Loaded question: MERLD and autism

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Just tell them your child has been tested for ASD and it has been ruled out. (Which is true, I assume?)

Yes, based on the dev pediatrician evil, it has been ruled out. Our 3 year IEP revaluation is coming up and the team has to decide what testing our child needs so that she gets the supports that she needs to go to K. So I am wondering what tests they are going to suggest for our child.

Did you do the Ados or cars? I would.

If child has been ruled out for autism, why continue to test for autism if the parents and Developmental Ped. have no concerns?

because the teachers are concerned, and there is so much overlap. also kids change a lot between 2/3 and 5 (which sounds like the age range here). and a second opinion is always a good idea for any kind of complex diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Just tell them your child has been tested for ASD and it has been ruled out. (Which is true, I assume?)

Yes, based on the dev pediatrician evil, it has been ruled out. Our 3 year IEP revaluation is coming up and the team has to decide what testing our child needs so that she gets the supports that she needs to go to K. So I am wondering what tests they are going to suggest for our child.

Did you do the Ados or cars? I would.

If child has been ruled out for autism, why continue to test for autism if the parents and Developmental Ped. have no concerns?

because the teachers are concerned, and there is so much overlap. also kids change a lot between 2/3 and 5 (which sounds like the age range here). and a second opinion is always a good idea for any kind of complex diagnosis.

She is only identifying the child as MERLD. Its not a complex diagnosis. It sounds like child has been tested and ruled out. Most teachers do not understand the difference between language disorders and Autism and should not be evaluating or providing diagnosis.

[Anonymous]

Anonymous wrote:We have a diagnosis of MERLD for our child from a dev pediatrician. I am wondering if any of you, whose child has the same diagnosis, have faced what we are facing. Some preschool teachers and a psychologist have suggested that our child may have autism even though they know our child has a MERLD diagnosis. Anyone faced this? I know this topic is a sensitive one on this forum.

Having a MERLD diagnosis in a preschooler doesn't rule out autism by today's definition. It just means that your child has both expressive and receptive speech delays at this point. What preschool teachers are probably alluding to is that your child has behavioral problems that they don't know how to address. They don't have any expertise, so they shouldn't be giving suggested diagnoses, just describing the behaviors of concern. That's the point on which you need to ask for more information. (I don't know what to tell you about the psychologist, but there might be something to that.)

Down the road whether your child will outgrow his current delays or given a language and/or communication disorder diagnosis, behavior can be problematic. I would ask for a functional behavioral analysis in the preschool setting and consider doing behavioral or ABA therapy with your child. It doesn't matter if he's on the spectrum or not, it sounds like language/communication issues are interfering with him participating in preschool activities.

[Anonymous]

Anonymous wrote:MERLD is only relevant for the preschool age at this point mainly b/c speech delays b/f school age often resolve: http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/

Past preschool age, children will be given a differential diagnosis according to the latest DSM V in which MERLD does not exist. This could include a language disorder, communication disorder (autism is one, but there are others), and/or ADHD.

MERLD is still relevant for kids after preschool age as it can and often continues into elementary school if not life long. Many kids learn to adapt and cope but the residual effects are still present. It really doesn't matter if it is called a language disorder or MERLD but MERLD is a specific type of language disorder identifying concerns with both expressive and receptive language. For most MERLD kids without other diagnosis, it is called a language disorder but it makes it difficult to say language disorder without identifying receptive and expressive language. A language disorder could mean anything from receptive, expressive, both, apraxia, stuttering and many more. Most parents find it easier to continue to call it MERLD regardless of the official diagnosis if their kids still struggle with receptive and expressive language.

Not all kids with language disorders have communication disorders (including autism) or ADHD/ADD or a learning disorder. Some do, but many do not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:MERLD is only relevant for the preschool age at this point mainly b/c speech delays b/f school age often resolve: http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/

Past preschool age, children will be given a differential diagnosis according to the latest DSM V in which MERLD does not exist. This could include a language disorder, communication disorder (autism is one, but there are others), and/or ADHD.

MERLD is still relevant for kids after preschool age as it can and often continues into elementary school if not life long. Many kids learn to adapt and cope but the residual effects are still present. It really doesn't matter if it is called a language disorder or MERLD but MERLD is a specific type of language disorder identifying concerns with both expressive and receptive language. For most MERLD kids without other diagnosis, it is called a language disorder but it makes it difficult to say language disorder without identifying receptive and expressive language. A language disorder could mean anything from receptive, expressive, both, apraxia, stuttering and many more. Most parents find it easier to continue to call it MERLD regardless of the official diagnosis if their kids still struggle with receptive and expressive language.

Not all kids with language disorders have communication disorders (including autism) or ADHD/ADD or a learning disorder. Some do, but many do not.

PP, kids can continue to have expressive and receptive language delays into elementary and beyond. However, in the latest DSM V published in 2013, the characteristics of MERLD fall under different diagnoses.

I have two kids who were diagnosed with MERLD as preschoolers by developmental pediatricians. Both have had full educational after age 6 and have received differential diagnoses, neither of which were autism. So either people are living in ignorance that there age 6+ have MERLD or they don't want to do full educational testing b/c they are avoiding a diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Just tell them your child has been tested for ASD and it has been ruled out. (Which is true, I assume?)

Yes, based on the dev pediatrician evil, it has been ruled out. Our 3 year IEP revaluation is coming up and the team has to decide what testing our child needs so that she gets the supports that she needs to go to K. So I am wondering what tests they are going to suggest for our child.

Did you do the Ados or cars? I would.

If child has been ruled out for autism, why continue to test for autism if the parents and Developmental Ped. have no concerns?

NP. It is something to keep an eye on, but not stress about. My child was initially diagnosed with MERLD. He is now diagnosed with ASD. As he went to therapy and his language improved, his autism symptoms -- perservative interests, lack of social understanding, lack of theory of mind -- became very, very apparent.

Lots gets go from an ASD diagnosis to a MERLD diagnosis, before the doctors settle on what is the right label. Mine went from MERLD to ASD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MERLD is only relevant for the preschool age at this point mainly b/c speech delays b/f school age often resolve: http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/

Past preschool age, children will be given a differential diagnosis according to the latest DSM V in which MERLD does not exist. This could include a language disorder, communication disorder (autism is one, but there are others), and/or ADHD.

MERLD is still relevant for kids after preschool age as it can and often continues into elementary school if not life long. Many kids learn to adapt and cope but the residual effects are still present. It really doesn't matter if it is called a language disorder or MERLD but MERLD is a specific type of language disorder identifying concerns with both expressive and receptive language. For most MERLD kids without other diagnosis, it is called a language disorder but it makes it difficult to say language disorder without identifying receptive and expressive language. A language disorder could mean anything from receptive, expressive, both, apraxia, stuttering and many more. Most parents find it easier to continue to call it MERLD regardless of the official diagnosis if their kids still struggle with receptive and expressive language.

Not all kids with language disorders have communication disorders (including autism) or ADHD/ADD or a learning disorder. Some do, but many do not.

PP, kids can continue to have expressive and receptive language delays into elementary and beyond. However, in the latest DSM V published in 2013, the characteristics of MERLD fall under different diagnoses.

I have two kids who were diagnosed with MERLD as preschoolers by developmental pediatricians. Both have had full educational after age 6 and have received differential diagnoses, neither of which were autism. So either people are living in ignorance that there age 6+ have MERLD or they don't want to do full educational testing b/c they are avoiding a diagnosis.

We have not done full testing. It is not recommended for our child right now. Our developmental ped did some basic testing (including IQ) and did not feel more was warranted. Its not a good idea to keep testing kids over and over again. Not all kids have academic or other issues. You do a full evaluation to understand what is going on, but for some kids, the parents and professionals have a good handle on it, so it is not the best idea in less new issues crop up later. You keep insisting how important it is, and it is important and a good idea for many but not all. OP child is not 6. If your kids have dual or multiple diagnosis and you need to better understand it, it makes sense. You may have had a misdiagnosis of MERLD, but some of our kids actually have MERLD (or what ever you want to call it).

Also, the diagnosis are always ever changing. That doesn't mean even if clinically it falls under different diagnosis, that its not an appropriate term for some of our kids. By us just saying language disorder, you have no clue what is going on. If I say more specific, then you'd understand better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Just tell them your child has been tested for ASD and it has been ruled out. (Which is true, I assume?)

Yes, based on the dev pediatrician evil, it has been ruled out. Our 3 year IEP revaluation is coming up and the team has to decide what testing our child needs so that she gets the supports that she needs to go to K. So I am wondering what tests they are going to suggest for our child.

Did you do the Ados or cars? I would.

If child has been ruled out for autism, why continue to test for autism if the parents and Developmental Ped. have no concerns?

NP. It is something to keep an eye on, but not stress about. My child was initially diagnosed with MERLD. He is now diagnosed with ASD. As he went to therapy and his language improved, his autism symptoms -- perservative interests, lack of social understanding, lack of theory of mind -- became very, very apparent.

Lots gets go from an ASD diagnosis to a MERLD diagnosis, before the doctors settle on what is the right label. Mine went from MERLD to ASD.

It happens very often as its very hard to tell in young kids but usually around 5-6-7 it teases out. All of the concerns they had for my child were pretty much gone but the language issues remained (but continue to improve). We had the opposite experience.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We have a diagnosis of MERLD for our child from a dev pediatrician. I am wondering if any of you, whose child has the same diagnosis, have faced what we are facing. Some preschool teachers and a psychologist have suggested that our child may have autism even though they know our child has a MERLD diagnosis. Anyone faced this? I know this topic is a sensitive one on this forum.

Having a MERLD diagnosis in a preschooler doesn't rule out autism by today's definition. It just means that your child has both expressive and receptive speech delays at this point. What preschool teachers are probably alluding to is that your child has behavioral problems that they don't know how to address. They don't have any expertise, so they shouldn't be giving suggested diagnoses, just describing the behaviors of concern. That's the point on which you need to ask for more information. (I don't know what to tell you about the psychologist, but there might be something to that.)

Down the road whether your child will outgrow his current delays or given a language and/or communication disorder diagnosis, behavior can be problematic. I would ask for a functional behavioral analysis in the preschool setting and consider doing behavioral or ABA therapy with your child. It doesn't matter if he's on the spectrum or not, it sounds like language/communication issues are interfering with him participating in preschool activities.

OP said they say a developmental ped. The first thing they do is usually rule in/out autism. No insurance is going to pay for ABA or behavioral therapy without an autism diagnosis. Also, depending on the child ABA is not a good fit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:MERLD is only relevant for the preschool age at this point mainly b/c speech delays b/f school age often resolve: http://www.asha.org/public/speech/disorders/Preschool-Language-Disorders/

Past preschool age, children will be given a differential diagnosis according to the latest DSM V in which MERLD does not exist. This could include a language disorder, communication disorder (autism is one, but there are others), and/or ADHD.

MERLD is still relevant for kids after preschool age as it can and often continues into elementary school if not life long. Many kids learn to adapt and cope but the residual effects are still present. It really doesn't matter if it is called a language disorder or MERLD but MERLD is a specific type of language disorder identifying concerns with both expressive and receptive language. For most MERLD kids without other diagnosis, it is called a language disorder but it makes it difficult to say language disorder without identifying receptive and expressive language. A language disorder could mean anything from receptive, expressive, both, apraxia, stuttering and many more. Most parents find it easier to continue to call it MERLD regardless of the official diagnosis if their kids still struggle with receptive and expressive language.

Not all kids with language disorders have communication disorders (including autism) or ADHD/ADD or a learning disorder. Some do, but many do not.

PP, kids can continue to have expressive and receptive language delays into elementary and beyond. However, in the latest DSM V published in 2013, the characteristics of MERLD fall under different diagnoses.

I have two kids who were diagnosed with MERLD as preschoolers by developmental pediatricians. Both have had full educational after age 6 and have received differential diagnoses, neither of which were autism. So either people are living in ignorance that there age 6+ have MERLD or they don't want to do full educational testing b/c they are avoiding a diagnosis.

We have not done full testing. It is not recommended for our child right now. Our developmental ped did some basic testing (including IQ) and did not feel more was warranted. Its not a good idea to keep testing kids over and over again. Not all kids have academic or other issues. You do a full evaluation to understand what is going on, but for some kids, the parents and professionals have a good handle on it, so it is not the best idea in less new issues crop up later. You keep insisting how important it is, and it is important and a good idea for many but not all. OP child is not 6. If your kids have dual or multiple diagnosis and you need to better understand it, it makes sense. You may have had a misdiagnosis of MERLD, but some of our kids actually have MERLD (or what ever you want to call it).

Also, the diagnosis are always ever changing. That doesn't mean even if clinically it falls under different diagnosis, that its not an appropriate term for some of our kids. By us just saying language disorder, you have no clue what is going on. If I say more specific, then you'd understand better.

Yes, it's evident that you haven't had a full educational diagnosis. The diagnoses aren't ever changing. The DSM is updated every few years based on review of the clinical evidence. DSM 4 was published in 2000. DSM 5 published in 2013.

I didn't say that all kids with MERLD end up with academic or other issues--that's your interpretation probably b/c you had a child initially diagnosed with autism. What I said was that a preschooler diagnosed with MERLD
--issues could resolve or could include
--language disorder AND/OR
--communication disorder AND/OR
--ADHD

Could doesn't mean will. An itemized list with commas ending with and/or in a sentence means these are possibilities. There are others.

(So it's great if your young child shows no social or educational issues at the moment. It would probably behoove you have a full educational evaluation b/f he finally leaves the tiny private that he currently attends, especially if he's transitioning to public.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:
MERLD can be an early catch-all when the symptoms don't quite add up to an autism or ADHD diagnosis. What people need to understand is that you don't observe young children and older children with the same battery of tests, and that therefore MERLD diagnoses are more frequent in younger children, and ASD/ADHD/etc diagnoses are more frequent in older children. MERLD is a symptomatic observation. It does NOT mean a 100% risk of Autism diagnosis down the road, but it certainly increases the likehood.

My son was diagnosed with MERLD as a preschooler, then was given a full neuropsych in late elementary and diagnosed with severe ADHD, inattentive type. We refused the additional tests for Asperger's, but we know he has always had Aspie tendencies, and that Aspie tendencies run in my husband's family.

if you refused diagnostic tests how can you speak definitively about it?

You really want to know?
1. Because I'm a research scientist who has read quite a bit of primary research literature on the subject, as well as observed my husband, and his family, closely.
3. Because we talked to several psychiatrists, psychologists and developmental pediatricians over the years, and they all said that yes, DS had tendencies, but even if more tests were done, they still might not lead to a definitive diagnosis. He's on the cusp, and it could go both ways, and it doesn't really matter anyway since we know he has tendencies, know how to manage them, and it's the ADHD which is really burdensome right now.

He has accommodations at school as well as medication for the ADHD, and that is what matters.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We have a diagnosis of MERLD for our child from a dev pediatrician. I am wondering if any of you, whose child has the same diagnosis, have faced what we are facing. Some preschool teachers and a psychologist have suggested that our child may have autism even though they know our child has a MERLD diagnosis. Anyone faced this? I know this topic is a sensitive one on this forum.

Having a MERLD diagnosis in a preschooler doesn't rule out autism by today's definition. It just means that your child has both expressive and receptive speech delays at this point. What preschool teachers are probably alluding to is that your child has behavioral problems that they don't know how to address. They don't have any expertise, so they shouldn't be giving suggested diagnoses, just describing the behaviors of concern. That's the point on which you need to ask for more information. (I don't know what to tell you about the psychologist, but there might be something to that.)

Down the road whether your child will outgrow his current delays or given a language and/or communication disorder diagnosis, behavior can be problematic. I would ask for a functional behavioral analysis in the preschool setting and consider doing behavioral or ABA therapy with your child. It doesn't matter if he's on the spectrum or not, it sounds like language/communication issues are interfering with him participating in preschool activities.

Don't do ABA therapy with MERLD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
MERLD can be an early catch-all when the symptoms don't quite add up to an autism or ADHD diagnosis. What people need to understand is that you don't observe young children and older children with the same battery of tests, and that therefore MERLD diagnoses are more frequent in younger children, and ASD/ADHD/etc diagnoses are more frequent in older children. MERLD is a symptomatic observation. It does NOT mean a 100% risk of Autism diagnosis down the road, but it certainly increases the likehood.

My son was diagnosed with MERLD as a preschooler, then was given a full neuropsych in late elementary and diagnosed with severe ADHD, inattentive type. We refused the additional tests for Asperger's, but we know he has always had Aspie tendencies, and that Aspie tendencies run in my husband's family.

if you refused diagnostic tests how can you speak definitively about it?

You really want to know?
1. Because I'm a research scientist who has read quite a bit of primary research literature on the subject, as well as observed my husband, and his family, closely.
3. Because we talked to several psychiatrists, psychologists and developmental pediatricians over the years, and they all said that yes, DS had tendencies, but even if more tests were done, they still might not lead to a definitive diagnosis. He's on the cusp, and it could go both ways, and it doesn't really matter anyway since we know he has tendencies, know how to manage them, and it's the ADHD which is really burdensome right now.

He has accommodations at school as well as medication for the ADHD, and that is what matters.

Is this the OP? I don't think you necessarily need a definitive diagnosis at the moment. If he has accommodations at school, are they working? And despite what PP mentioned, you can certainly do ABA or behavioral therapy with a child diagnosed with MERLD. I'm also really surprised that you're medicating so early. I would exhaust behavioral options first. If you are medicating, it may be trial and error.

P.S. I find it hilarious that you've been "observing" your husband and his family closely. The only genetic link they've found to autism is older fathers. Plus, as a research scientist, you're probably just as socially awkward as he and his kin are, you just don't realize it.

Bottom line, expressive and receptive delays can cause problems for a kid whether or not they're on the spectrum. Keep treating the symptoms. If you want a more definitive diagnosis wait until your kid is at least age 6 and then get an educational evaluation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
MERLD can be an early catch-all when the symptoms don't quite add up to an autism or ADHD diagnosis. What people need to understand is that you don't observe young children and older children with the same battery of tests, and that therefore MERLD diagnoses are more frequent in younger children, and ASD/ADHD/etc diagnoses are more frequent in older children. MERLD is a symptomatic observation. It does NOT mean a 100% risk of Autism diagnosis down the road, but it certainly increases the likehood.

My son was diagnosed with MERLD as a preschooler, then was given a full neuropsych in late elementary and diagnosed with severe ADHD, inattentive type. We refused the additional tests for Asperger's, but we know he has always had Aspie tendencies, and that Aspie tendencies run in my husband's family.

if you refused diagnostic tests how can you speak definitively about it?

You really want to know?
1. Because I'm a research scientist who has read quite a bit of primary research literature on the subject, as well as observed my husband, and his family, closely.
3. Because we talked to several psychiatrists, psychologists and developmental pediatricians over the years, and they all said that yes, DS had tendencies, but even if more tests were done, they still might not lead to a definitive diagnosis. He's on the cusp, and it could go both ways, and it doesn't really matter anyway since we know he has tendencies, know how to manage them, and it's the ADHD which is really burdensome right now.

He has accommodations at school as well as medication for the ADHD, and that is what matters.

So sounds pretty much like you are scared of an autism diagnosis? Why?

[Anonymous]

You know it doesn't really matter what this kid's diagnosis is. It sounds like he's having a hard time at preschool. OP, is he in the right environment? Have you considered switching to a therapeutic school or more inclusive school?