assessments for child, generating some ideas

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school is fast approaching and one of our goals this september is to have some assessments done for our oldest son who turns 14 at the end of this month. we really have no idea what exactly is going on with him, but we know something is going on and we are trying to narrow down the possibilities. we tried to arrange for some diagnostic assessments at the same psych clinic that diagnosed our youngest child, but the psych we did the intake with only wanted to do therapy sessions and not assessments, so it got us no where. his school has agreed to do the assessments when he returns in 3 weeks.

i was hoping some of you familiar with asd, adhd, nvld, sid, etc might have some ideas for what could be affecting him, even if slight possibilities, so we know things to try to rule out at the least. his youngest brother is diagnosed asd but they have different fathers, and his brothers father is asd. he does share a remarkable number of atypical traits with his asd brother.

this is really long, and i thank any of you willing to read the entire thing and give any input you may have =)

background info:
sensory issues: as a baby, couldnt sit on cut grass even on a thick blanket, would simply cry and try not to touch the ground. as a toddler, couldnt play in sandbox because as soon as he got sand on his hands he got upset and would come to me to get them wiped off. gets very irritated with the "noise" his younger brothers create. is a little sensitive to clothing tags and general feel of clothing.

impulse issues: has verbal outbursts on a regular basis. when startled even slightly he will scream or yell. when playing games he cant keep from verbal outbursts.

inability to accept responsibility for his actions: we struggled with this for years, and still do. he will refuse to accept blame for his own failings, instead blaming them on his teacher or us.

executive dysfunction: completely unorganized, even when given organizational structure he cannot remain organized. things like cleaning his room take him hours and hours, in a tiny room that isnt really that messy. forgets things he needs regularly (pens for class, calculator for math, script for play rehearsal, etc)

possible auditory processing difficulties: doesnt seem to process information correctly. when asked to retrive x from y location, he will go to and ask from z location where you said it was. this has been consistent his entire life.

social issues: wants very much to be social but has difficulty making friends. talks very loudly, all the time, and will adjust volume for a short time when prompted but reverts back to loud tone. will invade others' personal space and tends to want to "hang" on people. is self conscious (could primarily be due to being overweight), and is usually unwilling to enter new social situations. he is very immature and naive.

stims: over the past 3 years or so has been rocking, usually when involved in watching a tv program or other absorbing interest. has a habit of pulling his shirt up over his mouth, altho he doesnt chew on it.

food issues: has always been an extremely picky eater. has an intense gag reflex and will gag on anything he thinks he doesnt like. tends to eat soft, carby foods, and avoids meats and vegies. foods must fit a predetermined "look" to be right, ie he wont eat macaroni noodles with red sauce, only cheese sauce, or they "taste different". has only this past year willingly been trying new foods.

physical: has always been very clumsy even before he was overweight. he trips and falls a lot, is very uncoordinated, walks with an awkward gait, and cant really run. one of his legs turns out at the hip joint so he stands with his feet like | / instead of | |. he has seen an orthopedic surgeon, had xrays and mri done, and its considered just how his stance has developed and not medically a problem as it doesnt cause him pain. he is a very sedentary creature, preferring visually stimulating activities like tv or video games to physical activities.

oppositional: argues with us over everything. getting up, getting dressed, brushing his teeth, getting out the door for school, bring homework home, taking out the trash, going to bed, etc. has admitted in the past during an argument his primary goal was to prove his mother was wrong. extremely stubborn also, will argue until proven wrong, and continue to argue. will "cut off his nose to spite his face" on a daily basis. he will do anything to win an argument or feel he has won.

speech: acquired language a little bit late, but not significantly so. had severe speech issues, was completely unintelligible entering kindergarten, had speech therapy for 7 1/2 years before he was finished. still has to make an effort with certain sounds, and stumbles on some words and may have to repeat them a few times before he gets them correct. seems to have difficulty sounding words out and understanding the rules of the English language, and did horribly in Spanish this past year.

sibling relationships: he is a very loving big brother but is often controlling and tries to act as a parent rather than sibling. he doesnt seem to handle the chaotic nature of his brothers very well, getting visibly angry/annoyed at the noise they create and their level of activity.

school performance: he is very smart and this past year entered a new school for gifted students. at his previous school he was getting either straight As or As with a B+ or two mixed in. at his new school his performance on tests was good, almost always scoring As (except for Spanish which he maintained an F in all year except the final 2 months when they had a sub because the teacher left), but overall grades kept slipping throughout the year until he was getting Ds and Cs by spring. this is a result of not keeping track of assignments, losing his homework, and failing to turn things in. with a lot of work and us being watchdogs, he managed to pull all his grades up to mostly Bs and a couple Cs, enough to maintain his spot in school (they have to maintain Cs in all classes and C+ in their concentration class).

emotionally he had some issues at school this past year. he was "shutting down" in some of his classes, refusing to talk or do work and just sitting at his desk. sometimes one little thing going wrong, like forgetting to bring a pen for class, would trigger the shut down, other times there was no discernable cause. he had a few outbursts, once threw a book against the wall, and several incidences of bursting into tears in class. he has been unwilling or unable, not sure which, to give reasons for these behaviors. he has suffered some bullying and his school has been very proactive about trying to stop it, but he has been reluctant to tell them when it was happening again.

personality: despite his social issues, he is very much a ham. he has a great sense of humor and loves to make people laugh. while he is extremely self conscious, he loves to be on stage and has great presence and comedic timing. he cant remember things that are said to him, but has no problem memorizing multiple scripts at the same time for different plays.

discipline: we have yet to find anything that really works for him. consequences have never been a motivator. we have tried so many various things, spanking, grounding, 1-2-3 magic, taking away privileges, etc. when he enters a disagreement, his sole purpose is to come out the victor regardless of what he loses in the process. there is absolutely no reasoning with him when he gets his mind set. luckily he is overall a good kid, so there have never been any serious issues to arise like drugs or violence.

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ok thats all i can really think of. part of this is gathering memories and ideas for the coming assessments. we love him dearly but he has always been an extremely difficult kid to raise. we blamed ourselves for his behaviors for most of his life, until we had more kids and realized how different it was with his NT brother, and then how similar it was with his autistic brother.

i would appreciate any input anyone has, if you made it this far =)

I felt like I was reading about my 13 year old son. I am anxious to see any responses that will shed some light because I have not figured out how to get my son to do chores/homework/eat (he is now a vegetarian), take constructive critisism, etc etc. I found it interesting that your son would shut down in class, mine did that last year. He gets frustrated and cries when he is stressed, which doesn't take much. I have decided until I found out what is really going on, I am going to hold him accountable for his actions, and be firm and to the point with him. It seems to be working for now.

It's a good thing that the school is willing to do the assessment without dragging their feet. Are you in the US? If so, after the assessment is done, and the report is reviewed, you will presumably have an IEP meeting. When the issues concerning your son's behavior at school come up, like his shutting down, bursting into tears, forgetting to turn in his homework, you can request that an FBA (functional behavioral assessment) be done so that a BIP (positive Behavioral Intervention Plan) can be developed. Remember that the BIP should be positive supports - there should not be punitive interventions used in order to address the behavioral (or other) issues.

One thing to bear in mind is that schools do not always make diagnoses. They are concerned about figuring out what the problems are as they affect a child's access to education; sometimes that includes an actual diagnosis, but often it does not.

Oh! Oh! I have got just the thing for you.

If you haven't yet seen my recent post, I just finished my book.

It talks about things like figuring the source of the problems (i.e. shutting down) and also how to handle them. It also talks about effective 'discipline' techniques, and why your child seems to be 'oppositional and defiant'. It is a very good source of info, and I really think you should read it. Just click on the link below in my signature to get the book.

Btw, its a free book to download, I am not trying to sell you anything.

He sounds very much like an Aspie to me......or maybe PDD, or HFA. Hope all goes well with the assessment. Good luck!

We went to a psychologist for a year who initially said there was nothing wrong with my son, then later diagnosed him with Mood Disorder-NOS. Then a play therapist who was ineffective. Then a psychiatrist that agreed with the Mood Disorder NOS diagnosis and started him on medication (violence towards self and others). All these docs suspected Bipolar Disorder and one suspected OCD.

Then we had a 9 hour neuropsych testing. Here is a list of the tests they did:

Stanford Binet Intelligence Scale, 5th Edition
TEA-Ch
DKEFS
CMS
WRAVMA
WJ-III
NEPSY-II
DANVA
ADOS
CDI
RCMAS-2
BASC-2
M-PACI
CASQ
CMRS-P
SCQ
VAB, 2nd Edition
ADHD Rating Scale, IV
BASC-2
BRIEF-Parent

These test for almost anything that could be going on. His final diagnosis was PDD-NOS and Mood Disorder NOS. I fully agree with the results.

I strongly reccomend finding a child neuropsychologist and have the full testing done. These docs can find all kinds of hidden issues that psychiatrist, psychologists, peds, just can't see.

BTW - he has many of the symptoms my son had. For example, my son also started pulling his shirt over his mouth. He did this for months before he started chewing on it. I could go on and on....yes, there is something going on with your child that is different from other children.

I'm glad the school district is assisting. I agree with PP however - their interest usually isn't in diagnosing, at least that has not been our experience. For example, our daughter has an EI (emotionally impaired) diagnosis, due to the outbursts and a general lack of respect for rules that she sees as "stupid" and a lack of respect for authority (she does respect authority, it just has to be earned). She also qualified for some minor OT due to poor ball handing skills and difficulties with her writing grip (writing is generally legible, but it is frustrating for her at times). To date, the interventions that they have put together have not been effective.

I also recommend that you keep working towards a private assessment. Have you looked into using a neuropsychologist? Our insurance plan will only cover 2 hours towards the neuropsych testing, but, we are moving forward with it and paying out of pocket - which is likely to run around 2500. However, it's really the only way that we will be able to get a good picture with regards to what is going on with our daughter. My understanding is that it will point out any non-obvious learning disorders (I suspect that she has a non-verbal learning disorder - the last IQ test that she had at age 4 showed a HUGE disparity between her verbal IQ (139) and visual spatial IQ (110) - the neuropsych who did the testing also pointed out that the lower VS scores were due to "impulsivity" and to watch/be aware of ADHD, which DD was later diagnosed with.

We are also moving forward with an OT assessment - primarily to get a better picture with respect to sensory processing issues - our school district has not been very pro-active with therapy/suggestions on how to best handle some of the issues DD has been experiencing.

Good luck!