Possible high functioning autism? almost 4 yr old

[Pea1985]

I'm just looking for input from anyone with experience of high functioning autism as ive got suspicions my son could have this.

My son is 4 in May and he really struggles in social situations where there are lots of people. If we go to a kids party for example, it will take around 40mins for him to get off my knee and then I have to stay with him for another 20min until he's ok to go off on his own. He's always been like this but I assumed he was just a shy toddler but its not getting better. Its becoming more noticeable that the other kids aren't like this. Sometimes he will bury his face in my chest as well in these social situations like he's trying to ignore where he is and the other people.

The other major issue we have is his anger and meltdowns. I had put these down to toddler tantrums but they aren't going away and he gets very worked up and it can take half an hour or more to calm him down. It just seems so different to my other son at this age. Also when hes angry he gets this rage and sometimes will hit things, like banging his head or arm on the door. Also he may throw something or knock a chair over. Sometimes he runs into another room and shuts us out and won't let us near him. He'll scream and make his throat sore.

His development has been normal other than this. He was an early crawler/walker. His speech was on the slower side of average but not 'behind'.

He interacts normally with his older brother and he plays fine with him. No obessesions about certain toys etc, he'll play with anything and will watch any cartoons. Lots if make believe imaginative play etc.

He's been at nursery/pre school since he was one and none of the staff have ever raised concerns. I dont know if I'm imagining it but there's definitely 'something' that doesn't seem right.

Does this seem like something I should talk to a health professional about? If so, who do I talk to? If there is something I want to know so I can help him better.

My son has ASD (high functioning) and I also work with autistic children. 4 is quite young to diagnose HFA - my son was 8- the children I work with were both diagnosed at 3 but they are non verbal and still in nappies. I knew my son was different because he could tell the time at 3 and he needed structure from a very young age. I couldn't take him to any type of playgroup or toddler group as e would push children over or pull their hair, -- but of I took him to a structured music group or swimming class he was so good he followed all the instructions and excelled. At pre school they had no issues with him because it was very structured and followed a routine so I then thought ok maybe he is Ok and didn't think about it again until he started reception when he really struggled with the lack of structure as most of it is free play.

It is so hard to know when they are high functioning what is normal toddler behaviour and what isn't. I would wait and see how he fares in reception and if he does have ASD his behaviours will become more obvious and pronounced and if it is just toddler behaviours they will start to disappear. HTH

I would say you have nothing to lose from going for an assessment. I would also say it’s impossible for strangers on mumsnet to diagnose with autism. Sorry if that sounds glib but as the parent of a high functioning autistic kid I’ve had the opportunity to meet loads of other ASD kids and they’re all so different.

Your son sounds a bit like mine at 4, and it turned out he is autistic. Diagnosed at 5, now he’s 6 and as he’s getting older it’s becoming more pronounced / noticeable. However there are other kids i knew at 4 years who were basically non verbal, obsessive, much more what i would have thought as autistic who have totally grown out of it and are totally neurotypical kids.

The diagnosis process is quite complex as the doctor would need to look at observations of your child accross a host of factors and in different situations. They should be in a position to say whether it’s likely your child has a diagnosable condition or if that’s just their own unique quirky personality. Could be either x

You also asked who you could talk to.

I went to my GP and made a case for a referral to pediatric services for a proper assessment. I think you can also go through your health visitor but i know many are a bit patchy. Waiting list was 9 months. Was seen by a pediatrician who was a sort of triage, ruled out stuff like hearing disability, learning difficulty or (unspoken but clearly something they were looking for) abuse. She then referred to a psychiatrist for a formal autism assessment.

You could also go private, at this age a diagnosis would need to be given by a pediatric psychiatrist and should be what’s called a ‘multi disciplinary’ process. There are a lot of charletans out there so don’t get ripped off. Lots of pediatric psychiatrists also work in the NHS and those ones are generally legit, most have their CVs publicly available.

I also think there's no harm in asking for an assessment. It's difficult to get a diagnosis, it's a very involved multi-stage process, so the fears people have about "false labelling" are largely misplaced. I would ask your GP to refer you to a paediatrician, and ask both the GP and the school/nursery Senco about having an educational psychologist assess him in the setting.

His anger episodes do sound like meltdowns. If he is autistic, and they are meltdowns, the best thing to do is to stay completely calm, stay near him and make sure he can't hurt himself, but don't interact too much with him until he's blown himself out. When he's calmer, offer reassurance, hugs, whatever he wants.

My autistic son was always very into imaginative play - long, elaborate games that he would build on over time, imaginary world-building, he loved his play kitchen etc. Lack of imaginative play isn't a given. He was also very verbal and not behind developmentally at all (apart from perhaps physically).

Does your son have any sensory issues around foods, textures, fabrics/clothes, temperature?

I also think there’s no harm in asking the GP for a referral for an assessment, although you may find it difficult to get a referral. Also, rather than wait for nursery to raise anything talk to them about your concerns.

at this age a diagnosis would need to be given by a pediatric psychiatrist

Not necessarily, in some areas it is CAMHS that diagnosis but in others it is neurodevelopmental community paediatricians. Both could diagnose privately too.

@Imitatingdory my understanding is below the age of 6 it must be a psychiatrist according to national guidelines. Above the age of 6 can also be psychologist. I may have been misinformed but was told this by our clinical psychologist.

Nina that isn’t correct, in many areas community neurodevelopmental paediatricians diagnose autism in all children and young people. Psychologists cannot diagnose autism, although may be part of the MDT.

Best practice as per NICE guidelines (1.1.3) says the MDT should include a

• paediatrician and/or child and adolescent psychiatrist
• SALT
• clinical and/or educational psychologist

To clarify my last post, a psychologist alone shouldn’t diagnose autism although they can, and best practice is should, be involved in the MDT.

@Pea1985 I’m in a similar position with my almost 4yo too - did you end up getting an assessment for him or did he mostly grow out of these behaviours?

thanks!