Help with my 4 yr old ASD with social anxiety"shyness&q

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My daughter is 4 with autism. I have her in full inclusion in preschool(regular with the district) with an IBI tutor(she is needing hardly any prompting). She has social skills class, language program, and OT in school. She is potty trained, no obvious sensory issues(loves water, clothes don't bother her, loud noises are fine). I have her on the biomedical treatments(which has helped ALOT and she isn't having as much OCD type issues either, not a fight to get dressed anymore, I will change things up and she can go along with the change pretty well, able to reason with her etc. etc.)
My concerns are these...she says our dog's name(gypsy) in times of stress, happiness, and in public wherever she is exposed to strangers/parks(kids she doesn't know). She has a lot of social anxiety and I don't know how to help her, some days I just want to keep her home and give up trying so damn hard. She expresses a desire to want to play with other kids(shocks me!! !), but then when she gets into a situation and its overwhelming re: the kids all around her she verbal stims like crazy. she makes great eye contact, but when a child gets a little too close too soon she starts with "Uh oh Uh oh gypsy" "gypsy gypsy gypsy". I have done one on one playdates and she does great in my opinion. Its these public outings that are dreadful(she doesn't have a meltdown, but it will take about 20 mins for her to do it on her own, but she starts saying all our pets names over and over and she isn't really conversing appropriately, I redirect her to say hi to other kids when they approach but of course it gets awkward and they give up on her, she looks in their eyes but nothing "happens")
It breaks my heart, for I know we are supposed to get her "out there" with other kids in the world besides school(she does really well in the classroom). I read tons of social story books to her about playing, etc. etc.(I think I own them all). I talk to her, she talks back to me... but these moments where she is out in the world and there are alot of children she doesn't do well. I have taken her to several bday parties(they have had bounce houses and we had to leave, she couldn't handle the kiddos on top of her and all that contact), but its so gutwrenchingly painful to watch her stress out and start verbal stimming.
What else can I do to help her? I talk her through things to help her, but this saying the dogs name over and over is really worrying me. I wish she could handle when other kids get closer to her while she's playing. Its like we are there having fun and some kid comes along and she then starts up.
thanks if anyone can offer any suggestions. Does this improve over time?

I started my older son with classic autism on Prozac just before his 4th birthday. It does not make him sleepy, but he did experience a lot of hyperactivity when he first got on it for about two weeks.

In the U.S., it is available "off label" for young children--readily prescribed even if not FDA approved for autism. Neurologists and child psychiatrists where I live (Austin, Texas) prescribe it and other medications regularly.

It has been shown to be effective in 76% of children in research studies for selective mutism (a severe social anxiety disorder where the child cannot speak, appears mute in social situatlons). It cured my son's selective mutism and he is still on it at almost age 7 for anxiety. It is cheap and works great for him.

If you are willing to use drug therapy and have access to it where you live, there is a good chance that it will work for you.

This is a form of verbal stimming, if you don't know what stimming is; It's self stimulatory behavior us autistics do when we want to calm ourselfs, when we're overexited, when we're scared. they manifest themselves as usually repetitive (but voluntary) motor movements, in my case I rock back and move my legs up and down. She is doing basically the same thing as far as I can tell, just another repetitive action to calm her.



You are truly describing what so many of us were like as kids, loads of us want friends, but how?

Are you sure shes not making to much eye contact? autistics often either make to much (a constant stare) or very little.




Yes, almost universally autism gets less severe over time, almost universally. there are no easy answers to your problems, many of us are still grappling with these issues into adulthood, you are describing a four year old but you might aswell be describing half the members of this forum, we must face that it will never all go away, we just work with it and try adapt.
Don't make her socialise if she isn't up to it, their are long term consequences to making an autistic socialise for long periods, I personally went to a big busy school for about 4 years and finally had a bit of a nervous breakdown, just a warning.

Some practical advice? read Tony Atwood's "The Complete guide to Aspergers Syndrome" if you haven't already, it's very popular and as an autistic I approve of it's treatment of the diagnosis.
Stay in constant communication with her teachers, particularly her social skills teacher, who will probably tell you the same thing as I: things generally get better for autistics as they get older, though sometimes getting older leads to greater awareness that we are "different".

That's all i got
Phonic

Sounds to me like your daughter is doing great. I would not stress about this at all. Dont force the social issue so much, go slow at her pace. If she starts getting upset she is overwhelmed, thats all. This is no reason to "break your heart" just back off a bit. She may never like being overly social or in a big group, thats ok, its worse to force her and stress her out. Maybe since she has less issues now this bothers you as it stands out as autism, you need to accept that she always will be autistic no matter how much she progresses. Just slow down and relax and she will too....and for heavens sakes, dont even consider putting her on drugs....she is doing awesome for a 4 year old!

She may feel more confident if she has a good script that she understands...maybe next time prep her with a few cartoon social stories? She may not be able to take in information while the event is occurring. It's hard to prep for every social interaction - but some basics may make things better. I agree with other posters that big groups on noisy playgrounds are hard for anyone; just know she's going to be somewhat stressed in this kind of situation. If it were me - if she melted down or appeared to be close to a meltdown, I'd back off, but I think I'd consider a bit of stimming a natural reaction.

Can you take her to the playground at a time when there are almost no children there? I've found it's good to separate things out to make sure there aren't any additional stressors - who knows, maybe she's concerned about the environment as well.

When my son was that age, and we had no idea what was going on, I somehow knew to provide him with language ahead of time (he learns well verbally if you make him repeat it back) "Hi, my name is DS, what's your name? Do you want to play with me? Do you like Batman?" etc. He actually became so adept at making new friends that it covered up his AS for a significant length of time.

You can make a short, 3-panel social story yourself here: http://www.makebeliefscomix.com/Comix/

Here are some pre-made ones that may be helpful starting points: http://www.freewebs.com/kidscandream/page13.htm

Thank you for the validation she is doing well:) I was worried about the verbal stimming and what I can do to help her with that or if there is something I am missing. I know its a red flag she is stressed out, we even put interventions in her IEP about it. I just don't want to push her too hard but want to give her new experiences as well and get out of that comfort zone so to speak. I do get worried that the public school system will be overwhelming for her eventually.

She wanted to go to the what I call the "mosh pit" aka play area at the mall yesterday. I was in shock because a year ago she wouldn't go near them especially if there were other kiddos around. Frankly I hate those places but she wanted to give it a shot, her dad and I sat with her and she watched others. She eventually started climbing on structures but all the while was verbal stimming and it was hard to watch, I don't see it to that level usually so it concerned me somewhat and I second guess myself(am I pushing her too hard? am I expecting too much? Is it ok she does this or do I try to discourage it????etc. etc. etc..) I talk to her to prep her on there will be "different friends" where we go parks, etc. etc. (she called them that when we are out at other places besides school - "Mommie those aren't MY friends, those are different friends")
My daughter has had the habit of going to a park/place etc. etc. and there are little to no children around, it actually sets a precedent for her that she will avoid those places if there are children around and makes it harder for her to join in if that makes sense. So its easier to put her there when there are kiddos there so that's her expectation first off. I social story her and verbally prepare her constantly, help her say hi to other kids, all those things suggested(thank you for those ideas, been there done that LOL).

Thank you for saying she is doing great. I am so proud of her beyond measure.

Phonic I am getting that book and now probably a few more...

If she is asking to go and play somewhere but still verbal stimming its just how she is dealing with it. Im sure someday she wont need that anymore but right now she does so just let her do it. I know its hard because sometimes people stare at your child or stare at you....people can be rude and make us feel badly that our child may look or sound odd to them. If this is an issue just either remind yourself how far she has come or use it as a good excuse to educate people about autism.
Like I said, sounds like she is doing really well and if she is asking to do something, you are not pushing. She will let you know when shes had enough. Sometimes stimming is just "dealing"....it helps. Look at it as shes is being brave and willing enough to try things that may stress her out a bit, that has to be a good thing!

That was my thought too.. that if she is willingly do stressful things that is great. The stimming will fall away on its own. I hadnt ever thought about but I do a lot of verbal stimming in my head.... I'll just repeat the same dialogue over and over in my head and never realized why. Anyway, other than seeming like I'm in lala land it works for me and isnt obvious to others so she may start to do that as she gets a bit older.

My daughter is 5/6 and went through a similar phase to your's when she was 4. My daughter used to get possessive over her space in the playground at 4 and often resorted to physical pushing to keep other kids from getting too close. Nothing untoward, just a friendly push. Of course in school this is unacceptable (especially for other parents). When she came home from school we knew she pushed as she would keep repeating the scolding she got "You pushed Daphne off the slide, don't push" she would say over and over. We would talk the issue over and basically repeat over and over that she shouldn't push. It eventually worked, I guess repetition has some merit.

Wow - you are willing to say someone should give a potentially dangerous drug to a 4 YEAR OLD becasue she has some anxiety in social situations?! I could possibly understand this if the anxiety appeared to be debilitating but that does not sound like the case here.

It sounds like this child is doing fine. She's 4. Many 4 yo's cope in social situations by grabbing the toy they want regardless of who had it first and/or pushing other children out of the way to be first in line, that is unless there is adult intervention. You are on the right track by following her lead. One aspect to consider when trying to determine if situations are too much for her is how she reacts AFTER, even a day after. She is displaying obvious signs of stress with the verbal stimming during the event but sometimes kids display the stress in different ways after the stressful situation is over with increased meltdowns or other types of out-of-the-ordinary (for them) behavior. This might help you judge what is good "pushing the envelope" and what is just plain too much for her.

Selective mutism and social anxiety can be debilitating depending on the severity. (I had selective mutism myself as a child and wish that someone had done something.)

I wrote the advice about the Prozac based on the positive experience that I had with my son's classic autism and comorbid selective mutism, among other anxiety related issues.

Other than hyperactivity the first couple of weeks, Prozac produces little in the way of negative side effects, from what I've seen.

my 5 yo autie has severe social anxiety as well. he doesnt stim when stressed by being surrounded by kids, instead he ignores their very existence. doesnt look at them, doesnt talk to them, he plays as if they dont exist. sometimes he will play off to the side to limit his contact. he will get extremely bouncy and spastic though when overwhelmed.

the best thing you can do for your daughter is talk to her about what shes feeling. help her learn to recognize when she is feeling anxiety, and help her find ways to deal with it. verbal stimming is one way, she can also try breathing techniques and muscle relaxation. sometimes using an mp3 player with music or books will help with social anxiety. the most important thing ive ever done with my son was to talk with him about why he feels the way he does, and let him know that its ok to feel that way.

also consider if maybe putting her into more social situations is more stressful than helpful, especially if she is in full inclusion school during the day. a lot of autistics need decompression time after social interaction and may be physically exhausted by it. social exposure is good, yes, but not if it causes so much stress that she doesnt get a break from that constant anxiety. we limit the outings during school days to prevent anxiety overload. its ok to back off, mom =) getting out into the world is good for our kiddos, but it doesnt have to be every day or even every week. it can be difficult as a parent to acknowledge to ourselves that letting our kids play alone and not push them into social situations or to make friends is OK. it really is ok, no parental guilt required.

whether this will go away or not.... maybe yes or maybe no. there are a lot of autistic adults who still prefer not to have much contact with other people, and others who have learned to enjoy it. my SO also has classic autism, but wasnt diagnosed until this year at the age of 39. like our little autie, he has severe social anxiety as well. he learned his own "coping mechanism" if you want to call it that, he gets angry, sometimes VERY angry, when in social situations. he doesnt stim, he gets pissed someone blocking the aisle of walmart or following too close to his bumper would make him foam at the mouth. for a long time he took that anger out on me when grocery shopping; made for some very unpleasant shopping trips and almost killed our relationship on more than one occasion. things are much better now that he actually knows what is causing the anxiety and tension. i think if he had someone to talk to him about it when he was younger, he would have learned more effective ways of coping.

as for prozac, my SO actually just started taking it a few months ago. he was suffering from some depression in addition to a lot of anxiety, and it has helped him a bit with balancing out his moods. you do want to be careful with it tho, as it can cause increased anxiety, and even mania in children. for my SO, it hasnt stopped the social anxiety, but does dull it a bit so its not as severe (he says people dont tailgate him when he takes his prozac). he has an appt with his doc next week and we will be discussing trying a different med; when he misses his prozac, he feels crazy in his own head, and he doesnt like that feeling. but just because its readily prescribed doesnt mean its completely safe. if a child is coping well like it sounds this one is, there shouldnt be a need for drug therapy.

Medication for very young children with Autism should only be considered, in my opinion, in extreme situations. Such as self mutilation or being violent to others and therapy not working. I put my daughter on celexa for a short time when she was 13 because she was picking huge holes in her arms and legs. The small dose and therapy stopped this so we were able to wean her off the medication. I am appalled at how many kids are on medications for severe mental illness like Respiritol, they hand that stuff out like candy for kids with Asperger's because they irritate their Mom! I have seen kids in my sons old social group that are drugged out of their heads or are actually worse in behavior. I hear the parents talking about Respiritol like it is just something you are supposed to give you child if they are diagnosed with Aspergers.....they even asked me what dose my son was on. Being the blunt aspie that I am I said "Im sorry my son has Aspergers not schizophrenia". They all looked at me like I was crazy so I said "you know that drug is an anti-psychotic dont you?"......scary, none of them knew that. I cant imagine just putting my child on a medication without even knowing anything about it. This made me so upset and angry....as bad as the woman who would sit there and call her son a "jerk" all the time...of course she had her son on it too, I guess it didnt make him any less of a jerk.

I agree that Risperdol/Risperdone is best used in cases where the child is violent, older, and has classic autism. From what I've heard, it has unpleasant side effects.

Low-dose Prozac is completely different. It cured by son with classic autism of selective mutism at age four--very fast--and he would not have benefitted from any kind of cognitive-based therapy at that point. Getting rid of the selective mutism allowed me to more effectively work on his speech issues.

My older son (aged three) was prescribed Prozac for OCD, but he refused to take it. I am now giving him Relax-a-saurus herbal supplements with chamomile, passion flower, and l-theonine--some mild relaxation ingredients found in herbal teas.

Cognitive therapy with a child psychologist has also worked with some on these types of issues--if the child has the maturity and cognitive ability to benefit from this.

Unfortunately, kids can have mental illnesses, and kids on the spectrum are at high risk for comorbid mental illnesses. If a comorbid mental illness can be accurately diagnosed and treated, it can provide a lot of relief for the child and family. (You can check out the "favorites" section of my Autistic Kids Channel on YouTube if you want to hear some doctors discuss ASD, comorbid psychiatric conditions, and medication).

Going to the school counselor a few times did nothing for my selective mutism (which got better on its own by age 10), but maybe it could work with a child with milder issues. Or maybe extensive private therapy would have helped, but my parents would not have paid for that or have been willing to take me to a bunch of appointments.

http://youtu.be/v6w6r9isEjY

A child psychiatrist discusses autism and comorbid psychiatric conditions. I also have a good video about the same thing presented at Yale University in the U.S. These videos are on my YouTube Autistic Kids Channel in "favorites" (user vids4autkids1).

The research study was done on kids 10-14 years old with ASD. 70% had a comorbid psychiatric disorder. Social anxiety disorder, oppositional defiant disorder, and ADHD were the most common.

I know, I have a son who was early onset Bi Polar, he was not diagnosed until he was 12 but showed symptoms much earlier. His Psychiatrist also thinks he has ASD because of my description of him as a toddler and young child. His Bi Polar disorder is at the forefront if he does have autism at all. He also developed drug addiction as a teen and is now 24 with Hep C from IV drug use but he is clean right now and has his bi polar symptoms under control with medication.
I also have a 19 year old daughter with Asperger's who had a breakdown last year and now shows signs of either Bi Polar disorder or paranoid Schizophrenia. Her psychiatrist, before my husband and younger kids moved to France, was leaning more toward Bi Polar because her father is Bi Polar and her brother. She now lives with a boyfriend and his family after trying to live with my mom and dad in the US (she refused to come with me) who has been diagnosed with schizophrenia. I worry a lot as she refuses treatment and her diagnosis, I understand that, she does not want anything to be wrong with her. Right now I am very worried as she seems to be heading for another breakdown, very paranoid that other girls and even things on TV are trying to steal her boyfriend away from her. She gets very verbally combative with me if I even suggest her seeking treatment.
My two younger kids are Classic autism (my daughter age 6) and Asperger's (son age 9). I have Asperger's and my husband is undiagnosed Aspie or half-spie as I like to call him . My X husband, the father of my first three is, as I mentioned Bi Polar and there is a lot of early diagnosis of Bi Polar in his family now and other undiagnosed mental illness. His mother, Im convinced is schizophrenic. She would be very sweet and helpful one minute and then horrible the next (sounds bi polar as well, I know). One time she called us when we lived thousands of miles away from her and accused us of stealing her credit card. My X could not talk to her as she made no sense at all. I wish my older kids would have gotten their diagnosis and help earlier than they did. My daughter was not diagnosed until she was 16 and then they offered no help for her.

UH OH....Ive stolen a thread!! ! Sorry!