Should I Have my 4-year Old Evaluated? High-Functioning AS?

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I know posts like this probably come up here all the time. But I am new and I am wondering what other parents with AS kids think. I always wrote of my sons 'tendencies' because he was so verbal, but now I'm learning that there is a category for highly smart/verbal AS kids. Am I over-analyzing or do these following traits signify that I should have him evaluated? Sorry this is going to be too long . . . !


• Since he was a baby, he has been highly sensitive. To light and to sound—loud sounds terrified him (at a level different from other babies/toddlers). He still doesn’t like loud sounds. His room always had to be pitch black for him to sleep. Texture—he has literally FREAKED out over a clothing tag that is bothering him or a shirt that he thinks is ‘scratchy’. At one point, we had to cut all tags out of everything, although he is a little better about that now. We had to leave the Cars 2 movie at the theatre b/c he (at 4) became terrified. He said he never wanted to go back there ever again. Sense-wise it was too much for him and too scary.
• From birth to 2 he cried and screamed at EVERY single bath time. No matter how we tried to make the water cool/warm enough he hated it. At 2 or 2 ½ he saw how much his baby sister loved bathtime and that helped. He still cries every hair washing though.
• He is incredibly smart and verbal. Has always been highly verbal for his age. Elaborate words and sentence structures since he was less than 2. He was making full sentences (5-6 words) by 20 months. However, even at the age of 4, he still has trouble expressing his feelings at times—he will twist and writhe and melt into a fit of tears or screams or shrieks because he is upset and can’t express himself. We have to repeat over and over to him at these emotional moments, ‘use words, use words’ because we don’t know what the problem is. Then, at other times, he will express himself with astounding depth and seriousness for his age: “My heart is broken and the whole world around me has turned to dark colors, and I will never get it back. My life is ruined.”
• Sometimes he talks to us in what I call his “helium voice” –he puts on this nasal falsetto when calling us to do something, etc.
• Friends—he does not quite fit in with the kids his age. They do not play like he does. His favorite friends are girls 2-3 years older who will talk to him and who he can talk to. Or adults.
• Food. When he was an infant, he had reflux. He would also constantly gag and choke when breastfeeding. It was a tough time. Even when he started solids, he would gag on various textures. Then, as a toddler, he’d gag, even nearly vomit due to a certain taste or texture. He still does that sometimes, but less often b/c we’ve limited his diet so much. He is VERY, VERY picky about food. Abnormally so. So, it is a challenge typically to feed him, though now we know pretty much exactly what he will/won’t eat. His list of what he will eat is quite small compared to almost any other kid I know.
• He has very strong feelings for music/videos and although the Cars 2 movie scared him, after watching it at home twice (forwarding parts), he can listen to the soundtrack and accurately name every scene the music is from. He has also been terrified to watch most of the videos his friends are fine watching. He won’t go into our church kindergarten when ‘Tom& Jerry’ is playing b/c it is too loud and scary.
• When he was less than 2, he showed astute ability for details. For example, at 18 months, he could correctly identify any type of bank/atm. Just the idea that he could recognize and identify the difference between a bank sign and a real estate business at that age (although he couldn’t read) was astounding to me.
• He prefers to be at home. Social situations can make him uncomfortable. He has friends. Once we get out and play, he has fun. But he typically protests at first. He cannot stand loud environments with a lot of people. He complains every Sunday that the music at church is too loud. However, though pre-school was a big social adjustment, one of his biggest concern when we started pre-school was missing his toys!
• He is amazingly detailed and talented at building things with Lego. At the age of 3, he could conceptualize something like a bug or a lion and make a very believable replica out of small Lego pieces. However, he becomes very focused and very insistent on how it should be done.
• At the age of 2, he could do 30+ piece puzzles, as long as the image was something he was familiar with—cars, Pooh, etc.
• However, he has very low motor control when it comes to drawing. His 2 ½ year old sister can color & draw better than he can. He still cannot color inside lines or draw.
• It has proven very difficult to teach him to read. He knows his alphabet, but when we try to teach him phonics he is either absolutely uninterested or tries to take over as teacher to show us how it ‘really is’.
• He is emotionally connected to routine or to the way he thinks something should happen and just literally falls apart at least once a day when something doesn’t go the way he thinks it needs to. From a young age, any kind of change was particularly traumatic for him.
• When there is something he things should be a certain way—i.e. he wants to use only his McQueen toothbrush or he wants his sister to build her Lego car in a certain way, he has a tantrum/cries if it doesn’t go his way. We have to keep reminding him his sister is an individual he can’t control. But he’ll say—she’s doing it the wrong way. He is very concerned about things being done what he perceives to be as ‘the right way’. He has made me re-clip his sister’s hair clip b/c it wasn’t straight and would have thrown a fit if I didn’t.
• He is capable of saying hurtful things—I don’t want you, You’ve ruined my life—but doesn’t seem to understand the hurtful effect of them. That could be typical 4 1/2-year old boy but my daughter is so opposite to that at the age of almost 3. He often comes across as rude. Then, when we tell him what he did was hurtful/rude, he sometimes melts down b/c of that.
• As a baby eye contact was fine. Now we have to constantly ask him to look at us when we are talking to him. Hard to get a verbal response out of him sometimes too, even though he has an amazing vocabulary/sentence ability, but that might just be his age. He also often had the ‘limp body’ syndrome—where he would be picked up or held but not offer any of his own effort. “Hold me, hug me, pick me up” but then he is completely passive when you do. He’s much better about it now and he is fantastic about hugs/kisses.
• Socially, he just feels awkward most of the time. He doesn’t know what to say, although he has an amazing vocabulary and ability to express himself and describe things. Sometimes when people are trying to talk to him and he gets uncomfortable, he will dissolve into unintelligible jibber-jabber, flapping his tongue and wiggling his hands in a funny way—always the same way.
• The other day I watched his pre-school class walk to the playground. All of the kids walked in a semi-nice line. My son ‘bounced and flapped’ his way out the door. I also watched him during music time—similar thing.
• He sat through The Lion, the Witch, and the Wardrobe, a chapter a night, at the age of 4. And loved it. He can sit and watch at 10-20 minute TED talk on science and be fascinated.
• Since the age of probably 18 months, he had an uncanny ability for details. He gets very frustrated with us for not understanding how he is building something or how it works or for not getting what he is trying to explain. We struggle between our ‘logical’ minds and his task-oriented, visual one. He will be so obsessed by finishing a building project that he will cry and cry and resist though we tell him we are going to go on a family outing or play with a friend or go to school. It is very important to him that he finish creating the image or idea that he has in his head before it is interrupted. He also becomes obsessed with things like—we must park next to the blue car because he likes the color blue and if we don’t he is distraught.
• He used to ask quite often, “mom, are you mad?” “Mom, are you happy?” as if he couldn’t tell. He seems to get faces confused quite a bit and will think he recognizes someone on the street as one of his school friends or as someone we know.
• He is terrified of a lot of things. Particularly, even the very mild baby rides at amusement parks. Swinging on swings. At 4, he cannot swing higher than most 1-1/2 year olds or he freaks out. When he did swing high with me, he couldn’t contain his excited screaming, even drooling!
• Recently, he told me he was hearing voices talking to him in his room at night. I asked him if they were saying nice things or bad things and he said he didn’t know, that he didn’t know the words they were saying. He though they might be angels voices. (-: I think he may have a heightened sense of hearing and is hearing voices from the apartment above us which we cannot hear. Of course it concerned me—he sleeps in our room on the floor right now b/c he is so afraid to be alone in his room at night.
• I am not ‘freaked out’ about him at all. Typically I just think he is a normal 4-year old and all 4-year olds are like this, though perhaps he just is a little more nerdy in ways and less social. (If I am honest with myself, I will say he is not ‘normal’ but he is ‘our normal’.)
He is functional, he is bright, he is sweet. But life is also often stressful, emotional, and volatile with him. I don’t think we understand him like he would like us to.

We have worked with him A LOT in being social, responding to conversations, initiating talk, etc. I think that has helped and has fostered improvement in a lot of these areas. But I still wonder if a professional evaluation would be beneficial for knowing what directions we should move? Sorry this is long--I know this isn't a diagnosis forum but would love some parental support/thoughts!

Hi

Your son sounds really lovely. To answer your question, there would be no harm in speaking with someone about your concerns. If he does have an ASD, the earlier he is identified the better it is for you and him.

Your son actually sounds like a mixture between my daughter (6 in Nov) and my friend's son, both of whom are waiting for autism assessment, both have probable Aspergers. When my daughter was a baby, she had reflux too and I don't know if it's connected to her other issues. She gained very little weight until she was on solids and that was a worrying time. The sensory issues were pretty evident from day 1, but we had no idea that there was anything to be concerned about and didn't realise how different she was. She's a lot of work, with concentration dificulties and regular hyperactive moments and doesn't do very much she's asked to and appears to ignore us a lot of the time. There are social issues too and she doesn't tend to keep friends, but makes them readily. But, on the plus side, she's pleasant natured, highly intelligent, outgoing, inventive, imaginative and I can foresee a bright future for her. She can hyper-focus and sits for 25mins glued to a science show, aimed at teenagers and adults. She understands everything they are talking about and wants to be a scientist.

My friend's son has just as much potential. But, he's shy, terrified of crowds and has quite obvious dyspraxia. Like her, he's doing well academically, but struggling with a few things, especially the social issues and physical co-ordination, e.g. writing. Children with ASDs can be so different and those two are polar opposites, whilst both being highly functioning.

Good luck.

Your son and mine (mine's also 4, just turned in September) sound a LOT alike. The only exception, really, is that mine always loved baths (but I can't wash his hair. I am embarrassed to admit this, but I've all but given up on washing his hair unless it's visibly dirty). Mine also doesn't have friends, though:/

• Sometimes he talks to us in what I call his “helium voice” –he puts on this nasal falsetto when calling us to do something, etc.

Mine does this too, and I didn't know if it has a connection to any kind of disorder or if he's just. . .I don't know, immature? He oscillates from sounding like 4-going-on-30 and sounding totally babyish for his age.

I've had my son evaluated (both by a psychologist and his doctor), and no one will really pin a diagnosis on him at this point. Which I appreciate, I guess, but it doesn't really ease my mind. He is in wraparound services (home ABA therapy), which I think has been. . .I don't know. Not all that helpful, but good as a resource and for adding structure to his life I guess? I would like to get an OT referral for him, though. I'm not sure how much they do for sound sensitivity, but it's a huge issue for him.

Anyway. Yeah, sorry I can't be of much help as far as advice on an eval: they might give you the same runaround as me, but you can always have him re-evaluated when he's older so. . .it wouldn't hurt anything, you know?

Oh my goodness, you are describing my son. Especially the asking "Mommy, are you happy?" It actually made me smile knowing there is another little boy very much like mine out there. It's very easy to feel so different.

My little one, (just turned 4 this September) was diagnosed just last Wednesday with Asperger's. It was not a shock. I had known that there was something off with him forever. Mom's just -know- sometimes. Trust your instincts. Testing isn't going to hurt anything and can only give you answers-- and possibly some new understanding and tools going forward.

^^This and welcome to WP.

While the process of getting an evaluation can take a few or possibly several months to accomplish, it is not invasive and is not likely to cause your son much in the way of discomfort unless he has high anxiety over doctor's offices. Ours was pretty easy overall and even though DS (at the time of evaluation he was 3 going on 4) was typically pretty defiant about doing things we asked him to, he was rather cooperative with the therapists during most of the evaluation sessions. It helps when as you say they like to talk with adults, especially when those adults are so focused on them and allow them to talk and talk. I remember laughing to myself as I watched DS tell the psychologist a lengthy story about one of the flip chart pictures she asked him to name (it was an old-fashioned type thermometer with the red mecury in the bottom). She didn't cut him off, she let him tell the whole story, which was great.

You've identified character traits that are common to kids on the spectrum so follow your gut as a mom. I would caution you not to rely on your pediatrician for a diagnosis although maybe your ped can give you a referral to a specialist. Peds are by definition generalists and many don't pick up on the sublties our kids often present with AND some have been known to dismiss parents' concerns (see momsparky's thread about the "helicopter parent" label for more on that). Your keen observations of your son show that

Wow. It's amazing how almost EXACTLY your descriptions sound like my son. Just Wow.

My son is only 3 1/2 though and he's been through a small screening/evaulation through an elementary school. He failed the screening and it was deteremined he was 25% delayed (fine motor and social/emotional) however they told me that the more they saw him the less they believed he had autism. Then my ex-husband starting interfering saying that me causing so much change in his young life has caused the delays (like me leaving him). I don't believe my son has autism, because like your child, he does make eye contact and he does talk and he is very smart. He has good days and bad days of where it's painfully obvious something is wrong, and other days where it seems he's almost quiet normal. However my gut instinct is telling me something is off so I'm starting the process to get referred to a specialist.

Good luck!

Thanks everyone! It is comforting to hear from many of you how similar our kids are! I do think he has an amazing future in store for him, and I want to help him 'organize' himself (that's the best way I can think of describing it!) so his journey there is healthier.

I think we'll take the time to have him evaluated in the next month or two.

The amazing thing to me is how different he is from his 2 1/2 yr old sister. That is part of what made me consider things more seriously. She is calm, listens well, is kind, not quirky, draws well, and overall is just your average sweet, cute little toddler. It was kind of a shocker for my DH and I how different they turned out to be! Of course, everyone's personalities are different, but I'm talking more about behavior and daily functioning. I ADORE my son, but the constant energy level and direction he requires can be SOOO exhausting!!

At minimum, I know for sure he has sensory processing issues and some listening issues. Perhaps even some slight dyspraxia, though I don't know as much about that. At 4, he still has problems drinking from a cup, coloring, etc. Odd thing is that he is so amazing at building Lego.

Alright, ((hugs)) to you all for some quick support! All the best . . . I'll pop back on and give an update down the road . . .