Struggling with Diagnosis - Social Issues and Speech Delay

[Anonymous]

Our DS is turning three in a few weeks. He has a severe expressive speech delay and has been in speech therapy for 18 months. He has been evaluated three times (at 18 months, at 2, and just last week) and all evaluations have indicated that this is his only delay and area of concern. He understands words moderately well, is reasonably social with the person testing, can identify most letters and colors, can stack things, and do puzzles up to 50 pieces. At home, he makes eye contact, gives hugs and kisses, and is generally a whiny but cute toddler.

After a year in preschool three days a week, however, our preschool contacted us yesterday regarding concerns about his interactions with his peers. He has started just sitting on the sidelines all day not participating. Sometimes he will play on his own. They said that if he is the first kid to sit down and other kids come to him, he will not leave. He will never approach a group, though, and is the "most solitary kid in class."

His other symptoms don't scream Asperger's to me, but I'm pretty concerned. We just had his annual evaluation that didn't raise these issues, so I'm at a loss as to what this could be or how to help him. FWIW, I've always been a shy person, but I don't want to just chalk it up to shyness and miss something that could explain his issues in tandem and allow us to get him help earlier rather than later.

I welcome any suggestions or thoughts from anyone that has BTDT.

[Anonymous]

Does he have any unusual interests? When the other children come to play with him, is there back-and-forth with them?

[Anonymous]

Anonymous wrote:Does he have any unusual interests? When the other children come to play with him, is there back-and-forth with them?

On interests, not really. He wants to wear a cape and fly everywhere these days, and he is a little obsessed with his ABCs and Frozen. All seems pretty typical.

On back-and-forth, they say not really, although he clearly is listening to the kids and teachers. He will come home with new phrases and things that he clearly is picking up from the preschool and kids.

[Anonymous]

First, you can have expressive delays that cause socialization issues and not be on the spectrum.

Second, who did the evaluations? If it's through early intervention, they don't really diagnose. If your kid has a significant enough delay they can qualify for services, but not qualifying for services doesn't mean your kid doesn't have a delay. If you haven't already, I'd consider getting an evaluation by a developmental pediatrician.

Third, there are lots of social skill groups and speech based summer camp options. There's also the LEAP Preschool at the University of MD as well Dolley Madison in VA that specialize in speech if you're interested in the school year.

[Anonymous]

Meant to add that you can do social skill groups on the weekends too. You can also check out Ivymount's Outreach Programs.

[Anonymous]

Kids this age use language to mediate a lot of their play, so he may be having trouble finding his way into the group. That doesn't mean he's on the spectrum, just that his lack of expressive language is getting in the way of interactive play. Does he have alternative ways to communicate such as AAC or ASL?

I'd ask the teacher for the names of peers she thinks would be good potential playmates, and then invite them over to do some facilitated play and joint activities. That may carry over back into the classroom.

[Anonymous]

Your DS sounds a bit similar to my now 8 yo. He was evaluated by EI at 15 months and was found to have communication skills within normal range. However, by the timehe was 2, it was apparent there was a speech issue. His non-verbal communication and his engagement with us at home were very good but his expressive/receptive speech was very poor. He's the youngest of 3 and seemed very content to interact mostly with his siblings. He's been evaluated extensively (NIH studies have been fabulous and I recommend you join a few because one of the few things I look back on and can say that was an excellent decision is joining those studies - but I digress!). ASD was always on the table for us because he had some of the symptoms but it was always ruled out and as he's gotten older, it's quite clear he does not have an ASD.

He does have apraxia and a communication disorder. He is of average/above average intelligence and capable of age expectation learning. But, he's got the language/communication skills of a kid 3-4 grade below him. He doesn't fit the usual profile of kid with LDs/MERLD. He's not rare, just not common. My oldest also has MERLD but as he's gotten older, he's been less impacted by it and, at least communication wise, is now age appropriate. Not my youngest, it becomes more apparent as he gets older.

With appropriate supports in school, he's been doing very well. He's shown some anxiety and is a loner in groups (can't keep up with conversations, too much going on) but he is well liked and is always greeted by other students at school. We work on making sure he's knowledgeable about things kids his age are interested in (like Minecraft) and can talk about them. He's able to be more spontaneous with language he's familiar with and we give him lots of practice at home.

[Anonymous]

Anonymous wrote:Kids this age use language to mediate a lot of their play, so he may be having trouble finding his way into the group. That doesn't mean he's on the spectrum, just that his lack of expressive language is getting in the way of interactive play. Does he have alternative ways to communicate such as AAC or ASL?

I'd ask the teacher for the names of peers she thinks would be good potential playmates, and then invite them over to do some facilitated play and joint activities. That may carry over back into the classroom.

Yes, yes, 10000 times yes!

As a preschool director, please have 1 child at a time to your house for play - this will help build a bridge that will probably carry over into the classroom. He might not have the expressive ability to go up and suggest something or join in their play and 3 yr olds are starting to play together. But he will still want friends. Now, will the other children engage him? Is there a job your son can do with another child in the classrom (if there is a job where kids both do it, or help each other like putting out cots, mats, lunch boxes) to facilitate making friends? I'd see if your son's speech therapist could come to the classroom and observe and give the teachers suggestions to help bridge that. Is there a place where your son seems to be involved with the other children more (like on the playground when they are running around and using the climbing equipment) or when building blocks, writing with markers, etc.?

[Anonymous]

Anonymous wrote:Meant to add that you can do social skill groups on the weekends too. You can also check out Ivymount's Outreach Programs.

There are no outreach programs for kids that young.

[Anonymous]

I wouldn't wholly rely on a regular pediatrician to be able to catch a developmental delay. So if your annual check-up wasn't revealing, you really should go to a developmental pediatrcian.

Our regular pediatrician flat out told me that my son's arm flapping was nothing to worry about, even at three years old. He has since been diagnosed as ASD and his flapping is now worse. I'm just saying that if it's a concern, get it checked by a specialist.

And fwiw, my ASD son makes good eye contact and is very affectionate and engaging with family so it was hard for me to see it until the picture became clear from his pre-k teacher reporting that he didn't interact properly with other children.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Meant to add that you can do social skill groups on the weekends too. You can also check out Ivymount's Outreach Programs.

There are no outreach programs for kids that young.

Under the services link they do and OP's kid won't be 3 forever:
http://www.ivymount.org/Outreach.cfm?subpage=48

[Anonymous]

The socialization will come when the speech comes. You cannot have social play well without speech (as does imaginary play). My five year old has expressive and receptive and it started to show improvement at 4, and now at 5, he still struggles but its pretty mild per the testing. Socially at school he's doing great. Beginning of the year was a bit of a struggle but his teachers are amazing and now have no concerns. If anything, a few comment he talks constantly and they have to tell him to be quiet (they are thrilled). There are features that look like autism that are common in speech delayed kids, which is why many often get an autism diagnosis when its really a speech issue.

Given he's just turning three, I would not worry. There are a few late talker Facebook groups that are wonderful and really supportive. But, you may need a different school enviroment.

[Anonymous]

Anonymous wrote:I wouldn't wholly rely on a regular pediatrician to be able to catch a developmental delay. So if your annual check-up wasn't revealing, you really should go to a developmental pediatrcian.

Our regular pediatrician flat out told me that my son's arm flapping was nothing to worry about, even at three years old. He has since been diagnosed as ASD and his flapping is now worse. I'm just saying that if it's a concern, get it checked by a specialist.

And fwiw, my ASD son makes good eye contact and is very affectionate and engaging with family so it was hard for me to see it until the picture became clear from his pre-k teacher reporting that he didn't interact properly with other children.

And, we had the opposite experience. Developmental ped made a huge stink about features my son had, such as poor eye contact, some flapping (but he will stop if you say stop), spinning (he was in gymnastics at the time), lining up toys, and other stuff. Now, a few years later, none of the signs are there.

I would be concerned, but if OP is doing speech, hopefully 2-3 times a week, except ABA there isn't anything more that can be done. ABA is not necessary for speech delayed kids and if you have the wrong person, can do more harm than good.

But, I agree don't rely on a regular pediatrician. However, be careful with developmental peds as they don't specialize in speech issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Does he have any unusual interests? When the other children come to play with him, is there back-and-forth with them?

On interests, not really. He wants to wear a cape and fly everywhere these days, and he is a little obsessed with his ABCs and Frozen. All seems pretty typical.

On back-and-forth, they say not really, although he clearly is listening to the kids and teachers. He will come home with new phrases and things that he clearly is picking up from the preschool and kids.

Normal - he may be an early reader.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I wouldn't wholly rely on a regular pediatrician to be able to catch a developmental delay. So if your annual check-up wasn't revealing, you really should go to a developmental pediatrcian.

Our regular pediatrician flat out told me that my son's arm flapping was nothing to worry about, even at three years old. He has since been diagnosed as ASD and his flapping is now worse. I'm just saying that if it's a concern, get it checked by a specialist.

And fwiw, my ASD son makes good eye contact and is very affectionate and engaging with family so it was hard for me to see it until the picture became clear from his pre-k teacher reporting that he didn't interact properly with other children.

And, we had the opposite experience. Developmental ped made a huge stink about features my son had, such as poor eye contact, some flapping (but he will stop if you say stop), spinning (he was in gymnastics at the time), lining up toys, and other stuff. Now, a few years later, none of the signs are there.

I would be concerned, but if OP is doing speech, hopefully 2-3 times a week, except ABA there isn't anything more that can be done. ABA is not necessary for speech delayed kids and if you have the wrong person, can do more harm than good.

But, I agree don't rely on a regular pediatrician. However, be careful with developmental peds as they don't specialize in speech issues.

FYI, many kids on the spectrum naturally outgrow the hand flapping, lining things up, and spinning. I think the question here is how the OP can improve her kid's social interactions.