Possible autism in 3 year old

[Mummybeebumbling]

Hi everyone
Just after some advice really. I have a wonderful little boy who is 3 and a half. Autism runs in our family and I have started to notice a few signs in him, but have always brushed them off. However, nursery have now raised some concerns which has prompted me to have a real think. I think I’m confused because some of the things he does very much fit with being on the autistic spectrum, and some don’t.

The things that make me wonder if he is autistic are:

He has excellent language and understanding, but struggles with social communication. His way of making friends is to follow other, usually older children, around like a shadow. He loves it if these children interact with him, but isn’t upset if they don’t. He’ll tell me he’s playing with ‘those boys’ or ‘those girls’ even if he is just following them round and they’re not interacting with him.

He will play with other children but only on his terms. If a game doesn’t go how he wants, whether it’s imaginative play or building a tower, or another child takes something from him, he will cover his ears and scream. He does this at nursery and when he’s out with me.

He gets very overwhelmed in busy and loud places. He will cover his ears and become withdrawn, or sometimes he’ll get very upset and distressed which presents more as a tantrum.

He loves routine. Nursery have picked up on this and it’s something I’ve always been aware of. I could never pick him up from nursery and announce that we’re going to the park or to soft play. Even though he loves those places he’d get very upset and insist that he wants to go home, because that’s what he’s used to and it’s like he’s just had enough and needs some quiet time after nursery (although he does enjoy nursery and looks forward to going)

He covers his ears at loud noises and will become very distressed at things like a hand dryer in toilets

He flaps his hands when excited

He will play the same games or toys for weeks, in the same way, before moving on to something else.

He’s always become upset when we’ve gone somewhere new, from a very young age. He has to observe for a bit before he’s ready to play. He’s getting better at this though.

He used to hate new clothes to the point that it was difficult to buy him any because he would be so distressed. This has improved though although he would never take part in fancy dress.

The main issues are the social communication I think.

The things that make me think he’s not autistic though are

He loves imaginative play. It’s his favourite type of play. He could play with a stone for hours making up a story. However, I don’t think he really involves other children in this. He will do things like make pretend food for other children though

He understands feelings. When we’re reading a story he will often ask why a character looks sad for example, so he seems very in tune with that

He has no language delay. He probably spoke slightly later than his peers and is maybe ever so slightly behind in this area, but not much at all

He can make his needs and wants known

He’s always pointed, made eye contact and has always liked to bring me things to show me and involve me in what he’s doing

He’s very interested in other children and making friends. He just doesn’t seem to quite know how to

Sorry if that’s super long. Just any opinions or advice would be really appreciated. Me

Sounds like ticking every asd box to me, social communication issues/sensory issues/liking routine but high functioning/aspergers (I know they often lump everyone with asd in together now when diagnosing) which is why he has no language delay, points, loves imaginative play etc- does he talk to himself as he does it? Mine still talks to himself as a teenager and sometimes ear covers but has never flapped. Mine always had friends through nursery/primary it was only when secondary school hit that it became more difficult. Your lo can probably recognise sad, happy and angry it tends to be the more subtle emotions that are difficult to recognise - my OH still can't, beyond obviously happy/sad/angry he's often baffled.

Make sure you take that list you wrote of why he might have it to your GP/any assessment, it will be useful. Ask nursery if they can get someone in to observe him, my son was observed at school by a lady from SEND who was brilliant. This will also help with getting a diagnosis.

I recognise so much of what you say from my son! Especially the needing to go home and do nothing after school, he's still like that as a teen (but is able to cope with change pretty well). My advice would be to have high expectations of him and keep encouraging him to cope with things that he struggles with but that are important life skills ie keep taking him to louder places but perhaps with ear defenders/go when you know it won't be so busy, enjoy his quirkiness - my son sees words as colours which is fascinating - organise his life for him while he is little to enable him and then help him find ways to organise his own life as he gets older (ie writing things down to remind himself), keep taking him to new places even if he needs a bit of time to settle, and after diagnosis don't expect very much - we got a book list and a course to go on with a 9 month waiting list. x

Thank you so much for your reply @Tal45 that is extremely helpful. It’s funny because it’s always been at the back of my mind but I’ve always brushed it off until nursery mentioned their concerns. And now writing it all down it’s becoming more clear to me.

Yeah he constantly talks to himself whilst engaging in imaginative play, it’s quite sweet. But if anyone interrupts him or tries to get involved he gets very upset

I think my next step then is to get someone in to nursery to observe him. They’ve been really helpful already and have referred him to speech and language and will be doing some one to one work with him in the meantime.

I don't think anything on your 'not autistic' list would rule out autism, although obviously they are all positives. My son did many of those things and is very imaginative. Your DS has a lot in common with my son at that age, especially not being able to just announce you are going somewhere (though mine could never really cope with soft play), asking questions about feelings in books and refusing to do dressing up. With mine, I 'knew' from about the age of 3, but he has only been diagnosed more recently.

If you have all these concerns and the nursery is also raising issues then it sounds like it's time to visit the GP and get the assessment process started. The sooner you get on the waiting list the better really, as it can take ages as it is.

Thank you so much @landofgiants . Sounds like my son is quite similar to yours. He does like soft play but in short burst, and he doesn’t like the very big ones.

He does seem to be ticking a lot of boxes. However I’ve just done a few questions with him from the ages and stages questionnaire and he had no trouble at all. He was able to follow a 3 part instruction (clap your hands, go to the door and then sit in this chair). He thought it was great fun and has been giving me similar instructions 😂 so that’s put me back on the fence.

I think I just want to be really sure I’m getting him any support he needs, but also don’t want to go down the wrong path

Thank you @azimuth299 . I did wonder this as I have family members who waited 3 plus years for a diagnosis. And I suppose if we got the ball rolling and it didn’t turn out to be a concern long term we could just take him off the waiting list.

You have given such a considered and careful list of your observations and concerns / questions. As a pp said, nothing on your not-autistic list would rule out him being an Aspie profile, based on your other list.

It's really good you have nursery's support and I would absolutely go for it and pursue referral.

Don't be fobbed off if professionals try to minimise your concerns, particularly if anyone says he's not autistic "enough" to need a diagnosis. My gorgeous, "high functioning " boy was dismissed as "fine" until age 5 he utterly fell apart in school due to the increased social demands and pressures of formal learning. I wish I could turn back the clock to age 2/3 and refuse to no for an answer from professionals- if he'd been dx earlier we could have understood how to support him and crucially what he needed in a school. With our DD, as soon as we saw red flags age 2 we pushed for referral and she was dx age 3.

Your son's response to the 3 part instruction test situation is EXACTLY what mine would have done at that age. However, in a real life situation, such as getting ready for school (DS is 10 btw), if I said, "brush your hair, get your bag, then put your shoes on" he would almost certainly not do all 3 as he would get distracted somewhere along the way.

Knowing what I know now, I would definitely pursue assessment. As you say it may be 2 or 3 years before any diagnosis takes place and if you are no longer concerned then there will be no problem having his name taken off the list. If he is not autistic, then he would be very unlikely to be diagnosed.

Thank you @BoxPlant . I will definitely use that list when I speak to the gp. I found writing it down has made things clearer for me already.

@landofgiants that’s really interesting that you say that. I don’t know if it’s just because he’s 3 and a half, but if it was a real life scenario that took a few minutes he would most certainly become distracted halfway through and forget what he’s supposed to be doing.

I’ve been doing a bit more research and some of the things that I’ve just presumed are what all children do are starting to stand out to me, like echolalia. When he meets someone new, for example we went to the optician for my eye test and he met the optician, he tends to sing a song at them! So instead of maybe saying hi back when they say hi to him, he’ll sing his favourite song. I just thought this was a 3 year old thing (he’s my first) but it’s starting to read more like a bit of echolalia now and he’s using it to make himself feel more comfortable.

He also has this thing were he speaks completely incoherently for a few sentences. He knows he's doing it, and he'll throw the odd word in, but it always has the same rhythm to it. I always just saw this as him playing around with sounds but I am starting to wonder now if there is more to that too

@Mummybeebumbling the echolalia will be some form of communication, it's just a matter of turning detective and learning "his" language. I read an excellent book called Uniquely Human by Barry Prizant which I found incredibly helpful. Even if it turns out that he isn't autistic, I find the approach in this book so helpful for any child that doesn't find communication easy.

I’ve just done a few questions with him from the ages and stages questionnaire and he had no trouble at all. He was able to follow a 3 part instruction (clap your hands, go to the door and then sit in this chair) my ds could do this and he got a diagnosis of autism at 3.11. Exactly like PP said though, he would get distracted in a real life scenario. He also scored very highly in the ASQ communication section but those questions are not subtle enough to pick up the social communication differences between him and his peers.

You definitely have enough for investigation, I would ask the nursery to speak to their SEND contact. I took my ds to a speech and language drop in clinic but I’m not sure if these are running with covid.

Yes I think there are enough red flags for autism in your post to ask for a referral.

All children with autism are different. As somebody said, (can't remember who) "If you've met one person with autism, you've met one person with autism."

This might help:

secureservercdn.net/198.12.144.78/i87.725.myftpupload.com/wp-content/uploads/2017/11/UnderstandtheSpectrum.pdf

Sorry for the late response, it’s been a busy few days but I really appreciate everyone’s replies.
@azimuth299 that book looks great, I’m going to order it.
I’m going to speak to nursery at pick up today and see what they think about getting the ball rolling with a referral and anything they can do to support with that.

I do feel a bit worried. He is the loveliest, happiest little boy. He is quite innocent in the way he interacts socially and I just don’t want him being hurt.

@Mummybeebumbling good luck with the referral. It's totally understandable to be worried. Also remember though that even if he finds social interactions difficult, he is only three (so none of his peers are going to have excellent social skills yet) and it's also something that can be learned. If it is autism then many people have been down this path before you and can help you navigate these things to let your DS thrive.

Hi, i know this post is a couple of years old but wondered if you have an update? Your little boy sounds lovely 😊

@Quency25 thanks 😊

it’s funny to read this back in a way! My son is now 6 and doing brilliantly. The signs of autism became even more obvious as he got older and he has been on the pathway for an ASD diagnosis for over a year (took a year just to get to the pathway appointment because of Covid backlog) but his school are brilliant and support him as though he is autistic. They’re also considering a referral to the adhd pathway.

He still very much needs his routine, lots of downtime, is very sensory and struggles with social communication, but has a couple of little friends in his class who ‘get’ him and all the other children are lovely to him. I used to worry he’d be bullied but so far that’s all been fine.

He is the most brilliant, funny, wonderful and kind little boy and I count myself lucky to be his mummy 😊

Glad to hear he’s doing well and that school are supporting him. He sounds great!