Can ASD present in certain contexts only...

[Livingmagicallyagain]

....and other stupid questions?

I have worked with SEN children for decades. I work in broadly in education. But I find this knowledge is different to applying it to your own child!

My 6 year old son is in SALT and the therapist suggested he be assessed for ASD, though not due to her obs, rather from our chats about him globally.

Pressed send too soon!

He did not display any signs until 4/5 at the earliest. I have lots of experience in this area, and so do other close friends/relatives (including a close friend who is one of the top assessors for ASD in this country). We just didn't see anything.

Very sociable little boy, very funny and curious, highly emotionally literate and a string sense of empathy. It really didn't show until this year in school (year two of "kindergarten" where it is mostly play based but with phonics and early maths - more formal learning starts next year). He is REALLY struggling and the boy they describe is very different to the boy he is at home. He is withdrawn, silent, doesn't appear to hear instruction, doesn't play with friends (the minute the bell goes for yard or home/play dates he is there playing wildly imaginative games with his friends). We were surprised. School ruled out ASD (and ADHD assessment was so low he is nowhere near even close to the "mark" needed for ADHD). Dyslexia has been suggested but reading is slowly clicking, anyway.

At home and school he is kind and loving. At home he can go into himself when he doesn't want to do something, or lash out. But only sometimes. Going out and about with him is fine, though places where he has to be a bit quiet (like a church) and it is impossible - he just can't (not that we go often, but as an example).

Sleep/diet all really good.

So really, I am asking if ASD can "suddenly" start at age 4/5 and if it is context specific sometimes.

Autistic people have always been autistic, but it isn’t uncommon for signs not to be picked up until school age or later. This still applies even in cases where close family members have experience. Sometimes you can be too close to a situation to see.

It is also common for DC to present differently in different environments.

The demands and expectations increase as DC get older.

If the SALT is suggesting an assessment I would listen.

The SALT team are wonderful and were open to their suggestions. I did ask school prior to this and they said he doesn’t present with any of the signs they look for in terms of ASD, and while dyslexia could be a possibility he is too young for the assessment here.

The SALT therapist said the thing that stood out for her was the contextualised nature of his behaviour. So, not presenting at home but showing signs (as she thinks) in school. School are brilliant, but they may be missed it through focussing on possibly dyslexia. He’s getting a lot of support there. The school refusal was extreme but he never missed a day thanks to us all working together and now he’s happy enough.

School here finishes at 1 at his age and so it’s not a long day.

What are common signs pre age 4? I just find generic lists and he doesn’t tick any of those boxes. Whereas now I would tick some of them.

I think as his world is growing bigger, he is subjected to increasing demands.

I don’t know where you are, but in the UK schools are not always good at recognising signs. The increasing demands and expectations as DC get older is one of the reason the signs are recognised more in DC as they get older. Another trigger point is the transition to secondary school. For toddler age questionnaire have a look at the MCHAT. Not diagnostic but can give a general indication.

Quite a few "common signs" of autism are actually signs of a person under a huge amount of stress, so they tend to develop cumulatively.

My son has brilliant eye contact - until he is feeling anxious or stressed and then it really falls away. With me it is brilliant, with a teacher he has never met before or if he was being told off it would be non existent. He didn't tick any boxes for ASD at 1/2/3/4 though that I noticed - well he had a few sensory issues ie didn't like certain textures, was fussy with food, was shy with people he didn't know, was difficult to toilet train. But all things i could put down to his age. Preschool and school didn't pick up on anything. It wasn't until nearly secondary school where the differences started to really show. I worked as a TA in an SEN school but I'd had no idea that he might be autistic.

Interesting questionnaire, thank you. Literally no signs/the opposite in fact in terms of the early years.

He’s perfect, whatever the outcome of this process! I am glad SALT raised it, I do feel he needs much more support around school.

He’s perfect, whatever the outcome of this process! I am glad SALT raised it, I do feel he needs much more support around school.

This is really important. DS is the same child whether he has ASD, dyslexia, both or neither. Equally whether he has ASD, dyslexia, both or neither he needs more support at school.

According to DSM-V, the diagnostic manual, autism has to be present "across multiple contexts." Exactly what that means is not super clear to me (I'm a SENCO, not a psychologist). Our local CAMHS say "present in at least 2 contexts" so it could be eg. School and football club, but not at home.

Some children present differently at home because it is generally the safest place for them. It is also often quieter with fewer demands.

Thank you, so multiple contexts for us could be school (extreme!) and other places where he has to be a bit quiet/feels distressed.

The only "checklist" I have read where I think - yes, this could be him - is the PDA symptom list. That is him. He can either withdraw or have outbursts, both ends of the scale. And when I look at the times we have seen this presenting, the first was around 6 months after he became a big brother (age 4), and the second is now (since Sept) when he started the second year of Kindergarten.

He is hard a describe but I didn't think of any of this as he is no bother, I just see him and a kind and funny, stubborn at times and wonderfully wild little boy! The really tough "PDA" style moments I thought were part and parcel of parenting and I still do, I suppose. I have learned how co-regulation helps him and so we have gotten quite far with that, but of course as his world grows bigger we may need to look at reasonable modifications at school which would help in a similar way. Of course, even at home I am not always fully available, I have other children and am busy etc.! But when I can really slow down and co-regulate, it helps (us all!).

Little update here! In DS's SALT we have ruled out any language issues. We have made an application for him to be assessed for ASD - it is a 6 month max pathway here.

His primary school teacher has noted progress (they have been giving him lots of 121 support and small group teaching) in his academics, and he did really well in some class and standardised tests - much better than expected in some of them, scoring quite highly.

It seems to be that he is capable but in a group setting/school setting he just cannot cope and still withdraws into his own world, into imaginative play by himself.

What is coming out is that the school context brings out such a different side to him. At home he is engaging and definitely more .

Attention and focus continue to be issues at school.

I did wonder about DLD but that would present across all contexts, not just at school.

He is very strong at maths but not when a maths problem is presented in literacy iykwim.

So, where we are at the moment - it looks like some kind of ND, he appears capable of the academic side of things when other issues are removed.

Any insights appreciated!