Could this be ASD? Something else?

[Anonymous]

My DS who is 3 has passed every autism screening he’s had. He also had a full evaluation by our infants and toddlers early intervention program last year and it was normal and showed he’s very bright, verbal, social, and hitting all developmental milestones. But he has some serious behavioral challenges, that are leading me to wonder if it’s possible he might have ASD or some other issue?

To be clear, he doesn’t have what I know are the typical signs of ASD, but he does have restricted interests (obsessed with trucks and vehicles - but I know many boys this age are), GI issues (stool holding and chronic constipation), refusal to toilet train and anxiety about using the toilet, severe picky eating (we have tried feeding therapy, he avoids basically all meat and veggies and lives on a limited diet of white, tan and orange foods), unusual sleeping habits (he had to snuggle on mom or dad to fall asleep, and wakes and comes into bed with us nightly - freaks out if we try to get him in his bed alone - sleep training was a huge fail with him), and seems to have what I might describe as stims - he is obsessed with my stomach and belly button and often tries to pick my belly button when he gets anxious. He also can be very aggressive - had bit me and dad, can attack sister when he gets angry etc.

I’ve been working with a lot of different specialists on the various health issues and our pediatrician is aware of all of this and said I might want to consider a KKI evaluation (but didn’t specify what for) but didn’t seem to feel strongly about it. So I guess what I’m asking, is it possible for only behavior issues like this to be ASD? Or something else? I know a lot about ASD (used to work with special needs children and my nephew has and I was one of the first people to suspect it) and he doesn’t fit the typical profile but I know his behavior is not typical and I’m struggling for how to approach it holistically. Right now it’s been focused on the acute issues (GI for stool holding, feeding therapist for feeding) but I am starting to be concerned there’s a larger issue at play.

WWYD in this situation?

[Anonymous]

I think if he's meeting social interaction goals then it's not ASD, because that's the core of ASD's diagnostic criteria. But it could be a more subtle presentation of ASD that will be evident a little later when the goals are harder for him to meet. I would keep it as a possibility for now. Perhaps it's a combination of sensory processing disorder plus anxiety plus a digestive problem such as a food intolerance that you haven't figured out yet.

I think you're right to focus on the acute issues as they are affecting his daily life and growth quite a bit. Sometimes you just have to wait for a firm diagnosis, and that's frustrating. But you are trying your best to help your son with his most pressing issues and that will help him regardless of what he is eventually diagnosed with.

[Anonymous]

I would schedule an appointment with the developmental pediatrician. My DD was diagnosed with ASD at 2.5, but she had a year of severe constipation till she was 3.5 and her behavior was markedly worse during that time.

[Anonymous]

We are in a different but similar situation and are getting a full evaluation. If the eval is feasible for you, what are the downsides? I feel like it could really help to get an expert look at this. There was a great presentation by the authors of Is This Autism? last night hosted by X minds and they said that autism is often under diagnosed because some of the tests are not great and professionals are hesitant to diagnose.

[Anonymous]

Was he diagnosed with anxiety? A lot of what you described can be associated with anxiety. If so, do you have a plan to treat it?

At this age, it can be so hard to tell what's going on. If you work on what you know about it, things may become clearer as your child gets older.

FWIW, my eldest had some behavior problems and major GI issues at that age and I also suspected autism. He was first diagnosed with generalized anxiety and then, a few years later, with a learning difference. As we dealt with these and he got older, everything became much clearer.

[Anonymous]

Agree with other posters. Could be anxiety. ADHD, and/or something else. You can't treat everything all at once, so if it's too early to do a neuro psych, focus treatment on what seems to be the most problematic, acute issue and go from there.

[Anonymous]

I would try a nutritionist and perhaps functional medicine doctor in addition to your developmental pediatrician and ask them about a GAPS diet. I’ve worked with many kids like this and have seen only one thing consistently help-a strict GAPS diet and complete nutritional overhaul (anecdotal of course, your child may be different). You might also try ABA to support you through current behavioral challenges and those that might come with dietary changes. Find experienced practitioners that have worked with feeding disorders previously. SLP might also help if there are severe problems with swallowing or oral motor concerns.

[Anonymous]

Anonymous wrote:I think if he's meeting social interaction goals then it's not ASD, because that's the core of ASD's diagnostic criteria. But it could be a more subtle presentation of ASD that will be evident a little later when the goals are harder for him to meet. I would keep it as a possibility for now. Perhaps it's a combination of sensory processing disorder plus anxiety plus a digestive problem such as a food intolerance that you haven't figured out yet.

I think you're right to focus on the acute issues as they are affecting his daily life and growth quite a bit. Sometimes you just have to wait for a firm diagnosis, and that's frustrating. But you are trying your best to help your son with his most pressing issues and that will help him regardless of what he is eventually diagnosed with.

Is your child in classes or preschool? You may start seeing the social stuff more as your child ages and/or it may take a third party. With DD4 the older she got the more we saw something was different or off.

[Anonymous]

You might want to read "Is This Autism" by Donna Henderson of Stixrud. They delve into non-typical presentations of autism, many of which are not diagnosed until later. We just got our diagnosis at age 10. What passes for normal socialization at age 3 may very well turn out to be more limited later on. My kid did not seem autistic at age 3 but does share many of the traits you mentioned. It's a good book and easy for parents to read (not just for clinicians) and it's available on Amazon. https://www.amazon.com/This-Autism-Donna-Henderson/dp/103215022X

The book was just published in June and is at the forefront of the current broadening of ASD diagnoses (not without controversy.)

[Anonymous]

Anonymous wrote:You might want to read "Is This Autism" by Donna Henderson of Stixrud. They delve into non-typical presentations of autism, many of which are not diagnosed until later. We just got our diagnosis at age 10. What passes for normal socialization at age 3 may very well turn out to be more limited later on. My kid did not seem autistic at age 3 but does share many of the traits you mentioned. It's a good book and easy for parents to read (not just for clinicians) and it's available on Amazon. https://www.amazon.com/This-Autism-Donna-Henderson/dp/103215022X

The book was just published in June and is at the forefront of the current broadening of ASD diagnoses (not without controversy.)

+1 on their website they also have recordings of their book launch where the authors discuss the diagnostic criteria and co-occurring issues
https://www.isthisautism.com/book-launch-replays

[Anonymous]

I mean it’s something, right? It’s not typical, clearly. Yes, obviously get a full evaluation from a dev ped.

[Anonymous]

Anonymous wrote:Agree with other posters. Could be anxiety. ADHD, and/or something else. You can't treat everything all at once, so if it's too early to do a neuro psych, focus treatment on what seems to be the most problematic, acute issue and go from there.

This. My similar kid was later diagnosed ADHD and ASD rules out (at age 10). But don’t worry about the label - just address each behavior/issue that you can.

[Anonymous]

You are posting on the Special Needs Forum. You are going to get answers that direct you toward evaluation. Is that what you want? If you prefer reassurance, post on the General Forum.

[Anonymous]

It could be some other combination of diagnoses. Like ADHD, SPD, anxiety.

[Anonymous]

Anonymous wrote:You are posting on the Special Needs Forum. You are going to get answers that direct you toward evaluation. Is that what you want? If you prefer reassurance, post on the General Forum.

Generally yeah but her kid is still withholding and not eating. Nobody is going to be like oh totally normal.