Psych Eval Worth it for a 4.5 year old?

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I just found out how much my son's psych eval is going to cost, and we aren't sure if insurance is going to cover any of it.

So, now I'm a bit nervous about it all. My son mostly likely has Asperger's--but our biggest concerns are his development socially/behaviorally, as well as some possible mild sensory/auditory processing issues. And he is currently unable to write, draw, color, in spite of being quite bright. His pre-school teacher brought up concerns with his social interaction, transitions in the classroom, his motor skills (with drawing) and his following of directions.

Anyway, is a very expensive psych evaluation worth it at this point? Possibly? I just wonder what they can glean in the space of an hour. I know they are professionals, but I admit I am skeptical. And I know my son is smart and can be charming. If he has the undivided attention of one adult listening to him and playing with him, he'll probably be on pretty good behavior. Though, of course, the eval could still pick up on writing delays.

Can anyone tell me what this hour evaluation might look like? And what a realistic expectation of the report might be? I am imagining the psychologist saying something like--'Aha, he possibly has a few delays but it's hard to tell. He's young. Work on a few things and we'll wait and see in a year. Have a nice day.'

Should we scratch the psych eval and instead go with a speech eval (with a specialist I know who also is familiar with sensory/auditory processing issues)? We live in Asia, so our resources right now are limited. Just want to use our resources in the best way possible to ease frustration and keep DH from giving up on it completely . . .

Can you find someone trained to perform the ADOS? It is a very specific series of activities designed to identify autism spectrum disorders. Our DS took it at 5.25, but I think it would've still caught his issues at 4.5. It takes about 2 hours to administer, so I'd ask the psych specifically what tests they plan to do before going ahead. Our dx appt also had an IQ test, and at my insistence we and the preschool teacher filled out ADHD rating scales before the appt. I came in with lots of supporting info - emails from the preschool teacher and a report from a behavioral therapist (free through a YMCA program) who observed DS at school.

Thanks, zette--good points. I'll have to e-mail the nurse back about what they plan to do. She did say that the cost 'depended on what tests the dr decides to do'. So, I guess they'd do a general meeting/eval with parents and then decide on what tests?

I am planning on having his teacher write an evaluation that I can take in with me. Maybe I should arrange that speech/sensory/processing specialist eval in advance of the psych eval . . .

Are you getting an OT eval for the fine motor and sensory issues?

Also, you can say you are concerned about ASD, and request the ADOS or similar test directly. We got suckered by a psych who told us he would pick out subtests as needed - he decided none were needed because DS showed empathy during a game of connect-4! It delayed getting a proper dx by about 6 months.

In 1975 they did not know what was wrong with me so they slapped an ADHD label on me and dropped me into special education classes from 1st to 10th grade. In my area special education is pretty much a warehouse for the weird kids. I went to see a psychologist when I was 40 he found no signs of ADHD or anytype of learning disability. The other children called me a ret*d for 10 years of school and treated like trash because of it. They need to know what is wrong with your child so they can help him better. They did not know what Aspergers was back when I was 5 so they treated me for the wrong disorder pretty much ruining my life and making my autism traits worse and not to mention giving me a sub-standard education.

It is definitely worth it. I was evaluated when I was three, and knowing what made me so different was so helpful for my self esteem. My mom and I could tell others about my Asperger's Syndrome, and they would understand me better. Also, I don't know what country you're in, but in America part of special education is an IEP, which was extremely helpful for me (I didn't get one in elementary school because the my "worst enemy" happened to be the son of the hockey coach, who was friends with the school social worker, who refused to help me, but it was helpful in middle school). Also, it will help you get access to help earlier on. My mom got me to be helped by a bunch of occupational therapists and psychologists, ect, which was very helpful, especially with issues like when I refused to wear a coat.

I hope you get your kid evaluated. Good luck!

I honestly don't have an answer for this. While people consistently talk about how essential early intervention is, we had nothing - including no clue my son was AS - until he was 7, and because of his level of functioning, and the types of co-morbids he has, that was fine. I have a hard time seeing that he could really do any better than he has done. Not like he's perfect functioning in this world but also it's not like intervention will ever make the AS disappear.

I also continue to believe that if we had attempted evaluation with my son at 4 or 5 it would have missed the AS. By that age we did know he had sensory issues, and had been given some information on how to pay attention, mitigate the stress, et al ... Which was key for that time, but even with some professional observations no one was picking up on the AS.

What do you know about your future school district? How on the ball are they considered to be with autism? How likely are they to require a medical diagnosis before dealing with issues that crop up?

I confess, I'm cheap. I spend freely when I see need, and not when I am not completely convinced. Instead of tons of professional interventions when my son was little, I had figured out this: He needed ME. Instead of spending money trying to put labels on what was going on, I cut back on work to be with him more, and found the most wonderful nanny (that I paid above market) for when I couldn't. I think that for us it was the right solution, and the better approach. The AS got caught and labeled by the school, without me ever paying for it. A slow and stressful process, but no route will be anything less. But what process your family will need in this world of limited resources? I just don't know.

Thanks for the feedback--from all of you. Been thinking long and hard.

We don't live in the USA right now--in another country for work. So resources are limited in English. However, I have found an English speech therapist who has a lot of experience with AS and she also recommended an OT group that can do evaluations. Yay! I'm thinking I may go with an evaluation from the speech therapist and the OT before I head to the psychologist. Anyway, in the end it is OT that he will most likely need, since the biggest issues are sensory, and his inability to color, draw, write. I think the socialization issues are things I can work with him more on at home (as you said, DW, spend more and more time with him in stories and play) and in play groups.

Just a quick question--for any of you who did speech therapy. My son actually has amazingly advanced language for his age of 4 1/2--uses words like fortress, affliction, absolutely, pistons, you name it. However, he seems to struggle when it comes to expressing his desires/feelings or explaining something. He just says, 'I don't know' or melts down. Does speech therapy help with that type of speech issue? He also has some issues with answering to his name/answering questions. He has to be asked multiple, multiple times before we get eye contact or an answer (not every time, but often). Could be his age? Will speech therapy help with that? I suppose I am imaging speech therapy as teaching someone who can't talk how to talk, but I suppose I have an archaic understanding of it!

A good speech therapist will work on semantic-pragmatic problems as well as nonverbal language problem. This should help with conversational skills, and expressive-receptive skills.

From personal experience: I prefer the psych eval.

Our son was recently diagnosed with autism (we are in the U.S.) Prior to this, shortly before he turned 2, he had been evaluated for speech delay from the regional center and was labeled speech delayed and put into early intervention.

Fast forward 2 years. Our son is 4 years old and has been receiving speech therapy since age 2 and made little progress. I did everything I could short of becoming a speech therapist myself (believe me, I've seriously considered this.) I went through the 10 week "Hanen for Parents" (It Takes Two) program. I was as proactive as I reasonably can be to help my son communicate. I became very concerned when my son was injured (scratched badly) at school by another child and he was unable to communicate to us who had done this. I followed my gut: my spouse and I decided that we were going to find out once and for all what's happening with our son's speech.

We took him to an independent (expensive) speech therapist for a comprehensive evaluation. We did this because our "free" options kept giving up and claiming that our son was uncooperative and not evaluable. Of course this should have been a warning sign but you get what you paid for when it's free, and often parents get a crappy deal from the regional center and the school district in terms of quality and comprehensiveness of an evaluation. We began suspecting something else is interfering with his ability to learn.

It wasn't until we addressed the core issues in autism as part of the overall speech therapy strategy that we began to make progress with our son.

For us at least, the evaluation was worth every penny we spent (over two thousand dollars.) Because our son's symptoms are "mild", he was continually missed. Our "free" options ended up costing us delays in the right interventions for our son that could have him caught up in speech and language by now. But instead, we are just starting to play catch up.

I would try for the ADOS first and foremost.

Secondly, if you can afford the eval, go for it. I know it would take many months of saving (more like years) for me, so... if that's more your case, you'll have to pick and choose what you do.