How to tell parents a preschooler has Asperger’s
I am an early years teacher and would like your expertise on this matter. I have a young girl in my class. She is 3 years and 9 months old and I have been talking to her mother in regards to her challenging behaviours. Her mother is not responsive and I have been attempting to get her a referral from the GP to a speech Therapist to help her with language.
Mum has asked her doctor and he said there is nothing wrong with her. Now the mother is angry and wants a sit down meeting to discuss what I obviously think is wrong with her child. I have lots of written reports which I can show her, but want to be really careful not to overwhelm her.
Here is a list of behaviours and development that I have noticed:
- Resistant to change often screaming and will refuse to wear a spare hat if hers is at home but can’t understand that we need to have another hat to play outside.
- Has a preference for male peers and often younger
- imitates the actions/behaviours of others
- clumsy gait
- randomly hugs strangers
- unaware of personal space
- affection is over the top at times
- pronoun reversal – even after explaining that Felicity is a girl so it is her hat will say his hat
- Will scream at peers and adults without provocation
- does not show concern when another child is hurt or sad
- has trouble following routines and directions
- has trouble sharing
- will push over a much younger child and does not like to talk about how that would make her/him feel
Do you think I should take the wait and see approach, rather then distress the family who are already defensive?
You are so kind and insightful to tell the parents.
Its very difficult for doctors to identify Asperger’s in girls. And its very difficult for parents to hear there’s something wrong with their kids. Asperger’s is especially difficult for parents to see because its genetic and likely very comfortable, familiar behavior to them.
When the family experiences problems– when the girl is older – they will remember what you said. Give them the list you sent to me and tell them you think she has Asperger’s. They will use this information later and they will appreciate it.
Tell them to save the letter in case they need the information in the future.
Penelope
I have a 3 1/2 year old and I’m typically very open to considering feedback from others when it comes to him.
I surprised myself when I felt defensive after his teachers made multiple comments about his speech being behind. I checked with his pediatrician and he thought it was fine. And that there is a wide range of normal.
I don’t notice much of a difference between him and the other kids, but I’m proceeding with a speech eval anyway. I don’t want my ego to interfere with him getting the help he needs.
I respect your willingness to put yourself in an uncomfortable position for the sake of the child. I don’t think it will be appreciated at the time, but that doesn’t mean you shouldn’t do it.
For it to be effective, I think the list needs to include the developmentally appropriate behavior and his behavior side by side.
For every behavior you listed I can think of at least one child in my son’s preschool class that does the same. And I’m sure the parents will attempt to do the same.
Good luck,
Sue
I had a reverse experience in that the Montessori director told me that I was shopping for the diagnosis du jour when I realized that my 5 year old daughter probably had Asperger’s. Her grandson was severely autistic and my daughter didn’t act like he did at all. (Ironically, years later when I read about Pathological Demand Avoidance I thought that was a much better fit.)
That said, you cannot tell them that their daughter has Asperger’s without the proper qualifications for diagnosis. You may suggest it, but I don’t recommend that. Whenever I see a child that seems spectrumy, I suggest that they look into Sensory Processing Disorder. It is MUCH more gentle to hear and less frightening than “autism” and quite probably is going on for sure. The thing is to get them in to see someone who can make a proper diagnosis.
Your wording sounds like you could be in the UK and things may be different there, but here it is much easier to get in to see an occupational therapist who can do an assessment and then refer to an autism specialist if deemed necessary. But OT is most likely necessary for this child.
Many of the things that you list can be attributed to problems with proprioceptive input. It you don’t know where your body is in relation to others or know how hard or gently you are touching or being touched it can be pretty darn difficult to navigate a preschool classroom or the world in general.
You state “Will scream at peers and adults without provocation” please, please, please keep in mind that just because YOU can’t see what provokes her, that doesn’t mean the provocation isn’t there. If you could see things from her experience (possibly someone brushed up against her but it felt like a punch to her and her body reacted accordingly) you may notice that there may be a build of little things that aren’t on your radar but are a non-stop assault on her senses–which constantly betray her.
As Penelope said, if you use the word Asperger’s it WILL stay in their minds–whether you are correct or not. Again, I would stick with Sensory Processing Disorder, but if you feel you must throw the A word out there, I would say something like: “Try to find someone who is familiar with females as well as males. A number of doctors only know about the male presentation of things such as Asperger’s and miss the signs in girls because it looks different from the classic signs in boys.”
I commend you for wanting to help and possibly saving them years of confusion and a loss of a therapy window. Your observations will be invaluable to a specialist in making an accurate diagnosis–whatever that may be.
Best of luck!
I agree with Penelope’s advice. Also, I would continue to document the frequency of behaviors which you have listed as the question of – are the frequency of behaviors increasing, decreasing, or staying the same – may come up in the future. As difficult as it may be to have the insight you do on this young girl and not be able to act on it, I think it is best to be honest with your assessment to the degree to which the parents are willing to inquire. Give them some time to think things over and they may come back to you with more questions and perhaps asking for your advice.
This is a tough one. If you are in the UK, you as a carer have the responsibility to report these issues directly to the local authority. They will send the social services to their home to conduct an assessment and offer support and services if they see that the child does qualify. They will contact the doctor, teachers, relatives, and parents to have a wide view on the child’s behaviour. If they do not find issue with everyone’s input and the child’s behaviour, no further services will be administered.
Diagnosis bias aside, I would guess ^ that is why the parents are adamantly against this teacher having any say in what the child is progressing/regressing in. If you have made the parents known, and they then went to the GP, they do consider the issue closed and handled on their end. I doubt they are just ‘forgetting’ that sally might need some help, they probably just don’t want social services in their lives. They could be seeking private-paid services anyway.