developmental pediatrician visit
My son had his developmental pediatrician visit today. No diagnosis. The doctor said while he has some autistic traits as well as adhd traits but he said there just isn't a clear diagnosis yet. He wants to see how he does with starting in developmental preschool when he turns 3 next month and follow up in June. We don't need a diagnosis for school services yet so it's more a wait and see approach as far as diagnosis but he will continue to get private speech and OT as well as school district preschool. The doctor also wants us to have his hearing checked again because our son's voice is very loud and he seems to be unable to regulate his volume. I think he can hear fine myself since he constantly complains sounds are too loud and covers his ears but I'll take him back to the ent. Not sure if our experience was typical as far as a developmental pediatrician visit but that's how it went.
What kind of assessment did the pediatrician do? Did they sit down with you and explain the results?
If not, I'd get a second opinion - I find a lack of information on the specifics to be an indicator that the doctor isn't, well, very good. The CDC has a page of the standard tests for autism and AS here: http://www.cdc.gov/ncbddd/autism/screening.html
If so, sometimes it takes some time for a delay to really show up and solidify. It can also be hard to figure out exactly what is going on with a very young child - and it sounds like your child is getting speech therapy, which is the critical piece in early intervention. I'd go along with the hearing test, because if there isn't a hearing problem, that would point towards a delay (volume regulation problems can be an indicator of a pragmatics issue - I lose the volume control sometimes.)
The good news is that he's in the right place - you have a doctor, you have therapists, you have a developmental preschool. Whether or not he gets an accurate diagnosis is not as important as whether or not he's getting services, particularly services to help him communicate.
He did not do any formal assessments with him. Just based everything off of the evaluation early intervention did in November and the files from his OT and SLP since they are part of the same hospital system. He's verbal and speaks well now after over a year of therapy and i feel like a large part of why this doctor did not want to assess him for autism is because he does speak. Our son's speech therapist does not seem to think he has autism either because he can talk and his echolalia has decreased and his meaning full speech has increased. She keeps saying him rambling on about his own subjects and not engaging with us is normal at 3 as his the repeating like a broken record which he does a lot. His child care provider mentions the repetitive speech as not normal.
The doctor right now is saying preschool is the best thing for our son because we need to see how he interacts with other children. He thinks they can stop his meltdowns over everything and his inflexibility to change. I'm sure preschool will be good for him overall but I feel like today a lot of my concerns today were ignored. I don't know where I would get a second opinion without waiting 3-6 months or more.
I wouldn't worry about the wait: at this point you have time and it looks like you are getting the interventions you would get with a diagnosis anyway. However, not feeling heard is important and you should try to find a professional that you can communicate with.
My son didint get a formal diagnosis till he was almost 6, and he had been in EI and a special ed pre school. I agree with PPs, as long as he is getting the services then the lable can come later.
At 3,4 and even 5 my son wasnt flagged or labled on teh spectrum at all, in fact most professionals brushed it off or thought he had anxiety. he got speech, OT and PT at pre school, and they thought he was just fine!
Hang in there, keep a close eye and if down the line you are still concerned, then you can get more evals, etc...
With kids who have Aspergers or are on the HF end of the spectrum, it is VERY hard to get an early diagnosis.
_________________
Dara, mom to my beautiful kids:
J- 8, diagnosed Aspergers and ADHD possible learning disability due to porcessing speed, born with a cleft lip and palate.
M- 5
M-, who would be 6 1/2, my forever angel baby
E- 1 year old!! !
We met with the school today. The school psychologist said essentially the same things as the developmental pediatrician: possible pragmatic language delay, possible autism spectrum (which he said he could not diagnose but he did say much of how our son behaves is in line with being on the autism spectrum) and significant social/emotional and adaptive behavior delays. The good thing is that his receptive and expressive language is now testing in the normal range after a year of private speech therapy and the school does not think he needs speech therapy at the moment but they are going to be keeping an eye on his pragmatic skills and see where he is after a few months of preschool. I don't know how long we will continue with private therapy for speech right now. We will see what his slp says and she may agree he does not need it. He really is speaking very well as far as basic language skills and testing at his age level. We will be continuing his private ot that he gets every other week for his sensory issues.
The school will be placing him in a preschool class with 10 children and 3 adults as they do not feel he can handle a more traditional preschool like head start or integrated preschool with both special needs and typical children. I agree with them that he probably can't. We took him to a early intervention play activity again today and he was one of 3 kids who could not handle group time out of a group of 25 special needs children. Also he treated the other children like they were invisible or inanimate objects. He mostly ignored the other children with his sole interest in them to be to attempt to take a toy or push them out of the way to get to something he wanted. He will say hi to adults but other children may as well be invisible to him.
The school will also be giving him OT and PT for gross motor delay although his fine motor skills are within normal range. His cognitive skills are within normal range which the school said was a big plus for him.
I think the critical thing with a very small child, when they talk about the importance of early intervention, is a basic ability to communicate. I'm not in any way trying to downplay your concerns (you sound like you have a very good handle on it and are getting outside feedback that you are correct,) but I wouldn't worry too much about the speech therapy. Most of the skills for higher-functioning people aren't "now or never" kinds of skills - case in point: I didn't learn many of them until college.
If your child is high-functioning, the speech issue won't really show up as a deficit until the other kids jump ahead in language development. I think what they are telling you is that it is worthwhile to wait until this happens so they can target interventions specifically to the deficits that are there (for instance, while my own son had a horrible and glaring pragmatic deficit, he had about half of the necessary skills - he scored a 52% on the test, but what that didn't tell you was that he scored nearly 100% on the skills he did have and nearly 0% on the skills he was missing. Therapy that wasn't general, but focused on the problems was very helpful.)
Since he's in a supportive environment and everyone is keeping an eye on symptoms and being aware of the issues, I think you are OK. Save your strength and your finances for the issues that have a serious negative impact on all of you. (Though I'd be curious what the speech therapist says.)
If your insurance covers it, or you are willing to continue paying for speech, I would ask the SLP if your DS is ready for therapy with a "paired peer" or a small (3-4 kids) social language group.
In a couple of years, you might want to have him evaluated with the ADOS just before the transition planning for kindergarten happens.
We talked to his speech therapist yesterday. She had done the same language assessment as the school over the last few weeks and had the same conclusion that he does not really need speech therapy right now. I agree with her. He really speaks well now.
Being in preschool I think will be the best thing for him to develop social language since he will be with other children.
I'm over all happy with his language skills right now. The school will address his social, emotional and adaptive skill delays as well as his gross motor delays. I hadn't realized he was behind on gross motor skills until the school did their assessment but he does run a little differently then you would expect.
I'm happy the public school district here has been fairly easy to work with and will be providing what he needs
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