Need help understanding my son's status

Post Reply New Topic

My youngest son--6 years old--just started in Kindergarten this year. He has been in OT for several years for sensory integration problems. He hit all of his milestones, is quite verbal, and seems to be bright. He makes decent eye contact (we're working on it!), carries on good conversations, isn't TOO limited in his interests, and attempts to be social (while not being very good at it). He is curious about the world around him and quite kind--we gets lots of hugs and loves from him. He loves to be read to, and he seems to understand the characters' emotional states and motivations for the most part.

He does have some issues with vocalizations, some minor stimming (thumb-sucking and a blankie), and some emotional regulation issues that appear to be improving. He is pretty bad about staying with non-preferred tasks. He can get kind of perseverative about certain things, like our longsuffering dog.

He is on an IEP in school with speech therapy and some more OT. Most people who see him would never guess that he might be on the spectrum.

I've filled out all of the available profiles on him, and while he clearly has some ASD characteristics, he generally scores in the "sub clinical" range.

This is all very new to me. What do you guys think? Does he sound like he would be clinically on the spectrum, or merely part of the broad autistic phenotype?

I would say BAP.

Very Scottish screen name. Have you a great interest in Scotland? I want to go to the Highlands some day.

Thanks--Laird Angus McAngus was the name of the little scottie dog from my favorite childhood book: "Henry the Explorer." But yes, I am also of Scottish heritage.

As for my son, there are few other red flags as well: he's pretty dyspraxic, shows occasional transient echolalia, and will get somewhat obsessive in his questioning. But again, it's hard to know where the "line" is on these things. The best overall diagnosis seems to be SPD, but that is not recognized by the DSM or the schools. Sometimes I wonder if it is a real diagnosis, myself. I don't know...

Then there are other things that make me think he's not on the spectrum. He is great with shared attention. He does a lot of imaginative play. He points. He follows gaze/pointing/attention. He is not super-rigid in his routines. He is not terribly sensitive to sound, light, and other inputs. On the contrary, he is very much a "sensory seeker," much to our poor dog's chagrin.

I guess we will just continue to keep an eye on him.

The eye contact thing is funny. He's never been good at it, but he isn't terrible, either. Recently, I started working with him on it. He can earn "points" toward a special treat whenever he shows appropriate eye contact. Now, he's actively seeking me out for staring contests! lol! I asked him if it was easy for him or hard, and he said "it's easy, dad. especially when I know I can get a twinkie for it."

I responded to your thread. It is above your thread. I pressed the wrong button, but didn't want to lose my train of thought.

It might be worth it to have him evaluated. He is probably going to be able to be a lot more sociable with "safe" people like his family (especially if treats are involved!) than with other people, especially strangers. I've also known of ASD people that went the other way with eye contact: staring too much, when they were told they need to do eye contact more. I did the staring some in school. If he seems pretty well adjusted, it may not be an issue, but if he starts having problems like tantrums, meltdowns, poor performance in uninteresting subjects, or bullying in school, it's probably best to get checked out. They may be able to help with the SPD too, if it is SPD without the spectrum.

My son is diagnosed as high-functioning, and your son certainly sounds more "normal" than he was at that age. Your son seems BAP at the moment, but you'll probably get a clearer picture of where he is on the spectrum in a couple of years. At his current age even NT kids don't have great social skills, so it can be hard to tell what's what. Also, a lot of the things autistic kids do are things that all kids do; the only difference is intensity and frequency.

Well, I just spent the morning filling out various assessments:

ATEC: range of 8-12
CAST:11
Childbrain: range of 33-46 depending on answers

This leads me to believe that he is either in the process of achieving optimal outcome OR does not have clinical ASD. I know these instruments are not foolproof, but the consistency in the results is striking. He has some autistic traits, more than the typical child, but he may not be technically ASD.

Am I missing something? His main issues seem to be forming lasting friendships and emotional regulation.

There is a "with autistic traits" (or symptoms or whatever they are officially called) that can be added to basically any other neurological diagnosis (or atleast in can in the ICD 10, not sure about the DSM 5)
Example: AHDH (diagnosis code) with autistic (like) traits
Or at least where i live it is possible to get a diagnosis like that

I obsessing over this, and I know it is not healthy or productive. We have a meeting with the IEP team at school in a few weeks, o guess I'll learn more then.

So far, the feedback has been very positive. they say is is bright and is doing well both in the classroom and on the playground. He comes home talking about his buddies.

Last night, I asked him how often he sucks his thumb at school, and he got kind of pissy with me, saying, "Dad! I don't do it at all because the other kids would think I'm a baby!". I took that as a positive sign.

Then he asked me " dad, can ugly people get married?". That led to a discussion about how what matters is on the inside, a person's heart. I told him the best decision I ever made was marrying mommy. He got really excited and ran downstairs to tell her what I said. Kid seems to have good emotional insight.

Seems pretty "normal" to me in lots of ways.

I never cared much for the implication that Autistics don't have empathy or emotional insight. It's a very NT-centric way to looking at it. NT arrogance, almost. I'd wager that we are on par with NT, emotionally, it's just that we have difficulty placing exactly which emotion we're feeling at the time, or that we express it in different ways. But the feelings are there and they are deep.

I don't mean to pounce on your statement. It's just my gut reaction and I probably should have self-edited better.

As to the topic at hand, his response about thumb sucking at school gives me some pause. Yeah, peer pressure in a school environment can cross the NT-ASD divide... but something about his response tells me he still wants to stim but only discourages himself because of peer pressure. Maybe I'm projecting in that view.

I'd have to let these thoughts marinate for a bit before coming back with a reasoned response, but my initial response would be that your son might be high-functioning and has learned pretty good masking skills. But then again, I'm wavering already and thinking it's more BAP. I guess it comes down to just how broad you think the spectrum is, really.

Though, if you keep obsessing over this special interest, maybe you should be assessing yourself for BAP, too.

Thanks Kraftie. He's definitely different. Has always been our quirky, loving boy. Loves to rescue bugs and worms. Very affectionate. Tells us how loves us a lot. I'm going through my own issues right now after having a major anxiety episode a month ago. I'm back on my SSRI's, starting to stabilize. Then our littlest started school and I began to fixate on this question of his possible ASD status.

My wife is an OT and early childhood interventionist. Even she isn't 100% sure of his dx. My honest guess is that we could take him to 5 different neuros and get 5 different answers.

Anyway, I appreciate your taking the time to offer an opinion. You seem like. a really neat and strong person.

Sorry---i didn't mean to imply a lack of empathy in ASD folks. As for me, I am definitely BAP (or at least GAD)!

That is what I so frustrating about this: it is like trying to figure out where the land ends and the ocean begins. Constantly shifting and ill- defined even at "peak tide."

One other question I have is: should we be.doing any kind of intensive therapy such as aba or floor time, etc? Or is he too high functioning to benefit meaningfully from such approaches at this point?

Last edited by anguslairdmcangus on 15 Sep 2015, 12:12 pm, edited 1 time in total.

I'd agree with that. He seems to be very much on the borderline. Enough so that it shouldn't be a major hindrance going forward. Just be aware of whatever issues he might have and tend to them if they become problems.

I'd say you should definitely be on the look out for co-morbid anxiety or depression as he gets to his teen years. Being on the cusp of "normal," but not quite normal enough can cause a lot of unnecessary stress.

Good advice. I hate the thought of him being as anxious or depressed as I am. He has always been the most joyful, happy kid around.

Man, being a parent is rough. I understand my father sooooooo much better now.

Let me use the above anecdote to show the difference between my son (HFA) and yours.
My son would suck his thumb at school, if that was what he liked to do (he actually has another, worse habit).
He would not notice other kids looking at him. He would not care if other kids thought he was a baby. He would say it's stupid of them to think that, since he doesn't wear diapers. He would only stop if the other kids started bullying him, but even then he would still forget and do it sometimes.