2 year old - Autism, or speech delay?

[Greyhop]

DS has a speech delay. He is have appointments with a speech and language therapist. He has had 1 appointment with a paediatrician. Next appointment he said would be with 2 professionals with a possible ASD diagnosis.

To me, it seems a bit ‘early’ for an ASD diagnosis. The speech therapist advised me to stress this to the paediatrician.

DS has not attended nursery yet, and I’d like to see how he gets on at school.

DS is very calm, happy - doesn’t greet people or attempt to have a verbal conversation with unfamiliar adults readily - but makes eye contact/smiles. He tends to otherwise ignore.

Not much waving, pointing etc - but will in context of a repeated song.

DS is obsessed with numbers/letters/colours/shapes. Knows numbers to 100, counts in 2’s, 3’s, 10’s. Writes numbers to 10 with no reversals.

He does ‘talk’ a lot - mainly naming objects through singing.

He doesn’t express his needs, not yet using sentences, not much imaginary play (prefers to sequence/or play with numbers).

I’m just wondering if this ‘sounds’ like ASD. And any thoughts about pushing to delay diagnosis until he is a bit older/has experience of school?

Just wondered, is this private? Because it usually takes years to diagnosis on the NHS.

Definitely some traits you have described sound similar to my dc who is diagnosed asd but I’m not a professional.

I imagine you can ask to wait to be diagnosed until later but I think so many parents have to fight for the diagnosis when children are older and you may wish you had taken it when it was offered.
It can only give your child more support by having a correct diagnosis. A health professional is very unlikely to diagnose any child with autism if they are not certain about it.
If you are worried about labels, remember you don’t need to tell the world about the diagnosis, you can keep it to yourself. I kept out diagnosis quiet for a while, not because I was ashamed of it, only because I know a lot of peoples understanding of autism is limited and I didn’t want anyone making assumptions about my child at age 2.

Honestly I would probably just go for it. A Dx isn't something you have to use or even mention if it turns out he doesn't need any support later - but especially if he is "high functioning" it can become hard to get a Dx later in order to get him accommodations he needs. Autistic children who don't have intellectual disabilities and without very extreme sensory issues may be able to start to "mask" their autism very young, making it harder to get a Dx later, even for a child who is struggling (but may be able to hide this very well for an hour during an assessment). A lot of autistic kids only get a Dx in teenage years when executive function and social demands suddenly ramp off and the wheels fall off - so much better to find out before you hit crisis point if you can.

My DD had some similar traits: not late in speech but her speech was different (she had lots of words - more than age expectations but mainly nouns - and she didn't ask for things like snacks or help with toys until she was much older than is typical, didn't seem to know what to say to other kids if she wanted to play with them, etc.) She did have imaginary play but again mainly with us - not so much in situations where she was less comfortable. She hated the sound of hand driers and motorbikes. Would curl up in a ball when the nursery fire alarm went off.

She's doing very well now (age 8) but her Dx still helps us get a more supportive and understanding approach for her in school with things she finds hard (transitions, anxiety - particularly around public performance like talking in assembly or in front of unfamiliar people). Like your DS she was a super calm, happy smiley baby and toddler and is still a fun, funny and in many ways outgoing girl today (when she is comfortable).

But as a young toddler her engagement and eye contact etc. was initially only really with her family, only later spreading to include other familiar adults, and then later again familiar children (and still not really there with strangers TBH! But then I am much the same in my 40s...) The fact that she did engage with us and do imaginary play at home made it very hard for me to really understand that she was autistic (plus the fact I have a lot of similar traits myself, so lots of the things she found tricky seemed very understandable/familiar to me).

I think if we didn't have the Dx we'd just be seen as overprotective parents and DD would just be seen as oversensitive and that she should just "buck up" and "push herself" a bit and stop being "silly", in ways that could be very detrimental to her mental health. Whereas actually with a gentler approach and proper support she can do pretty much anything she wants to.

DD understands that because she is autistic she is wired a bit differently, and therefore finds some things easier and some things harder than her friends as a result. She knows it is not her "fault" and there is nothing "wrong" with her. There are some brilliant non-pathologising materials for autistic YP now, so they can grow up just naturally knowing all of this about themselves, rather than having a "grand reveal" and reassessment of everything they thought they knew about themselves when they are older. Books like Abigail Balfe's "A Different Sort of Normal" really helped DD understand her differences.

Obviously that's some way off for your DS even if he does turn out to be autistic, but I think you'll feel very encouraged and more reassured if you start reading around autism in any case. E.g. Chris Bonnello's "Autistic not Weird" website has some great articles, and Jessie Hewitson's book "How to Raise a Happy Autistic Child" is also very good, and/or Luke Beardon's book on Autistic Children.
blackwells.co.uk/bookshop/product/9781847094926?gC=5a105e8b&gclid=CjwKCAiA4KaRBhBdEiwAZi1zzgat8mZh8ma885NhnUlW2FfdcKxXvMp0Zw66jgGQmpG-zS8fs_vPixoCMZwQAvD_BwE

@Sapphire05

Thank you for your response, that’s very helpful - and great to hear from you as you’ve been through the process.

It’a NHS, and yes I was also surprised at how quick it’s all been. I filled out the development questionnaires, saw a distinct gap in DS’s speech/language - ands it’s all followed from there. They’ve said how good it is to get him in the process early on, and I’m very pleased that that’s happened.

From my own reading - I’ve looked at Einstein Syndrome, Hyperlexia and then ASD. Einstein Syndrome more applies to a late talker who then otherwise develops as expected - and then ASD would apply more to continued support needed throughout his life.

The speech therapist said - quite rightly - to pursue it as ASD, as more is

Known here - in terms of getting him the right support.

I think I do have a question mark over a stereotypical view that may be placed on him by others. And then thinking - will he need to disclose for a future career, or driving? It’s making sure it’s the right diagnosis, because I’m thinking it will be a lifetime diagnosis.

It seems fairly subjective, just because a lot of the referrals so far (particularly the paediatrician) were based on questioning me/my view. I want to make sure I’m giving the right answers

@LightTripper

What a fantastic reassuring post. Thank you. And the same to @Sapphire05 too.

I have copied and pasted those links to my notes, and I shall have a good read.

Im finding - more and more so - that strangers will try and engage in conversation with him - what’s your name, how old are you… - and he simply doesn’t engage in this way - he doesn’t understand, so he’ll blank them - and I’ll answer for him! But that social engagement just isn’t him, and it’s finding the words to explain that! I’ve been saying - oh he hadn’t interacted much due to Covid, but it’s not that. He simply isn’t wired that way.

@LightTripper

I really do concur with everything you’ve stated there. As he goes through his education, it is so much better if the professionals understand that there is a reason/areas where he needs support. I am very grateful that he’s got this early support, and it’s so much better that he is in the system sooner rather than later.

If you haven't already, google M-chat test for toddlers. It's a basic screening tool used to indicate possible flags for autism.

As I'm sure you know, communication is so much more than language. People can communicate pretty effectively without speaking and this is something that speech and language experts are very aware of.

Does your DS bring you things to show you that he finds interesting? Does he point out things to show you and then 'check' with you that you've seen it? How does DS communicate to you that he wants a drink? Snack? Does he 'use' you as a tool to get what he wants by taking you by the hand and then putting your hand on the thing he wants?

Before my Ds was diagnosed with autism, (he was my first/only), I had no idea about how neurotypical babies/toddlers are almost hard-wired into being able to communicate/interact without language.

My Ds didn't say a word until he was 4. He now has an incredible vocabulary but still uses language in an a-typical way and always will do.
That said, like other posters have said, he has grown and developed in ways I never thought possible.

If I were you, I would be tempted to get him on the pathway for an assessment. You can always withdraw him at any time. Where I am, the wait time for an assessment is over two years so IF he does have autism, then hopefully he will be seen before he starts primary.