Waiting on new dev ped - but would you suspect Asd?

[Anonymous]

I know I know I know that nobody can diagnose over the Internet. But we are waiting on seeing a new dev ped for our four year old and I'm frustrated about losing valuable time and worried. Here's the deal. Born at 34 weeks; late to sit; did early intervention for pt; walked on time. Speech issues but did not qualify for services so pursued private, always been described as "mild" speech delays, now in average range, but I can tell not as sophisticated as peers. Dev ped noted at 3 fine motor delays, attention issues, speech receptive mild delay. As a new four noted speech and fine motor improved to average range with therapy. She noted no autistic features. He makes eye contact, greets everyone, tries to engage, joint attention, attached, etc. so diagnosis was severe ADHD.

We have had continuing behavioral problems. He used to throw everything constantly. He does not follow directions. Very impulsive. Has to be watched constantly. Hits occasionally and randomly. Runs away, although this has abated. Seeks negative attention. Will do something over and over again after being asked not to as if obsessed with it. Is defiant. Tantrums every time we say no. Gets very focused on doing something he wants and freaks out if we say no. For example, we talk about going to the pool this summer. He wants to go this morning. He cries and screams when we can't go to the pool and talks about it for at least ten minutes. We are in private preschool and he is having a very difficult time. He's basically got someone with him all the time watching him.

So. Is this autism? Have we missed 4 years not doing what we should be doing? I'm angry and frustrated. The dev ped has been very superficial and I do not trust her and our appointment is not until December with a new one. He will be almost 5. We will probably medicate then.

[Anonymous]

First, big hug. You didn't waste four years. You've raised and loved your kid for the last four despite some challenges. Now you're showing love by having him evaluated so you'll better know how to address these challenges. Your kid is luck to have you. Good job, now just breathe.

[Anonymous]

Thanks. I'm just mad because I have had him evaluated - by a dev ped, by child find, etc., and I'm worried I missed the first three years of intervening. I'm frustrated.

[Anonymous]

Nothing here screams ASD to me.

[Anonymous]

Would you mind sharing who your dev ped is? Belsito?

[Anonymous]

Does it scream extreme behavior challenges? That is what it seems to me. And there is just a total disconnect sometimes. Like, he knows how to behave and he just can't. And at school I feel like he sometimes acts like he doesn't even know he is there. I think it might be anxiety. I don't know. It is so hard. I'm so tired and he's only 4.

[Anonymous]

With all the caveats about not diagnosing over the internet, I don't see how the behaviors point to autism. Severe impulsivity, yes, which fits with the ADHD diagnosis. Also, maybe some severe anxiety, which might be causing the obsessiveness and the tantrumming and the oppositional behaviors. Have you considered CBT approaches? Good luck.

[Anonymous]

It is belsito. Not happy.

[Anonymous]

Anonymous wrote:I know I know I know that nobody can diagnose over the Internet. But we are waiting on seeing a new dev ped for our four year old and I'm frustrated about losing valuable time and worried. Here's the deal. Born at 34 weeks; late to sit; did early intervention for pt; walked on time. Speech issues but did not qualify for services so pursued private, always been described as "mild" speech delays, now in average range, but I can tell not as sophisticated as peers. Dev ped noted at 3 fine motor delays, attention issues, speech receptive mild delay. As a new four noted speech and fine motor improved to average range with therapy. She noted no autistic features. He makes eye contact, greets everyone, tries to engage, joint attention, attached, etc. so diagnosis was severe ADHD.

We have had continuing behavioral problems. He used to throw everything constantly. He does not follow directions. Very impulsive. Has to be watched constantly. Hits occasionally and randomly. Runs away, although this has abated. Seeks negative attention. Will do something over and over again after being asked not to as if obsessed with it. Is defiant. Tantrums every time we say no. Gets very focused on doing something he wants and freaks out if we say no. For example, we talk about going to the pool this summer. He wants to go this morning. He cries and screams when we can't go to the pool and talks about it for at least ten minutes. We are in private preschool and he is having a very difficult time. He's basically got someone with him all the time watching him.

So. Is this autism? Have we missed 4 years not doing what we should be doing? I'm angry and frustrated. The dev ped has been very superficial and I do not trust her and our appointment is not until December with a new one. He will be almost 5. We will probably medicate then.

OP- this sounds like my son at four. More severe but similar type behaviors. He was later diagnosed with ADHD and social programmatic communication disorder-- not ASD.
Of your child has issues with social pragmatics they may "look" ASD, if that makes sense, but may not fit all of the criteria. Non verbal learning disorder could also cause some of the behaviors that you describe.

[Anonymous]

When can you start cbt? I need some immediate help re what type of behavioral therapy to do. And where. I'm having a hard time finding anyone.

[Anonymous]

I am suspecting nvld, I think that totally fits him, actually. Thanks for suggesting that. My gut actually says not Asd but something, something else that isn't being addressed. I guess I just don't know what.

Re belsito, I feel like she is judicious about diagnosis and she really doesn't believe you know with a lot of these kids who are complicate and "mild" - it does not feel mild at all - and I get that. But it's not my approach.

[Anonymous]

Anonymous wrote:I am suspecting nvld, I think that totally fits him, actually. Thanks for suggesting that. My gut actually says not Asd but something, something else that isn't being addressed. I guess I just don't know what.

Re belsito, I feel like she is judicious about diagnosis and she really doesn't believe you know with a lot of these kids who are complicate and "mild" - it does not feel mild at all - and I get that. But it's not my approach.

Sorry - I meant to write that she does not really believe much can be predicted about these kinds of kids, and she is hesitant and conservative. I guess I do understand that, but I don't think it's fitting in our case. I think she pegged us quickly and incorrectly as transient delays.

[Anonymous]

Anonymous wrote:When can you start cbt? I need some immediate help re what type of behavioral therapy to do. And where. I'm having a hard time finding anyone.

I'm PP from above who suggested CBT. We didn't start it until my DD was a bit older, but Alvord Baker therapists came to Maddux (where my DD attended pre-school and pre-K) to talk about CBT for kids her age. They can work with kids at their level because it's concrete. Call Alvord and ask. There are also lots of other CBT therapists around. As for NVLD, that has a significant spatial component, so you would see challenges with spatial abilities or very different ways of solving spatial-based problems. You may have an LD or LDs in your future, but I wouldn't worry about that now - if the behavior is the thing that's causing the most disruption for you and your child, you should try to focus on getting that under control. If it's anxiety-based (or because of ADHD), you might want to consider medication. Medication has been a lifesaver for my DD; it has helped her in every area of her life. If you are interested in that, however, I would see a psychiatrist for the meds (not a dev ped or your regular ped).

[Anonymous]

Anonymous wrote:Does it scream extreme behavior challenges? That is what it seems to me. And there is just a total disconnect sometimes. Like, he knows how to behave and he just can't. And at school I feel like he sometimes acts like he doesn't even know he is there. I think it might be anxiety. I don't know. It is so hard. I'm so tired and he's only 4.

He knows how to behave and just can't" is ADHD impulsive at it's core. Add in slow acquisition of skills (speech and OT) but responds well to therapy and it really sounds like ADHD. And average skills on paper but qualitatively seems immature? That is very typical for ADHD too.

Even if it turns out to be something else, although it doesn't sound like it to me, you did the right thing. You clearly identified his needs and sought out intervention that worked. You are absolutely doing right by him.

I will also say that things will allow certainly get better from here. I say that for a variety of reasons.

1) Kids with special needs are almost always at their most challenging when they are at an age/stage where all kids struggle with the same issue. 3/4 is an age where almost every kid struggles with impulsivity and experiments with defiance, so a kid who is wired that way will be even more that way than at other ages.

2) Play based preschool can be really hard for kids who need a lot of structure, they constantly he the message that "you can choose whatever you want" followed closely by "except that". It is confusing and frustrating. Kindergarten is often easier.

3) Meds will help

4) He will presumably go to K either at public school, which has a ton of expertise in kids with disabilities, or at a school you chose because they are a good match for him.

So, please don't borrow trouble from the future, and know that you're a great parent who has absolutely done right by him so far and will continue to do so.

[Anonymous]

This doesn't scream ASD to me either. The dev ped ruled it out based on these very good indicators:

He makes eye contact, greets everyone, tries to engage, joint attention, attached, etc.

You didn't mention other signs either... so it doesn't look like the dev ped missed anything -- unless you are seeing something new?