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

[Anonymous]

Anonymous wrote:

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?

+1. All you need to do is thank them for their report, and be receptive to their input. Have the occasional conversation or meeting about it.

No, it's not unusual for a 3 year old. What's unusual is that she didn't have trouble with this last year, and that it's in the context of you having concern about her development so the therapist probably thought it would be relevant. What motivated you to get all the assessments that you've had so far?

[Anonymous]

School SLP here, it sounds like she gets distracted during transitions and needs extra prompts to join everyone. They are not alluding to any diagnosis just pointing out the facts of what happened.

You don't need ABA or any other nonsense that PP are suggesting, but maybe your child needs a visual schedule in the classroom. Does she receive speech therapy?

[Anonymous]

,+1 You don't need anymore evaluations you've already done that. Just meet with be the speech therapist and ask your questions.

[Anonymous]

Anonymous wrote:,+1 You don't need anymore evaluations you've already done that. Just meet with be the speech therapist and ask your questions.

No, I think she needs to get on the list for another evaluation at Childrens or KKI or her area equivalent. The wait list will be at least 6 months and that gives plenty of time to see how things develop. The goal here is to have an autism diagnosis (if any) and STRONG IEP when she starts Kindgergarten. Also I’d check in on fine motor with an OT to see if support is needed to be ready to learn writing letters in K.

If there’s any time period to pour on evaluations and resources, it’s to set the child up for a successful mainstream year in K so they stay on track and can access all the wonderful teaching & learning that happens in K and 1st.

I also agree with the PP who gave the script for directly asking the SLP about what she means & recommends.

[Anonymous]

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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.

What state are you in? There is almost certainly an autism or child development clinic at the children’s hospital in your state or region. Better than private evaluations.

[Anonymous]

To me it's significant this is happening at school. I think you take the information and try to figure out why she is acting the way she is. It could be defiance or that she's hyper focusing, but it's likely more about ignoring or a lack of awareness around social cues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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?

+1. All you need to do is thank them for their report, and be receptive to their input. Have the occasional conversation or meeting about it.

No, it's not unusual for a 3 year old. What's unusual is that she didn't have trouble with this last year, and that it's in the context of you having concern about her development so the therapist probably thought it would be relevant. What motivated you to get all the assessments that you've had so far?

But she's 4 now and not 3. There are different expectations of 4 year olds than 3 year olds in preschool. There are more transitions, there is less time between transitions, etc. Even if you are in a play-based preschool, the curriculum is preparing students for a K classroom. Maybe DD didn't struggle as much because she was given more prompts before transitions or maybe there weren't the same expectations around transitions.

[Anonymous]

Anonymous wrote: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.

Op here. She has epilepsy and is on medication for it so the developmental pediatrician is one of the things our neurologist recommended.

You make a good point-we had parent teacher conferences a couple weeks ago and DDs teacher said that DD is a delight. The teacher did say that DD can sometimes be distracted or unwilling to join circle time but the teacher said at 3 this is expected and we still have a whole other year of preschool before DD has to start kindergarten so the teacher is giving DD some flexibility this year. DD is also the youngest in the class so I think the teacher is mindful of that.

[Anonymous]

PP The child has already been evaluated for autism (didn't have it) and given the diagnosis of developmental delayed. I think she has an IEP now. ..? The child will have to be reevaluated by the time she turns six so what's the point in having more evaluations now. OP Put your time and money into receiving therapies and meeting with those therapists to find out recommendations.

Good point to the previous poster who mentioned that the school expectations might be higher at this older grade level.

[Anonymous]

Anonymous wrote:PP The child has already been evaluated for autism (didn't have it) and given the diagnosis of developmental delayed. I think she has an IEP now. ..? The child will have to be reevaluated by the time she turns six so what's the point in having more evaluations now. OP Put your time and money into receiving therapies and meeting with those therapists to find out recommendations.

Good point to the previous poster who mentioned that the school expectations might be higher at this older grade level.

Op here. Thanks. Maybe you’re right.

DD does have an IEP.

The classroom hasn’t changed this year though-same classroom, same teacher, same class size. The therapist is comparing what DD could do at the end of last year and pointing out that DD cannot do those same things this year. I do know it basically took ALL YEAR last year for DD to follow expectations. I guess it is worrisome that we’re two months into the school year and still not back to where we were at the end of last school year.

[Anonymous]

You don't have to do anything. The feedback is informational. Something to keep for your next evaluation, probably before kindergarten. All you have to do is internalize that there's still something going on (as opposed to getting better). You're doing everything already and you seem to be doing great.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

Op here. She has epilepsy and is on medication for it so the developmental pediatrician is one of the things our neurologist recommended.

You make a good point-we had parent teacher conferences a couple weeks ago and DDs teacher said that DD is a delight. The teacher did say that DD can sometimes be distracted or unwilling to join circle time but the teacher said at 3 this is expected and we still have a whole other year of preschool before DD has to start kindergarten so the teacher is giving DD some flexibility this year. DD is also the youngest in the class so I think the teacher is mindful of that.

Ah, that's some good context. I think the epilespy meds could have some side effects on behavior, right? And being the youngest. It's possible this is nothing. If practitioners took really detailed notes of our daily lives, all of us would look very weird! I think your focus should be how well she's able to learn and perform the daily living tasks you'd expect of a 4 year old. As well, she should be enjoying playdates and starting to talk about other kids in class.

[Anonymous]

Anonymous wrote:

Anonymous wrote:PP The child has already been evaluated for autism (didn't have it) and given the diagnosis of developmental delayed. I think she has an IEP now. ..? The child will have to be reevaluated by the time she turns six so what's the point in having more evaluations now. OP Put your time and money into receiving therapies and meeting with those therapists to find out recommendations.

Good point to the previous poster who mentioned that the school expectations might be higher at this older grade level.

Op here. Thanks. Maybe you’re right.

DD does have an IEP.

The classroom hasn’t changed this year though-same classroom, same teacher, same class size. The therapist is comparing what DD could do at the end of last year and pointing out that DD cannot do those same things this year. I do know it basically took ALL YEAR last year for DD to follow expectations. I guess it is worrisome that we’re two months into the school year and still not back to where we were at the end of last school year.

What is the IEP for, though? I agree it's worrisome that she can't do what she was doing last year, but not following instructions is very common for a 3 year old.

Is she older or younger, relative to the other children in the class, than she was before? Teachers tend to calibrate the complexity of their instructions to the students they are working with. Or if she's suddenly surrounded by younger children when she wasn't before, that can certainly be a distraction and a more chaotic environment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP The child has already been evaluated for autism (didn't have it) and given the diagnosis of developmental delayed. I think she has an IEP now. ..? The child will have to be reevaluated by the time she turns six so what's the point in having more evaluations now. OP Put your time and money into receiving therapies and meeting with those therapists to find out recommendations.

Good point to the previous poster who mentioned that the school expectations might be higher at this older grade level.

Op here. Thanks. Maybe you’re right.

DD does have an IEP.

The classroom hasn’t changed this year though-same classroom, same teacher, same class size. The therapist is comparing what DD could do at the end of last year and pointing out that DD cannot do those same things this year. I do know it basically took ALL YEAR last year for DD to follow expectations. I guess it is worrisome that we’re two months into the school year and still not back to where we were at the end of last school year.

What is the IEP for, though? I agree it's worrisome that she can't do what she was doing last year, but not following instructions is very common for a 3 year old.

Is she older or younger, relative to the other children in the class, than she was before? Teachers tend to calibrate the complexity of their instructions to the students they are working with. Or if she's suddenly surrounded by younger children when she wasn't before, that can certainly be a distraction and a more chaotic environment.

Op here. The IEP is for the speech delay, but also I think because of the epilepsy with meds.

DD is still the youngest in the class, but I think maybe has closed the gap somewhat as other kids have graduated to kindergarten.

[Anonymous]

OP, she does have a diagnosis that explains what is going on. She has a GDD diagnosis and epilepsy and these sound like cognitive issues. She likely is not following along. You need genetic testing at some point. But at this point, I agree, you will not know much until you get an IQ test. My son with a low average IQ and epilepsy had similar issues. They are different than autism and that’s what the doctors were telling you. It tracks. I’d stop trying to get a more pin point diagnosis because you may never, and start intensive speech and remedial learning. You may be looking at special school.