DD1's intake appt. with the ped. nuerologist

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So, Evie (4.5 year old twin DD) had her intake appt. with the ‘goto’ pediatric neurologist for autism in these parts. I couldn’t attend due to work (I actually do work sometimes, believe it or not!), but their mom gave me the run-down.

Basically, the MD said that Evie was “mild” and that she’d be “fine”. She said she the proper placement for her will be a mainstream classroom. She said her language is “great”, just some minor pragmatics issues that can be learned. She said her biggest challenges will be social – just not “getting” the social cues – stereo-typical HFA/Aspie stuff.

Sounds like mom was asking the doc about the girl’s imagination – how they always are pretending to be animals and characters. She said that’s fairly common with HFA/Aspie kids, and she knew about 12-13 kids like that. She said, typically, the pretend play will evolve into obsessions with things such as ‘neo-pets’ (whatever that is) and the like – they’ll transfer this imaginative play and obsessions onto collectable toys and cards and the like.

She said that she thinks that Evie will do fine learning the academics that are expected of her.

She recommended ‘Social Stories’ by Carol Gray (sp?) and getting Evie into classes and activities where she’ll be around peers.

She said no to ABA/VBA – said it’s not going to help her much with given her current functioning level. She said no to special diets and to bio-medical interventions (because there’s no evidence of any problems that might be helped by those things). She said that we should just address issues as they come up – as we’ve been doing – with language therapy for her pragmatics issues, getting her evaluated for OT (we did that yesterday), that sort of thing.

She wrote a prescription. The prescription is as follows:

“Evelyn will do best if treated more as a typical child with behavior and expectations”.

My wife actually asked her to write an Rx like that so I’d stop obsessing about getting every treatment under the sun for the girls.

She asked us to come back in a year for a follow-up visit.

Abigail's (twin DD2) intake is tommorrow. I reckon it will be a similar assessment, though Abbie doesn't function quite as well as Evie (she is more rigid and has more language pragmatics issues).

Interesting…

What is DD?

DD == "Dear Daughter".

Oh, ok! I thought it was something else.

Is it unusual for them to have imaginary friends at 4.5? I would think that's normal. Maybe they'll grow up to be writers and all of these characters will end up in books!

I think Abbie maybe more like me...more introverted. I'm pretty rigid in my routines and was when I was that age.

Imaginary friends are a normal stage of growth, most children have them.

Are you two related?

I'm not sure about autistic kids - I think more profoundly affected kids have trouble with imagination, or imaginary play. Their mother was trying to cite this as evidence that Evie wasn't autistic, but the doc's retort was her anecdote about the neo-pets and the HFA/Aspie kids. Still, her pretend play goes beyond typical kid's stuff. It's a manifestation of her social impairment. For eaxmple, a stranger said 'hi' to her the other day, and her response was, "Hi! My name is Danger and I'm a skunk and I have a stinky but! PSSSSST!! !!".

The woman sort of walked away, confused

Oh, ZanneMarie and I are not related - at least as far as I know!

I have an NT daughter who only answered to "Barbie" for quite some time. She walked around with a tiara on her head and would only wear pink.

Many adults don't know how to interact with kids, unfortunately the one that said hi to your daughter missed a chance at a moment of fun. Children experience the world in a much fuller way than we do as adults. The example you give doesn't sound like a "manifestation of social impairment" but rather a show of youthful spirit and imagination.

OTOH, my son with AS never had any friends, imaginary or otherwise, as a youngster. He obsessed on the usual (trains, schedules) but everything was very concrete. My husband was (and is) the same way.

I got the related thing as she mentioned "Abbie" (using the informal for your daughter) and relating her behavior to her own.

As an aside (just because I hear this from people from their docs all the time and it drives me nuts) do you have any idea what the dr meant by "mild"? Being as that's not a dx.... Did he give a solid dx or just some behavior and OT suggestions?

I was consulting with this doctor for medical guidance, more than anything. I want to knwo if there is anything bio-medically I should be doing, as well as know "where" on the spectrum my daughters are, as that will influence the kinds and quantities of educational therapies that I try to get for them. The dx she wrote on the paperwork was 'delay in reaching developmental milestones' and 'encephalopathy' - both, I think, generic terms to obfuscate the diagnosis for insurance purposes.

Both girls have an educational classification of 'autism', and they're both defintiely autistic (confirmed by Phd psychologist and expert from TEACCH, and now, anecdotally, by an experienced ped. nuerologist).

The 'mild' is anecdotal. It was based on her observation and interaction with my daughter. Evie is not very obviously affected by her autism. Her autism manifests itself as odd, overly pedantic speach patterns, a lack of normal 'back and forth' conversation (her conversations tend to be one sided!). She is more interested in the things in the room than in the people in it. She has poor eye contact - that sort of thing. She doesn't exhibit a lot of rididity or sensory issues. She doesn't stim. Her IQ is average. She's pretty easy going, actually. So, her autism doesn't really interefere with her quality of life (such as it is for a four year old)- it merely impacts her ability to make "friends" and, to a certain extent, function in school (joint attention issue).

I'm not a shrink, but I think the "lacks imagination" description actually refers to not engaging in SOCIAL imaginative play (for children), not a wholesale lack of imagination. So if the child engages in imaginative play in a solitary manner, but avoids it with groups of other chidren, this is still congruent with HFA/AS.

That;s interesting, en_una_isla! My girls definitely engage in this sort of play with others, including children - though, more often than not, the other children just end up confused. They'll pretend to be a 'dragon' or a horse or something, and chase each other around.

My son actually has very little of this imaginative play EXCEPT during social situations. He rarely pretends to be a character on his own, for example, but will take on a persona during recess at school, or when playing with his sisters.

His sisters just seem to get "stuck" in their roles

I have noticed that my son (HFA) has imagaginative play with the 1 sister he is very close to. Beyond that, it never seems to work out-- either he doesn't want to or the other kids, including his other siblings, are put off or confused. So in that sense his play is still somewhat soitary-- it's limited to one person, his sister. He also spends a tremendous amount of time playing alone.

I reckon the girls would be mostly playing on their own, too, if not for each other. They're inseperable. It's a challenge having two ASD little kids, but it's nice to know that they'll always have each other.

IMO you shouldn't do anything but encourage their bond; I thank god every day that my son has his next youngest sister. Without her he would have NO friends, except me, but I don't think I count because I'm his mom.

Hi Squaretail,

I hope my response is appropriate to you ... I'm a 47yo aspie ... and I'm into Neopets. It's a website with games, social groups, a whole virtual world. There are also IRL products such as stuffed animals, a magazine, etc. I started playing it to vett it to decide whether to allow my kids to play. Now I play it more than they do LOL. It is wholesome as long as you keep parental controls appropriate to their age. I belong to a social group there where they don't even know I'm odd LOL. Anyway, just FYI and hoping it helps somehow.

The best to you and your dd.