I’m uneasy

[Anonymous]

I can’t quite figure out what I’m seeing but I would love some ideas on how to either stop worrying or do something about it. Right now I feel like I’m stuck in limbo. I have an almost-three year old boy. He was diagnosed with apraxia at two (not “officially” but highly suspected) and has been in intensive speech therapy since then. He’s now speaking sentences and even if they’re sloppy we are thrilled with his progress. He’s affectionate, engaged, makes eye contact, shows us things, wants to play with us.... and yet. Something is making me uneasy. When we are around other kids I can’t shake the feeling my son is not quite the same as other kids. Is this the language delay? He had never sung. He was a late waver although he always pointed. He likes other kids but he’s also happy to play alone. He warms up to groups slowly - he tends to stand back and watch intently in a way that seems much older than his peers. He’s never been incredibly affectionate unless he’s sick. He definitely had a little sensory seeking behavior and has moments where he seems out of control of his own boys. He has a couple of strange things - he pushes up his sleeves obsessively, he hates swings, he can’t ride a tricycle.... but nothing that appears to interfere with his ability to function. We have asked his teachers and SLPs and they think he’s doing great. They have repeatedly ruled out autism. Does this sound crazy? What am I picking up on? Are some kids just slightly odd? Do they put grow it? Have I been overly sensitized by his early CAS diagnosis? What would you do if you were me?

[Anonymous]

I think apraxia usually doesn’t travel alone and I would expect other issues. You should do the ADOS. It may be asd.

[Anonymous]

Yes, that can be very normal with a speech delay, especially receptive. Are you sure its apraxia? Its often overdiagnosed and at that age hard to tell until they talk. With speech delays it is normal they do things like bikes later. Get him a good scooter like the micro or Y brand.

[Anonymous]

Anonymous wrote:Yes, that can be very normal with a speech delay, especially receptive. Are you sure its apraxia? Its often overdiagnosed and at that age hard to tell until they talk. With speech delays it is normal they do things like bikes later. Get him a good scooter like the micro or Y brand.

OP here. We are almost positive it’s apraxia. He’s been evaluated now 4-5 times privately, through strong start and early stages. They all have shown his receptive language is fine. But with his peers and interactions he’s been almost always 6-9 months behind. He just started imaginary play. I can’t put my finger on exactly what I’m seeing, which is so frustrating. I just don’t know what I should do other than wait and see?

[Anonymous]

Anonymous wrote:I can’t quite figure out what I’m seeing but I would love some ideas on how to either stop worrying or do something about it. Right now I feel like I’m stuck in limbo. I have an almost-three year old boy. He was diagnosed with apraxia at two (not “officially” but highly suspected) and has been in intensive speech therapy since then. He’s now speaking sentences and even if they’re sloppy we are thrilled with his progress. He’s affectionate, engaged, makes eye contact, shows us things, wants to play with us.... and yet. Something is making me uneasy. When we are around other kids I can’t shake the feeling my son is not quite the same as other kids. Is this the language delay? He had never sung. He was a late waver although he always pointed. He likes other kids but he’s also happy to play alone. He warms up to groups slowly - he tends to stand back and watch intently in a way that seems much older than his peers. He’s never been incredibly affectionate unless he’s sick. He definitely had a little sensory seeking behavior and has moments where he seems out of control of his own boys. He has a couple of strange things - he pushes up his sleeves obsessively, he hates swings, he can’t ride a tricycle.... but nothing that appears to interfere with his ability to function. We have asked his teachers and SLPs and they think he’s doing great. They have repeatedly ruled out autism. Does this sound crazy? What am I picking up on? Are some kids just slightly odd? Do they put grow it? Have I been overly sensitized by his early CAS diagnosis? What would you do if you were me?

Much of this is typical behavior for a child with language delays in my experience.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, that can be very normal with a speech delay, especially receptive. Are you sure its apraxia? Its often overdiagnosed and at that age hard to tell until they talk. With speech delays it is normal they do things like bikes later. Get him a good scooter like the micro or Y brand.

OP here. We are almost positive it’s apraxia. He’s been evaluated now 4-5 times privately, through strong start and early stages. They all have shown his receptive language is fine. But with his peers and interactions he’s been almost always 6-9 months behind. He just started imaginary play. I can’t put my finger on exactly what I’m seeing, which is so frustrating. I just don’t know what I should do other than wait and see?

Do intensive speech and wait. Not much more you can do. 2-4/5 is very hard with language delays. As the speech comes, everything else should change/get better.

[Anonymous]

He has apraxia.

[Anonymous]

Hey OP I have a similar kid! OT helped a LOT in helping him
build confidence playing physically. He was not really into imaginary play until 3.5 then he loved it. Autism has also been ruled out but he get support on social skills in K with an IEP. At 7 we will do full testing (I suspect adhd inattentive, anxiety, and just being unique, but would not be surprised to find very mild HFA.) I may also get some more intensive support for social skills next year.

[Anonymous]

OP again. I appreciate this. Maybe it’s just getting harder now because his peers’ language is exploding and he’s on a different path.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, that can be very normal with a speech delay, especially receptive. Are you sure its apraxia? Its often overdiagnosed and at that age hard to tell until they talk. With speech delays it is normal they do things like bikes later. Get him a good scooter like the micro or Y brand.

OP here. We are almost positive it’s apraxia. He’s been evaluated now 4-5 times privately, through strong start and early stages. They all have shown his receptive language is fine. But with his peers and interactions he’s been almost always 6-9 months behind. He just started imaginary play. I can’t put my finger on exactly what I’m seeing, which is so frustrating. I just don’t know what I should do other than wait and see?

MY kid with MERLD (diagnosed around 4) really never engaged in imaginative play. he simply didn't have the language skills to tell a story - he couldn't generate plot elements or details or organize a story line. In MS now it's still hard. He also has slow processing issues, which make it hard to engage in conversational exchanges because by the time he has processed and formulated what he wants to say, the conversation has moved on and it's to longer appropriate to say what he wanted to say. He also hated loud noises.

FWIW, as he grew older he was diagnosed with dysgraphia, developmental coordination disorder, ADD-Inattentive w/ executive dysfunction and slow processing along with reading disorder NOS at times. We sent him to a SN school for a couple of years specializing in reading. And yet, despite all the diagnoses he is a very smart kid who is mainstreamed and doing well in school, with some help and structure at home and an IEP at school which mainly provides the accommodations he needs (special instruction provided by the school is worthless, YMMV).

I fully expect him to graduate HS and to go to college.

Receptive and expressive language can be at different levels. Being behind in expressive levels can make it difficult to interact with peers. Also being behind in social praatic communication can make groups or pairs difficult.

[Anonymous]

Anonymous wrote:OP again. I appreciate this. Maybe it’s just getting harder now because his peers’ language is exploding and he’s on a different path.

Children with language delay tend to be behind in play skills. My daughters imaginative play didn’t pick up until 4-5.

I suggest you get a private evaluation with Mary camarata

[Anonymous]

Everyone will tell you that kids with language delays also have delayed social skills, which is true. Everyone told me the same about my child who was diagnosed with apraxia at 3 but I felt something was still off. At 6 we finally got a confirmed ASD diagnosis. Trust your mom instinct and have him do the Ados. I wish we had done it earlier, it would have helped insurance costs so much more with an earlier ASD diagnosis

[Anonymous]

Anonymous wrote:Everyone will tell you that kids with language delays also have delayed social skills, which is true. Everyone told me the same about my child who was diagnosed with apraxia at 3 but I felt something was still off. At 6 we finally got a confirmed ASD diagnosis. Trust your mom instinct and have him do the Ados. I wish we had done it earlier, it would have helped insurance costs so much more with an earlier ASD diagnosis

Sometimes its a language delay, sometimes ASD. The problem is if you have an ASD and its not ASD, that follows the child forever and it causes other issues. My child was clearly a language delay and yes, social skills are impacted.

[Anonymous]

There's a tendency on this board to feel that everything is a "red flag" for autism. Language delays have profound impacts on every sphere of development, which is why early intervention becomes so important.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Everyone will tell you that kids with language delays also have delayed social skills, which is true. Everyone told me the same about my child who was diagnosed with apraxia at 3 but I felt something was still off. At 6 we finally got a confirmed ASD diagnosis. Trust your mom instinct and have him do the Ados. I wish we had done it earlier, it would have helped insurance costs so much more with an earlier ASD diagnosis

Sometimes its a language delay, sometimes ASD. The problem is if you have an ASD and its not ASD, that follows the child forever and it causes other issues. My child was clearly a language delay and yes, social skills are impacted.

And sometimes it's something else. My kid has a genetic disorder which we figured out around this age. He also has apraxia and other issues. If you're gut is telling you something is wrong take steps to suss it out, better now than later and you will feel better to be doing something.

I assume you are already doing early intervention in DC/your county. If not, start.
Get a work up from a developmental pediatrician. Get on the waiting list at CNMC, KKI or look for a private one. Search the recommendations here.
The balance and especially the swing issues mean there are vestibular issues--you can get an assessment from an OT (who will probably recommend private OT).
Look into getting an assessment with a neurodevelopment psychologist and/or the autism clinic at CNMC.
Full workup from your ped including the baseline genetic tests that most pets can run and a full CBC. Everybody wants to jump on autism but many medical issues can begin to manifest at this time as peers advance.