. . .I'd say that you should gently push your friend toward getting the child evaluated.

The kid may be autistic or may not be, and if the LW isn't actually a mental health professional, I wouldn't advise mentioning "autism" again. But the LW could point out that, at some level, the child seems to be suffering, and that learning more about what may be causing the child to suffer is in that child's best interest.

FWIW, I would tend to agree that "Susan" may be in denial about this, particularly since she worked with autistic kids in the past and may not want to face the possibility parenting one herself. The thing is, the kid's behavior might be caused by any number of things: Physical pain, allergies,auditory issues, etc, which could be easily treated. We don't know, and Susan won't know, until the child has been evaluated by professionals.

If Sam is autistic, he will benefit from having parents, teachers, neighbors, friends, and relatives who are aware of his condition and know how to interact appropriately with him. If the people around him have no clue about his situation, that which is hurting him now will continue to do so, and likely worsen his condition.

As Cary notes, there might well be a risk to the friendship of the LW pursues this issue. My feeling (and I haven't always lived up to this ideal myself) is that we need to value our friends above our friendships. Yes, the LW may lose a friend, but she can also sleep easy knowing that she did the best she could to help a friend and protect that friend's child from further damage.

I wish this LW well.

Hey Cary thanks for letting us know that you are healing and able to be off pain meds currently.

Good luck to the LW also! I hope it works out OK.

You know what? Sometimes I wonder how many problems could be solved by just spitting it out. (I include myself in this wondering; the LW is surely not the only one.)

Often when I read/listen to a problem, the person has already articulated the solution. For instance, why not just say exactly what you said here:

I'm not sure what else I can say to [you... You are] a kind, attentive, conscientious mom who clearly adores [your] son. So here's my question: Do I simply butt out and hope, for Sam's sake, that [you] eventually [take the kid to a doctor?] Or do I force the issue, [risk] pissing [you] off and [risk] losing this friendship? Or something else I haven't thought of. [What, Susan, do you think I should do here?]

It's kind and to-the-point. I mean, just share your conundrum with her. Approach as an equal friend, sharing, not as someone who has an answer that she'd better get through her head.

So, this woman's your friend and she's mentioned to you before that some people may think her son has autism. This means, despite her denials, that she's given it some thought--if someone says something to you that you know is crazy, it doesn't even eat at you because you know it's so off-base. It's only those things which may have a grain of truth that eat at you.

That's your in. I'd say to her, "Susan, you've told me a few times that people have mentioned to you that Sam may have autism. He's really smart, but I have noticed some things about him that strike me as unusual. You know, just to be safe, why don't you call the school system and have them evaluate him to put both our minds at ease?"

For what it's worth, calling the school system is her best bet for getting quick services. If he's over three, he's out of the reach of Early Intervention, so they're the next people in line. In my area, the wait time to see an expert who can officially diagnose your kid with autism ranges from six months (for kids under three) to a year (for kids over three). This is CRIMINAL, particularly when you think about the value of getting therapy early. Plus, after that, we have therapy waiting lists that range from 6 months to two years. And to get on these lists, you have to have your official diagnosis and be approved for Katie Beckett, which is an medical assistance for kids with severe disabilities so they can be cared for at home rather than in hospitals or institutions, and getting Katie Beckett takes time as well.

For what it's worth, autism is the diagnosis du jour, an it may well be that this kid has a global developmental delay and not "autism". The thing about the alphabet did catch my attention, as my autistic kid knew the alphabet at 18 months, but many conditions look the same and I question the value of the "autistic" label as well, since it's merely descriptive. I DO know that the thought of everyone in the play group sitting around and saying "There's something wrong with this kid" is very sad. Maybe that should stop, if it's not leading to help for him. I can also tell you--and you may come to know this on your own some day--that being a mother with a child who is different is really, really hard. So don't be surprised, if he is diagnosed with a disability, if she doesn't want to be your friend any more or friends with all of you whose big problems with your kids are "did soandso eat his oatmeal?" rather than, "Will my child be able to go to regular school? Have friends? Live on his own?"

I'd advise you to push the issue. Your friendship with the mom is not nearly as important as the welfare of the kid, and I think you know that. Autism is a time sensitive disorder, and by ignoring it she's doing him serious harm. If he doesn't have autism, whatever else is going on with him still needs to be treated.

Ideally, you will find a way to push it that will avoid alienting her, thus increasing the chance that the kid gets the treatment he needs.

Can you enlist other mothers in the playgroup to help you make your case?