does child i care for have aspergers, and how to tell the parents

[supafreak]

I have a child in my care in my care that i'm very conderned for.  He is almost 4 years old, and I'v never heard him have a back and forth conversation with anyone.  When he does talk, he can use big words for his age, but seems to ramble on, not making any sense, with only one or two words being revelent to what he is trying to say.  He says a lot of "well you see" or "it seems as"  He has difficulity making eye contact, perfers to play alone, and dosn't seem to understand or be bothered when he is left out of play by the other children.  The other children are starting to notice his differences, and are starting to make fun of him, but he doesn't get bothered by this.  His eating habits are awful.  He  only eats a limited number of foods, and he continues to shove every bit of it in his mouth until it is gone and his entire face is covered in food.  I have babies in my care that eat more gracefully.  When he is excited he will flap his hands, twist his wrists.  He is always singing, repeating things he heard.  Always in a high pitch with unusual tone and influx.  He seems to have no common sense.  He has dropped his pants in the middle of my patio and urinated in front of everyone, as well as on the soccer field in the middle of a game!  He also drools nonstop, and spits all over you when he talks.  I'm seeing many red flags, but his parents don't think anything is unusual, and think he is a little eccentric.  I'm not sure if i should say anything to them, and i know if i say anything it will have to be black and white, because i'v already tried to imply things many times, but to no avail.  

[William L Holcomb, Ph.D., BCBA]

The variability of behavior and development in children usually means these problems are not “black or white.”  I think the examples of the child’s various behaviors you list are cause for concern and I understand that you feel a responsibility to communicate your concerns to the child’s parents.  I think your question boils down to how to do this in a way that won’t alienate the parents, but will move them to have their child evaluated by the appropriate clinicians.  First remember that you may be the first person to bring these kinds of concerns to the attention of the parents.  (What I said above about the variability of behavior and development in children can also be applied to the experience and approachability of parents.)  It’s not an easy thing for anyone to present information to parents regarding a concern about a child’s development.  I can tell you that I have found patience, understanding, and frankness coupled with sensitivity to be important.  Here are a couple of suggestions of how you might go about speaking with the child’s parents.  
You might want to start a conversation in a relatively neutral way.  For example, asking if the child has been seen for his regular well-child physical by his pediatrician?  Or, since he is four-years-old, has he been to his local school for kindergarten screening?  If the answer to either is no, then you might want to suggest that they schedule this (and, if you are in a position to help with this, actually assist the parents in getting this going).  If they have done either or both, that opens up a door for you to ask, in as non-threatening way as possible, what were the results? Hopefully this will allow you to add your opinion about your concerns.  You can even volunteer to talk to the doctor or school district if the parents would like you to.  
If some variation of the above suggestions doesn’t work, then you may also have the option of presenting your concerns in a written form.  If you are in a center-based preschool, do you have a system for sending home progress notes or home-log notes on children?  You might want to ask about any assessments that the child has had, or write some of your concerns that you suggest the parents might want to discuss with a child development professional.  (One note of caution here; extra care is called for with written comments.  Since you are not there to gauge the parents’ reaction to the information, it may come across to them as being more severe than you intend it to be.)  Again, instead of listing out the specific behaviors of the child you might want to invite the parents in for a meeting.  If you know of an appropriate professional to refer them to, you may want to do that as well.  
Finally, caring for a child that behaves in the ways that you describe can be frustrating, especially if the feedback you receive for the parents doesn’t match up with what you see as obvious.  Make sure you have the supports you need to remain effective and professional.  It sounds to me like that child would benefit for at least a visit to a professional who specializes child development.  

[Sally44]

I presume you are a nursery care provider?  Aren't there usually procedures that educational settings should follow?  I think before you speak to the parents you should find out what the referral procedures are and maybe speak to some of the professionals eg. Speech and Language Therapist, Educational Psychologist etc about how to go about informing the parents of your concern.  In the UK the Health Visitor is usually still involved pre-school.  Once you have found out what the procedures are it might be worth arranging a meeting with the parents and another professional to talk about your concerns.  Ask them if they have any concerns about him.  There is always the possibility that one of the parents may also be Aspergers, or may have some autistic traits.  I know that my family has alot of autistic traits and therefore it was hard to see what was different with my son.  In the end it was the degree it affected him that brought him within the criteria for a diagnosis.  But I can still attribute alot of his behaviours to family members!
Try to explain to them that their child may find it harder at full time school and that it would be better to find out now and get the supports needed in place before he starts school, rather than leave it until the school calls them or their son starts to get really upset.  
It maybe that he doesn't have Aspergers, although I agree that alot of what he is doing is familiar, but the fact is it is your job as the professional to raise your concerns with the parents.  
Try to understand that this will be devastating for the parents to hear.  Afterall it is a lifelong condition that will affect all aspects of the childs life.  Getting a diagnosis is not the end of the world, but it does feel like that at the beginning.  Try to get across that you are trying to do what is best for the child and are giving your recommendations to the parents.  Try to empathise with them.  Don't take it personally if they get really upset or angry.  When I was first told that my son was probably on the autistic spectrum, I felt as if a policeman had just told me that my son was dead.  All my hopes, dreams, expectations were suddenly torn away.  I was absolutely devastated and cried and grieved for a long time.  I know that's going to scare you a little to be the messenger.  But you are the first person to notice possible problems, and in future years, they may thank you for it.  Or if they don't, maybe the second or third person to say the same thing will finally sink in that there is a problem.
Tell them your concerns.  Ask them if they are happy for you to refer your son to other professionals for them to assess him, and take it from there.
No easy answers I'm afraid.  

[Shonna1234]

I understand your concern, but to say the child acts if he does not have common sense is not warrented.  If I were the parents I would not want you with my child.

[888mom]

You could bring the urination thing up to the parents.  That seems a little non-hygenic.  I guess he really has to go and doesn't understand he needs to tell you he has to go to the bathroom?  (One of my friends is dealing with their child going in the bushes and on public fire hyrdrants since he's immitating the newly acquired family dog... so I have heard stories about that type of issue.)  

If you think the parents don't want to hear the word autism, you could recommend they take him to a developmental pediatrician to have some of his behaviors assessed.  My daughter's developmental pediatrican, who we waited 5 months to have our first visit with last winter, has offered us very helpful advice on how to deal with certain behavioral issues related to PDD (autistic spectrum) and also the diagnosis of PDD.  There are also other things the child might have if not autism, but that's  for the  specialist doctor to figure out.  But you could list the behaviors and communication issues the child has, and  recommend they take the child to either a developmental pediatrician, a child psychiatrist, or even have the child assessed through the public school system (if you live in the U.S.).  If he is quite verbal, he may qualify on other behavioral issues like adaptive skills (self feeding and I guess  not going pee in public) and social communication skills (how he interacts with others).  Personally I'd recommend both the specialist doctor or psychiatrist and the school system, but sometimes the parents can't afford seeing the doctor if their insurance doesn't cover it, and the school system assessment would be free.  I think it is... I guess I will find out for certain on that one very very soon.  

I guess stress to the parents that there are lots of opportunities for the child  to learn  to  overcome his "eccentricities" either through therapy or child counseling and that a preschool or daycare is not trained to provide those types of services.