OP, my child has auditory processing problems, a language disorder, and ADD/Inattentive, but most definitely is NOT autistic or on the autistic spectrum in any way. The way you describe how your nephew's verbal expressive weaknesses make social interaction hard for him is much more consistent with Mixed Expressive/Receptive Language Disorder (MERLD) than autism, IMO. The lack of expressive narrative imaginative play is exactly like my child. That lack of play, IME, has not only social impacts, but later language impacts. For example, if you do not have a lot of imaginative verbally narrated play as a child, you are not practicing expressive speech as much nor are you learning how to organize a story, etc. So, at a later age, when these skills are expected, the child is not at a normal developmental point.

IME, a very good speech/langauge assessment can tease out the underlying language problems, but schools are not really well qualified to do this. Nor is a developmental pediatrician or psychiatrist or psychologist. These all give just the most general overviews of language development.

Who gave the PDD-NOS diagnosis? Did that come from the school system? Schools are reluctant to code for anything more specific than PDD below age 7 (slightly later in some states) unless the diagnosis is very obvious. This is because the skills needed to clearly diagnose a language disorder (like reading and writing) are not even expected to develop until the 6-8 age window. Similarly, with ADD, a child generally can't even be tested for ADD reliably before age 6, because the testing relies on skills that the average child won't have until 6 or later.

Has your sister had your nephew evaluated with a full speech and language assessment and full neuropsych (it might be a bit early for the neuropsych, but definitely could be done by age 7) outside of the school system? If not, this should definitely be done. Most neuropsychs can make the differential diagnosis between autism and MERLD and ADD, but it will help if there is the fuller speech/language assessment from a SL pathologist to consider while making the diagnosis.

IME, schools are not that well qualified to differentiate between more functional autism and moderate to severe language problems. They are also often motivated to steer toward the autism diagnosis because many school systems have autism programs whereas they don't have programs for those with serious language disorders.

Anonymous wrote:

Schools think every kid who has special needs is autistic. They are driving the autism "epidemic.'

Glad you said this. Sure seemed that way to me after reading this thread.

Schools think every kid who has special needs is autistic. They are driving the autism "epidemic.'

Anonymous wrote:Can a child have Auditory Processing disorder, ADD, and a language disorder? Or would most physicians just call this ASD?

My nephew was a rule out PDD NOS at 2 yo. But now at 6 y.o. I do not think he is still on the spectrum. I think he has multiple disorders especially a language deficit which impacts everything. I believe he thinks socially, and can be social without a lot of language. He likes to do things with friends, especially non language based activities - like play at the park, or crafts etc. He likes kids and asks for them, and smiles at them, but is not very verbally comfortable with them. He can do the "basics" like greeting and showing them around the house, showing his toys, etc. but when it comes to pretend play he just can not keep up verbally.

Also my sister has him on celexa for severe anxiety. He started speaking and answering us immediately after this. So I even wonder if he had selective mutism. Anyway, he has a lot of things going on, but he is so compassionate and always has been. He is so affectionate and always has looked at us, his family, in the face and been aware of our feelings and seemed emotional in tune with us. He has no negative behaviors. And does not some reassurance when things change, because of his anxiety. His teachers call him a people pleaser and perfectionist.

I think this school thinks he is Autistic. Of course this is fine if appropriate, but to me he is so much more improved since he was 2 y.o. Could this be MERLD? He definitely is a visual learner.

Does any know someone who spends time getting to know the child and family before giving an ASD diagnosis? If it is autism I would be really surprised. I just think it is something else and would like someone who did not use a language based test but other ways to determine what is going on?

I understand there is a different approach with ASD and Merld or significant Language Disorder and would want to make sure we were using the appropriate techniques at home and in class.

Where are you coming from, or rather going, with this? It sounds like your sister has been getting her DC the help he needs. You "think" the school thinks he's autistic? Surely, your sister has the specific information about whats going on. You should bring these questions to her.

My DS has multiple diagnoses: ADHD (inattentive/impulsive), language disorder, coordination disorder, GAD. He also has some stereotypy behaviors. He was evaluated twice by NIH, by a dev ped and, just recently, by neuropsychologist. He doesn't meet the criteria for ASD. In combination, I understand why some would suspect ASD and, in fact, his school suggested it at the last round of IEP meetings which, in part, led us to the recent neuropsych eval.

Kids with multiple disorders can be very complex and it's important to have thorough evaluations done by competent professionals in order to determine the presentation and impact of the disorders. In our case, the school was attributing DS's social challenges to ASD when, in fact, they were a result of language and anxiety. What they perceived as a lack of interest in other kids was really his inability to follow/contribute to conversation. When the language load is less heavy, he's social and participatory. The anxiety just makes it all worse. DS is also good at faking understanding by reading body language and other cues - which is why standardized testing is so critical. We found that the testing done by the school was not sufficient. IME, the school has far fewer assessment tools available than a neuropsych, their interpretations are primarily focused on academics and (again, this is my experience), there's a conflict of interest in that they are required by law to provide appropriate services but they don't have sufficient resources.

Multiple diagnoses of DSM-recognized disorders are possible and in fact likely because of the way diagnoses are made and the way the DSM is divided up: certain numbers of symptoms for certain periods of time. But the symptoms that pertaining to your child may cross disorders. This the multiple diagnoses.

My DS had anxiety,ADD,MERLD and Auditory processing diagnosis between ages 3-4
Then at age 4 he got the PDD-NOS diagnosis added ( by the same neuropsychologist)
She said he might probably outgrow some of these by age 6
She said; he will talk/move/write ; but
the quality will be different.
At age 5.5, his differences are still noticable but much less.

Anonymous wrote:Yes, you have those things together and not have an ASD.

ASD is marked by impairments in a triad of areas: social interaction, social language and repetitive behavior and restricted interests. It can occur with attention issues or without attention issues.

Children can have language issues and auditory processing issues without having ADD. They can can have those things with ADD, too.

Yes you can be non-ASD and have multiple disorders. Anxiety can also be present too with or without ASD, which sounds like your nephew has if he's been prescribed Celexa.

If he's 6, he should probably have a neuropsych evaluation done by a psychologist. They can test for speech delays, pragmatic issues, autism, adhd, etc. Don't get too hung up on whether or not he's on the spectrum. (Ruling out something at 2 doesn't mean much. PDD-NOS doesn't exist any longer in any case in the DSM.) He must have been evaluated by someone fairly recently to diagnose the anxiety since he's been prescribed medication.

At home/school techniques aren't going to vary too much whether he is ASD or not from what you described. It also doesn't really matter what the school labels him as long as he gets appropriate services. It sounds like he needs lots of speech therapy at a minimum. I wouldn't depend on the school to meet all his needs. Supplementing with private is always a good idea. Keep in mind that it's not really your place to suggest these things unless his parents ask.

Yes, you have those things together and not have an ASD.

ASD is marked by impairments in a triad of areas: social interaction, social language and repetitive behavior and restricted interests. It can occur with attention issues or without attention issues.

Children can have language issues and auditory processing issues without having ADD. They can can have those things with ADD, too.

Anonymous wrote:Can a child have Auditory Processing disorder, ADD, and a language disorder? Or would most physicians just call this ASD?

My nephew was a rule out PDD NOS at 2 yo. But now at 6 y.o. I do not think he is still on the spectrum. I think he has multiple disorders especially a language deficit which impacts everything. I believe he thinks socially, and can be social without a lot of language. He likes to do things with friends, especially non language based activities - like play at the park, or crafts etc. He likes kids and asks for them, and smiles at them, but is not very verbally comfortable with them. He can do the "basics" like greeting and showing them around the house, showing his toys, etc. but when it comes to pretend play he just can not keep up verbally.

Also my sister has him on celexa for severe anxiety. He started speaking and answering us immediately after this. So I even wonder if he had selective mutism. Anyway, he has a lot of things going on, but he is so compassionate and always has been. He is so affectionate and always has looked at us, his family, in the face and been aware of our feelings and seemed emotional in tune with us. He has no negative behaviors. And does not some reassurance when things change, because of his anxiety. His teachers call him a people pleaser and perfectionist.

I think this school thinks he is Autistic. Of course this is fine if appropriate, but to me he is so much more improved since he was 2 y.o. Could this be MERLD? He definitely is a visual learner.

Does any know someone who spends time getting to know the child and family before giving an ASD diagnosis? If it is autism I would be really surprised. I just think it is something else and would like someone who did not use a language based test but other ways to determine what is going on?

I understand there is a different approach with ASD and Merld or significant Language Disorder and would want to make sure we were using the appropriate techniques at home and in class.

My DS has ASD but he does not have auditory processing disorder or ADD according to his neuropsych eval. His language disorder is only for pragmatics - so if he ONLY had problems with pragmatics (and not the obsessive interests and repetitive behaviors AND the pragmatic language problems) - the diagnosis would be "social communication disorder". So no, it would not be called ASD. FYI, DS is very affectionate to his friends and family and his eye contact is fine. He is great with language, he attends a language immersion school and scores in the top 1% for expressive/receptive language. Definitely no MERLD but definitely ASD.

Please tell your sister to take her son for an evaluation either with a developmental pediatrician and/or for ADOS/ADI-R testing if she is concerned that her son is on the spectrum. A lot of people have preconceived notions about how kids with ASD kids "look" like and many things that are NOT ASD presents like ASD. Good luck!

Anonymous wrote:

Anonymous wrote:A speech pathologist is your best bet. It is common for kids with just speech issues (like mine) to be diagnosed with ASD. Many of the issues are similar. There is someone down south somewhere that is supposed to be really good if they want to make a trip. We gave up worrying about the diagnosis and are just focused on treatment. Either way, most of the therapies are the same. I would just do intensive speech therapy (several times a week).

Are you referring to the Camaratas?

Yes, I was thinking about calling them for us.

Yes, you can and should get a multiple disabilities code if that's appropriate to your DS. I thnk that's what your asking. My DS has one. I was told - wrongly - that my county school couldn't do that. But they can and they did after our neurospsych got on the phone during our IEP meeting we requested to specifically have the label changed.

Having this codes opens up a full spectrum of services which is what you are after. Less of a fight in the future if things need to be ramped up.

Anonymous wrote:A speech pathologist is your best bet. It is common for kids with just speech issues (like mine) to be diagnosed with ASD. Many of the issues are similar. There is someone down south somewhere that is supposed to be really good if they want to make a trip. We gave up worrying about the diagnosis and are just focused on treatment. Either way, most of the therapies are the same. I would just do intensive speech therapy (several times a week).

Are you referring to the Camaratas?

A speech pathologist is your best bet. It is common for kids with just speech issues (like mine) to be diagnosed with ASD. Many of the issues are similar. There is someone down south somewhere that is supposed to be really good if they want to make a trip. We gave up worrying about the diagnosis and are just focused on treatment. Either way, most of the therapies are the same. I would just do intensive speech therapy (several times a week).

Can a child have Auditory Processing disorder, ADD, and a language disorder? Or would most physicians just call this ASD?

My nephew was a rule out PDD NOS at 2 yo. But now at 6 y.o. I do not think he is still on the spectrum. I think he has multiple disorders especially a language deficit which impacts everything. I believe he thinks socially, and can be social without a lot of language. He likes to do things with friends, especially non language based activities - like play at the park, or crafts etc. He likes kids and asks for them, and smiles at them, but is not very verbally comfortable with them. He can do the "basics" like greeting and showing them around the house, showing his toys, etc. but when it comes to pretend play he just can not keep up verbally.

Also my sister has him on celexa for severe anxiety. He started speaking and answering us immediately after this. So I even wonder if he had selective mutism. Anyway, he has a lot of things going on, but he is so compassionate and always has been. He is so affectionate and always has looked at us, his family, in the face and been aware of our feelings and seemed emotional in tune with us. He has no negative behaviors. And does not some reassurance when things change, because of his anxiety. His teachers call him a people pleaser and perfectionist.

I think this school thinks he is Autistic. Of course this is fine if appropriate, but to me he is so much more improved since he was 2 y.o. Could this be MERLD? He definitely is a visual learner.

Does any know someone who spends time getting to know the child and family before giving an ASD diagnosis? If it is autism I would be really surprised. I just think it is something else and would like someone who did not use a language based test but other ways to determine what is going on?

I understand there is a different approach with ASD and Merld or significant Language Disorder and would want to make sure we were using the appropriate techniques at home and in class.