How can you distinguish between language delay and ASD?

[nikos]

Wasn't quite sure how to title this. I've mentioned on the boards before that ds3 is being assessed for ASD. We have had the ADOS and DISCO questionnaire and in the words of the paed he 'doesn't tick many of the boxes for ASD' and 'he is a complex character'. His play therapist is also starting to doubt ASD as he has natural eye contact, a great desire to communicate. She also says 'he is a quandry'.
Ds has very good 1-1 support at his preschool and is coping really well, but probably wouldn't if he didn't. He interacts very well with his siblings but prefers to be on his own at preschool unless encouraged by support. He is a happy compliant boy unless out of his depth.
We are going for probably a diagnosis meeting in mid-November. I'm happy to have a provisional diagnosis of whatever if it gets him a statement and the support he needs for reception.
I suppose my concern is that if we treat it as ASD we might be missing something else. Anyone able to share experience/wisdom about this?

I think it gets confusing because with ASD you can have 2 children with the same dx but who are very different to each other. I see it a lot with my 2 boys.

On the language side of things the speech development for my two has been very much disordered rather than delayed. Most people who know ds2 (5) would probably be very surprised to find out that he needs SALT. His expressive language is ahead of where it should be, although it can still be quirky and sounds very formal. His understanding of language is a way behind and he still has trouble with instructions with more than 2 parts to them. He still takes things very literally.

Ds1's (8yrs) understanding of language was also very odd in that he didn't get very basic concepts but could understand some of the more complex ones. I think the example they used at his assessment as a 3yr-old was when he was shown pictures of two animals and was asked to point to body parts. He couldn't do it. He was then asked which animal was the heaviest and got it right each time.

I think the stereotype of what a child with ASD is like can also confuse people. Mine have never really been all that interested in lining things up. Both are affectionate. Ds2 loves being hugged and squeezed, while ds1 always tells me "I love you, Mum" whenever he's feeling happy about something. Both are imaginative. Ds1 makes up stories about an imaginary universe and the superheroes who rule each planet.

we're living in limbo too - and for a while longer as our most recent salt appointment has been postponed.

ds (2.10) sounds VERY similar to others mentioned here; a curious mixture of asd and non-asd traits. though i suppose every child with asd will tick some boxes and not others?

"asd traits"
delayed echolalia/ very repetitive learned phrases from tv

talks constantly using learned phrases but uses very little 'original' expressive language

receptive language problems - ability to follow instructions emerging, but still can't answer basic questions

non-verbal stimming behaviours when tired

constantly on the move/bouncing/running

very visually aware - attention to detail

uses my hand as a tool, regularly but not always

lies close in to his toys regularly, but not always

difficulty with names - calls all his friends by the same name (though improving)

"non-asd traits"

very much improved eye contact
sense of humour
very sociable
very affectionate
no real problems with changes to his routine

my instinct is that he is somewhere on the autistic spectrum, but i'm constantly questioning this, especially given the scepticism of family members.

Thanks for so many replies. Can I ask those of you who have children with language delays, how that affects their social interaction?

i think that the stereotypes that my family have make it very difficult for them to accept that ds could have asd.

i put the traits and the non-traits in inverted commas because many of the traits could apply to nt children and many of the non - traits could apply to asd children.

i'm glad it is be someone else's responsibility to diagnose these things - my mind is completely boggled by it all!

woops x post. sorry.

ragged - at 2.11, my DS was v similar to your DS with speech and behaviour. He was very aloof, hard to get his attention. But 18 months on, his language is much improved, echolalia still there but much reduced. DS is very sociable - the language problems do I think have some impact socially, but he muddles along pretty well. so much so that his teacher doesn't seem to think he has a language problem anymore

Nikos, I'd say social interaction is (or was ) the biggest problem for DS. He's very chatty, sociable and friendly but as his SLI is receptive he doesn't 'get' the rules of games like his peers. He has to copy other children in most physical activities though this has improved enormously. Games like football can cause problems, though I don't get negative feedback from school, so maybe it's just heightened paranoia on my part!

As far as friendships go, he's very popular (gets invited to every party for example) but doesn't have a BF at school. Maybe that's normal for 6 year old boys though?

tc - it's great to hear that your ds's language has improved so much. did your ds have any of the non-verbal "asd type traits" that i listed (such as non-verbal stims, lying close in to toys, using my hand as a tool/ to point). these are the things that make me suspect autism rather than language delay, but i'd be really interested to know if some of these non-verbal traits also cross-over iyswim?

yes, my DS did the lying on the floor looking at toys thing too. He rarely does it now (did it a day or two ago when recovering from a tummy bug). He didn't use my hand to point but would say drag me over to the fridge to get something rather than point to the fridge.

there are such a lot of cross-overs then, it's very difficult to take it all in!

Nikos, I would say that at 3.5 years, Ds2's biggest problem is verbal communication and social interaction at nursery.

At home with family,including cousins, he will chat away in 3-5 word sentences about what he is doing or some imaginary game. Also when I take him to the playground to pick up DS1, swimming or the park, he is always trying to engage with other children his age. However, they say at nursery he speaks very rarely and when he does it is very quiet and solely about getting his needs met, for example asking to go to the toilet. He shys away from the other children if they try and approach him or he stands back observing what a group of children are doing. His key worker thinks it is almost as if he does not know what to say to break into the group so he leaves it .

Hopefully,the IEP they have in place for him will aid this.

poshpaws - at 48 months DS was much the same as yours - observing, sociable, but not quite knowing how to initiate/join in. He has definitely (I think with schools help) improved quite a lot over 6 months or so.

"As far as friendships go, he's very popular (gets invited to every party for example) but doesn't have a BF at school. Maybe that's normal for 6 year old boys though?"

Yes normal.

TClanger: re family history: has your DH ever left his keys in the washing machine - not just in the pocket of trousers but just put them in the machine? This is the sort of thing I do though I've trained myself to do it much less, particularly after I once set fire to someone's kitchen when absent-minded. I am widely considered eccentric. My conversations go awry all the time because I find it hard not to respond to people's basic statements with an allusion that they often don't get (like a teenage boy quoting monty python though thankfully I have a wider range). Again, I control this as much as I can. But I guess someone who got my eccentric traits but didn't get the academic abilities would struggle in society.

This thread is making me feel quite strongly that the problem-based approach generally used in this country in the first instance is better than a diagnosis-based approach used in the States. I'm very very uneasy about these diagnostic criteria on the ASD/language delay borderline. If you can do English and maths and make friends, it doesn't matter if you lie down to look at your toys.

lingle - snap to the eccentric stuff! going on completely off topic (sorry!) did you find the eccentricity hampered you as a lawyer? I definitely felt it did, that I struggled to fit in to the politics of private firm life, and was looked down on for it.

back to the main point:-
it's not the lying down that's the issue, it's whether that's a sign of other sensory problems/sensory overload. Sensory problems are n't inevitably due to ASD, but they are common in ASD. The difficulty with the problem based approach is that it can be so hard getting help - that you end up feeling that a DX will at least provide more of a chance of getting help/being taken more seriously by school etc.

Total: the funny thing is that I can understand "hard" politics like the strategies you use in litigation dispute resolution. I'm very good at these and since I went out on my own I have a very high success rate. But it was always hit and miss whether I could earn the affection and loyalty of the secretaries in the more informal relationships with them. To be a good secretary, you simply cannot_ be eccentric in the way you think or present yourself, so it took time for us to get to know each other. It's these casual daily "school-gate type" encounters where I often "blow it" despite trying to be tactful. I don't have good skills in large informal groups - have discovered that I'm a bit of a figure of fun in the PTA, for instance, after being regaled with an anecdote that turned out to be about me! But one-to-one, I'm often told I'm a good listener. People confide in me when they are in trouble. You can't have it all.

This is such a timely thread for us, am really considering whether I should play up ds1's mild ASD traits to get him a dx which might help him at school, or play down to avoid a dx which may not ultimately be right, and which he'll have for life.
I'm glad it's not me making the decision.

Raggedrobin, will be following your progress as your ds sounds very similar indeed to mine, (only diff is he doesn't really use me as a tool, we've managed to get him pointing and requesting now, and he's also starting to identify people by name but that is recent, and at 3.2 he's slightly older than your ds) and totalchaos, it's encouraging that your ds improved so much from the point that we're now at.

I do wish you all lived near me, it would be so nice to have a proper coffee and a RL chat. if any of you ever come down to the west country, let me know!

I could not cope with 'real world' law - that' s why i'm in academia. I'm not a good communicator though I'm supposed to be good at listening too but that is probably learned behaviour in that I have noted what it is that NT talkers are looking for - approval, understanding, agreement , admiration etc

Cyber, I'm really surprised you say that - have always thought you're a great communicator on here!

thanks ! I'm a bit better online though I think.

KT - unfortunately I am up in Liverpool! so miles away from you. I do hope to make it down to the West Country next year, as there are a number of lovely ladies on SN board who live there. In terms of asssessment - play it straight. Simplest and least stressful approach. A thorough assessment (I don't think DS"s was though unfortunately) should give them a good handle on your DS, whatever you say.

Lingle - yes I found the secretary stuff massively hard to deal with. I tended to get on well with the older slightly eccentric male solicitors. I was OK with the hard politics and basic advocacy -(CMCs etc) as it was like there was a set of rules to learn and apply. In terms of being a good listener - yes and no - I find people will open up about say mental health issues/family problems - but I obviously come over as too strait laced as I never get the sexual confidences!!!

I do actually sometimes wonder if there are a disproportionate number of lawyers, academics and accountants on here. We definitely tick the boxes for law and accountancy in our family.
Baron-Cohen has been doing a bit of research on the link between ASD and certain professions in parents, (but mainly engineering and accountancy I think) he needs to come on MN..