Autism or something different?

If we are to ensure that children get the correct diagnosis and the most appropriate support, all practitioners need to get out an ‘attachment lens’ and use it to look at the child’s development.


Billy is three-years-old. He struggles to give eye contact, he does not initiate interaction and seems unaware of his peers around him. He has limited play skills and chooses the same limited range of resources; he likes to follow his own agenda and gets distressed when unable to; he shows a need to have things done in a certain way, and he has limited speech and language. He can show extreme behaviours.

Billy has recently been diagnosed as having an autism spectrum disorder.

Carter is also three-years-old. He will fleetingly give eye contact. He does not seek out interaction with others and pursues his own interests. He chooses to go to the same area in the setting and does not explore beyond it. His play is simplistic and repetitive. He loves vehicles and often carries a car around with him. He can show extreme behaviours and has limited speech and language skills.

Carter is currently undergoing assessment – he could also be diagnosed as having an autism spectrum disorder. Such diagnoses are being given at younger and younger ages, and often without a holistic understanding of the child’s development.

Early diagnosis is absolutely key to ensuring children have their needs fully understood and met as soon as possible. But, is it an autistic spectrum disorder or could it be something else?

Do we think about and consider the child’s early history? Have they experienced relational losses, early trauma, lived with prolonged stress, or have they experienced any of the risk factors, which makes them vulnerable for a poor attachment?

Children who have poor attachment histories can regularly present with the same types of behaviours and characteristics as a child with an autistic spectrum disorder. However, the driver for these behaviours begins in a very different place and, therefore, needs very different support and interventions.

Carter has experienced the separation of his parents following persistent domestic violence. His mother continues to suffer from mental health difficulties as a result. She was forced to move to a different house and stop working. Finances have proved very tricky and they have been supported by Sure Start and food banks.

Carter is likely to be diagnosed with an attachment disorder due to his adverse childhood experiences (ACEs), plus having other risk factors, such as ongoing poverty, which put him at further risk of his relational needs not being adequately met. Adverse childhood experiences include physical, sexual and emotional abuse, neglect, domestic violence, substance misuse, mental illness, parental separation/divorce, and crime and imprisonment.

Children in various states of America are now routinely ACE-scored and preventative measures are put in place if a child has an adverse childhood experience score of four or more.

If we are to ensure that children get the correct diagnosis and, therefore, the most appropriate support, all early years practitioners and colleagues in associated professions need to get out an ‘attachment lens’ and look at the child’s development through it.

Children absolutely need their difficulties to be identified at the earliest stage, but if the child is given one diagnosis without a full history being explored it could be that they are being denied interventions that would benefit their development.

Let us challenge each other in the early years arena to ensure we look at the child’s earliest starting points. This may mean looking as far back as minus nine months and the early postnatal period to see what was happening.

We all need to develop our attachment awareness and to be emotionally literate to ensure children’s needs are accurately assessed, identified and supported. eye

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