Expert: Dr. Sharon A. Mitchell - 1/25/2009

Question
Hi Sharon, my son has severe difficulties with social interaction.  He doesn't interact with his peers (though he does with his sister)and he shows quite extreme anxiety in social situations oftern retreating to the corner and covering his face. However, he has no communication problems, nor problems with play and imagination.  His imaginative play is original not copied recited.  It is also hugely varied.  He also has empathy and shows concern for his sisters.  He has no sensory issues nor rituals nor does he have a special interest.  Nor does he have any dyspraxic tendencies.  But his social problems are severe and he has said he would rather there was just him and his teacher in nursery. I'm intersted to know whether he can have a mild form of AS if he only displays problems in one area.  BTW, he pointed at 10mths and has always had excellent joint attention at home (showing and sharing).  He passed the CHAT test at 17mths with flying colours.  I'm far more concerned with strategies to help him that a diagnosis. Thanks in advance.

Answer
Hi Carrie,

Although it's impossible to determine without meeting a child, from what you describe, no I don't think he has a form of autism.

It's obvious that you have done quite a bit of reading in this area as you already know the symptoms diagnosticians look for when wondering about an autism spectrum disorder. For each of the main symptoms, you say that he does not display those characteristics. I can see how he'd pass the CHAT quite well.

You're quite right to focus on strategies. The label does not matter nearly as much as finding out what to do to make your child more comfortable in situations outside your home, with other children.

There are lots of things you can do to help. In fact, you may already be doing some of them instinctively.

Do you feel that being extremely shy is at the heart of your son's difficulties? If so, you may find some useful suggestions at this site: http://socialanxietydisorder.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=soc...

If  it goes beyond what you feel is just shyness and you enjoy doing internet research, try using the words social anxiety in your search. Some of the sites you'll find will pertain mainly to adults but social anxiety disorder is also seen in children as young as preschoolers.

Such kids may cling to their parents, not want to be separated from family, freeze up, avoid interactions with other kids, be especially shy or even cry, whine or tantrum when in new situations. Children with social anxieties are afraid of doing the wrong thing. They are unsure in unfamiliar circumstances.

Small children often don't say what is bothering them. You're lucky that your son has given a clue when he told you he'd would prefer that there was just he and his teacher in nursery school.

It's also a positive sign that he does not mind being with his teacher, who likely was a stranger not that long ago.

There is a resource that I like. It's free and a good starting point, with practical suggestions that readily fit into a family's life. You can take a look by going to Anxiety BC at http://socialanxietydisorder.about.com/gi/dynamic/offsite.htm?zi=1/XJ/Ya&sdn=soc...

Here you'll find information on things like:

- explaining to your child about feeling anxious or worried
- teaching him how to make friends and interact with other children in a gradual, supervised way
- teach him strategies that will help him to relax when feeling stressed
- help him to face his fears with strategies to handle them

Have you discussed your concerns with your son's nursery teacher? She may have been through this with other children and could be a wonderful ally in helping your son. Also, the school may have other resources such as a psychologist or Speech-Language Therapist. Although your boy may speak well, Speech-Language Therapists don't just deal with how children pronounce words but with all aspects of communication, including social skills.

If there is no Speech-Language Therapist attached to your child's nursery school, you can search for one near you by going to this website: http://www.asha.org/proserv/

Your pediatrician and public health nurse are other good people to talk with about your concerns for your boy. They may know of other resources in your area that could be helpful.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca