How common is this?

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A friend has a grand son who was "normal/happy/talking/age appropriate", who is now at a big deal, nationally known hospital. The child would be placed in the level II/III autism leve now. He's in his own little world currently. Does not engage with anyone. He talks, but it's to whatever is happening in his head. The screaming and meltdowns are just terrible.

Can you have such a big slide losing skills at such an older age? I've usually heard around 1 to 2, where the child has such dramatic mile stone losses.

The kid had (all negative) head/neck MRI, head/neck CT scan, all labs looking for infection, spinal tape, EEG, toxicology screening, and had just about every department look at him.

As far as I know there wasn't any personal trauma, and I don't know if he had been slowly losing skills and this was the last big slide.

He did have a mild stomach bug 3 weeks ago.

The hospital wants to discharge the boy because physically he's normal, but his parents are beyond upset. The kid went from engaging with the world to basically nothing. The working diagnosis is autism, but no one believes that.

I guess my short question to this long post is, can you be 4 years old and have your social skills regress to that of less than a 2 year old?

From my own unprofessional impression, I would say it just might be something other than simple autism.

Especially if the family can afford it, I would get him a thorough neurological examination.

And maybe genetic testing, for he may have some rare congenital condition.

It’s also possible he might have suffered some sort of trauma.

Any big changes in his life? Moving? Kintergarten?

My daughter "regressed" awfully last year and it was clearly an effect of her new, awfully rigid teacher.
Covid stress is also a factor. Children sense adults are anxious and things are not normal, even if not understanding it.
If I'm right and the main problem is anxiety, the hospital would likely make it even worse - but surely, all possible other illnesses need to be ruled out first.
Does he have someone he feels comfortable with?

I hope the family can get some answers soon.

Yes you can be 4 yrs old and regress to less than that of a 2 year old. I did and do did my son. All that you’ve described, Tawaki, is what happened to my youngest son. He is autistic and doing very well now. At the age you described the regression and this family in subsequent extreme distress is very traumatic. My youngest was Very affected by his autism in the extreme. It took melatonin at night to calm the night terrors, as well as ensuring all patterns of responding were predictable to him(eg no raising of voice, a calm, cool, collected demeanour so that the child involved knows he can rely on the parent to be in control, thus keeping the child safe and secure. Low arousal environment is important.)

Routine is paramount. Many parents and teachers as well, no matter how well meaning, need to alter how they respond to autistic children, if they wish to bring about change in behaviour. The child is reacting to his environment and as his behaviour escalates, it means “Help me! Make me safe!”

An autistic child’s behaviour can be calmed consistently and their home environment made autism-friendly reducing heightened anxiety which, if left as is, can become resolutely terrifying to both the child and the parents.

I was able to ensure all was calm at home, but then later, once school began, extreme regression returned yet again. After calling for meetings, attempting to educate staff on how to respond and create a calming environment, a “safe place” for him to retreat to, this was not possible for them. I tried both private and public schools to no avail. I even got the NAS onboard. To no avail.

It took me home educating my son to restore his mental health and hence, his ability to learn. There are some golden rules in ensuring children who regress are granted peace from terror. Peace and inner calm cannot be achieved unless all on board are consistent and can ensure that routine is maintained.

I wish this family you know my very best. My heart goes out to them. My son lost his speech, his toileting skills, began having night terrors attacking me in the night(I was closest to him, being his mother and he was trying to communicate with me his deep distress). He also had meltdowns that put holes in walls at their worst, he engaged in head banging, he stopped eating. So distressing when a child and family are in trauma. Thankfully, with those points I mentioned above, and as a child matures, provided he remains “safe” in his environments ... home, school, etc, he can thrive and gain beyond what may think possible. My youngest is now doing his first year at a London University, having gsined 2 scholarships, is a singer/musician/actor both in film and voice actor in video games.

I have three autistic children and I am autistic. I was never once immunised and also regressed as a child. I became mute, but now speak and present as “normal” I’m told. My children and I have all achieved beyond what was ever thought possible. Both I and my daughter went on to work with similarly affected children in our own careers.

There is a very sensitive subject in Autism circles of reactions to vaccinations. There are few subjects that can raise such passions. The reason I raise the subject is not to suggest that the child might have had a recent vaccination, but to consider that vaccinations can occasionally produce side effects.

One side effect is brain swelling. This can in rare cases result in such great internal pressure as to cause some degree of brain damage. However, vaccinations are not the only possibility for brain swelling. If the child had a recent illness in which brain swelling could have occurred, that might have been a factor.

People can be mystified by a sudden drastic and permanent change in a child. This would be different than a more common developmental regression. There can also be the possibility of horrific or traumatic experiences that can produce the severe effects that you describe. However, the circumstances are often such that the family would know about it.

The key is to work with the child to draw them out and regain as much normalcy as possible.

For me I was (I am awaiting assessment so I have not been diagnosed) very early in my first three words of speech, but then I said nothing at all until the normal age. (I can remember saying the words as I copied the TV advert, and my Dad was soo thrilled he aas jumping for joy and shouting, and I assumed I had done something wrong so I did not say any more. My Dad said the words came out perfectly clear. I remember doing it to see if I could copy).
But though I would have periods at an early age of tempers where I would turn blue and stop breathing and my Mum or Dad would have to hit me to get me to breathe as a very young child, the stresses took place when I started at school from the ages of four onwards. I went from talkative to dead quiet and I remained basically dead quiet until I was in my early 20's when I was trained to be noisier ad more confident through more then one source. One was due to working in a retail enviroment, and one was where an elderly shopkeeper went to help me. She shouted at me and got me to shout with her. (She was a lovely lady who was doing this for my own good. She said she had never seen such a shy young man before (I was 17 or 18 at the time).
But the stress of school made me go all quiet. There was too much going on!

But also take a look at prosopragnosia. It is common for young children to be talkati
ve in the enviroment of their own homes but if they are in places without their parents they regress into being very quiet, shy and unsure of themselves (Especially if away from home in a hospital!)
The reason for this is at home, they are safe because they know who is going to be there and they can recognize them, but as soon as they are away from the home enviroment, they go dead quiet and are scared and very clingy because they could easily loose their own parents in a croud and they are scared of loosing them. As long as they are next to a parent they are ok, but as soon as the parent is a step away from them and someone walks between them and their parent where their view of the familiar parent is momentarily interupted, the panic sets in.
I know this as I was such a child. My Mum also has this and she was similar.
And school was a horrible enviroment for someone who has prosopragnosia to be in. Also with this condition, one is always homesick when in school, collage or in work. The entire time one wants to go back home.
The majority of people with prosopragnosia are also on the autism spectrum so it is a condition where the two almost go hand in hand. (I think it was 83 or 85% of those that have prosopragnosia are on the autism spectrum? It is what really prompted me to ask to be assessed when I found this out).
It is not easy to tell if some traits are due to prosopragnosia or autism as the two merge into one at times if one looks back at ones life and how one reacts to certain situations etc.

Juliette knows what she's talking about, because she's had vast experience in this.

So have all the other folks who posted in this thread.

Tawaki, I have no experience at all with regressive autism, but I cannot even begin to imagine how difficult it is for this family. One minute you think you have child A, and the next you discover you actually have child B. It has to be so very hard to deal with such a large and sudden change, and I send them thoughts/positive energy/prayers/good vibes/whatever they believe in.. The good news, to my eyes, is that the family KNOWS the potential is there in the child, that he has the mental capacity to learn and function, if only the barrier can be crossed. They have a lot to learn and catch up on quickly in order to create the stress-free, calm and consistent environment he needs right now. It is a hard road.