Steps for getting evaluated for 4 year old for potential autism

[Anonymous]

Anonymous wrote:Is she in preschool?

Any input from her teachers?

If you're in ffx co, the teachers should help you reach out to Infant Toddler Connection .

Age 4 is too old for the Infants and toddlers program.

[Anonymous]

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Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

Yes, this is the most cost effective way. But a warning that many schools are using outdated concepts of autistic behavior that misses autism in many girls.

Sigh. No, they will perform the ADOS which is the gold standard assessment (and gender neutral). If they don’t do the ADOS then insist on it or to get an independent examination after.

I'm a special ed lawyer. I have never seen a school psychologist perform an ADOS or be certified to do so. They don't even have PhDs. What school district are you in that does the ADOS?

In addition to the poster who said PG, I've seen school psychs administer the ADOS in LCPS and MCPS. You're a special ed lawyer and you don't know that some school psychologists have PhDs? Most are certified with a specialist degree, but there are school psychologists in every local district with PhDs in school psychology. Some are practicing with only their school psych certification and some are also licensed psychologists. Also, the publisher of the ADOS classifies it as needing level C qualifications to administer (which includes certified school psychs at the specialist level) rather than a level N (needs to have a PHD).

What’s with the attitude?

Probably from how frustrating it is to deal with special ed lawyers who make incorrect claims and waste families thousands of dollars!

I'm not the special ed attorney but I feel like the truth is somewhere in between. I don't doubt many school districts can administer the ADOS, the question is will they and if so how long until they will actually do it? Autistic girls (on average) often do better than autistic boys at younger ages and then struggle more at older ages as social demands increase. Unless there is a significant educational impact right now Child Find will wave you off. And even if they don't wave you off their goal will never be to diagnose your child ASAP. They will do what they are legally required to do. It is not their job to provide the top level gold standard of services to treat neurodevelopmental conditions.

The point I am trying to make is that families are ill served by the common notion that you need to panic and pay $$ to get all the services ASAP. if it is autism there is no cure. It’s ok to take some time and consideration. The only thing I would probably fast track is a language delay but even then you can just go straight to an SLP.

Early identification of autism is associated with better outcomes. For us it has been really helpful. My goal is not to save as much money as possible.

There is MUCH less certainty in autism outcomes than that statement suggests. All parents should be attentive and seek care for their kids, but we don’t need scare tactics pushing families to spend money they don’t have on interventions or testing that is not ultimately going to change much.

I'm not using scare tactics. Jfc.

You may think OP's child is too "high functioning" for a diagnosis to matter. I don't know what you are basing this on, but I am here to tell you as a parent of a child in this situation that the diagnosis and therapies have definitely helped our child a ton. We started the therapies before the diagnosis but the diagnosis gave us such a helpful understanding of our child and helped us understand that we needed to stick with the therapies even though DD was doing better. They work, and she needs them.

Ok. Not everyone has $5k to pay for a diagnosis. All I am saying is that there are multiple reasonable and responsible paths. It is not at all like skipping chemo for cancer.

Yes, it sucks that diagnosing and treating autism is not adequately funded and as a result many families do not have access.

Accusing people of using scare tactics because they mention research supported benefits of early identification helps no one. Stop

It IS a scare tactic when it is coupled with advice to avoid free resources (like Childfind or Early Stages or equivalent) and to make people feel like the need to pay a lot on therapies out of pocket. Or even just the fact that ABA companies routinely push 10-20 hours of services weekly.

You sound misinformed. I hope parents are intelligent enough not to listen to you.

I’m a parent of a 13 year old with HFA and many friends with similar kids. I actually know what I am talking about.

You’re telling other parents not to sell early intervention, and also telling them they will be no better off if they seek early intervention. This is blatantly false information.

I think for a lot of parents with high functioning kids, the pressure for “early intervention” is not based on sound research. Particularly when it is used to urge therapies like OT that have little support.

Certainly I would love to tell everyone there is a magic therapy you do at 4 years old but it doesn’t work that way.

We all got IEPs for our kids but also all regret a lot of the stress and over vigilance about things that just were not within our control.

If you waited until 4 then you missed the best years you had.

[Anonymous]

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

[Anonymous]

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Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

Yes, this is the most cost effective way. But a warning that many schools are using outdated concepts of autistic behavior that misses autism in many girls.

Sigh. No, they will perform the ADOS which is the gold standard assessment (and gender neutral). If they don’t do the ADOS then insist on it or to get an independent examination after.

I'm a special ed lawyer. I have never seen a school psychologist perform an ADOS or be certified to do so. They don't even have PhDs. What school district are you in that does the ADOS?

In addition to the poster who said PG, I've seen school psychs administer the ADOS in LCPS and MCPS. You're a special ed lawyer and you don't know that some school psychologists have PhDs? Most are certified with a specialist degree, but there are school psychologists in every local district with PhDs in school psychology. Some are practicing with only their school psych certification and some are also licensed psychologists. Also, the publisher of the ADOS classifies it as needing level C qualifications to administer (which includes certified school psychs at the specialist level) rather than a level N (needs to have a PHD).

What’s with the attitude?

Probably from how frustrating it is to deal with special ed lawyers who make incorrect claims and waste families thousands of dollars!

I'm not the special ed attorney but I feel like the truth is somewhere in between. I don't doubt many school districts can administer the ADOS, the question is will they and if so how long until they will actually do it? Autistic girls (on average) often do better than autistic boys at younger ages and then struggle more at older ages as social demands increase. Unless there is a significant educational impact right now Child Find will wave you off. And even if they don't wave you off their goal will never be to diagnose your child ASAP. They will do what they are legally required to do. It is not their job to provide the top level gold standard of services to treat neurodevelopmental conditions.

The point I am trying to make is that families are ill served by the common notion that you need to panic and pay $$ to get all the services ASAP. if it is autism there is no cure. It’s ok to take some time and consideration. The only thing I would probably fast track is a language delay but even then you can just go straight to an SLP.

Early identification of autism is associated with better outcomes. For us it has been really helpful. My goal is not to save as much money as possible.

There is MUCH less certainty in autism outcomes than that statement suggests. All parents should be attentive and seek care for their kids, but we don’t need scare tactics pushing families to spend money they don’t have on interventions or testing that is not ultimately going to change much.

I'm not using scare tactics. Jfc.

You may think OP's child is too "high functioning" for a diagnosis to matter. I don't know what you are basing this on, but I am here to tell you as a parent of a child in this situation that the diagnosis and therapies have definitely helped our child a ton. We started the therapies before the diagnosis but the diagnosis gave us such a helpful understanding of our child and helped us understand that we needed to stick with the therapies even though DD was doing better. They work, and she needs them.

Ok. Not everyone has $5k to pay for a diagnosis. All I am saying is that there are multiple reasonable and responsible paths. It is not at all like skipping chemo for cancer.

Yes, it sucks that diagnosing and treating autism is not adequately funded and as a result many families do not have access.

Accusing people of using scare tactics because they mention research supported benefits of early identification helps no one. Stop

It IS a scare tactic when it is coupled with advice to avoid free resources (like Childfind or Early Stages or equivalent) and to make people feel like the need to pay a lot on therapies out of pocket. Or even just the fact that ABA companies routinely push 10-20 hours of services weekly.

You sound misinformed. I hope parents are intelligent enough not to listen to you.

I’m a parent of a 13 year old with HFA and many friends with similar kids. I actually know what I am talking about.

You’re telling other parents not to sell early intervention, and also telling them they will be no better off if they seek early intervention. This is blatantly false information.

I think for a lot of parents with high functioning kids, the pressure for “early intervention” is not based on sound research. Particularly when it is used to urge therapies like OT that have little support.

Certainly I would love to tell everyone there is a magic therapy you do at 4 years old but it doesn’t work that way.

We all got IEPs for our kids but also all regret a lot of the stress and over vigilance about things that just were not within our control.

I'm sorry OT wasn't helpful for you, and I have friends with similar frustrations so I definitely believe it and I don't in any way want to discount your experience.

I do want to share for OP's benefit that OT has been immensely helpful for us (we started it at age 4 and DC is 6 now). We were very fortunate that despite not having an ASD diagnosis at the time, we were matched with a therapist whose main area of expertise is autism. Although the initial OT eval we did (with another therapist at the same practice) focused a lot on sensory stuff that I didn't really understand, the OT sessions are all about executive functioning, play skills and social skills. For my child that was extremely reserved and gets overwhelmed with multiple step directions, it has really helped her confidence and built her skills.

[Anonymous]

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Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

Yes, this is the most cost effective way. But a warning that many schools are using outdated concepts of autistic behavior that misses autism in many girls.

Sigh. No, they will perform the ADOS which is the gold standard assessment (and gender neutral). If they don’t do the ADOS then insist on it or to get an independent examination after.

I'm a special ed lawyer. I have never seen a school psychologist perform an ADOS or be certified to do so. They don't even have PhDs. What school district are you in that does the ADOS?

In addition to the poster who said PG, I've seen school psychs administer the ADOS in LCPS and MCPS. You're a special ed lawyer and you don't know that some school psychologists have PhDs? Most are certified with a specialist degree, but there are school psychologists in every local district with PhDs in school psychology. Some are practicing with only their school psych certification and some are also licensed psychologists. Also, the publisher of the ADOS classifies it as needing level C qualifications to administer (which includes certified school psychs at the specialist level) rather than a level N (needs to have a PHD).

What’s with the attitude?

Probably from how frustrating it is to deal with special ed lawyers who make incorrect claims and waste families thousands of dollars!

I'm not the special ed attorney but I feel like the truth is somewhere in between. I don't doubt many school districts can administer the ADOS, the question is will they and if so how long until they will actually do it? Autistic girls (on average) often do better than autistic boys at younger ages and then struggle more at older ages as social demands increase. Unless there is a significant educational impact right now Child Find will wave you off. And even if they don't wave you off their goal will never be to diagnose your child ASAP. They will do what they are legally required to do. It is not their job to provide the top level gold standard of services to treat neurodevelopmental conditions.

The point I am trying to make is that families are ill served by the common notion that you need to panic and pay $$ to get all the services ASAP. if it is autism there is no cure. It’s ok to take some time and consideration. The only thing I would probably fast track is a language delay but even then you can just go straight to an SLP.

Early identification of autism is associated with better outcomes. For us it has been really helpful. My goal is not to save as much money as possible.

There is MUCH less certainty in autism outcomes than that statement suggests. All parents should be attentive and seek care for their kids, but we don’t need scare tactics pushing families to spend money they don’t have on interventions or testing that is not ultimately going to change much.

I'm not using scare tactics. Jfc.

You may think OP's child is too "high functioning" for a diagnosis to matter. I don't know what you are basing this on, but I am here to tell you as a parent of a child in this situation that the diagnosis and therapies have definitely helped our child a ton. We started the therapies before the diagnosis but the diagnosis gave us such a helpful understanding of our child and helped us understand that we needed to stick with the therapies even though DD was doing better. They work, and she needs them.

Ok. Not everyone has $5k to pay for a diagnosis. All I am saying is that there are multiple reasonable and responsible paths. It is not at all like skipping chemo for cancer.

Yes, it sucks that diagnosing and treating autism is not adequately funded and as a result many families do not have access.

Accusing people of using scare tactics because they mention research supported benefits of early identification helps no one. Stop

It IS a scare tactic when it is coupled with advice to avoid free resources (like Childfind or Early Stages or equivalent) and to make people feel like the need to pay a lot on therapies out of pocket. Or even just the fact that ABA companies routinely push 10-20 hours of services weekly.

You sound misinformed. I hope parents are intelligent enough not to listen to you.

I’m a parent of a 13 year old with HFA and many friends with similar kids. I actually know what I am talking about.

You’re telling other parents not to sell early intervention, and also telling them they will be no better off if they seek early intervention. This is blatantly false information.

I think for a lot of parents with high functioning kids, the pressure for “early intervention” is not based on sound research. Particularly when it is used to urge therapies like OT that have little support.

Certainly I would love to tell everyone there is a magic therapy you do at 4 years old but it doesn’t work that way.

We all got IEPs for our kids but also all regret a lot of the stress and over vigilance about things that just were not within our control.

If you waited until 4 then you missed the best years you had.

This is just not true - not supported at all by any kind of definitive evidence. But yes, this is the reason why Children’s now has to triage - because parents panic at any sign of difference and sign their kid up to be evaluated.

[Anonymous]

Anonymous wrote:

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Anonymous wrote:Just FYI - Children's is no longer evaluating children for autism who are older than 4 (48 months).

Really? Any sources? Why? DD did the evaluation spring 2024 when she was age 5 at children hospital. She got provisional autism diagnosis.

from the Children’s website:

“ CASD, along with many other autism centers nationwide, is struggling to meet our community’s evaluation needs. We currently have waitlists that exceed two years for many services and have made the difficult decision to temporarily close our evaluation waitlists. At this time, we are only able to accept referrals for patients requiring evaluation related to gender and autism care needs or young children (children below 48 months) with autism concerns requiring initial diagnostic evaluation. This decision was made to help encourage families to seek services elsewhere in the community because we are unable to offer them in a reasonable timeframe. It will also allow our team to work on new models of care that will enable us to support more families in the future.”

Reading between the lines - the “worried well” are likely clogging up the system seeking out “full neuropsychs” for their kids with very low support needs - the consequences of the lowered DSM-V standards in action. So Children’s has opted to focus on the younger kids who are likely to have more severe needs and actually need the resources.

Absolutely, kids that get diagnoses before age 4 are likely to have higher support needs than children where autism concerns emerge later. However, to suggest that any family with a child over age 4 concerned about autism is just the "worried well" is patently false and offensive. That's your interpretation and is not at all what I infer from the Children's statement.

I bet a LOT if you asked the Children’s administrators and clinicians that is exactly what they would say: there is a flood of anxious parents with kids barely on the spectrum on the wait list, meaning that kids that are more in need have a harder time than they should getting seen. and they almost certainly mean the schools when they talk about other “community resources.”

There are mountains of research that contradict your implication that kids that don't get a diagnosis before age 4 don't really need a diagnosis and don't actually need any support. That is why I doubt that experts at Children's would so much as imply this because I can't imagine they believe it. And again, I think it's a reasonable choice to focus on evaluating younger kids as one of the two major places that takes insurance.

If the kids are level 2 or 3 autism - yes it would really be a big miss if they got diagnosed after 4. That is why Children’s is focused on that age cutoff. The issue is all the kids going for testing who are normal IQ/no language delay at older ages taking up resources.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

Stop with the misinformation. They absolutely do evaluate for autism.

[Anonymous]

Anonymous wrote:

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Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

Yes, this is the most cost effective way. But a warning that many schools are using outdated concepts of autistic behavior that misses autism in many girls.

Sigh. No, they will perform the ADOS which is the gold standard assessment (and gender neutral). If they don’t do the ADOS then insist on it or to get an independent examination after.

I'm a special ed lawyer. I have never seen a school psychologist perform an ADOS or be certified to do so. They don't even have PhDs. What school district are you in that does the ADOS?

In addition to the poster who said PG, I've seen school psychs administer the ADOS in LCPS and MCPS. You're a special ed lawyer and you don't know that some school psychologists have PhDs? Most are certified with a specialist degree, but there are school psychologists in every local district with PhDs in school psychology. Some are practicing with only their school psych certification and some are also licensed psychologists. Also, the publisher of the ADOS classifies it as needing level C qualifications to administer (which includes certified school psychs at the specialist level) rather than a level N (needs to have a PHD).

What’s with the attitude?

Probably from how frustrating it is to deal with special ed lawyers who make incorrect claims and waste families thousands of dollars!

I'm not the special ed attorney but I feel like the truth is somewhere in between. I don't doubt many school districts can administer the ADOS, the question is will they and if so how long until they will actually do it? Autistic girls (on average) often do better than autistic boys at younger ages and then struggle more at older ages as social demands increase. Unless there is a significant educational impact right now Child Find will wave you off. And even if they don't wave you off their goal will never be to diagnose your child ASAP. They will do what they are legally required to do. It is not their job to provide the top level gold standard of services to treat neurodevelopmental conditions.

The point I am trying to make is that families are ill served by the common notion that you need to panic and pay $$ to get all the services ASAP. if it is autism there is no cure. It’s ok to take some time and consideration. The only thing I would probably fast track is a language delay but even then you can just go straight to an SLP.

Early identification of autism is associated with better outcomes. For us it has been really helpful. My goal is not to save as much money as possible.

There is MUCH less certainty in autism outcomes than that statement suggests. All parents should be attentive and seek care for their kids, but we don’t need scare tactics pushing families to spend money they don’t have on interventions or testing that is not ultimately going to change much.

I'm not using scare tactics. Jfc.

You may think OP's child is too "high functioning" for a diagnosis to matter. I don't know what you are basing this on, but I am here to tell you as a parent of a child in this situation that the diagnosis and therapies have definitely helped our child a ton. We started the therapies before the diagnosis but the diagnosis gave us such a helpful understanding of our child and helped us understand that we needed to stick with the therapies even though DD was doing better. They work, and she needs them.

Ok. Not everyone has $5k to pay for a diagnosis. All I am saying is that there are multiple reasonable and responsible paths. It is not at all like skipping chemo for cancer.

Yes, it sucks that diagnosing and treating autism is not adequately funded and as a result many families do not have access.

Accusing people of using scare tactics because they mention research supported benefits of early identification helps no one. Stop

It IS a scare tactic when it is coupled with advice to avoid free resources (like Childfind or Early Stages or equivalent) and to make people feel like the need to pay a lot on therapies out of pocket. Or even just the fact that ABA companies routinely push 10-20 hours of services weekly.

You sound misinformed. I hope parents are intelligent enough not to listen to you.

I’m a parent of a 13 year old with HFA and many friends with similar kids. I actually know what I am talking about.

You’re telling other parents not to sell early intervention, and also telling them they will be no better off if they seek early intervention. This is blatantly false information.

I think for a lot of parents with high functioning kids, the pressure for “early intervention” is not based on sound research. Particularly when it is used to urge therapies like OT that have little support.

Certainly I would love to tell everyone there is a magic therapy you do at 4 years old but it doesn’t work that way.

We all got IEPs for our kids but also all regret a lot of the stress and over vigilance about things that just were not within our control.

I'm sorry OT wasn't helpful for you, and I have friends with similar frustrations so I definitely believe it and I don't in any way want to discount your experience.

I do want to share for OP's benefit that OT has been immensely helpful for us (we started it at age 4 and DC is 6 now). We were very fortunate that despite not having an ASD diagnosis at the time, we were matched with a therapist whose main area of expertise is autism. Although the initial OT eval we did (with another therapist at the same practice) focused a lot on sensory stuff that I didn't really understand, the OT sessions are all about executive functioning, play skills and social skills. For my child that was extremely reserved and gets overwhelmed with multiple step directions, it has really helped her confidence and built her skills.

PP here. We benefitted from OT at 4 as well - for about 6-8 months. With no autism diagnosis needed because the concrete motor skills challenges were objective and had a billing code. I’m very in favor of evidence based therapies that address clear need.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

Stop with the misinformation. They absolutely do evaluate for autism.

No they do not. Infants and toddlers, child find and the public schools will not diagnose that. They will diagnose the language/education issues associated with Autism but not the Autism itself. I’ve worked in special education in MCPS for 15 years.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

Stop with the misinformation. They absolutely do evaluate for autism.

At best, they will identify issues that make a student eligible for services under an autism eligibility code. They don't have the expertise to make medical diagnoses.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

Stop with the misinformation. They absolutely do evaluate for autism.

At best, they will identify issues that make a student eligible for services under an autism eligibility code. They don't have the expertise to make medical diagnoses.

Exactly-If the counties/schools were doing these types of evaluations to diagnose Autism nobody would be waiting years on waiting lists for insurance covered evaluations or paying thousands for private evaluations.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Unless you are made of money, start with your county or state free evaluation which will also set you up for an IEP. If you want something more specialized most large hospitals and all childrens hospitals have autism clinics likely covered by insurance.

The state/county do evaluations for services but do not evaluate for Autism. The places mentioned-KK and Children’s are covered by insurance for evaluations but have more than a year waiting list typically. But the free state/county evaluations will get someone in services if needed so that’s always a good place to start but they definitely won’t diagnose Autism.

Wrong. We got an autism diagnosis from a psychologist in the Montgomery County Infants and Toddlers program, and it was accepted by our insurance to begin ABA.