Question about Neurologists

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Background:

My 3.5 yr old nephew has a speech delay, ostensibly as the result of hearing problems relating to recurrent ear infections. In addition to speech therapy etc, he does see a neurologist. He has a lot of tendencies and aptitudes that could be spectrum related, but it might take them awhile to diagnose (if that is even appropriate/correct) due to the hearing issue history.

The neurologist diagnosed eye tracking problems relating to amblyopia in his left eye, and also apparently he is "too left brained" and is undergoing therapy at the neurologist for this which involves things like shining lights on the side of his head to get the right side of his brain to fire off neurons. They are also doing physical therapy at the neurologist encouraging left/brain coordination and alternate hand/foot movement.

He says this has been successful, but does anyone know if this is actual scientifically based therapy? It sounds a little dicey to me, and I would be curious if anyone has experience with this.

On another note: Our current pediatrician had originally referred us a while back to a psychiatrist for a diagnosis (in case he needed meds, I guess, which he didn't) This was a total waste of time and money as he let the school district do all the work, and just pronounced his opinion on meds, which we were never seriously considering at that point, anyway. We were never referred to a neurologist. I have heard not very good things about neurologists on here, and given our other experiences, if we took him to one we would have to do a lot of research first to choose one.

Our son has not had symptoms of seizures or anything of that type. What criteria is generally involved with deciding to see a neurologist? Our son gets OT at the school as well as speech.

1. 3.5 years seems a little young for school.

2. The speech delay is caused by the hearing problem. If you can't hear speech, you have trouble engaging in it, without some kind of help. If his hearing can't be helped, your son will need to learn sign language.

3. If your son is having coordination problems, he does need physical therapy to correct this.

4. You don't say why your son was referred to a psychiatrist. Has he been acting up, or acting very different from others? I mean besides what would be caused by his hearing and coordination problems. If he has not been having psych problems, then he doesn't need a psych doctor, and anyone who recommends a psych doc if your son doesn't need it should be told to see the doc themselves. If your son has been having psych problems then he may need psych help, just not the jerk you went to. In that case, have your pediatrician refer you to a psych doctor who specializes in children (not adults) with the type of psych problem your son has been diagnosed with. Those who don't work much with kids, and don't have experience with what your son may have been diagnosed with, are of limited or no help.

5. Do not let anybody buffalo you into drugging your kid, especially a 3.5 year old! Meds have side effects and can be toxic, and many are addictive. Also, at such a young age, everyone acts up from time to time, so it can be difficult to tell if a child is just being very active, and emotional, or really does have some serious issues. It takes time to figure that out. You are not supposed to drug people for normal behavior, but too many teachers prefer to do that, because they can't handle normal, active youngsters. Drugs should be a last resort of treatment, and only for those who need help, not to keep normal kids acting like zombies for the convenience of the teachers.

I was on Phenobarbital and Ritalin when I was young. I eventually took myself off them without telling anyone, because I didn't like feeling like a zombie, and I didn't like being made unsteady on my feet. Also, they didn't help "fix" my problems, so I was suffering the side effects without any benefits. Decades later I told my dad that I had taken myself off those meds as a child, and why. He said that was okay, and that he was glad I did, as he and my mother had been worried that I would trip and fall, or that I would have more trouble with my school work as a zombie, or that I would have other problems if I stayed on the meds. They eventually stopped taking drug prescriptions for me when I was in my teens because of all of this. Meds are dangerous and should only be taken if and when absolutely necessary.

Too many NTs, including doctors think you can "fix" Autism/Asperger's Syndrome and other related problems by drugging people. However, there is no drug "fix" for spectrum disorders. Some of us are helped somewhat by anxiety and depression meds, but they don't cure the spectrum problems that led to the depression and anxiety. They just make it easier for us to deal with the emotional down side of the problems.

You didn't say if your son has been diagnosed with a spectrum disorder, and how that was determined. It can be very hard to tell spectrum disorders from normal behavior at that age. It usually isn't that easy to tell until school age, unless there is a non-hearing related speech delay. Since your son's delay is hearing related, I would not rush to judge him as having any disorder at all, at this point. First fix the hearing problem, or get him started on sign language, if the hearing can't be fixed. Then give it a couple of years after that.

And remember, don't let anyone push you into drugging your kid unless the drug is absolutely necessary.

Removing Double post--oops

A few clarifications:


The 3.5 yr old is my nephew. My nephew can hear, now, but he is delayed for his age. He has other issues than just speech, but because of his past hearing problems it is hard to sort from ASD issues.


My son is 7. I only brought up my son to wonder why he was referred to a shrink for ASD diagnosis but not also to a neurologist. My son was referred to get an ASD diagnosis from a pediatric shrink because my pediatrician is biased in favor of medicating autistic children, and felt he might need it. I was not understanding that intent at the time, and just thought it was for diagnosis purposes. If I had known that I would have gone directly to the school district for diagnosis.

I do not agree with meds but that was not the point of the post. The shrink was lazy anyway and just had the school do the diagnosis. My son had echolalia and has social/pragmatic speech issues, but his vocab is high. My son is diagnosed as HFA, due to severity, although his skill profile is more Aspie. He is clumsy but not enough to be eligible for PT. He has no issues with left/right coordination. That is my nephew who does.

My nephew evidently has other issues unrelated to hearing hence the additional therapy--hence why I suspect other issues-but the therapy is not being done by by a PT it is being done by a neurologist. He goes to pre-k, which he is eligible for at his age due to his special needs. Where we live this stuff is done through the county 0-3 and after that by the school district. I understand why he would need PT for PT issues but the neurologist is doing it for brain issues and also doing light therapy. That sounded weird to me to have PT in a neurologist office and I was also wondering if anyone was familar with the light therapy which also sounds odd.

I know we are talking about ASD and not head injuries, but the basic premise below applies well. Neurologists and psychologist often overlap in their evaluations, but basically the neurologist focuses on structural problems and problems in areas of the brain. The tests are more medical. The psychologist focuses on symptoms, and areas of delay and/or dysfunction. The tests are more psychological. I hope the information below is helpful. ~Erica

WHAT IS THE DIFFERENCE BETWEEN A NEUROLOGICAL AND A NEUROPSYCHOLOGICAL EVALUATION?

Neurological evaluations are typically performed by medical doctors (M.D.'s). Neurological examinations typically examine Cranial Nerves (very often omitting CN - I, olfactory sense) basic sensory and motor functions, reflexes, and muscle tone. Observations may be made about speech, orientation, mood and general level of alertness. Memory and cognition is usually examined briefly, such as asking for recall of 3 objects in five minutes, the current or past president's etc. Sometimes a more formal measure such as the Mini-Mental Status is performed. The neurologist relies on medical history, neuroimaging, laboratory findings, and studies such as the EEG. Some neurologists are trained in behavioral neurology and may perform other brief tests of naming, construction, praxis, and/or motor planning. While neurologists generally have the most expertise in a "neurological examination", one may often see a basic neurological examination performed in emergence settings or as part of a general physical examination. Psychiatrists or neuropsychiatrists may also employ some or all of the above techniques and measures.

A neuropsychological evaluation is typically performed by a neuropsychologist (normally a Ph.D. and sometimes a Psy.D.) licensed as a psychologist. Both the neurological and neuropsychological examination rely upon history and symptoms, and reports of medical findings are considered. Neuropsychological evaluations typically involve neuropsychological testing which includes assessment of general intelligence, basic achievement, sensory, motor, spatial, constructive, language, attentional, memory, learning, and executive functions as well as coping, personality, and adjustment. This is a more lengthy process, but offers the advantage of greater sensitivity to deficits than the typical neurological evaluation or even imaging techniques. Tests are generally well standardized allowing for fine grain comparisons with age, education and between-test differences. In litigation or forensic contexts standardized and embedded measures of test validity and/or adequacy of effort are employed, allowing for greater confidence about the validity of results.

http://cpancf.com/Brain_Head_Injuries.asp

I don't have any experience or opinion on the light therapy your nephew is receiveing from his neurologist, so I can't comment on that.

In my opinion, the best specialities to see for diagnosis and meds have "developmental" in the title -- our son was diagnosed by a developmental psychologist, and is currently being treated by a developmental pediatrician. Often regular pediatricians aren't really aware of who can diagnose what. At one point -- when I originally suspected ADHD (before the AS dx), our son's ped tried to refer him to a neurologist. When I called, the neurologist's office informed me that they didn't treat ADHD. My sister-in-law recently completed a fellowship in child psychiatry, and her exposure to patients with autism and Aspergers was fairly small. She said she would diagnose AS just by talking to the child for awhile, and wasn't familiar with the ADOS.

ADHD meds have recently been approved for kids as young as 4 years, in serious cases after OT has been tried. For some kids, my son being one, they make a dramatic improvement in ability to focus and learn. We tried OT first, and after 9 months even the therapist agreed that it was time to give meds a try for DS, now 6. He is definitely not a zombie on these meds -- instead they seem to decrease his frustration. We hear a lot less screaming of "I'm so stupid" every time something little goes wrong when he's had his meds. It's the difference between being able to sit and build a lego toy and throwing all the pieces and giving up.

Sorry, didn't mean to send the thread off on a meds vs no-meds tangent.

Every specialist will see a child through the lens of their own training, and be likely to declare that the best treatment is what they're most experienced with. So it might be worth it for your nephew to get a second opinion from another discipline, perhaps an OT or developmental psychologist.