Can you help me decipher therapist notes for almost 4 yo DD?

[Anonymous]

Anonymous wrote:What therapist? It sound like receptive language.

Op here. Speech therapist provided by the school.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

Kids with ADHD inattentive type tend to ignore or space out or fail to finish directions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

(the tell is “even when pointing out what peers are doing …”)

OP what did autism evaluation say?

Op here. The autism eval said no indicators for autism, but happened more than a year ago.

If that evaluation was done by anyone affiliated with the school, or a doctor in the same school district, I’d get a second opinion.

I’d ask, in writing, for a BCBA to conduct an assessment of transitions so they can create the necessary classroom tools or address skill deficits in this area.

I’d start a home ABA program. Focus on parent training.

Op here. We paid privately for the autism assessment and it was done by a neuropsychologist. This was when DD was 2, almost 3, so not in school yet.

We’ve tried to get ABA but can’t get insurance to cover it without an autism diagnosis. That’s why we did the autism eval was to try to get the diagnosis. We should maybe get another one.

Will the school provide the BCBA or do we need to arrange and pay for that privately?

The school-to my knowledge, please check- will cover the FBA, they should have a BCBA on staff or they can hire one to do it. You can argue as a parent that assessments should be done by a qualified individual, that is a BCBA. There is no other profession that should be doing an FBA. I’m not sure it’s required by Wrights Law but I think typically if parents push for the BCBA they get one, again because of the qualified individual performing an assessment. Consult an advocate or check wrightslaw.com for specifics in that area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

(the tell is “even when pointing out what peers are doing …”)

OP what did autism evaluation say?

Op here. The autism eval said no indicators for autism, but happened more than a year ago.

If that evaluation was done by anyone affiliated with the school, or a doctor in the same school district, I’d get a second opinion.

I’d ask, in writing, for a BCBA to conduct an assessment of transitions so they can create the necessary classroom tools or address skill deficits in this area.

I’d start a home ABA program. Focus on parent training.

Op here. We paid privately for the autism assessment and it was done by a neuropsychologist. This was when DD was 2, almost 3, so not in school yet.

We’ve tried to get ABA but can’t get insurance to cover it without an autism diagnosis. That’s why we did the autism eval was to try to get the diagnosis. We should maybe get another one.

Will the school provide the BCBA or do we need to arrange and pay for that privately?

You might try a comprehensive evaluation if you’re having difficulty getting a diagnosis. It’s sometimes used as a bridge to a diagnosis that can provide more comprehensive and thorough background information to the provider that’s writing the diagnosis. These are usually 15-25 hours long and consist of various different assessments and observations in home, school, community, etc. At age 3 it might include things like: a review of background information, ABLLS-R or VB-MAPP, Vineland, PPVT, EVT, baseline data collection for specific behaviors of concern, interviews with parents and teachers, etc. Assessment tools selected will be based on age, parental/teacher/child concerns, and direct observations. It might be performed by one qualified individual or several individuals typically in the same office and might also include separate speech, OT, and PT evaluations. Sometimes doctors will use that information to provide a diagnosis in lieu of a neuropsych evaluation / psychologist performing a diagnostic assessment. This is kind of the old school way people got diagnoses before there were standardized assessment tools and people sought out neuropsych evaluations mostly based on insurance requirements. Personally I think it paints a much better picture of the whole child than a 3-4 hour assessment in an unfamiliar office.

If you can’t find one person to do all the assessments, find individual providers and present everything- in a nicely laid out easy to read binder- to the pediatrician.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What therapist? It sound like receptive language.

Op here. Speech therapist provided by the school.

A SLP should be able to identify receptive language concerns. Are you in outside therapy? I'd get a hearing test and a full speech evaluation outside school.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What therapist? It sound like receptive language.

Op here. Speech therapist provided by the school.

A SLP should be able to identify receptive language concerns. Are you in outside therapy? I'd get a hearing test and a full speech evaluation outside school.

Op here. Hearing has been checked multiple times, it’s definitely not the issue. We do also get private speech but I find it useless.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

(the tell is “even when pointing out what peers are doing …”)

OP what did autism evaluation say?

Op here. The autism eval said no indicators for autism, but happened more than a year ago.

If that evaluation was done by anyone affiliated with the school, or a doctor in the same school district, I’d get a second opinion.

I’d ask, in writing, for a BCBA to conduct an assessment of transitions so they can create the necessary classroom tools or address skill deficits in this area.

I’d start a home ABA program. Focus on parent training.

Op here. We paid privately for the autism assessment and it was done by a neuropsychologist. This was when DD was 2, almost 3, so not in school yet.

We’ve tried to get ABA but can’t get insurance to cover it without an autism diagnosis. That’s why we did the autism eval was to try to get the diagnosis. We should maybe get another one.

Will the school provide the BCBA or do we need to arrange and pay for that privately?

You might try a comprehensive evaluation if you’re having difficulty getting a diagnosis. It’s sometimes used as a bridge to a diagnosis that can provide more comprehensive and thorough background information to the provider that’s writing the diagnosis. These are usually 15-25 hours long and consist of various different assessments and observations in home, school, community, etc. At age 3 it might include things like: a review of background information, ABLLS-R or VB-MAPP, Vineland, PPVT, EVT, baseline data collection for specific behaviors of concern, interviews with parents and teachers, etc. Assessment tools selected will be based on age, parental/teacher/child concerns, and direct observations. It might be performed by one qualified individual or several individuals typically in the same office and might also include separate speech, OT, and PT evaluations. Sometimes doctors will use that information to provide a diagnosis in lieu of a neuropsych evaluation / psychologist performing a diagnostic assessment. This is kind of the old school way people got diagnoses before there were standardized assessment tools and people sought out neuropsych evaluations mostly based on insurance requirements. Personally I think it paints a much better picture of the whole child than a 3-4 hour assessment in an unfamiliar office.

If you can’t find one person to do all the assessments, find individual providers and present everything- in a nicely laid out easy to read binder- to the pediatrician.

You can also try a developmental ped but I'd do outside speech therapy and only do ABA if you are having behavioral issues at home.

[Anonymous]

Diagnosis is often secondary to intervention, but a necessary evil if you want insurance coverage. If you can afford to start with some part time ABA (5-10 hours) and focus on parent training I imagine it would help immensely. This will help you address the issue at hand, have someone to bounce ideas off of and provide direction, give more information for diagnostic /background purposes, provide continuity between home and school by having them observe in school and possibly attend IEP meetings, provide you with someone to do some of the assessments listed above, etc. The intake process can be the longest part, this will help get your foot in the door so to speak, if your insurance eventually covers more it should be easy to increase hours.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

(the tell is “even when pointing out what peers are doing …”)

OP what did autism evaluation say?

Op here. The autism eval said no indicators for autism, but happened more than a year ago.

If that evaluation was done by anyone affiliated with the school, or a doctor in the same school district, I’d get a second opinion.

I’d ask, in writing, for a BCBA to conduct an assessment of transitions so they can create the necessary classroom tools or address skill deficits in this area.

I’d start a home ABA program. Focus on parent training.

Op here. We paid privately for the autism assessment and it was done by a neuropsychologist. This was when DD was 2, almost 3, so not in school yet.

We’ve tried to get ABA but can’t get insurance to cover it without an autism diagnosis. That’s why we did the autism eval was to try to get the diagnosis. We should maybe get another one.

Will the school provide the BCBA or do we need to arrange and pay for that privately?

You might try a comprehensive evaluation if you’re having difficulty getting a diagnosis. It’s sometimes used as a bridge to a diagnosis that can provide more comprehensive and thorough background information to the provider that’s writing the diagnosis. These are usually 15-25 hours long and consist of various different assessments and observations in home, school, community, etc. At age 3 it might include things like: a review of background information, ABLLS-R or VB-MAPP, Vineland, PPVT, EVT, baseline data collection for specific behaviors of concern, interviews with parents and teachers, etc. Assessment tools selected will be based on age, parental/teacher/child concerns, and direct observations. It might be performed by one qualified individual or several individuals typically in the same office and might also include separate speech, OT, and PT evaluations. Sometimes doctors will use that information to provide a diagnosis in lieu of a neuropsych evaluation / psychologist performing a diagnostic assessment. This is kind of the old school way people got diagnoses before there were standardized assessment tools and people sought out neuropsych evaluations mostly based on insurance requirements. Personally I think it paints a much better picture of the whole child than a 3-4 hour assessment in an unfamiliar office.

If you can’t find one person to do all the assessments, find individual providers and present everything- in a nicely laid out easy to read binder- to the pediatrician.

Op here. I’ve tried to find someone to do a comprehensive neuropsychology exam (privately, at our own expense) but they’ve told me that DD is too young and they don’t do them prior to age 7. The developmental ped has done 4 different evaluations (basically just administering those milestone tests), which all pointed to various issues but the providers wouldn’t diagnose ASD (we asked, they said that’s just not the picture they were seeing and instead went with global developmental delay). We also got a separate autism specific evaluation with a neuropsychologist but it was only administering the autism test, it wasn’t totally comprehensive like what you describe above.

I don’t know where the disconnect is-I am in the SW area of the US and I wonder if they just approach things differently than DC. Maybe we should try to go to california or DC to follow these things up.

[Anonymous]

Op here. I want to be receptive and responsive to the input from the therapist but I am not clear on what the appropriate follow up is, other than I’ll share this information at the next appointment with the developmental pediatrician.

I also just do not know how to contextualize this information. Is this really so unusual for a 3 year old (albeit DD is almost 4)? The preschool is only 3 hours, 3 days per week. I’m worried that following up with anything other than gratitude will seem like I’m being defensive (I’ve had what feels like a small amount of tension or something with this therapist in the past).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What therapist? It sound like receptive language.

Op here. Speech therapist provided by the school.

A SLP should be able to identify receptive language concerns. Are you in outside therapy? I'd get a hearing test and a full speech evaluation outside school.

Op here. Hearing has been checked multiple times, it’s definitely not the issue. We do also get private speech but I find it useless.

Speech therapy gives kids tools but throng will not improve till they are ready. Get a new private therapist.

[Anonymous]

OP, your DD is currently 3? What prompted seeing a developmental ped?Are the behaviors disruptive? If not, I would give her time. She has had a lot of assessments for a 3 year old and it doesn’t sound like anyone has a solid diagnosis or path you should be following currently. Sometimes things are more clear as kids develop.

[Anonymous]

Anonymous wrote:I always feel like they are saying something without coming out and saying it. This is regarding Larla, age 3 (almost 4):

At the end of last year, she was transitioning independently following the classroom routines; but this year, Larla is struggling following direct instructions. Sometimes she shows she understands the directive but will get distracted half way or will not respond to the re-drection and continue on with her activity. Even when pointing out what other peers are doing, she doesn't always join them at the rug, even when the routine has been modeled to her in the past. It is important to note that she is not defiant or fighting re-direction; when given moderate support (holding her hand or guiding her to the rug), she will join her peers.

Are they trying to say she’s regressing? Or that she doesn’t understand? Are they alluding to ASD or ADHD? What am I supposed to do to follow up or provide support here?

We have similar struggles at home. I just do not know what to do.

Well, they might be trying to say she is regressing, but at this point in the school year she might just be re-adjusting. Does she have a larger class size? Even with same teacher, the classroom dynamic or complexity of instructions can change. I do think since it may be regression it's something to keep an eye on.

It sounds like they are implying inattentiveness, to me. But they aren't necessarily implying anything. If they know you are seeking outside support, they don't need to urge you to do so. They are providing the day to day observations that will inform the analysis. You don't need to substantively respond to each communication, you can just say "Thank you for the observations." And put it in your binder. You seem to have a good handle on this so just carry on with your efforts. Sometimes it just takes time.

[Anonymous]

Anonymous wrote:Op here. I want to be receptive and responsive to the input from the therapist but I am not clear on what the appropriate follow up is, other than I’ll share this information at the next appointment with the developmental pediatrician.

I also just do not know how to contextualize this information. Is this really so unusual for a 3 year old (albeit DD is almost 4)? The preschool is only 3 hours, 3 days per week. I’m worried that following up with anything other than gratitude will seem like I’m being defensive (I’ve had what feels like a small amount of tension or something with this therapist in the past).

I would suggest scheduling a meeting with this therapist and saying all this. "I read through the notes you provided. Thank. you for being so thorough. Now that you've observed Larla, I have some questions:
-I'm not asking you to provide a diagnosis, but do you have thoughts about what is going on with Larla?
-What should I be doing to support Larla at school and at home?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like it’s pointing to ADHD and ruling out ODD

No, it actually sounds like autism. ADHD is inability to focus or hyperactivity, but this evaluator is trying to describe ignoring/unawareness of social cues.

(the tell is “even when pointing out what peers are doing …”)

OP what did autism evaluation say?

Op here. The autism eval said no indicators for autism, but happened more than a year ago.

If that evaluation was done by anyone affiliated with the school, or a doctor in the same school district, I’d get a second opinion.

I’d ask, in writing, for a BCBA to conduct an assessment of transitions so they can create the necessary classroom tools or address skill deficits in this area.

I’d start a home ABA program. Focus on parent training.

Op here. We paid privately for the autism assessment and it was done by a neuropsychologist. This was when DD was 2, almost 3, so not in school yet.

We’ve tried to get ABA but can’t get insurance to cover it without an autism diagnosis. That’s why we did the autism eval was to try to get the diagnosis. We should maybe get another one.

Will the school provide the BCBA or do we need to arrange and pay for that privately?

Get on the list at the children’s hospitals in your area.

You can have her evaluated by the school/county again as well.