lighttripper, take the assessment. Otherwise you'll always wonder. It's why I pushed for my DS to be observed by the HV at playgroup - on assessment alone when she came to visit, she said he's absolutely fine and "not autistic"! But his issues were flagged by playgroup, so I wanted the HV to see what they see.

Yeah they said an ASD assessment, cut a long story short, we had a parents evening in November last year, that’s when nursery said they wanted to refer her to a speech therapist, we were already on the list but the wait is long. We had the assessment with speech in March the therapist diagnosed her with a language delay, didn’t bring up any concerns to me about autism, she said her understanding was were it should be on certain things and just under on others, and to come back in 6 months, I also attended a parenting speech session to help her out at home. Then just after the assessment with speech we had another parents meeting that’s when they first brought up the stuff about the trouble with understanding, and transitions, so I asked are you trying to say you think she’s got autism, and they said we’re not doctors we can’t diagnose. So I had a meeting with the head of senco at the school, and she said she would go in for an hour 1 day a week over 3 week period to observe her, and we’re have a meeting afterwards to see what she thinks. At the meeting she said she observed my daughter, she suggested I went ahead with the referral, the reasons she gave we’re, she was riding a trike properly to start with, but then started pushing it with her feet, the children were asked to stand in a line to go somewhere, and another child was told not to hold her hand and let go, but then my DD went to hold his hand, they were playing a game of duck duck goose and my daughter was joining in, but when it came to her go to do it she done it but then got upset cos she couldn’t sit in her original space, and the staff let her sit there, she went over to the senco lady and said hello showed her a car and said baby car, as it was a little car, and lastly when they was having story time she sat nicely listening to the story, but when the staff started talking about sports day, it looked like my daughter wasn’t listening and was playing with her hair. To me they don’t seem like obvious signs but the senco said that she thinks each year the same stuff will keep getting brought up, so that’s why I agreed

Ah ok, all sounds very grey doesn't it. I wouldn't know what to think to be honest, which is how I feel about my DS. At least the SENCO did a reasonable amount of observation. Hopefully your appointment won't be too long.

Presumably you've had her hearing checked? DS2 never had an ear infection or any obvious sings of hearing loss, but had glue ear and enlarged adenoids. He had the adenoids removed and grommets put in and it's made a slow difference in speech and communication . He is NT, yet his speech was awful and even now, at 6, he has to make a real effort to make clear speech.

We've been to the doctors about her hearing as she can talk really loud sometimes, but the doctor couldn't see anything wrong, but did refer her for an hearing test just to make sure, were waiting for an appointment

Definitely worth getting her hearing checked.

As others have said none of it sounds at all obvious, but it also sounds like they are quite switched on so if they see something it's worth trying to find out what (if anything) it is.

I know the wait is horrible though.

Hi, I just wanted to give an update, my daughter has now had her ADOS and she's not autistic, she didn't score even close to getting a diagnose. I'm so relived its all over with now, but I do feel a little bit angry with my daughters school, they were so quick to think it was autism, and not just a speech and language delay, that they really pushed for this assessment, when I as her mum didn't really have them concerns, but found myself constantly thinking doubting myself cos I wasn't a professional. I feel that I've lost a year of her life that I'm not going to get back through worrying. I just wanted to do an update so in the future it might help someone else, I think as mothers we need to trust our instincts a little bit more, I wish I spent more time over this last year enjoying my daughter, rather then analysing her every move, spending endless nights up late googling. My daughter is now 4.5 doing well in reception reading, writing, making wonderful friendships, but she still does have a speech and language delay, thank you to everyone that gave me advice

Thank you for updating! I think it is really valuable for parents in the future to come back and see all the different outcomes there can be. Brilliant to hear that your daughter is thriving at school!

The other way of looking at it is if she had been autistic she would have got her diagnosis early.

My son had speech and language delay so everyone put everything down to that. We had concerns about autism from when he was 3.

We were fobbed off by professionals continually (one teacher told us there was nothing wrong with him, he was just naughty ) until a Speech and Language therapist who was working intensively with him for a few weeks picked up on the behaviours we had been flagging up for years.

He was finally diagnosed with ASD when he was nearly 8 by which time the damage to his self esteem and mental health had already been done.

I agree @Ellie56, I think it's very hard for schools/nurseries to be sure, so it's good if they refer and get a proper assessment done as early as possible. I can see with my DD that it likely would have been harder to diagnose the older she got (due to masking), until she was unable to mask any more - at which point as you say you have a lot of fall-out that you would have hoped to avoid (or at least reduce) with a Dx. Hope your DS is doing better now xx