Re: update on psychiatrist autism evaluation

[Guest guest]

your son sounds like my boy, without meeting him they will say or suggest PDD

but when they meet him and he is not in a testing situation they will no way.

my son is in K right now and we did not diagnose for PDD and did not recieve

services he needed in preschool. I feel that you should have to get a PDD/autism

label in order to get teachers to come to home. we had special ed preschool and

4 hours weekly of SEIT teacher shadowing him in a typical school. now being in

a typical school it helped him a lot but I would have liked him to have home

teacher to help with cognitive issues. he gets it now in K. I had said in a

meeting when he first started that his scores should grant hm extra help not his

label and they agreed. I am sped teacher for autistic/PDD indiv. and they

acually scored average to above average in cognition whereas my son scored in

low in everything and in preschool they felt he didn't need extra help. so

dumb. I understand your stress and the advice I could give you and is to remind

them that his scores are what the services not the label.

let me understand, the school is testing to take away services or is this

testing an annual review? they do get tested every year and especially before

Kindergarten.

its very frustrating to know how bright your child is all you can do is

advocte for him and remind them that this is child not thing that had a

disorder. I would focus on his frustrations of not being able to talk and how

hard it is on him and so on. this made him human being not some kid in their

district.

please write me back about my question and hope I helped with my story

chris

Grassia <miche@...> wrote:

I wrote a while back about my concerns about a psychiatrist's ability to

diagnose or un-diagnose my son. First I have never agreed with autism and

I really don't think he is autistic, but I have reservations about him

being tested now. I have him scheduled in a year (when he'll be 5.4 yrs)

at a place qualified to negate the diagnosis. The schools want to wait

because if they can negate it now they will provide him less services. The

school psychologist called today to schedule an eval. She's not even an

MD, she has a masters in educational psychology. She claims she has worked

with many autistic kids. She claims she understands verbal dyspraxia

(despite it being rare in our area.) She also thought that *I* was the one

who requested this testing!!! I explained my reservations. First is a

single person qualified to give an accurate diagnosis on a minimally verbal

child? His SLPs say no so it's not just my concern. I asked what the eval

would entail. Sure enough parent completed surveys as well as cognitive

testing. She would test him both with verbal and non-verbal tests. She

didn't specify which one. We do NOT suspect any cognitive delays. Even

his new SLP (through the schools) thinks that when his expressive lang

improves he will actually most likely test gifted in some areas and she

would not be surprised if he had a high IQ. Tested formally I know he will

NOT show this. He was already labelled as cognitively delayed at age 2.5

when he was diagnosed with autism. It took a second day of observations in

a non-testing environment and the psychologist completely reversed her

report. She changed it to unable to determine due to the speech and lang

delays, but off the record said the same as his new SLP - she said he was

very bright!

So my questions are many. The first that comes to mind is what does

cognitive testing have to do with an autism diagnosis. IQ is not what you

base a diagnosis on.

If I am forced to agree to this testing (which I would do anything to avoid

as he's going through a low emotional period right now where he is easily

frustrated and quick to just " shut down " ) what are the best non-verbal IQ

tests for an apraxic child. We have a double whammy as he has both

expressive and receptive delays. He has about 200 words, most infrequently

used (a good 1/4 to 1/3 being animals.) He also had significant receptive

delays which are most likely due to language storage and recall issues and

possibly auditory processing or discrimination concerns. Formally he tests

at 17mo-2.5yr in expressive and about 6 months higher in receptive, but in

day to day function with non-auditory cues and proper supports he functions

at a higher level than that. He has some aspects of language that are spot

on developmentally such as correcting others and criticizing! His speech

clarity is poor. He's barely stringing more than two words

together. Sometimes he does 4-5, but only at home and only family can

/sometimes/ understand what he says when he does. He doesn't understand

commands such as " show me " or " point to. " He will do these things if given

about 5 practice runs where you physically move him through the motions to

let him know what is expected. He is classically apraxic in that he

absolutely cannot access a motor plan when on the spot and he's VERY aware

when he is being tested and just shuts down.

Given this can a non-verbal test even be accurate? I have SERIOUS

reservations about allowing anyone to touch on his supposed cognitive

levels and again slap a label on him that isn't accurate. It also ticks me

off that the schools aren't doing this for HIS best interests. They are

clearly requesting an eval so they can take away services and set

precedence on placement for next year.

Any advice?

[Guest guest]

> let me understand, the school is testing to take away services or is

> this testing an annual review? they do get tested every year and

> especially before Kindergarten.

Thanks for the reply

He has a diagnosis of moderate autism at age 2.5. No one believes it is

still accurate (except the autism specialist who worked with him last

summer, but she doesn't understand apraxia and he was not yet diagnosed -

she helps another child at his school so she still sees him.) They

requested a test to diagnose or refute the autism diagnosis. I asked that

we wait until next winter when we can get it at the reputable clinic. They

want it now. If he is not autistic (which he probably is not - if he is it

is very mild) they are going to argue they don't need to make up the 60+

hours of services from his Sept IEP and that his appropriate placement is

at the special ed school, not the private preschool. It is obvious that

the sped school is not his LRE, but it was the autism label that got us the

other placement (based on best practices and state guidelines that no more

than 2 children with autism be in the same classroom.) If he doesn't have

autism they will take away his placement (which they haven't paid for

anyway.) If he is parent placed in private school they are not obligated

to give him ANY services. He will (on paper) lose the 3 hours of autism

support which I don't mind as he'll never get those anyway. But he will

also lose the two hours of speech he finally started getting a few weeks

ago. They have been on his IEP since last May and amended to be one-on-one

instead of group in Sept. They agreed to pay my out of pocket costs for

private speech since last fall and they agreed to make up compensatory

time, BUT again if the autism label goes away they will refuse all that.

I don't want to keep the label because I don't feel it is fully accurate,

but I also don't want it taken away by a single diagnositician. I want a

team, a qualified team like who we are set to see in a year. I also don't

want cognitive testing to slap another issue on him that is not there. No

one suspects his IQ is low, but IQ test him and it will appear that way

because he doesn't test well.

The biggest things I'm asking is if I'm forced to IQ test him (he's next

mandatory test is not until just before entering K which is fall '07) which

tests should I request they do. What is the best non-verbal test for a 4

yr old with language around age 2 and possible auditory processing issues

(with receptive being only about 6 mo higher than expressive.)

Miche

[Guest guest]

I don't think a school psychologist is qualified to diagnose a child,

particularly a child who is not very verbal, with autism. If I were

you, I would take him to a pediatric neuropsychologist - their testing

is very thorough. IMO school districts have a financial interest in

under-diagnosing. In my state, we are only required to agree to

testing every 3 years, so check the laws in your state. Or tell them

that if he is evaluated, you want an outside expert (a neuropsych of

your choosing) to do the testing at their expense.

Cognitive testing is not used to diagnose autism. It sounds to me like

they are testing to see if he qualifies for a MR dx.

good luck,

>

> I wrote a while back about my concerns about a psychiatrist's

ability to

> diagnose or un-diagnose my son. First I have never agreed with

autism and

> I really don't think he is autistic, but I have reservations about him

> being tested now. I have him scheduled in a year (when he'll be 5.4

yrs)

> at a place qualified to negate the diagnosis. The schools want to wait

> because if they can negate it now they will provide him less

services. The

> school psychologist called today to schedule an eval. She's not

even an

> MD, she has a masters in educational psychology. She claims she has

worked

> with many autistic kids. She claims she understands verbal dyspraxia

> (despite it being rare in our area.) She also thought that *I* was

the one

> who requested this testing!!! I explained my reservations. First is a

> single person qualified to give an accurate diagnosis on a minimally

verbal

> child? His SLPs say no so it's not just my concern. I asked what

the eval

> would entail. Sure enough parent completed surveys as well as

cognitive

> testing. She would test him both with verbal and non-verbal tests.

She

> didn't specify which one. We do NOT suspect any cognitive delays.

Even

> his new SLP (through the schools) thinks that when his expressive lang

> improves he will actually most likely test gifted in some areas and she

> would not be surprised if he had a high IQ. Tested formally I know

he will

> NOT show this. He was already labelled as cognitively delayed at

age 2.5

> when he was diagnosed with autism. It took a second day of

observations in

> a non-testing environment and the psychologist completely reversed her

> report. She changed it to unable to determine due to the speech and

lang

> delays, but off the record said the same as his new SLP - she said

he was

> very bright!

>

> So my questions are many. The first that comes to mind is what does

> cognitive testing have to do with an autism diagnosis. IQ is not

what you

> base a diagnosis on.

>

> If I am forced to agree to this testing (which I would do anything

to avoid

> as he's going through a low emotional period right now where he is

easily

> frustrated and quick to just " shut down " ) what are the best

non-verbal IQ

> tests for an apraxic child. We have a double whammy as he has both

> expressive and receptive delays. He has about 200 words, most

infrequently

> used (a good 1/4 to 1/3 being animals.) He also had significant

receptive

> delays which are most likely due to language storage and recall

issues and

> possibly auditory processing or discrimination concerns. Formally

he tests

> at 17mo-2.5yr in expressive and about 6 months higher in receptive,

but in

> day to day function with non-auditory cues and proper supports he

functions

> at a higher level than that. He has some aspects of language that

are spot

> on developmentally such as correcting others and criticizing! His

speech

> clarity is poor. He's barely stringing more than two words

> together. Sometimes he does 4-5, but only at home and only family can

> /sometimes/ understand what he says when he does. He doesn't

understand

> commands such as " show me " or " point to. " He will do these things

if given

> about 5 practice runs where you physically move him through the

motions to

> let him know what is expected. He is classically apraxic in that he

> absolutely cannot access a motor plan when on the spot and he's VERY

aware

> when he is being tested and just shuts down.

>

> Given this can a non-verbal test even be accurate? I have SERIOUS

> reservations about allowing anyone to touch on his supposed cognitive

> levels and again slap a label on him that isn't accurate. It also

ticks me

> off that the schools aren't doing this for HIS best interests. They

are

> clearly requesting an eval so they can take away services and set

> precedence on placement for next year.

>

> Any advice?

>

>

>

[Guest guest]

, I am not sure if your son has autism or not but, I did not have my son

dxed until I needed services. He is moderately autistic he also has

downsyndrome.We saw 3 Developemental Peds.Never told any of them about each

others findings and within an hour of examnations and testing all of them dxed

him asd. What you are calling shut down for your child is what we call

non-compliance in the asd world.In my opioion if it takes the dx to get the

services that is in his best interest.If you go to some autism websites many of

them show you the criteria for dxing autism and on what level.Thats how I knew

before we ever went to a doctor about Autism.He just did not fit in the

downsyndrome world.He fits perfectly in both though. Hope this helps some.

Laurie mom to Mic

[Guest guest]

something just doesnt sound right here all professionals I know who

know about autism also know about apraxia almost all asd kids are

apraxic.Someone is trying to cut your services, go over their heads.Find the

expert in your area and get an eval the school cant touch that.You will get the

services he needs. Laurie

[Guest guest]

He has an apraxia diagnosis from Prompt. They aren't touching that, but

that only qualifies him for two hours of speech in the special ed school

(which is awful.) Even with an expert giving this diagnosis it took the

public schools six months to comply with his IEP and actually start

providing services.

The ONLY expert who can diagnose autism in a young child is SWAN (southwest

autism network.) I have an eval scheduled in a year. The waiting list is

a min of 4-6 months. They could get him in earlier, but they agree with me

that it's in his best interest to wait. The public schools don't want to

wait even until summer. That is the problem. I highly doubt that anyone

will find him autistic, but I also don't want them to slap a MR label on

him. No one believes he has any kind of cognitive delays. He clearly has

language delays, including receptive, and even with a non-verbal test he

needs to understand the directions he is being given. He wants to

understand, he is attentive up to a point, but unless they are flexible

with methods of explaining to him he doesn't always understand.

Miche

At 12:58 PM 2/22/2006, you wrote:

> something just doesnt sound right here all professionals I know

>who know about autism also know about apraxia almost all asd kids are

>apraxic.Someone is trying to cut your services, go over their heads.Find

>the expert in your area and get an eval the school cant touch that.You

>will get the services he needs. Laurie

>

>

[Guest guest]

>Only a

>developmental pediatrician, neurologist or psychiatrist can make this

>diagnosis via dsm guidelines.

Is this written somewhere in the dsm? I ask because I thought I had seen

that it has to be a medical doctor who diagnoses, but I can't find it

now. This is why a pediatrician is on the early childhood

multidisciplinary team diagnostic groups. Originally the schools said they

would have a psychiatrist and I wasn't thrilled about a single person

making this determination, but a psychologist seems completely inappropriate!

>If you are concerned about the methods being used to

>dx please bring your child to a reputable child psychiatrist, neurologist or

>developmental pediatrician.

He's been twice to a reputable pediatric neurologist who failed to confirm

the initial autism diagnosis. He does not present as obviously autistic,

in fact she highly doubted that was accurate. Mainly she did not feel the

label was necessary at that time when considering the impact the testing

would have on the child. What was important is that he continued with

speech therapy no matter what we called it. That was good enough for Early

Intervention.

Thanks everyone for your feedback. At this point I'm waiting for another

call from the schools. I spoke directly with the psychologist last time

when she called to schedule him. I addressed my concerns to her. She is

going to again speak to the sped dir. What I need to emphasize in the next

discussion is that they are looking to overturn a medical diagnosis without

providing a medical diagnostician to do it. Also that I do not agree to

cognitive testing as it has nothing to do with an autism diagnosis.

Miche

[Guest guest]

CAN YOU HAVE HIM TESTED PRIVATELY TO GET A SECOND OPINION? your child may

test differently as he gets older and especially as the communication improves,

josh gets stuck with certain behaviors but he sure has changed alot in 3 years

and i am now being told that we may not need services for speech and ot after

next year which means alot to us because i hate to pull him out of school to

get private therapy. can you believe that? no therapy after next year, thats

what we are hopeing for and we are hopeing to go to disney world next year.

charlotte henry