ASD/ADHD Four Year Old

[Harmoney]

Hi everyone, I’m new to the forum so not sure if I’m doing this right or not, but I’m looking at some guidance on possible ASD and ADHD in respect my four year old son (nearly five).

For most of his life I would say he was a “typical” boy however, over the past two years or so, some features have come about that I’d say aren’t so typical. I will list below his behaviours/difficulties to make it easier to read and try to keep the thread as short as possible:

• He always has to sit on the same chair at home and has a “meltdown” if anything is different about the chair or his place at the table
• At parties he becomes extremely excitable, to the point his behaviour becomes very erratic, his listening becomes very poor but when it comes to sitting at a table to eat party food, he becomes really overwhelmed and choosing where to sit and this triggers one of his meltdowns. It takes a lot of patience and waiting to overcome what I can only describe as a complete mental block for him in overcoming the scenario - despite various tactics to try and support him through it.
• We had to (on the advice of a health visitor) completely remove him from his pre-school due to the distress it caused him by having to go and leave me. Again, having tried everything I can think of (with it getting worse as he got older)
• He has Encopresis.
• If he makes a mistake, he really struggles to overcome them. Once a mistake has been made he will either have a meltdown or become very quiet and calm but present as low in mood, for example… I gave him two snacks one day and he passed one to me for me to open. I open it, pass it back and he then goes in to full meltdown. I ask what happened and he replies “I wanted to open that snack, I wanted you to open the other one. I made a mistake. I can’t eat them now” and despite being hungry, he refused to eat either snack. He has never been punished for making mistakes or had any involvement with food used as a punishment (very much the opposite!) so I honestly can’t make sense of it myself.
• He will only read books at bed time. Before 2 years ago, I couldn’t get him to engage in books at all, so this is progress in itself.
• He has things in general that he feels he has to do. For example: go down the stairs first, be the only one to open the baby gate or cupboard door.

• He has a really good, balanced diet which I’m so grateful for however, his mood is massively affected by his eating and vice versa. If he is excited he won’t eat. Quite often, we can be out all day and he simply won’t eat. Similarly, if he’s hungry, his emotions become extremely heightened where he again can’t eat, despite food in front of him and if the food in front of him is not what he expected/wanted/imagined, this can trigger a meltdown.

All of the above are only very small snippets of our life. Well done and thank you if you’ve gotten this far. But I guess what I’m asking is… are these “typical” four year old behaviours? Are they phases? Or are they potentially ASD/ADHD traits? I have spoken to two health visitors and a GP who have all given me their advice and my son is currently under a CAMHS referral but I really wanted to talk to other parents who may know what we’re going through as some days are so, so tough and draining and I feel often like I’ve failed. He is such a loving, caring and thoughtful boy but I feel as time has gone on that there are certain aspects of life where he is extremely overwhelmed and cannot cope easily. I am in the middle of trying to access what support I can and whilst I wait at least, I’ve come here to see if anybody else can make sense of my son’s behaviours.

I hope I’ve made sense… any advice/guidance is extremely appreciated.

Doesn't sound like ADHD at all to me.

There are snippets there of behaviours that some children with Autism might have but it doesn't sound like a typical presentation.

What is his language like ?

How long did he try pre-school for ? How were his settling in sessions ? When was it he tired pre-school? Had he previously been to Playgroups / Stay and plays etc with you ?

Hello, thanks for your response.

His language was slightly delayed throughout his infancy and we had to use a lot of picture cards to get him to verbalise and stop using his body to communicate (e.g. hitting out when he couldn’t say what he wanted to) but now I’d say it’s okay, despite mins pronunciation of some words.

He started nursery at one and pre-school at the typical age so age three until now nearly five until he was pulled out in early July this year. He has always been very active and busy with me. We always went to play groups from a young age, met up with friends and their children and we always did lots of varied activities with him at home (I’ve always worked in childcare so this helped).

I guess what I’m trying to depict is the above behaviours which I don’t feel are typical for his age (especially due to their duration and current presentation) and his erratic mood swings, sensitivities to a lot of things and he will say to me after a meltdown “I don’t know why mummy, my brain does it and I can’t stop it” - I’m not sure what that means but I do know his behaviours can limit us on what we do daily.

The rigidity in behaviours sounds like possible ASD to my non - expert ear. As far as I know, language and pretend play are also areas to look out for. My ASD 4 yo is non-verbal and has no pretend play, for example.

Didnhis language come naturally or did you need SaLT?

He is extremely rigid to the point we can’t get past certain “issues” sometimes as I don’t know how else to try and overcome them. I feel like I’ve tried everything so waiting for CAMHS and also support from his school SENDCO (he starts reception next week).

A couple of people I know felt he needed SaLT when he was around 2 but I didn’t feel he did so kept working on his speech at home with very short sentences, lots of playing and encouraging his speech and he came through it.

He struggles to pronounce some words and says things like “bic-sit” instead of biscuit and “bak-sit” instead of basket but he can hold full sentences.

He really struggles emotionally (despite my best efforts) and can go from 0-100 in seconds. He has lots of tantrums as a result of his emotions and not knowing how to handle a situation e.g. he wants to go to his grandparents who live next door to us but doesn’t want to go unless I’m there and says he doesn’t want anyone to look at him or talk to him. I’ve tried to ask why but he can’t explain why to me and it’s really difficult. He’s utterly spoilt with them and they’re so kind and loving but this is how he behaves in most scenarios (well, one of his many challenges anyway).

Do you think he is having ‘tantrums’ like a part of typical development when he doesn’t get what he wants? Or are they ‘meltdowns’ where he can’t cope with something and is totally overwhelmed?

Thinking about the difference is helpful in working out what to do, in my experience.

Hiya, I can tell when he’s tantrumming as just a typical 4 year old boy and when it’s a “meltdown” because he presents quite differently with both. With a meltdown he loses all self-control and can start to really lash out and becomes very frustrated and I have to remove him (from wherever we are) to somewhere quiet, and simply ride it out until it’s over which can take up to 40 minutes and my usual tactics don’t work. With a typical tantrum, it usually lasts no more than 5 minutes and my tactics tend to work well such as: distraction.

I don’t know how best to overcome his meltdowns when they occur because everything I try seems to fail.

I’ve only just started really learning about ASD and ADHD (when they were mentioned to me by professionals) so I’m not sure if he meets a diagnoses for either or both but it would be good to get others perspectives.

Having spent a lot of my adulthood in the childcare sector, I feel that some of his behaviours aren’t neurotypical however, I don’t know what’s causing it.

Thinking right back to when he was 1 and started nursery, he never wanted to separate from me then and it would end in tears and I thought he would settle in time however, he’s actually been the same throughout right up until now, it’s just he’s older, has more of an understanding now and fights back a lot more.

Hello, to me it does sound like ASD. For ADHD they won't assess until he is 6, and I've been told that it can be difficult to distinguish between the two when they are young.

I'd suggest using autism friendly techniques, try to keep him calm using sensory input. For example, my son with autism can be calmed by white noise or by swinging. Try and figure what calms your DS and which situations wind him up.

It might be best to avoid birthday parties as they are overwhelming even for NT children? Or you could try arriving early and agreeing in advance where he is going to sit.

Hi I know this is an old post but how is your son now ? My 4 yr old is very similar