Can't figure out DS and how to address his needs

[Anonymous]

DS is 3 and has been in PEP for a few month now. He is doing OT, speech, and physical therapy in PEP and we are also doing private OT. He has major speech delays and seems to have some sort of sensory processing disorder. He often is unaware of surroundings, in terms of other people/kids and objects and would bump into them. He also hits other kids and adults (he will come up and just all of a sudden push you with a lot of force). The physical therapist noticed that he has problems sitting straight too. The PEP OT and the private OT have tried a number of things (weighted/compression vests, rocking chairs, etc.), but nothing seems to help and he refuses to try most of those things. In addition, after each OT session, he seems to be more hyper. He also has a very short attention span when it comes to things he doesn't like (e.g. group activities at the table). Further, any deviations from normal patterns/schedule drive him crazy (e.g. going to a different room than his normal classroom). I don't know what else to try and I have no idea what he has (ASD, ADHD, sensory processing disorder). He is very social and loves being around other kids and no repetitive behavior so I don't think it is ASD. Maybe it doesn't matter whether he gets a diagnose right now, but I just want to be able to help him more.

[Anonymous]

It might be too early to get a definitive diagnosis, but have you been to a developmental pediatrician?

I would focus hard on speech and/ or AAC. When kids can't communicate with language, they communicate with behavior.

How is his receptive language?

[Anonymous]

Anonymous wrote:It might be too early to get a definitive diagnosis, but have you been to a developmental pediatrician?

I would focus hard on speech and/ or AAC. When kids can't communicate with language, they communicate with behavior.

How is his receptive language?

OP here...we went to a developmental pediatrician when he was 2.5 and it was not helpful (other than that she told us he may be slow on the cognitive side). I don't know if he is slow cognitively because of speech delays or because of other things (however, he seems intelligent on some level, very good with transformer like toys or electronics). His receptive is getting better but many times I feel like he has selective hearing. For example, I know he knows the word for food, but most times, I have to put the food in front of him for him to pay attention enough to come sit down and eat.

[Anonymous]

Agree to see a developmental pediatrician, and if he hasn't had a thorough speech evaluation (preferably by a private provider, not the county) that would be my next step.

[Anonymous]

Have you had his vision checked?

[Anonymous]

Sounds like my DS, who was diagnosed ASD when younger. Now in middle school, he's definitely ADHD. Medication has helped, but is not a cure-all.

Lots of physical activity - swimming, running, jump rope is a must.

[Anonymous]

Anonymous wrote:Have you had his vision checked?

That is one thing I would like to get checked. Is there a way to get it checked with speech delayed kids? Sometimes, I will wave to him when I am approaching daycare and he won't notice me until I am very close. We did get his hearing checked and it is fine (if not above normal).

[Anonymous]

Anonymous wrote:Agree to see a developmental pediatrician, and if he hasn't had a thorough speech evaluation (preferably by a private provider, not the county) that would be my next step.

We did do private speech for a while but it did not seem to help. His private speech therapist said that there is no point in giving a full diagnose as it doesn't change the treatment. He also seems to drool a lot and his lower jaw always hangs open.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Have you had his vision checked?

That is one thing I would like to get checked. Is there a way to get it checked with speech delayed kids? Sometimes, I will wave to him when I am approaching daycare and he won't notice me until I am very close. We did get his hearing checked and it is fine (if not above normal).

Yes - there is. Go see David Plotsky in Rockville. http://www.docplot.com/

[Anonymous]

Anonymous wrote:

Anonymous wrote:Agree to see a developmental pediatrician, and if he hasn't had a thorough speech evaluation (preferably by a private provider, not the county) that would be my next step.

We did do private speech for a while but it did not seem to help. His private speech therapist said that there is no point in giving a full diagnose as it doesn't change the treatment. He also seems to drool a lot and his lower jaw always hangs open.

I"m not a doctor, and no one can diagnose your kid over the internet. But your child sounds a lot like mine did at that age although mine didn't have receptive speech issues.

When a child has significant delays in receptive and expressive speech, and motor issues --you need to find out if they have developmental coordination disorder (DCD), also called dyspraxia. It's a neurologically based disorder. Many children with DCD can also have apraxia of speech.

Kids can overcome these conditions, but it takes YEARS of treatment -- with an OT or PT for the gross motor issues, and with an SLP experienced in treating motor disorders.

I would 1) try another SLP -- the one you had was correct that it can take a few months with a very young child to land on a firm diagnosis. But the progress in gaining verbal speech may be very slow, it doesn't mean it isn't working. In the meantime your child could be learning to use an augmentative method of communication (sometimes and Ipad or a more paper driven method) to reduce frustration and work on language.

2) Get an appointment iwth a developmental pediatrician at the Kennedy Krieger Institute in Baltimore and get comprehensive recommendations for moving forward.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Have you had his vision checked?

That is one thing I would like to get checked. Is there a way to get it checked with speech delayed kids? Sometimes, I will wave to him when I am approaching daycare and he won't notice me until I am very close. We did get his hearing checked and it is fine (if not above normal).

We had this issue – a speech-delayed kid who followed very quickly in her siblings' (and father's) footsteps of needing glasses very early. We saw a pediatric ophthalmologist, and my DD didn't need to really participate (reading charts, etc.) because the doctor checked everything she needed to know with instruments that a regular optometrist will not have. Everything was incredibly precise, and it really helped our child.

[Anonymous]

I would also try another developmental pediatrician. You need someone who will help you with services and do more follow up. Dr. Dan Shapiro is excellent, although hard to get into (private practice) and does not take insurance.

Otherwise, you may want to try an evaluation with Kennedy Krieger.

[Anonymous]

OP here...thanks for the recommendations. We went to KKI the first time and did not feel like we got much out of the evaluation and report from them. DS has an appointment in November at Children's so hopefully we will get a better idea of how to proceed. We do want to get his vision checked out so that we can at least know if that is the issue or at least contributes to the issue. I just wish there was something I can do to help him stop hitting other people as if he is seeking more sensory input.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Agree to see a developmental pediatrician, and if he hasn't had a thorough speech evaluation (preferably by a private provider, not the county) that would be my next step.

We did do private speech for a while but it did not seem to help. His private speech therapist said that there is no point in giving a full diagnose as it doesn't change the treatment. He also seems to drool a lot and his lower jaw always hangs open.

You definitely need an SLP trained in Prompt to address this. This is one of my kid's problems. It happens because of low tone and weak muscles in the mouth area. As for the behavior, sounds like ADHD to me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Agree to see a developmental pediatrician, and if he hasn't had a thorough speech evaluation (preferably by a private provider, not the county) that would be my next step.

We did do private speech for a while but it did not seem to help. His private speech therapist said that there is no point in giving a full diagnose as it doesn't change the treatment. He also seems to drool a lot and his lower jaw always hangs open.

I"m not a doctor, and no one can diagnose your kid over the internet. But your child sounds a lot like mine did at that age although mine didn't have receptive speech issues.

When a child has significant delays in receptive and expressive speech, and motor issues --you need to find out if they have developmental coordination disorder (DCD), also called dyspraxia. It's a neurologically based disorder. Many children with DCD can also have apraxia of speech.

Kids can overcome these conditions, but it takes YEARS of treatment -- with an OT or PT for the gross motor issues, and with an SLP experienced in treating motor disorders.

I would 1) try another SLP -- the one you had was correct that it can take a few months with a very young child to land on a firm diagnosis. But the progress in gaining verbal speech may be very slow, it doesn't mean it isn't working. In the meantime your child could be learning to use an augmentative method of communication (sometimes and Ipad or a more paper driven method) to reduce frustration and work on language.

2) Get an appointment iwth a developmental pediatrician at the Kennedy Krieger Institute in Baltimore and get comprehensive recommendations for moving forward.

NP here. My child was recently diagnosed Dyspraxia and he sounds similar to yours, minus the behavior issues you mentioned. Speech and OT are the main things we are doing, in addition to accommodations in the school setting via IEP. I of course am not diagnosing your child, just sharing my experience with a child who seems somewhat similar. I think there is probably a lot of overlap though with diagnoses' that include motor issues and language delays, so I would say to get some good/thorough up to date evaluations done, get feedback from the preschool teacher and present it all to a developmental pediatrician at KK, so he/she can take it from there and lead you in the right direction.