What does high functioning autism look like?

[Anonymous]

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

Then you would know that severity plays a significant role in when a diagnosis becomes clear. Kids with severe ASD can be identified in their second year of life and that is really helpful for them. Kids with mild and borderline levels of ASD are often not identified until there are greater social demands in school and other settings.

Sixrud is not a practice that throws out the possibility of ASD lightly, so there is likely something going on with this child’s social interactions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

+1 My dd was diagnosed at age 10, and only borderline then. Her social skills weren’t far from the norm until she got older. I agree with Stixrud. Your dd could have ASD, but if so, she’s high enough functioning that it’s difficult to say. The good news is that she clearly doesn’t need serious interventions.

My DD is 10, and was diagnosed at 9, after previously being diagnosed with selective mutism and anxiety. At 6, she was a quiet kid who was very into make believe and acting out her favorite stories with her stuffies. She often ignored people speaking to her, but again, she was cautious and quiet. It didn't seem too far out of the ordinary. She didn't have "intense" interests but was, like a lot of 6yos, really "into" certain characters or activities. She had friends and knew all about the kids in her class, but didn't really play with them (no playdates, no birthday invites). We were concerned for her mental health, but as I said, we were told anxiety, and so we tried strategies related to that. In 2nd grade, things really came together (or fell apart, depending on how you look at it) and her behavior began circling further outside the norm. We began 3rd grade with pursuing testing and the ASD Level 1 (the current term for what was once called high functioning autism or Aspergers) diagnosis came that spring. Now at age 10, she has very obvious traits of autism and we are confident that the diagnosis is correct.

It's worth understanding that ASD looks different in girls than boys, and girls are generally underdiagnosed, and diagnosed much later. What prompted you to take her to Stixrud? If they determined it's too early to tell, it probably is. For girls, it's really not unusual.

What are the “outside the norm” behaviors tgst give you the confidence in her autism diagnosis?

[Anonymous]

My child was diagnosed early with asd (high functioning) at 3. He has inflexibility, rigid, stimming, cries easily, not perfect eye contact and miss some social cues. It took them over 1 year before they can tell me he has asd. At IEP meeting, they mention a few times that my child has asd diagnosis early because I gave them the private ados report result have IEP code updated. What do they really mean? Good that we have asd diagnosis through private evaluation early or Bad that normally kids should not be diagnosed early with asd that young especially with high functioning one ?

[Anonymous]

Anonymous wrote:

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.

You just don’t know what you’re talking about. My dd was seen by her primary pediatrician and two different developmental pediatricians, none of whom felt she had ASD. We were assured repeatedly that she didn’t, and that all of her issues could be explained by her diagnoses of ADHD and anxiety. We had a full neuropsych exam done on her at age 10 for academic reasons (she was entering a gifted program and we wanted to make sure she had appropriate supports) and that’s when she was diagnosed. One developmental pediatrician openly disagreed with the neuropsychologist, and the other said the diagnosis didn’t really matter because dd was so high functioning that we would never have known without a full neuropsych exam. We followed up by having the ADOS administered by a highly recommended speech pathologist, who concluded that dd “probably” does have autism, but she went out of her way to stress to me that she didn’t have any concerns for dd. Both developmental pediatricians and the speech pathologist all agree that autism interventions would not be appropriate for dd. The speech pathologist suggested that dd only seek intervention if she wanted to communicate more easily with peers, and even then, she felt dd just needed 1-2 sessions of one-on-one coaching. DD just came up with her own solution: she’s became best friends with a boy because she felt that boys are easier to navigate friendships with — which is interesting because the neuropsychologist said that the brains of girls with autism are most like those of boys who don’t have autism, not boys with autism or other girls without autism.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

You just don’t know what you’re talking about. My dd was seen by her primary pediatrician and two different developmental pediatricians, none of whom felt she had ASD. We were assured repeatedly that she didn’t, and that all of her issues could be explained by her diagnoses of ADHD and anxiety. We had a full neuropsych exam done on her at age 10 for academic reasons (she was entering a gifted program and we wanted to make sure she had appropriate supports) and that’s when she was diagnosed. One developmental pediatrician openly disagreed with the neuropsychologist, and the other said the diagnosis didn’t really matter because dd was so high functioning that we would never have known without a full neuropsych exam. We followed up by having the ADOS administered by a highly recommended speech pathologist, who concluded that dd “probably” does have autism, but she went out of her way to stress to me that she didn’t have any concerns for dd. Both developmental pediatricians and the speech pathologist all agree that autism interventions would not be appropriate for dd. The speech pathologist suggested that dd only seek intervention if she wanted to communicate more easily with peers, and even then, she felt dd just needed 1-2 sessions of one-on-one coaching. DD just came up with her own solution: she’s became best friends with a boy because she felt that boys are easier to navigate friendships with — which is interesting because the neuropsychologist said that the brains of girls with autism are most like those of boys who don’t have autism, not boys with autism or other girls without autism.

P.S. Per the neurologist exam, her previous diagnoses were confirmed, so we didn’t replace them with ASD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

You just don’t know what you’re talking about. My dd was seen by her primary pediatrician and two different developmental pediatricians, none of whom felt she had ASD. We were assured repeatedly that she didn’t, and that all of her issues could be explained by her diagnoses of ADHD and anxiety. We had a full neuropsych exam done on her at age 10 for academic reasons (she was entering a gifted program and we wanted to make sure she had appropriate supports) and that’s when she was diagnosed. One developmental pediatrician openly disagreed with the neuropsychologist, and the other said the diagnosis didn’t really matter because dd was so high functioning that we would never have known without a full neuropsych exam. We followed up by having the ADOS administered by a highly recommended speech pathologist, who concluded that dd “probably” does have autism, but she went out of her way to stress to me that she didn’t have any concerns for dd. Both developmental pediatricians and the speech pathologist all agree that autism interventions would not be appropriate for dd. The speech pathologist suggested that dd only seek intervention if she wanted to communicate more easily with peers, and even then, she felt dd just needed 1-2 sessions of one-on-one coaching. DD just came up with her own solution: she’s became best friends with a boy because she felt that boys are easier to navigate friendships with — which is interesting because the neuropsychologist said that the brains of girls with autism are most like those of boys who don’t have autism, not boys with autism or other girls without autism.

P.S. Per the neurologist exam, her previous diagnoses were confirmed, so we didn’t replace them with ASD.

I also forgot to mention that dd, now 14, presents like a classic case of what used to be called Aspergers, according to her psychologist. It’s just become more apparent with age.

[Anonymous]

Anonymous wrote:

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.

Poster above again. I thought about this some more, and I really wouldn't say our daughter even has an intense interest -- it's more that it's a rigid interest. So what it can look like is bossiness or stubbornness -- only wants to play babies, refuses to play games you suggest. It looks very like social play, but in some subtle ways, it lacks the back-and-forth aspect of socialization.

[Anonymous]

Anonymous wrote:

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.

Some of my daughter's anxiety went away with the ASD diagnosis itself, to be honest, after she had a few weeks to sit in the diagnosis and feel her way around a little. The incidents of her "losing it" at school and needing to isolate or get away from the classroom went down. I think it was a little bit of a relief to know that the pressure she was feeling wasn't HER, it was the way she is built, and having that, she accepted it and herself a little more, and had more trust in herself.

She is still on an antidepressant and we still use anxiety strategies, and I'm sure there will be more anxiety as she gets older, but for now the diagnosis itself was something of a relief.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

You just don’t know what you’re talking about. My dd was seen by her primary pediatrician and two different developmental pediatricians, none of whom felt she had ASD. We were assured repeatedly that she didn’t, and that all of her issues could be explained by her diagnoses of ADHD and anxiety. We had a full neuropsych exam done on her at age 10 for academic reasons (she was entering a gifted program and we wanted to make sure she had appropriate supports) and that’s when she was diagnosed. One developmental pediatrician openly disagreed with the neuropsychologist, and the other said the diagnosis didn’t really matter because dd was so high functioning that we would never have known without a full neuropsych exam. We followed up by having the ADOS administered by a highly recommended speech pathologist, who concluded that dd “probably” does have autism, but she went out of her way to stress to me that she didn’t have any concerns for dd. Both developmental pediatricians and the speech pathologist all agree that autism interventions would not be appropriate for dd. The speech pathologist suggested that dd only seek intervention if she wanted to communicate more easily with peers, and even then, she felt dd just needed 1-2 sessions of one-on-one coaching. DD just came up with her own solution: she’s became best friends with a boy because she felt that boys are easier to navigate friendships with — which is interesting because the neuropsychologist said that the brains of girls with autism are most like those of boys who don’t have autism, not boys with autism or other girls without autism.

Agree with this. I raised a lot of early concerns about my DS having autism. I literally was writing on this board back when my kid was very little, asking questions and trying to figure out next steps. But he hit all of his milestones on time, and maybe we got tired of being told we were being overreactive first-time parents, and we were somewhat relieved when he was doing fairly well in preschool and then elementary. Teachers in his large public school didn't really share much with us overall. His grades were fine. He made a friend or two in school. Teachers had little to say about him during conferences - he wasn't getting in trouble but wasn't raising his hand much or overly excited about learning. He was kind of just "there." Fast forward to post-pandemic, and he started having meltdowns we had not seen before. I think all the changes and increased social challenges after isolation made it so he couldn't mask anymore.

Still, no one suggested ASD, and we didn't really have it on our radar. Thought maybe depression or ADHD. Online therapist was a total flop except that she finally said, "I think you should get him evaluated. His inflexibility suggests to me maybe he in on the spectrum." Instantly, we knew it was true. Got the eval at age 10 and a diagnosis. I think he falls into this same category as someone who has ASD but is pretty good at masking and is pretty high functioning. Our pediatrician and another therapist we started seeing both doubted the diagnosis when we first got it, but both now think it is accurate. I think with a girl, it could be even more challenging.

[Anonymous]

This thread is an example of exactly what op and others are confused about - no one - even many medical professionals - have a real sense of what hfa is. Super frustrating diagnosis in many ways