Friend’s child possibly on autistic spectrum

[Cam77]

Hi everyone, I have a friend who I used to see often before moving away a few years ago. Now we don’t meet so often as we live in different towns. He and his wife have a two year old child and they are concerned because he isn’t speaking at all yet, not a single word or even similar sounds, nor really babbling. He makes noise but not typical toddler babbling.

We met with them once six months ago when their child was 18 months, and again last week (aged 25 months) and i strongly suspect their child is on autism spectrum. I am not an expert or a professional on the field but did spend a year ten years ago providing care for children with learning disabilities, some of who had ASD. Unfortunately their son at age 25 months, delayed language aside, has many outward symptoms: extremes difficulty focusing, hitting his own head, grabbing, not interaction at all with his parents or other people, not responding to his name etc. I am quite certain that he has issues beyond delayed language acquisition.

My friends know that something is amiss as they’ve expressed their concerns - but only in terms of his slow language acquisition. I don’t know if they suspect anything else. And they’ve read that sometimes children don’t start speaking till three, so I think they may just leave it at that for now.

They are fairly new immigrants from India and I think they are somewhat nervous about contacting doctors/health care providers/support services. Also I’m not sure whether they know anything about ASD or even aware of its existence.

I’ve read that Aspergers is not diagnosed till later on, but I fear he may even be further along the spectrum and I’ve heard early intervention can be very important. What should/should I do/say? Should I just leave them be? Or say “I think your child may have ASD, you should get a consultation/observation from a specialist” or “his behaviour is atypical in how he is communicating, I think he should see a doctor”. What would you do? I feel I should do something, but don’t know what to say.

I'm completely stuck on the fence. On the one hand I'd have been overjoyed if someone had suggested autism to me when my DD was little. Instead I had years of hell until someone on a parenting forum suggested it when she was 15.

On the other hand I know some parents react very badly to the idea that their child may be autistic. My brother was furious and still won't tolerate any suggestion that is son is autistic, despite said son being 26 and having a diagnosis.

It really depends on the couple and how receptive they’d be. My friend spotted the signs of my dd being autistic but didn’t say anything. If talked about problems their little boy was having and help I would maybe mention seeing the health visitor and gp.

Thanks for the responses. I feel I have to say something but don’t know what. The cop out would be something like “perhaps just take him to the GP to get his ears checked”, and then rely on the GP to go deeper (assuming it’s necessary). But I just fear that, especially, in the current environment and with say just 5-10 minute appointment, a GP may not necessarily be sufficiently observant of a two year old child. He might be more focused on sticking a thing in the ear of a struggling child than making an overall observation of behaviour. I really don’t want to be the one to drop the bombshell on them but perhaps I need to raise it. Perhaps suggests they see a GP first for their opinion, and then ask he/she if their son should see a specialist?

Just suggest they see a GP about lack of speech/babbling/focus and trust the GP to put them on the right path?

I think you should take the lead from them. Ask how he's doing and if they tell you they're worried ask if they have any ideas of what the problem may be. See where they go with it and if it sounds like they'd be receptive to suggestions.

A first step may be to get them to self refer to their local speech and language service for advice about the lack of speech. A good SLT might then be able to pick up on other issues. But as they have acknowledged the lack of speech, it is a good 'in' to other areas of difficulty.
They also should be having a 2 year developmental check - though maybe these are delayed right now.

SLT referral is a great idea.

Do they also have a health visitor? They should do a 2 year developmental check anyway. If your friend raises concerns say about the child's lack of communication, they can do the MChat-R test around 24 months. It's available online, your friend could have a look at it - but it depends how she would take the results when adding up the score for her own child.

Don't suggest it if you think the parents won't take it well. There's nothing worse for a child than parents who are in denial and continue to be so, like FatCatThinCat's brother, or my partner about our DD who is also diagnosed. .

Asperger's hasn't been diagnosed for a while now, it's just a dx of Autism.

My experience was that any suggestion that the dc might be developing atypically was seen as an accusation of poor (even abusive) parenting, and (as it came independently from a few people) as a co-ordinated attack on the family. It wasn’t until the dc entered a childcare setting age 4 and was immediately referred for urgent assessment that the parents were prepared to consider that there might be an issue. I would tread very carefully.

Please don’t suggest that their child may have ASD. You are not a professional and cannot judge this from two fairly limited interactions. A lot of different things could be going on but don’t underestimate the effect that delayed speech and language (especially receptive) can have on a child’s general development and presentation. If you are that concerned I would suggest to them going to a speech and language drop in at their local children’s centre and let the therapists there decide if there is likely to be anything else going on. We did this with our DD (aged 23 months at the time) and that then led to other tests including hearing to rule out hearing issues.

Using my DD as an example - she was very similar at that age. However, once her receptive and expressive speech improved she was like a different child in terms of behaviour. She is still quirky now and awaiting ASD assessment, however her paediatrician is fairly certain she doesn’t have it. I would have hated someone mentioning the possibility of ASD to me when we were really worrying about her development. I was in a very dark place mentally and it would have pushed me over the edge. AsIt is not anyone else’s place to suggest this. As parents they will already know that there may be a serious issue.

I would encourage you to find a gentle but clear way of suggesting ASC. Waiting lists are long, and navigating the system requires parents to take the lead. Sadly it is only the children with the most obviously "severe" expressions of autism who will definitely be picked up by other agencies.

Could you try writing to them, so they have space and time to consider what you're saying?

Can you include an outline of what autism is and how it may present, and suggest they try to see a SLT if they feel, after reading the description of ASC, that some of it might fit?