Family member asking if I think their child is autistic

[Unico]

Hey all, sorry for the novel. There is a tl;dr at the bottom. A family member put in me in very precarious situation the other day when she essentially asked me if I think her son might have autism. Being an MS4, I started with the standard "I am in no way qualified to answer your question." After that I told her the truth, which was that I thought it was really unlikely, but I haven't had the proper training to tell her anything useful. I did not add that if she thinks it's an issue she should go have him evaluated, which is where I could use some sage advice.

Quick overview: 7 yo M only child to older parents (late 50s). No SPMHx, FHx of schizoid and depression (maternal uncle and grandmother respectively). Bright kid, skipped a grade, doing well in school. *Very* social child (likes to tell jokes, be goofy, outgoing), no repetitive behaviors or obsessions, negligible witnessed preoccupation with order but wnl from my [limited] experience although parents claim he is moderately preoccupied with sameness/order. Makes appropriate eye contact for age.

So here is the meat of my situation: after a few days together, I think his parents are rewarding/reinforcing behavior that could be misconstrued by others as being autistic. Case in point: kids spills his juice on the table in a restaurant, starts turning red, holding back tears, crosses his arms and is visibly upset. He clearly states, "now I can't drink my juice," "I want more juice," and jesters to his mother when the waitress comes by to make sure she knows to bring him more. The parents (and my four year old son) wipe up the table while the kid is sulking. The parents tell the kid he is embarrassed and proceed to tell the whole table that he gets very upset when things go wrong. Instead of trying to deescalate or teach perspective, the parents seem to enforce/enable him. The pattern I see is: kid gets upset, parents ascribe a feeling, ignore the actual issue, missed teaching opportunity and the kid knows how to manipulate them for attention or a desired result if he doesn't get what he wants/something goes wrong. They're teaching/rewarding him to be rigid and inflexible. Combine that with his intelligence and I can understand while his teachers might think he's autistic.

Tl;dr
Parents seem to be enforcing/enabling rigid and inflexible behavior in 7yo M. Teachers are concerned kid is autistic, mother asked for my opinion.

Thoughts? I know early intervention is key, but are there any tips I could give to the parents on what to look for in a professional when seeking assistance? Do practitioners normally do a family assessment? Also, CAP is my area of interest and if there are any good reads for this please let me know, thanks!


Sent from my iPhone using SDN mobile

---

Members don't see this ad.

 

[Stagg737]

Hey all, sorry for the novel. There is a tl;dr at the bottom. A family member put in me in very precarious situation the other day when she essentially asked me if I think her son might have autism. Being an MS4, I started with the standard "I am in no way qualified to answer your question." After that I told her the truth, which was that I thought it was really unlikely, but I haven't had the proper training to tell her anything useful. I did not add that if she thinks it's an issue she should go have him evaluated, which is where I could use some sage advice.

Quick overview: 7 yo M only child to older parents (late 50s). No SPMHx, FHx of schizoid and depression (maternal uncle and grandmother respectively). Bright kid, skipped a grade, doing well in school. *Very* social child (likes to tell jokes, be goofy, outgoing), no repetitive behaviors or obsessions, negligible witnessed preoccupation with order but wnl from my [limited] experience although parents claim he is moderately preoccupied with sameness/order. Makes appropriate eye contact for age.

So here is the meat of my situation: after a few days together, I think his parents are rewarding/reinforcing behavior that could be misconstrued by others as being autistic. Case in point: kids spills his juice on the table in a restaurant, starts turning red, holding back tears, crosses his arms and is visibly upset. He clearly states, "now I can't drink my juice," "I want more juice," and jesters to his mother when the waitress comes by to make sure she knows to bring him more. The parents (and my four year old son) wipe up the table while the kid is sulking. The parents tell the kid he is embarrassed and proceed to tell the whole table that he gets very upset when things go wrong. Instead of trying to deescalate or teach perspective, the parents seem to enforce/enable him. The pattern I see is: kid gets upset, parents ascribe a feeling, ignore the actual issue, missed teaching opportunity and the kid knows how to manipulate them for attention or a desired result if he doesn't get what he wants/something goes wrong. They're teaching/rewarding him to be rigid and inflexible. Combine that with his intelligence and I can understand while his teachers might think he's autistic.

Tl;dr
Parents seem to be enforcing/enabling rigid and inflexible behavior in 7yo M. Teachers are concerned kid is autistic, mother asked for my opinion.

Thoughts? I know early intervention is key, but are there any tips I could give to the parents on what to look for in a professional when seeking assistance? Do practitioners normally do a family assessment? Also, CAP is my area of interest and if there are any good reads for this please let me know, thanks!


Sent from my iPhone using SDN mobile

Also just an M4, but from an outside view it sounds like you're right. It doesn't really sound like autism, maybe some anxiety/OCD underlying the manipulative stuff that's being reinforced.

Nice thread though, am really interested to hear what the residents and attendings think.

 

[OldPsychDoc]

Hey all, sorry for the novel. There is a tl;dr at the bottom. A family member put in me in very precarious situation the other day when she essentially asked me if I think her son might have autism. Being an MS4, I started with the standard "I am in no way qualified to answer your question." After that I told her the truth, which was that I thought it was really unlikely, but I haven't had the proper training to tell her anything useful. I did not add that if she thinks it's an issue she should go have him evaluated, which is where I could use some sage advice.

My sage advice: State quote above, repeat prn.

 

[calvnandhobbs68]

Tell them to go to their pediatrician with this concern. He/she will refer them for assessment (or do the assessment themselves) if warranted. The end.

I think your intuition is right though, for your own knowledge. I'm not even sure I see anything wrong with his behavior based on your report. Kid gets mad when his juice spills on the table? Yeah, me too.

 

[singasongofjoy]

I second the reiteration of "if she think's it's an issue she should go have him evaluated." Even if the result is that they're told it's not ASD, a good assessment should end with a referral for some basic parent training.

 

[thoffen]

Agree with the above and also would note for all, even minor, family medical questions I would get in the habit of punting. Aside from the interpersonal issues, I have found that most people simply cannot expect to think like doctors in these settings. That has certainly been the case for me.

 

[Candidate2017]

Tell them they suck as parents. The truth will set them free and set you free from their pesky questions.

 

[Jules A]

Tell them to go to their pediatrician with this concern. He/she will refer them for assessment (or do the assessment themselves) if warranted. The end.

I think your intuition is right though, for your own knowledge. I'm not even sure I see anything wrong with his behavior based on your report. Kid gets mad when his juice spills on the table? Yeah, me too.

Lol, I recently saw a kid with ADHD appropriately medicated by PCP. Does well in school and with peers but parents were concerned with anxiety/panic attacks and seeking medication evaluation. They described recent incident where kid was crying, screaming, pacing, labored breathing. When I asked about precipitant, any behavior mod or consequences? parent reported the child's video game had been removed because of not finishing well known and reasonable household chores. Great kid, loving parents but bottom line which I minced no words in presenting: tantrum. My prescription back to PCP for ADHD med mgt and therapy.

 

[Shikima]

Lol, I recently saw a kid with ADHD appropriately medicated by PCP. Does well in school and with peers but parents were concerned with anxiety/panic attacks and seeking medication evaluation. They described recent incident where kid was crying, screaming, pacing, labored breathing. When I asked about precipitant, any behavior mod or consequences? parent reported the child's video game had been removed because of not finishing well known and reasonable household chores. Great kid, loving parents but bottom line which I minced no words in presenting: tantrum. My prescription back to PCP for ADHD med mgt and therapy.

Well done! Hallmark of a good C&A - teaching parents how to be parents.

 

[Ceke2002]

Hey all, sorry for the novel. There is a tl;dr at the bottom. A family member put in me in very precarious situation the other day when she essentially asked me if I think her son might have autism. Being an MS4, I started with the standard "I am in no way qualified to answer your question." After that I told her the truth, which was that I thought it was really unlikely, but I haven't had the proper training to tell her anything useful. I did not add that if she thinks it's an issue she should go have him evaluated, which is where I could use some sage advice.

Quick overview: 7 yo M only child to older parents (late 50s). No SPMHx, FHx of schizoid and depression (maternal uncle and grandmother respectively). Bright kid, skipped a grade, doing well in school. *Very* social child (likes to tell jokes, be goofy, outgoing), no repetitive behaviors or obsessions, negligible witnessed preoccupation with order but wnl from my [limited] experience although parents claim he is moderately preoccupied with sameness/order. Makes appropriate eye contact for age.

So here is the meat of my situation: after a few days together, I think his parents are rewarding/reinforcing behavior that could be misconstrued by others as being autistic. Case in point: kids spills his juice on the table in a restaurant, starts turning red, holding back tears, crosses his arms and is visibly upset. He clearly states, "now I can't drink my juice," "I want more juice," and jesters to his mother when the waitress comes by to make sure she knows to bring him more. The parents (and my four year old son) wipe up the table while the kid is sulking. The parents tell the kid he is embarrassed and proceed to tell the whole table that he gets very upset when things go wrong. Instead of trying to deescalate or teach perspective, the parents seem to enforce/enable him. The pattern I see is: kid gets upset, parents ascribe a feeling, ignore the actual issue, missed teaching opportunity and the kid knows how to manipulate them for attention or a desired result if he doesn't get what he wants/something goes wrong. They're teaching/rewarding him to be rigid and inflexible. Combine that with his intelligence and I can understand while his teachers might think he's autistic.

Tl;dr
Parents seem to be enforcing/enabling rigid and inflexible behavior in 7yo M. Teachers are concerned kid is autistic, mother asked for my opinion.

Thoughts? I know early intervention is key, but are there any tips I could give to the parents on what to look for in a professional when seeking assistance? Do practitioners normally do a family assessment? Also, CAP is my area of interest and if there are any good reads for this please let me know, thanks!


Sent from my iPhone using SDN mobile

A big fat 'YES' to what others have said, if they think their child might be autistic then get an assessment done. But as the aunt of a young nephew who has ASD, I'd also say that I think your intuition might be right on the money here.

 

[Ceke2002]

I think your intuition is right though, for your own knowledge. I'm not even sure I see anything wrong with his behavior based on your report. Kid gets mad when his juice spills on the table? Yeah, me too.

LOL, exactly. Heck I don't even know if my nephew with ASD has ever cried over a spilt juice, he has; however, gone into a meltdown, started stimming, and needed to be removed to a quiet area with a special stress pillow to help him relax (he finds repetitively stroking, or patting certain textures to be comforting) when another kid suddenly changed the established direction a ball was being passed during a game.

 

[SeniorWrangler]

I would just add, if they are going to get the kid checked out, don't go to a local pediatrician, go to a specialist who sees a lot of ASD. I see kids who are awkward/introverted/delayed speech etc. get called autistic all the time, and I'm not even child psych. It's just something in the culture. Teachers are especially unreliable, in my experience, likely to assume that the kid who isn't responding to their teaching technique must have a psych diagnosis.

 

[Unico]

Update: Punted the question w/ "if you are concerned, get him checked out," and the parents stated they are not having him check out per conversations with "other trusted professionals." I was not able to tease out who these people were, but her father was a physician so I'm assuming she has connections.

Thank you everyone for the input.

Again, if anyone has suggested reading on the topic, please let me know. TY.



Sent from my iPhone using SDN mobile

 

[OldPsychDoc]

Update: Punted the question w/ "if you are concerned, get him checked out," and the parents stated they are not having him check out per conversations with "other trusted professionals." I was not able to tease out who these people were, but her father was a physician so I'm assuming she has connections.

So they asked their friends, not family...

 

[deleted343839]

I would just add, if they are going to get the kid checked out, don't go to a local pediatrician, go to a specialist who sees a lot of ASD. I see kids who are awkward/introverted/delayed speech etc. get called autistic all the time, and I'm not even child psych.

While they're sitting on the waiting list for an evaluation, the parents might just cut right to the chase and go see a behaviorist, who will probably be less interested in the specific diagnosis than in the overall pattern of behavior. Whether the child has ASD or not, the intervention principles are the same. They might end up cancelling the evaluation after all is said and done.