Gifted Issues Discussion homepage Forums Twice Exceptional Aspergers?, ADHD? and gifted?

We are still in the early stages of all of this, as my son is only 4...so seeking some insight from those with older kids who have been in our shoes possibly...the more I learn about giftedness and also aspergers, the more I feel my son may be twice exceptional. I could go on an on about the quirks/behavior difficulties we are dealing with. His memory is incredible and he thinks differently than your average 4 year old...The behavior issues are incredibly stressful for our entire family. He seems highly intelligent, but also has some extreme sensory needs and is very defensive/angry a lot. When he is in his realm though, he exceeds all of his peers in problem solving, logic and reasoning skills. A new doctor who specializes in kids on the spectrum did feel that after observing him that he does have some definite aspergers traits...looping conversations around to always be things he is interested in..perseverating on particular topics etc. He is incredibly hyperactive also, VERY impulsive...defensive...stubborn. The doctor also saw some traits of ADHD as well...Just incredibly trying for us as parents. The doctor is sending us for a psych consult in the next couple of months to hopefully get a diagnosis so we can better understand him. I want them to do IQ and giftedness testing also but not sure if they will do that right away or have to send him somewhere else after...

I guess my questions are for those with children with aspergers, and/or ADHD and giftedness , how did they present as 4 year olds? Any tips or things that helped manage the meltdowns, emotional highs and lows, impulsive behavior/sensory seeking behavior? How were you able to bring out the gifted side that you know is there? I feel that aspergers (if he indeed has it) is getting in the way of his giftedness...he gets stuck. How are these children doing later on into elementary school and beyond? He has social difficulties already...do they do ok academically? Can they function in life? It's so hard to imagine him being a rational well behaved child one day...just hoping we get there. Obviously some of this behavior may be typical 4 year old behavior but I feel he takes everything to the extreme.

I would give it a few years to see what happens.

Age 4 seems a bit young to get a good read on these issues.

Some people with these issues do just fine. Some don't. It depends on the person.

I think you need to see more than that to have Aspergers. DS is 7 and he's just now getting to the point where he understands that he is boring other people and refrains from going on and on about his idiosyncratic interests. Just last spring his speech therapist said she would turn his back on him while DS was babbling on (once going so far as to "hide" under the table from him) and DS would't even notice. Now just 6 months later his current IEP team (new people) is shocked that he was like that. They said it's actually an advanced skill for a 7 year old to realize whether they are boring their audience and what is appropriate to talk about with certain people (for instance other 7 year olds aren't interested in talking about Pearl Harbor).
DS walks on his toes sometimes and used to flap his hands and even with that the neuropsych who tested him said it's not enough. You need to fill out ASD inventories/checklists, look at things like "theory of mind" (there is a test for this), etc. The neuropsych who saw DS said a lot of clinicians diagnose based on superficial characteristics, so make sure you get a good eval. There are a lot of things that can cause extreme behavior. DD has ADHD for instance and has a lot of ups and downs and off the wall behavior. If your DS isn't that interested in other kids (4 year olds still don't necessarily play WITH each other that well, it's more parallel play), doesn't understand or enjoy social games, is obsessive about things (like needing to flip lights on and off), doesn't show signs of empathy, is very rigid about needing things to be a certain way--those would be red flags. I remember around age 1 1/2 or 2 DS was so quirky that I thought he might as well have ASD written on his forehead, but he would do things like give his sippy cup to another child who was crying and I knew he was probably developing normally. A lot of the quirks have decreased dramatically over time.

Yes I realize he is young and it will probably take years to figure out what exactly we are dealing with....It's tough, being our first born he seems older to me than just 4 because of the types of conversations we have. I feel he should be capable of more than he is, which I know I shouldn't have those expectations...it's hard with an intelligent kid who also does things you feel they should be able to control. It's also tough because we have been having these struggles and I have been wondering what is going on since before he turned 2...so it already seems like forever. I was just hoping at age 4 we could finally get a better grasp of what we are dealing with. The doctor seems to think now is the time to begin figuring it all out so that we can better help him (and us).

Glad to hear that some quirks have decreased over time...he just differs from his peers and trying to figure out why exactly that is...He never did really do the hand flapping. He has had some facial tics that he still does occasionally like opening his mouth wide, talking out of the side of his mouth...and likes to yell at the top of his lungs/blurt out loud phrases at deafening levels out of the blue just for fun. I worry of tourettes but not sure because he can control it at times so it seems... His eye contact is good and always has been. He can be very rigid/obsessive about things. He is a total perfectionist and can be OCD about things. If something doesn't go as anticipated or he can't do something the moment that it enters his mind, a full blown meltdown ensues. He does seem to have trouble with empathy...I constantly have to remind him that other people have feelings, that we can't just hit/shove etc. but I feel it falls on deaf ears. We have to repeat these concepts constantly all day long but he still does the behaviors. He will repeat what you say to appease you, but then do it again. Mostly he is just playing rough but he doesn't seem to be able to dial it down a few notches so that nobody gets hurt. It's just incredibly tough especially when he plays so rough with his younger sister and really doesn't seem to realize that he is hurting her. Stuff like that has me scratching my head...socially he likes to be around older kids but has difficulty with children his age or younger than him. Older kids keep his behavior in check better and I feel intellectually he has more in common with them so he gravitates towards them...He does like to be around other kids though and likes to have someone to play with...sometimes he can play appropriately with others and he seems like a normal kid. He has an imagination and likes to pretend things with others....Other times he does things that annoy other children and they don't want to play with him and his feelings get hurt...if his feelings get hurt or someone does something that doesn't go his way, he can get aggressive or angry. He isn't a joiner as far as some social activities, he can be shy...but I feel he has come out of his shell more recently and does enjoy active play like jump castles and playgrounds playing in groups of other children. Occasionally he can get rough with other kids in these situations but most of the time he does ok.

I know we won't really have any answers until the evaluation but just curious...yes I realize it has to be a really thorough evaluation and I trust this doctor and who he is sending us to. He said she does an extremely comprehensive detailed evaluation and he trusts her for all of the kids he sees. He is the best in our area as far as kids that are not neurotypical so I am thinking we are going to the best psych here. Although I may see if he can send us to someone else who specializes in testing for giftedness as well so we can also make sure we are picking up on anything else that may be going on if he is indeed gifted. It's just so hard to piece this all together and so tough at these younger ages. As a mom I know something is different with him and always has been.

Well - I've had a lot to say on this sort of topic recently. I'll consolidate it to this: We started down the assessment path when a well-meaning preschool teacher insisted DS (now 7) was Asperger's. We did ASD, SPD, ADHD, and anxiety assessments and others. My two cents is this: if you take a PG kid to a specialist in any of these areas, they will probably say, "Well - it's not a clear cut case, but there are several indications that he could be [X diagnosis]."

This is not because the assessor is bad or ineffective. It's because a PG kid has brain-wiring manifestations that present LIKE symptoms of all those other things. They may ALSO have those other things, but it's hard to tell when the PG kid is in the throes of asynchronous development.

And I don't use the word "throes" lightly. Early childhood is really, really tough for a PG kid and the kid's parents. You don't know (can't know) what is really going on but your kid feels broken and you feel an overwhelming need to help.

I have heard over and over from other HG/PG parents that (1) it becomes clearer as they grow, and (2) it becomes easier and the kids will be more functional and stable, emotionally and socially, as they grow.

I will tell you that this has been the case for my DS. If you read my other posts, you'll see that we are hardly out of the woods. My heart still seizes when I see the school caller ID on my phone! But - things are getting better and better. His "issues" are indeed both diminishing AND coming into clearer focus now, and it's easier for us to know how to support him.

You are smack in the middle of the time that was very hardest for us. When DS was between 4-6, he just had a very tough time. And so did his Dad and I. We survived by remembering that the problem is not always that "he won't." In fact, it's almost always that "he can't." Once you convince yourself to at least consider that point - it will help guide you to the best supports. And always know that he really is trying so hard to be good. So give him lots of unconditional love. Especially when he is having a bad day.

Lots of hugs to you,
Sue

What everyone else has said. Word for word. Four is worst. By six, things will get so much better. And especially what suevv said about HG kids and clear cut answers - you probably won't get them at this point.
What we did - a sort of functional approach, all trial and error:

Cut down social stimulation. One activity a day, period.
Ramp up intellectual stimulation.
Ramp up sensory diet (google that). And time outside, in nature!
A couple rounds of OT.
Fish oil, zinc, magnesium.
A low carb, high fat high protein diet, to regulate blood sugar.
Rewards for time periods without doing hurtful things to others (yanking my hair, maniacally),
Even after we had the "it's not ASD, but..." Diagnosis,I'd still read up on ASD strategies, figuring if it looks like ASD, ASD methods must help, and they did. If it looked more like sensory issues, we did sensory stuff. And so on.
And calm down, give it time. Eval periods are stressful, don't forget to enjoy the holidays. It won't be that bad.

Hi, my son is almost 5 and has an ASD diagnosis. I can agree with suevv in that the most helpful thing for me was to give up on the idea that he should be doing better and accept that he was doing his best. When I did this my stress went down. When my stress went down DS seemed to be happier and ended up doing a bit better.

I still am not confident that my son is on the spectrum. The experts who diagnosed him simply state that: ASD is the best diagnosis to explain his current difficulties. The diagnosis will get him the therapies he needs right now.

My son is terribly impulsive, rigid, oppositional, bossy, hyper, generally difficult. We started early intervention at 2 and he tested at 9 months for social development. At 2.5 we got an ASD diagnosis.

He is not like any of the other kids who have ASD in our community. He spoke early at 5 months and quickly ended up speaking in complex sentences. Testing at our ASD evaluation at 2.5 put his expressive language at over 4.5. Now at 4.5 he talks like an adult pretty much. He has a great imagination. He lags in play skills, but he can make up stories and come up with amazing ideas no problem. He does appear to have empathy, learned or natural I can't say, but he will run to help someone who needs help. He will also take out a baby who even looks like he might mess up something DS is working on.

My son gets PT and OT, 2 hours each per week. He has sensory issues and is clumsy in general. He has amazing fine motor skills though. He wants to play with the other kids. This is more recent. They don't always want to play with him though. He gets along a lot better with older kids and adults. I think this is because they are more predictable and follow rules better.

My son has been kicked out of 2 preschools and has a full time aide in his current preschool. 2.5 years of therapy, including behavioral therapy, was entirely ineffective. 4 months ago we found ourselves looking at getting kicked out of yet another school and very worried about the future.

We were desperate and our dev ped suggested Prozac. We were not yet ready to try medication. 2 months ago, we were. He had started biting again and was banging his head at school during meltdowns. My son has improved so much there are no words to describe it. Is he normal? No. But he can function now. The Prozac is to treat anxiety, he had lots of OCD symptoms and some tics on and off and was always so worked up about what awful thing might happen he never could enjoy himself. Now he is happy. Not all of the time and today was a rough day, but overall my son is happy. He no longer hits or pushes or bites or hurts himself.

Now I wonder if he really is ASD? Maybe it was anxiety? He's still super hyper. Maybe it's ADHD? Our dev ped says that anxiety and ADHD are often part of ASD and they still feel his diagnosis best captures where he is at right now. Just like any parent, I just want the best outcome for him as he grows up. It's difficult. There is nothing clear cut about any of this. DS is so amazingly advanced academically and so far behind socially I have no idea how he is ever going to manage to find his place in the world. We can only do our best to help them do their best.

I'm still in the same boat as you. Hopeful for some end to the difficulty. Waiting for my son to be old enough for IQ testing. Confused by everything. All of the other kids just run out onto a playground and start playing. Spontaneous and happy. That is what I want for my son. These days it even happens on occasion. He is just as likely to need to take a special path or to want to walk around to perimeter or to play on the bench the moms sit on rather than on the playground equipment or to use the wood chips to make math equations. If it's a playground we have been to before he is likely to go in order doing exactly what he did there the last time, which at one playground is counting all of the cutout circles in the metal platforms on the playground. How is that more fun than actually playing? It's frustrating for me. But I'm sure it is more frustrating for him.

What will we do with him when he starts school? He's not yet 5 and is academically at a 2nd grade level. And that is with minimal instruction. Basically we teach an idea and he runs with it. I taught him negative numbers and he immediately integrated it into his independent math play. He loves to read Magic Tree House and is obsessed with mazes. I now buy him adult maze books because he breezes through them so quickly. He makes mazes every time he touches a writing implement. He makes them out of everything. The other kids at preschool are learning their letters. I'm terrified of transition to K.

I guess there is no knowing where you will end up with kids like these. My son is so loving and wonderful at his good times that I just try not to think about the future any more than I have to. There are lots of books on autism and lots of books on giftedness. There isn't a lot on children who seem to combine the two. I don't know if my son is gifted yet, but I do know that his mind is amazing and entirely different from his peers. It's hard work raising children. It's really hard work raising special children. Just keep swimming.

"He will also take out a baby who even looks like he might mess up something DS is working on."

Hee hee. Same here. Or a girl with a screechy voice who looks like she might start singing "Let It Go."

Our DS (now 7) was pretty angry, impulsive, etc around that age. He spent a lot of time doing his own thing and resisting doing anything anyone else wanted, or following a schedule of any kind. He would be unable to keep himself from pushing buttons he was explicitly and nicely told not to. A very trying time. (We found The Difficult Child Workbook helpful, or at least it made us feel like we had a plan). For those years the best thing was focusing on anything positive he did, and trying to be understanding about all the rest. He mostly feels close to us and I didn't always think he would.

He has slowly improved over the last few years so that now much of the time no one would notice he's pretty different, more quirky. Teachers see him as anxious or perfectionist or having this or that minor behavioral thing, as exhausting maybe, but no one has come to us and said he needs evaluation for ASD. We have had comments on ADHD but that is usually adjustment and he figures out the routine and what to keep track of given a little extra time (ie at the beginning of the year most kids can organize their desk and know where things are after say the first 2 weeks, and DS takes 5 or 6 weeks of daily help from the teacher to get it down, but then he does).

Now we get more comments about the giftedness, teachers notice a child who remembers facts well and has things to add to the classroom discussion. Socially he's a mess but teachers don't care because he clearly tries hard and he's good at apologizing once his attention is drawn to a problem. Teachers also don't seem to listen too much to the actual content of the dialogue so if he seems to be chatting to other kids they assume he has no social issues with them.

For him being ill or tired or hungry are things that make him swing over the line that separates functional from not. It's just not much of a trip from one side of the line to the other. (He is tired right now -- yelling and throwing pencils away from his homework as I type, but it's Thursday night so to be expected for him).

So long term for us taking those 3 things very seriously has helped him maintain a "normal" child experience. Other kids maybe you can play catch up and feed them a cookie and have them ready to go out to some after school activity when they come home and shed a few tears about something that happened at school, but not DS. I just don't send him to school if he wakes up and seems like he's having an ASD/ADHD sort of morning, because I know that he's more prone to meltdowns on those days. I don't send him to school Monday am if he doesn't seem recovered yet from the previous week. We limit after school activities. We only have playdates on Sundays and Mondays when he's the best rested.

His schools have never complained about attendance, I think they can see what happens if I send him too tired, he has a meltdown and that's the last thing they want in class.

So it can be a struggle, but he likes school and goes all day and that makes us parents very relieved as we weren't sure that was a given when he was 4 or 5 or even 6.

He used to have to change all his worksheets mentally into whatever his interest was. He would pretend it was adding dinosaurs. It worked mostly. Now he finally just this year seems to have moved beyond that and can actually just do it without the rearrangement of it into his personal safety zone. That seemed to happen right around the time he turned 7.

I see school getting easier for him because: in a few years they will finally move to having their own desks and he struggles with the interpersonal issues created by rubbing elbows with random kids you didn't choose to sit next to at a claustrophobic tiny work table; there will be a little more academic content to focus on; there will be less emphasis on blurry group cut and paste projects, less get-to-know-you group activities, etc.

We did OT for over a year, I saw no difference. In fact the extra focus on fine motor skills seemed to make him hate writing even more. Maybe it just wasn't the right OT for him.

I have one of those and BTDT. DS12 has ASD with side helping of ADHD and is also PG.

Gifted kids with ASD are often misdiagnosed as not having ASD because their language skills can be exceptionally good. DS's verbal IQ is off the charts high-- which makes him not seem like typical Asperger's at all.


A lot like yours. When little girls came running up to me in the preschool to tell me (in an accusatory way) "what DS did today" I never knew whether it was going to be filling a whiteboard with math or biting someone. Or both.


Develop a zen-like calm. If you get riled, things will spiral more. Continue to teach him even in those moments that feel like a crisis.

Develop a sense of precisely what lessons and skills you want him to learn, and incentivize that like crazy. Break skills down into small steps as needed, and teach the steps.

Do not shy away from meltdown-inducing situations: teach him to tolerate the triggers.

Explicitly teach things that other kids seem to know ("no, we don't hit babies, here is how you touch a baby").


We did ABA therapy, which is tailored to the individual (and could therefore take advantage of the fact that gifted kids learn really, really fast).

As we got his reactivity and temper more under control (therapy and meds combined) it was obvious to everyone that the giftedness was a huge piece of the puzzle.


I think preschool through early elementary is the hardest period with a child like this.

This is DS12's best year at school ever and I expect things to continue to improve. He has really serious organizational issues, but every year his behavior has improved. He is getting along with people pretty well. He is loved by his teachers (he learns and is enthusiastic).

Our expectation is that he will continue to be a person who makes conspicuous mistakes, but at least he's learned to apologize really, really well. There are glimmers that he'll be a socially conscious, fair-minded adult with a full capacity for empathy and an excellent sense of humor. Work ethic remains to be seen, but he's 12!

Some of his perseverative interests are academic. That makes a difference, too.


I would recommend a neuropsychologist for this, preferably one at a children's hospital autism center or somewhere else where they've seen thousands of kids on the spectrum. That is where you will get the finest-grained reading on where he is.

IQ and achievement testing should be part of that workup. Note that kids with social skills issues often get wonky scores on these tests when they are young. If you remediate the ASD, the scores typically become more coherent and go up.


This is useful advice. Ours is very clearly ASD (loved spinning objects at age 6 mos.) What the dx got us was a genius case supervisor who made school really effective for DS so that the could learn throughout his day, every day. And who trained us to be the ninja parents DS needed. Couldn't have done this as well without him. A dx is just a tool.

DS is also happier since dx. Before he thought he was a badly behaved child, and he felt terrible about himself. After dx, he understood that "it's not his fault, but it's his challenge" to manage his behavior in accord with social norms. He likes who he is.

DeeDee

Completely agree with Suevv and Tigerle.

At age 4, my 2e/pg ds9 was in a special needs pre-k program due to a speech delay and physical/SPD issues until we pulled him and put him in a gifted school at age 5 and 6. Between 4-6, ds was misdiagnosed with Asperger's/PDD and ADHD. He was also in vision therapy and that presented a different picture to specialists too. It wasn't a fun time for us.

With some kids, including my son, the visual system seems to take longer to fully integrate, imo. So that can really muddy the waters and make a child appear to have ADHD.

Ds has been un/homeschooled for three years now and I've seen many improvements slowly over time. There's no magic bullets here, but at least with un/homeschooling a lot of the pressure is gone. It's a least-worst scenario for us.

With school, there are expectations and children are pegged against averages of neurotypicals. First, you've got behavioral, attentional, social, and group expectations. Then, there are tons of other expectations in terms of academic performance, which is pitched to a 'normal' developing child and not a pg one. It's a lot for little ones to navigate, especially when you've got asynchronous development or a 2e kid. If your child is a pg introvert, then it can be even worse and make them feel even more self-conscious and aware of their differences.

THANK YOU everyone for all of your advice. WOW. that helps tremendously...everything seems to make a little more sense now. I keep reminding my husband that we are in the throws of it right now... we are definitely in the trenches. Some days are great, some days are absolutely horrible. It is curious that he presents much like some HG and PG children. I might add that he just turned 4 in Oct also so he is just barely 4...we have a long road ahead of us it sounds like. Fortunately right now he is in a home school/unschooling montessori preschool environment with only a couple of kids of mixed ages and a teacher who believes in him...her twin 10 year olds are gifted and she recognizes the traits that she saw in her boys in him and hasn't seen these traits in any other children. I'm not sure exactly what area he is gifted in, I just know he is highly intelligent. He does like numbers but isn't really writing anything out yet. He figured out how to read before turning 4 but is still just reading short words. He does seem to gravitate towards geography and the world and his teacher said that the other day when he saw a map of the continents he correctly named them all with ease and he had only seen this map once before and that was 2 months ago. Stuff like that...and his memory and attention to detail are extremely advanced. He is very passionate about EVERYTHING. He talks like an adult with mannerisms and everything is a big deal with lots of excitement explaining things. I think this trait will serve him well one day, so that is encouraging to hear about the older kids doing well academically in classroom settings. I plan on keeping him in a montessori atmosphere for as long as we can, even into elementary school if possible...

I do plan on using the assessment as a tool and taking what they say with a grain of salt. Obviously some of these behaviors I feel he will grow out of. If anything, it may help us better understand what traits he has. You're right, he has little pieces of several different disorders. He is not a clear cut aspergers, or clear cut ADHD case etc. His verbal skills have always been advanced and he talked early. His teacher said she has been around kids with both and he doesn't quite fit them although she can see pieces of them at times...I don't want him to get labeled with something when he may in fact be HG or PG and this is his way of coping...but at the same time, I think a diagnosis used the right way may help us realize that there really is something different going on with him...help family understand that it's not our parenting...that is a huge stressor right now.

Did anybody else have difficulty getting family (grandparents, uncles/aunts etc) to understand your child? Did you get blamed a lot for doing something wrong as parents..comments like "you never acted this way as a kid" etc. It's easy for them to point the blame...saying we aren't tough enough with him etc. It's highly unfair and I am finding myself wanting to distance ourselves from them and not allowing them to visit. They commented last time that if he is this out of control they don't think we can come visit them. That is extremely sad for him (and DD) and I hate that they feel that way. When my son was acting particularly ASD...yelling loudly, jumping all around, not letting anyone talk my father said some pretty hurtful things which I know my son understands and I am pretty upset about. I don't think it's emotionally fair to surround him with such negativity but at the same time, don't want to deprive him from going to family functions. Did anybody deal with this, and if so have things gotten better over time with family understanding your child too?

That is interesting about being tired or hungry and the behaviors escalating. I have noticed this. He currently eats gluten free and dairy free because I have linked those to extremes of behavior...almost uncontrollable. If we keep those out of his diet it keeps things a little more under control. Not perfect, but better. He also eats all organic, no GMOs etc...He gets fish oil daily along with a probiotic. We also use an essential oil blend with remarkable results! It seems to mellow him out at preschool...his teacher has noticed a huge difference the days I put it on him....it has been a lifesaver. So all in all, I am hopeful. I think this info will help DH understand him a bit more. Day to day is HARD...I understand him much better than DH. He still feels like he should act and respond like a "normal" child which just doesn't work. It's hard not knowing what you are dealing with and why they act the way they do. I can see my son trying to do the right thing, or being misunderstood because he is doing something that looks like a huge mess that he should know better than to do...but he sees it as exploration and discovery.

Sounds like we are on the right track though...gotta take it day by day and focus on the good. Yesterday was a good day. He was calm, thoughtful and a delight...today may be completely opposite. He could melt down, kick and scream...hit at me etc. At least I know the good days exist and will cherish those and try to get through the bad ones. On the plus side, he always has some witty funny off the wall statement or question for us that is not typical of a 4 year old, so that can be entertaining. He intrigues me and is so complex, it's fun in a way...I just think we need to get past this preschool age so he can better express himself and mature a little bit.

LOL and I laughed at the comment "he will take out a baby who thinks about touching his stuff" because that is sooo my son as well. He can be kind and share things, especially with older kids...but he can also revert to 2 year old behavior and try to tackle a child who bothers him. But then later if that child were hurt he would feel bad for them and get them a band aid and think of all sorts of ways to comfort them. Seems like a disconnect there, but then again at least he does seem to show empathy at times.

My daughter is 10 and diagnosed with ASD (Asperger's). We just got the diagnosis this year. Oh how I wish that it had occurred to me or anyone else for that matter, that DD had autism when she was four. That time was so difficult for me. I thought maybe I would share some of the behaviors that she had at that age. Looking back, it seems clear that she did have autism, but many are still very uneducated about autism and its symptoms. I do a lot of self-blame regarding her delayed diagnosis. There are a lot of things that can be done as early intervention that will allow your son to enter school with minimal difficulty. Without them, you could be looking at years of OT, PT, speech therapy (for pragmatics) and other delays that will keep him from performing his best in school. I would not worry that your son could be wrongly diagnosed, there is a fairly high bar for diagnosis and a physician or psychologist trained in diagnosing ASDs should be able to differentiate his symptoms. I am not saying that kids aren't misdiagnosed, just that it probably doesn't happen that often. Trust your gut at this stage, if you are noticing symptoms, keep a journal and note how often they are happening. That will be extremely helpful to anyone working with your son. DD symptoms at 4:

1. Explosive tantrums (daily)
2. Inability to share or play in group setting, need to control play
3. What the daycare described as "eloping" from classroom when stressed or upset
4. Sensory issues with food, sound, touch (only eating a handful of foods, sensitivity to noise and loud places, not liking to be touched unless it was on her terms)
5. Hyperlexia, DD started talking at 5 months and could speak in full sentences by 12 months. She started reading sight words @ 2 and independently reading books at 3. Most consider this a splinter skill for spectrum kids, but DD is highly gifted fwiw.
6. Motor skill delays, both gross and fine motor. These delays trended throughout elementary school. Don't listen to those that tell you your child will grow out of it! They most likely won't without some assistance. Any speech, language, and motor skill delays will need therapy to correct.
7. Rigid, unyielding personality with inability to transition from activities. I know a lot of PG kids do this. However, this along with many other autism symptoms is a red flag. On its own, it is probably just a function of high IQ.
8. Narrow iterests and focus
9. Constantly interrupting or talking over others. Not necessarily a red flag if it happens only occasionally, but if it is all day, every day, then you can see a pattern of behavior.
10. Echolalia...I had no idea what this was until she was diagnosed. DD would memorize commercials, lines from her favorite movies and t.v. shows and repeat them ad nauseam. I was proud at first that she had such a good memory!
11. Ritually stacking or lining up objects during play. I would not be concerned if you see this once or twice, but consistently doing this is a symptom of autsim.

I would agree with those that said their child was happier and better adjusted after diagnosis. Teachers can be very judging, and some of the symptoms of autism can be interpreted as the behavior of a bratty child. Realizing that these behaviors stem from a disorder will help those around him understand and work to improve his behavior. I wish you luck on your journey!

My daughter had these behaviors from ages 4-6:

1. Explosive tantrums
2. Inability to share or play in group setting, need to control play
3."eloping" from classroom when stressed or upset
4. Sensory issues in the school setting -- sound, over-reaction to touch
5. Early fluent reading

7. Relatively Rigid, unyielding personality

School personnel consistently said Autism Spectrum, various medical professionals consistently said no.

Now at age 8, she has outgrown these issues completely as far as I'm concerned. This year she was given a 2 year grade skip, and she is not having any behavior problems, she is doing all her work, and WOW - she has even made friends! She does report being bored with school and wants to homeschool so she could go at her own pace and learn more... but at least for a few more years we'll keep her at school. She is happy with herself, and her words exactly: "I'm not normal, I'm awesome!"

Those difficult years aged me a lot... IMHO, I really don't think it's possible for anyone to make an accurate prognosis for a 4 year old. I also don't know if anything we did for her made a difference, or if she just "outgrew" the difficult phase. I just know it was really difficult.

Personally, I'd consider any dx given to a young child age under 8 to be provisional and think of it as a mean to get services paid by insurance.

My DD4 shares some of the traits too:

1. Explosive tantrums (though it is infrequent but when it happens, omg)
2. Inability to share with her parents, need to control play almost with everyone
4. Sensory issues with just about everything under age 3; limited to clothes and loud sound at the moment
5. Early reader although she can comprehend what she reads or else she won't read it
7. As she declared a few days ago, "I'm NEVER going to be flexible."
9. "I get to talk FIRST."
11. She used to line everything up and made patterns after patterns at age 2. She no longer does this.

Whenever I list these things down, I feel like I sounds like a mom who is in denial that her child is on the spectrum but honestly, anyone who spends a minute with her would know she is not autistic. I'm not sure if she has ADHD. It runs in my family but so far, although she can be impulsive, she is functioning well within school setting. I'd have to keep an eye out as she gets older and the demand for organizational skills increases.

OP, my DD had extreme sleep problems and everyone thought it was our fault for letting her stay up that late. I eventually stopped trying to explain why we can't have morning playdates or why I look so tired. I don't think most people can relate to what it is like to parent a child with "special" needs.

I'll also chime in and say that I have a child who was a very difficult toddler and preschooler who had some ASD traits. She was informally assessed twice for ASD during other assessments (gross motor delay and auditory processing disorder--she was not sufficiently dleayed for services in gross motor and we apparently were way off with APD suspicions) and both times the professionals said no way. But she is/was rigid, with meltdowns and sensory issues. Slow to play with other children and preferred older kids or adults as a toddler and preschooler. She never had perseverative interests of any kind, though. She too was extremely verbal very young.

Her social skills have improved gradually over the years and she is now a popular 5th grader who functions extremely well in a demanding school...however, she struggles with anxiety, anger issues, and depression.

I think that there are two camps of people: one that says you have ASD if you have ASD traits and one that says that you don't if you don't quite fit every characteristic because you are also gifted. Regardless of which position you take, please don't assume that your child will grow out of his or her issues. If he/she has issues that are affecting you or other people in your family, you need to find a way to improve the situation. Even if you don't accept an ASD diagnosis, find the resources that are available for ASD kids in your area. If your child needs help with social skills, find a social skills group. Your kid can be popular (mine is) even when there are underlying issues.

Totally agree. Addressing problems, giving the child strategies for managing their deal, is very helpful for the short and the long run.

I think this oversimplifies the situation a bit. Many people on this board have had professionals tell them their child has some ASD traits but is not ASD. I have some ASD traits (I have SPD) but I am very confident that I do not have ASD.

I definitely agree that it is unwise to assume any child will grow out of any issue and that issues in the family should be addressed. But I do think it is important to understand that diagnosing ASD and ADD can be difficult with some children. I don't know if the OP's child is in this category or not.

In some cases, a focus on finding a diagnosis for a gray-area child could be counterproductive. I have already spent money and time having my child assessed and finding nothing. I am weary of it and at this point I do not want to spend more money finding nothing because she is savvy and compensates well in a testing environment.

And I think, Ultra, that you've done a lot of strategic thinking about the issues that *are* clearly there, and ways to help her learn and grow and manage them. That seems like the most important thing.

(DH and I are probably each 1/2 to 3/4 of a case of ASD. Not diagnosable, but part of the "broader autism phenotype." I get it.)

A diagnosis is a tool-- as is a therapeutic strategy, a curriculum, and so on. The diagnostic tools we have are so imperfect, and yes, they don't always fit that well. Sometimes you just have to keep teaching skills, treating issues as you find them, and see what emerges.

What I don't consider a good approach is excusing behavior that's disruptive or disordered or distressing on the grounds that the child is gifted. We've BTDT, and it set us back for the long term. I'd rather see the challenges addressed than excused.

I agree. In our case, we never "excused" anything. I read lots of books, and used a lot of 'strategies'. She received an IEP (based on ADHD diagnosis) and support and services at school. A lot of people have worked really hard (especially me!) to help her; it's just impossible to know what would have happened otherwise.

There are two things that we chose not do:
1. Pay out of pocket for any assessments or services.
2. Put her on any medications.

I'm not saying that these are bad; I know that many people have gotten good results from private consultations and/or medication. I'm only sharing my personal experience.

Another vote for the functional approach, all the way. Being HG+ means you are not neurotypical, period, but the ways you are atypical may sometimes add up to an ASD diagnosis and sometimes not. (There is also the theory that there are gifted/ADHD/ASD traits which are all part of some much broader autistic spectrum than is currently believed, you may want to check out "bright not broken".)
Personally, it him it is the theory of mind-blindness that should be the ultimate test, not a collection of traits, and I do not think that parents should be forced to push for a premature, possibly inaccurate diagnosis simply to get their children services that schools or insurance might otherwise be unwilling to provide even though the functional impairment is clearly there.
However, I think kitkat24 has written an excellent post that shows how sometimes it is really the degree to which traits are present and impair functioning should drive the diagnostic/therapeutic process. It's not black and white - from her pits, I can gauge exactly in retrospect why in the event, even though almost all of those traits were there in DS case, they were not there "enough", kWIM? For instance, I remember thinking o my god when he sat down in front of the washer,staring at the spin cycle. But he did that exactly once, and so it did not count as a red flag in the end

I definitely agree with this, of course.

I don't think of DD's challenges as related to giftedness at this point. The main problems now are managing everyday emotions--not gifted-related. Now, she is emotionally intense in a typically gifted way--upset by things like war, death, etc-- but I actually separate that from her overreactivity to everyday issues. It lends clarity that DS is also emotionally intense in that way but NOT overreactive to normal life issues. I can see the difference now.

That makes a lot of sense, given my family history and SO's. No one has gotten diagnosed with ASD but no one is really all that NT either. I see this outside my family too. I am working with a boy who is crazy advanced visually (he is 5 but functioning more like an advanced 8 year old - he is fascinating) but his older sib has ADHD.


In US, theoretically, it should be possible for schools to provide services based on functional needs but in practice, at least in my experiences, things don't move quickly unless there is a diagnosis. If I thought my DD needed services, I would rather go through our insurance so we can choose providers.

Years ago when I was trying to decide if I wanted to allow the school to test my DD for LD's this was what went through my mind. For 1st & 2nd grade the school was correctly providing extra help to ANY kid that was slow to learn to read. But budgets were getting cut and I was worried that the money would dry up to help her if I didn't get formal documentation. In addition the extra aids the school hired to just help everyone struggling were only around for the lower elementary. Knowing I could get her the help she needed ended up trumping my worry about labeling my daughter when it seemed premature. Glad I did get her tested and she needed help into H.S.

I agree it shouldn't be used to excuse behavior. But it can be used to UNDERSTAND said behavior and know how best to react to it. I had people who told me the best thing to do with my son who was having anxiety attacks, was to just be more 'strict' and if I just punished my child more he would behave better. In the long run, helping him learn how to deal with his anxiety helped the behavior better. (My son was melting down and screaming in the middle of class in a gifted 6th grade classroom.) Getting him help, putting in practices in the classroom such as a quite place he could go to calm down helped, and a teacher who could recognize the situation before it got bad. And I'm glad that although I had other issues with DS's elementary school & principal they were willing to understand this difference.

I just caught up on this thread and saw some additional comments. I just wanted to clarify a few things. Autism is not a disease. There are symptoms, but they are mostly a loosely connected laundry list of associated behaviors, and not used as diagnostic criteria. They have been assembled to help parents, teachers and other non-experts identify children to facilitate diagnosis. Diagnostic criteria include several hallmarks of the disorder, such as: lack of empathy, lack of theory of mind, limited or no eye to eye gaze during conversation, flat affect, limited or lack of social emotional reciprocity, inability to sustain conversation, use of stereotyped language, echolalia or repetitive language, restricted patterns of interest, adherence to routines and rituals, repetitive motor mannerisms, and impairments to social skills, communication, or imaginative play prior to 3 years old. Not all autistic children have the same behaviors/symptoms. However, for a diagnosis of autism, the child would need to have a majority of these symptoms to some degree.

No parent can accurately identify these traits in their child. It takes years of experience. This is why pediatricians and schools should not be performing diagnostic testing for autism. It takes a trained eye to discern "quirky" from disordered. A PG child can have some neuroatypical symptoms, but not have met any diagnostic criteria for autism. Neuroatypical does not equal autism! Further, you absolutely can diagnose a child with autism before the age of 8 with a high degree of accuracy. Waiting to get a diagnosis for your child until they are “older” will just make improving some of the more rigid behaviors associated with autism more difficult. I cannot stress this enough. Children with autism do not outgrow it. You can with time, reduce dysfunctional behaviors with therapy, but they will always be there to some degree.

I agree with what others have said that you shouldn’t excuse behavior that is abnormal in a gifted child and dismiss it as “gifted” behavior. DD10’s gifted teacher filled out all her diagnostic questionnaires in the normal range. Everyone else that completed diagnostic paperwork put her firmly in the autistic camp. Trust me, you don’t want someone like this involved in the diagnostic process for your child. I actually had my daughter’s 4th grade teacher try to dismiss some of DD10’s autistic behaviors as “hormonal changes” (a.k.a PMS) in her IEP meeting. I have never wanted to strangle anyone as much as I did that woman in that moment. People’s ability to marginalize or hand wave autism symptoms away can be ridiculous at times.

I think this was in response to my earlier comment so I wanted to make a clarification. With my earlier comment, I meant to address the OP's case specifically but re-reading it now, I can see that I didn't make myself clear at all.

I have not met the OP's DS so of course, it is a pure speculation on my part but he seems to have a cluster of symptoms that overlap across several developmental disorders. On top of it, he is only 4. I'd like to believe that with enough interventions, support, and time, he would be doing much better by the time he is 8.

That is all what I meant by it and I definitely did not mean to imply that I want parents to withhold treatments from their children.

I agree completely.
And same here, during this past year, we have been through all of the assessment as far as ASD and SPD. Our DS is 4 in two months so the doctors felt that ADHD isn't something to look at yet. We have a regular child psychologist but our insurance doesn't allow them to do cognitive testing. Our local school district is doing that in a few weeks.

I really, really feel for you. I have days when all I want is an answer. All I want is some direction, some hope.

Oh yes. It has taken a lot of explaining to our families. I think what you said should be said to them. Your son can hear that and may internalize his family's words.

Basically, our son has been babysat for an hour maybe twice by grandparents. One of his grandfathers yelled at him at 2.5 and I told my husband that I no longer trusted him to take care of our son. So our son has completely supervised visits with family. I have told everyone that he has extreme anxiety and that he is not having a "tantrum" he is having a "meltdown". Our families are coming around but I have cried to them many times to please understand. I know that they still have their judgements but they are trying. When he was a baby, my mom was convinced I was doing something to make him scream at every single diaper change of his entire infant life. Looking back, how ridiculous that any of us thought it was something we were doing. Clearly, this child is sensory sensitive. He hates new places, new people, new anything and so everytime someone visits, he struggles to control himself.
We do time outs for hitting, we have a lot of side talks with him if he needs support, we take him to his room for some quiet time and spend time with him reading if the visit is too much for him. I think my family hears me saying things like, "Pushing is not OK", "Please use a quiet voice", etc. So they do think I am doing "something" but I know on the ride home they say that we are too easy on him, that he behaves like that because....etc. My mom always tells me I should spank him. !!! Ya, so that's what I'm dealing with.

Yes. My son as a four year old presented as having all three, and he was very, very atypical and required constant management. He was a very happy kid but could melt down at the drop of a hat. He had massive sensory issues (mostly vestibular and proprioceptive seeking, but also oral, auditory and tactile). He was insatiably curious and way ahead of age peers in a few areas. He was HHHYYYYPPPPEEERRRR.... and SOOOOO IMPULSIVE. I could (LITERALLY) not take my eyes (or a hand) off of him in public or he'd flee in search of his latest adventure (he actually escaped from preschool once and caused a building lock down and search - they found him in the parking lot THANK HEAVENS)... I could go on and on (and on)...

Now he's ten and a completely different kid. He has an ADHD diagnoses and spectrum issues have been ruled out. He great now. Absolutely great. Again, I could go on and on about all the behavioral areas in which he's improved, but for the sake of brevity I won't. (Fyi, he's never been medicated - it's all been structure, consequences, diet, exercise, and good old fashioned growth and maturity).

Anyway, so yes... 4 is young, and some kids just need more time.