What does high functioning autism look like?

[Anonymous]

Anonymous wrote:My kid is 6 years old. She is flexible, has friends and has no intense interests. On the other hand, her eye contact is inconsistent. When she tells stories, she always looks all around as if the story is playing out in front of her. We often have to remind her to look at people when she asks a question or says “thank you.” She loves make believe games with friends and is very creative, but if a friend loses interest, she’ll just keep the make believe game going on her own, talking to stuffed animals, narrating out loud, etc. She engages when she sees friends after school on the playground, but, at recess, she prefers to play alone (again, talking to herself as she engages in make believe).

Stixrud said we should “keep an eye on” things for a possible ASD diagnosis. Does this sound like ASD to you? What’s your ASD kid like? How did you know it was ASD?

I'm going to throw you a wrench and say that this sounds like what our 7yo daughter was like a year ago. I do think that if it's ASD, it'll become more apparent in the next year or two. The "intense interests" in girls are usually masked by gender; so my daughter was into playing with dolls what seemed like a normal amount compared to her peers -- but as they got older, it became more apparent (but still subtle!) that it was more of an intense interest.

I really encourage you to put your child on the list for an evaluation now with a clinic who specialize in ASD in girls, such as Children's. Perhaps in a year or two, you no longer need the appointment. But it's better to get on the list in case that shifts.

While ASD is harder to spot in girls, it is not any less impactful. Many girls "mask" more successfully, and the stress of doing so as they grow older puts them at risk of mental health complications.

[Anonymous]

Seems like there was something that led to the evaluation that you are not mentioning. Without that information, there's no way to say on this.

"High-functioning ASD" can mean a variety of things, and it often is very hard to tell at the younger ages, even more so with girls. Our DS got a diagnosis at age 9. We felt like his interactions as a baby and toddler were a little different and suspected ASD at that time but were assured that he seemed to be developing typically. He had no milestone delays at all, and things seemed fine during his preschool and early elementary years. He was a bit quiet but usually made 1-2 close friends each year in school.

As friendships became a little less about physicality (i.e. tag, chasing, etc), the social issues presented more. The complexities of bullying and cliques were hard for him, and that's when he started misbehaving and getting into trouble. He was clearly much more stressed at school, and that led to meltdowns at home. He had always been sensitive to fabrics and foods, but we were always told by the pediatrician that it was nothing because he was physically healthy.

The only reason we got him evaluated was due to increased behavioral problems and meltdowns we had never seen before. Once we did, we saw in retrospect that some of his interactions with others and rigidity made sense from an ASD lens. However, he never had particularly abnormal eye contact, no significant intense interests, etc. He was always very independent and "do it myself," but up until about age 9, the inflexibility and rigidity weren't major issues we saw or observed as problems.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a girl, it can be too early to tell.

Never too early, I’ve worked with kids 16 months old

So why not test at birth then, since it's never too early.

For some children, yes, 6 may be too early to tell.

They should be tested at 9 months and 1 year as that’s when you can see signs. Early intervention before age 6 is most important. Many doctors do test and if yours doesn’t you should find one that does

[Anonymous]

I’m guessing you suspected and that’s why you were at Stixrud. So, there must be a reason, right?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a girl, it can be too early to tell.

Never too early, I’ve worked with kids 16 months old

So why not test at birth then, since it's never too early.

For some children, yes, 6 may be too early to tell.

They should be tested at 9 months and 1 year as that’s when you can see signs. Early intervention before age 6 is most important. Many doctors do test and if yours doesn’t you should find one that does

OMG. What is this magical "early intervention" of which you speak? Dying to know here.

[Anonymous]

Sounds a little like my daughter who was diagnosed at age 12 last year with ASD. It's the loner behavior on the playground that stands out to me, and the talking to herself.

My kid had a few friends, but I think she might have needed that alone time at recess to recover from the effort of keeping it together around other kids during classes.

Does your daughter get overwhelmed from anything on a routine basis? That was another thing for us but it doesn't sound like an issue for your daughter. Also some trouble with handwriting, memorizing math facts. She is only 6 so it's a little early for some of these, but I'd be on the lookout.

Re the being alone at recess, I also remember reading something about ASD kids playing at recess alone but seeming to follow other groups of kids around the playground, and just be near them, so that it was hard for teachers to actually tell that the kid was isolated, because they seemed like part of a group to someone just casually watching. My kid did that as she got older.

[Anonymous]

Honestly, this sounds a lot like my daughter at that age. She was diagnosed with inattentive ADHD with some anxiety at age 14.

As a kid, she’d be off in her own world a lot of the time, and have a hard time coming back to the real one. Lots of bleed-through from her imaginary life to her everyday life. It was harder to focus on conversations with more than one or two other kids, but she did Ok in a group when she could lead the play and be the one to get others involved. (All of this is in retrospect—we had no idea this was what was happening back then.) But more often than not, she was much more at ease when she was alone or with one trusted friend.

She was bright enough that she learned pretty quickly how to mask the other ADHD symptoms at school, so we just thought she had a really vivid imagination that led her to prefer her imaginary world to the real one. I guess that was part of it, but in some ways it was probably a defensive strategy developed as she became aware of her differences.

Medication has helped her manage small talk a little better, and she can keep eye contact, follow the thread of a conversation, and doesn’t need to fidget constantly to keep her focus from drifting.

But she’s still working with her therapist to overcome the social anxiety and move away from the coping strategies that had become ingrained over the years. She’s never been one to participate actively in small talk because she was always afraid she’d missed something and was about to say something way off-base, so she kind of has to learn that skill from scratch.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a girl, it can be too early to tell.

Never too early, I’ve worked with kids 16 months old

So why not test at birth then, since it's never too early.

For some children, yes, 6 may be too early to tell.

They should be tested at 9 months and 1 year as that’s when you can see signs. Early intervention before age 6 is most important. Many doctors do test and if yours doesn’t you should find one that does

OMG. What is this magical "early intervention" of which you speak? Dying to know here.

You should consult with your developmental pediatrician to explore various options for early intervention.

[Anonymous]

Anonymous wrote:Honestly, this sounds a lot like my daughter at that age. She was diagnosed with inattentive ADHD with some anxiety at age 14.

As a kid, she’d be off in her own world a lot of the time, and have a hard time coming back to the real one. Lots of bleed-through from her imaginary life to her everyday life. It was harder to focus on conversations with more than one or two other kids, but she did Ok in a group when she could lead the play and be the one to get others involved. (All of this is in retrospect—we had no idea this was what was happening back then.) But more often than not, she was much more at ease when she was alone or with one trusted friend.

She was bright enough that she learned pretty quickly how to mask the other ADHD symptoms at school, so we just thought she had a really vivid imagination that led her to prefer her imaginary world to the real one. I guess that was part of it, but in some ways it was probably a defensive strategy developed as she became aware of her differences.

Medication has helped her manage small talk a little better, and she can keep eye contact, follow the thread of a conversation, and doesn’t need to fidget constantly to keep her focus from drifting.

But she’s still working with her therapist to overcome the social anxiety and move away from the coping strategies that had become ingrained over the years. She’s never been one to participate actively in small talk because she was always afraid she’d missed something and was about to say something way off-base, so she kind of has to learn that skill from scratch.

For us, the anxiety was coming from the ASD. It had always been coming from the stress of dealing with the ASD. We wasted so much time trying to treat the anxiety ("try taking some deep breaths" omg the gall!) when the issue was so much deeper.

It does seem like ASD and ADD/ADHD get confused and cross-diagnosed with one another a lot. My daughter has been diagnosed with both at various times. Glad you figured things out.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Honestly, this sounds a lot like my daughter at that age. She was diagnosed with inattentive ADHD with some anxiety at age 14.

As a kid, she’d be off in her own world a lot of the time, and have a hard time coming back to the real one. Lots of bleed-through from her imaginary life to her everyday life. It was harder to focus on conversations with more than one or two other kids, but she did Ok in a group when she could lead the play and be the one to get others involved. (All of this is in retrospect—we had no idea this was what was happening back then.) But more often than not, she was much more at ease when she was alone or with one trusted friend.

She was bright enough that she learned pretty quickly how to mask the other ADHD symptoms at school, so we just thought she had a really vivid imagination that led her to prefer her imaginary world to the real one. I guess that was part of it, but in some ways it was probably a defensive strategy developed as she became aware of her differences.

Medication has helped her manage small talk a little better, and she can keep eye contact, follow the thread of a conversation, and doesn’t need to fidget constantly to keep her focus from drifting.

But she’s still working with her therapist to overcome the social anxiety and move away from the coping strategies that had become ingrained over the years. She’s never been one to participate actively in small talk because she was always afraid she’d missed something and was about to say something way off-base, so she kind of has to learn that skill from scratch.

For us, the anxiety was coming from the ASD. It had always been coming from the stress of dealing with the ASD. We wasted so much time trying to treat the anxiety ("try taking some deep breaths" omg the gall!) when the issue was so much deeper.

It does seem like ASD and ADD/ADHD get confused and cross-diagnosed with one another a lot. My daughter has been diagnosed with both at various times. Glad you figured things out.

What changed in terms of how you approached ASD vs anxiety? My DC has a similar profile, where I think the anxiety is coming from the ASD, but it feels like there are limited things we can really do to "treat" the ASD, whereas anxiety comes with more meds and strategies.

[Anonymous]

Sounds a lot like my son with mild ASD. I’d do the screening now or at least get on a wait list ( they’re up to and over a year long right now unless you want to pay 5k out of pocket).

[Anonymous]

At 2 my DD had speech therapy for mild delays
At 4 my DD had issues at preschool so we took her out
In Kindergarten she was having issues but school didn’t want to do anything
In 1st grade she got diagnosed with ADHD and got an IEP
In 2nd grade she started meds and got diagnosed with ASD Level 1
Now in 3rd grade and the main things in her IEP are related to social/emotional things, academically she is at grade level.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a girl, it can be too early to tell.

Never too early, I’ve worked with kids 16 months old

So why not test at birth then, since it's never too early.

For some children, yes, 6 may be too early to tell.

They should be tested at 9 months and 1 year as that’s when you can see signs. Early intervention before age 6 is most important. Many doctors do test and if yours doesn’t you should find one that does

OMG. What is this magical "early intervention" of which you speak? Dying to know here.

So I disagree with pp — sometimes it is too early to tell. But I agree that if you’re noticing challenges when they’re young, then early intervention is key. DC was receiving OT and speech long before we ever had an evaluation and I truly believe those therapies changed the trajectory of his development.

[Anonymous]

Get the kid tested from what you said I’d say definitely need an ados

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a girl, it can be too early to tell.

Never too early, I’ve worked with kids 16 months old

So why not test at birth then, since it's never too early.

For some children, yes, 6 may be too early to tell.

They should be tested at 9 months and 1 year as that’s when you can see signs. Early intervention before age 6 is most important. Many doctors do test and if yours doesn’t you should find one that does

OMG. What is this magical "early intervention" of which you speak? Dying to know here.

Speech, OT, ABA and services provided by the county.