Expert: Trey McGowan - 4/2/2008

Question
Hi- I am really struggling to know what to do.  I have had suspician for a long time that my son is very high functioning asbergers.  However, I have had him evaluated twice with a developmental pediatrician who said he does not meet criteria but may have some characteristics.  My son just turned 4.  An ABA in home therapist came to our house and told me she sees no red flags.  I have had him to speech and occupational therapy and again they say he does not need to be there.  I now have him seeing a play therapist.  I am so confused on what the best thing is;  First of all my son typically performs rather normal when someone is there to assess him.  The ABA asked to see his room and he ran in and also said here is my toy box to.  
I see many different things in him sometimes they are more pronounced than others.  He is in pre-school and not doing bad- not fantastic but not bad at all.  He has some friends at preschool one in particular.  Here are the things that I see and can't get any help for.
1.  Play- I don't see him playing with the million toys that he has.  He will play at times with me.  However, it is a rare occasion that he will sit down and play by himself.  He would rather run around the house.  When playing with other kids he would much rather play chase and wants to constantly and repeatedly say things that he and the other kids find funny.  ALthough they say the same things as well.  My son does not seem to know when to quit and at times that seems to be all he is saying.
I would like to help him sit down and play.  I try to play with him as much as possible and sometimes it is very easy and we interact in play.  Other times he is difficult to move into more complex play.
2.  He speaks well.  However, he is constantly asking why questions and typically to the ones that I have already answered.  I ask him why he wants me to tell him again and he says it's fun.  He gets upset when I tell him you already know the answer.  He keeps saying tell me.
3.  He has some tantrums that are much worse than most kids his age.  He will scream so loudly that it hurts your ears.  And he does not quit when you tell him to.  I have started to put him in time out for it and tell him he can get out when he is done screaming.  I also leave a place if he starts it.  This had definately helped.  However, it is not over yet.
4. He has trouble going to bed and sometimes screams then. He just keeps telling me he needs me.  And lately has been very interested in being a baby.  He says mama like a baby and then asked why do babies talk like that.  
5.  I guess my other concern is he does not know when to stop when you tell him.  He does not listen it is like pulling teeth.  
6.  He is sometimes all over the place particularly when he is tired.  He falls all over.  Its more annoying I think than anything thing else yet falls outside of what I have seen other kids doing.  He sometimes flops around when you try to grab his arm to get him to stop doing something.

So, I know this is very long.  My questions are how do I help him want to play with toys more.  And play toys with other kids.  He will sometimes, he even asked his friend if he wanted to build a train track and when his friend ignored him that was the end of that...
How can help him from a disciplinary stand point.  I feel like other parents look at me like I am not a very good disciplinarian but I feel that he can't always control what he does.  How can I be more effective that way.
How can I get him to follow directions without telling him 50 times?
Should I continue to push for resources?
Your answers will be really helpful.
Thanks
Diane

Answer
Hi there, Diane!

The letter is very long, and the questions at the end had very little to do with the amount of detail that has been given. I understand that you are looking for ways to help your son, but at the same time, you seem to be forgetting one important thing: children are as children are. You are worried about your son not interacting 'like all the other children', but to be quite honest, there is very little 'all the other children'. Particularly at his young age. While there might be some characteristics (as your doctor has said), one characteristic does not autism make.

I suppose what I am trying to say is that the best way to answer #1 is to help him play with toys more... by finding the toys and games he likes. Rather than trying to tell him how to play, let *him* tell *you* how he plays. See what sort of games and such he enjoys playing with. And if he doesn't like playing with the million toys he has, then maybe the best thing you can do is to start helping thin down that million toys a bit, and find the two or three he *does* like. The same with playing with the other kids. If he enjoys building train tracks, then find another child who enjoys the same. Unfortunately, at that age, you can't much force a child into playing something they don't enjoy. Besides, part of the point of playing is... to have fun.

With discipline, the biggest thing to find out is what works on him. If he doesn't know when to stop, then it is up to you, the parent, to tell him when it is time to stop. And if he doesn't listen, then it is up to you to tell him it is not appropriate. At his age, you will need to be consistent: letting him know what is right and wrong will likely come down to 'It is wrong until I directly say otherwise', rather than 'It is wrong except in this and this and this case'. Little minds can sometimes miss small details, like 'why it's appropriate now and not before'. So by giving him a solid 'no', you can avoid this issue. At least until he has matured enough to be able to understand a little more of the small details about why it's not.

As for pushing for resources, I can't tell you that, unfortunately. It may help you with education, but I am not a doctor. I can't give you a diagnosis of any sort, particularly not just from hearing from one letter. Reading over it, though, it sounds like he has a severe case of 'four-year-old syndrome'. There may be something on top of it, but everything you have told me sounds like a healthy four year old with some disciplinary issues. See if the discipline and instruction of him helps curb some of this. If not, then I would say you may want to consider looking further into things.

As for the 'why' questions? That's normal. Very. Very. Normal. :) All children at that age want to know 'why'. It is, after all, how they learn about the world around them.

Wish I could give you more info on this one, but after deliberating for a few days on just what I *could* say, this seemed the best way to do it. As always, follow-ups, questions, comments, et cetera, are welcome. Good luck with your formidable 'fours'!

Trey