Would you have this child evaluated?

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Hi,

My son is almost 5 years old, and since he was about 2 I have had questions about whether he is somewhere on the spectrum.

His speech development was not really delayed. At his 18 month checkup they said he should have 20 words he uses, and at the time we could only think of a dozen. Within six months he was caught up to where "average" is supposed to be.

He learned all the letters of the alphabet, numbers, and colors very young, and clearly has good cognitive ability. Early in his speech development he often spoke by repeating lines he had seen on TV or movies (although in context and "correct" for the situation) although he now no longer does this and outgrew that tendency by age 3 1/2 or so.

His speech now is characterized by sometimes odd word choice, but is grammatically correct. His prosody is pretty normal for a 4-5 year old, as far as I can tell. He make eye contact only occasionally though. I've been working on this - if I say "Eyes!" while he's talking to me he'll briefly look me in the eye. If I'm talking to him and ask him to look at me when I'm speaking he will, but his gaze seems... Unnatural I guess I'd say.

He's VERY emotional, but can be talked down most of the time so I'm not sure I'd characterize him as having the kind of explosive tantrums like I've read about.

He walks on his toes unless I remind him not to. I should say that my sister and I did as children as well and we're both neuro-typical.

He is in kindergarten, and his teachers often remark about how smart he is. He struggles a bit with fine motor skills (holding a pencil and writing , coloring inside the lines, etc.) but is very athletic and "nimble" as his teachers say on the playground.

He has friends at school, but his teachers remark that he often prefers to play alone. Not always, but often. They also remark that he sometimes "does not consider others feelings" - but I guess that could be just being a child...

He has a very selective diet. He likes dairy products, chicken, and fish. He'll also eat vegetables. Asking him to try anything else results in a blowup.

He used to flap a hand or two when really excited, but I think this is dying out now. Ditto with walking around in circles.

He has a great imagination and creatively plays alone or with his brother and cousin at home all the time.

At any rate, does this sound like a child you'd have evaluated? It seems to me that if he's on the spectrum, he's very high functioning and I guess I'd like to know if a DX would even be worth it if it was there. He has a blood relative with Asperger's, who really struggles (although he's independent - and brilliant!) and I'm not sure if this is just making me worry unnecessarily.

Thanks for your time,

Eddie

The important question here is whether the boy needs help with anything. That's what a diagnosis is for--to get him whatever help he needs, to learn things he's slow at.

He has autistic traits, but you have to understand autism is the extreme end of a continuum that blends into the average pretty smoothly; and there's no real reason to seek therapy unless he needs it.

You probably won't know until he's in first to third grade somewhere, when the social demands start to increase, whether or not he's behind in that area.

Regarding his not looking you in the eye--I wouldn't push it. Personally, I don't look people in the eyes because I have difficulty multi-tasking both eye gaze and speech comprehension; so I look past their heads or away in order to pay attention better.

Learning to speak by copying phrases at first is very common in autistics; that's how I learned--I had a library of phrases and conversations I would pull out to use because it was easier than figuring out how to say something on the fly. It seems to have worked for him, and if he's expressing his desires in a useful way, then that's functional communication and it's what he needs.

Creative play in autistic kids is actually pretty common, and playing with one's siblings is also pretty common. I wouldn't take that as an indicator one way or the other.

Sensory issues are common on the spectrum; but NT kids can be picky eaters too. Lots of NT kids also flap their hands and walk on their toes...

So, I guess the bottom line would be--Yeah, he could be autistic; but at this point, I wouldn't worry too much even if he is, because he seems to be developing in a way that's pretty compatible with his strengths, and learning effectively. You may get him evaluated just because you might need some kind of record to get him into useful programs later on if he needs them; or you may want to wait a while and see if he needs help with socializing and such. It's likely that if he has issues, they won't be related to academics but to organization, self-regulation, social skills, and other such things. If he has academic strengths, chances are these are what will get him a job later on--encourage those and make sure school and learning stay fun for him.

Thanks Callista!

That was a very helpful and well thought out response. I have been leaning towards just taking a "wait and see" approach and then, as you said, getting help if it's needed later. Your thoughts have made me feel a little more secure about my own.

Depending on where you live, and what kinds of supports are available, it may or may not be worth having your child evaluated. If reasonable supports are available, an evaluation and diagnosis (if appropriate) would be useful.

If your child is on the spectrum, his need for supports in the area of pragmatic language skills will increase as he gets a bit older. Similarly, his social skills will become more apparently delayed as he gets older - but the diagnosis now, if made, would give you the starting point from which to receive the necessary services.

If he has fine motor deficits, whether or not he is on the spectrum, he needs occupational therapy support.

Like Callista, I wouldn't push the eye contact at this point - children who don't make eye contact often can't pay attention if they are looking people in the eye. I would rather a child focus on the information than on making eye contact!

It takes a long time from when you request an evaluation until the evaluation is completed, so it is a good idea to request one before you feel like it is urgent. Kindergarten is a much more easy-going experience than the rest of school, and when your son starts first grade, he is likely to have many more demands placed on him. With the greater demands, he is likely to feel more stress, and that could result in more outbursts and other "difficult" behavior in school. It is best not to wait until a crisis before you start the process.

Mm, yeah, there is the waiting-list issue... don't wait until things are urgent. Better to get an unnecessary evaluation at the first signs that he may need help, than to have to wait months when it's obvious he needs help and needs it quickly.

If it were up to me, I would have him evaluated. If nothing else, in the event that he falls on the spectrum it will give you a better understanding of why he behaves the way he does. My parents and teachers knew there was something different about me, but just shrugged it off and it has had a negative impact on my life. In 1987 they just said that I was gifted and left it at that. I lived for more than 25 years thinking I was the only person who thought about things the way I did. Knowing more about AS and talking to others like me is something that was so life-changing that I can not put it into words. I wish I had understood my differences at a younger age instead of just floating around in chaos and exhausting myself trying to be someone/something that I simply could not be. So yes, talking to a prefessional is worth it in my honest opinion. Good luck!

If you live in the United States, a public school will evaluate your child for free.

You can also get a cheap diagnosis from a developmental psychiatrist for under $200. I think I paid about $150.

My personal guess is that your son is neural typical.

I would definitely get him evaluated. He could be on the spectrum, and if he does develop problems, the information could be useful. My concern is that he is the sort who could easily get overlooked. Do not take it too seriously at this time. Just be aware that there is a possibility. It probably is the wrong time to do anything special. Just keep track of his social development. Remember that some teachers are better at catching social problems than others.

If he does run into problems, it will probably be in a few more years, maybe when he is about ten years old. That is the point at which children start to develop more complicated social structures.

In any case, this is just a precaution. Do not let yourself get too worried about it.

"He has friends at school, but his teachers remark that he often prefers to play alone. Not always, but often."


err.. yes. this alone warrants it.