diagnostic help please !!!

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Registered: 05-09-2003
diagnostic help please !!!
3
Tue, 09-27-2005 - 12:13pm

Ok, I'd love to hear your take on Jake's behaviors and whether they seem "typical" or more spectrumish. I figure you guys are the experts! :) First off here's the positives:
- he smiles, and laughs, and loves to get chased, and tackle people
- he plays with toys, moving trucks and tractors around and making noises, and he likes pretending to go to work and work with tools
- since starting therapy his speech has improved and he makes attempts at spontaneous speech (rather than just repeating) - but I can't understand a word he says....
- he seems to understand most things that are said to him, and seems to be very smart (of course probably every parent thinks that)
- he's pretty well behaved when he's not throwing fits (that's sounds funny, huh) - but he doesn't run off, and he's not running around like a maniac or jumping off furniture or anything like that.....

Now, here's the stuff I'm not sure about:
-he often does not respond to his name (especially if he's watching tv or playing, he'll even ignore a hand being waved in front of his face or being tapped on the shoulder- he just kind of spaces out)
- he lines up his toys, and food sometimes too. Sometimes more than others, but less than he used to (that's ALL he used to do)
- he deliberately arranges toys (lays out his tools, etc in a very deliberate way although I haven't noticed any pattern to it, but it's very specific and neat) - although I do have to add that most times he doesn't get too upset if you move it- sometimes he just puts it right back without a fit, other times he does throw a fit, and sometimes it doesn't bother him at all and he doesn't even put it back)
-he avoids direct eye contact (he'll look at you throughout the day, but if you try to get him to look at you for any reason- he'll deliberately look away, and if you turn his face he'll fuss and try to pull away and look down so he doesn't have to look at you)
- he rarely initiates physical affection (hugs/kisses)- he'll snuggle beside me or back up into my lap (not looking at my face of course), and he often refuses to hug if you try he pulls away and fusses (but sometimes he will let you hug or kiss him, and there has been a RARE occasion that he's come up and given a hug or kiss)
- he absolutely hates getting his face/head wet and will scream and try to climb out of the tub, he also hates toothbrushing and nail trimming and needs to be held down for this.
- he crawls under tables in restuarants (to suck his thumb, and lay not to play)
- he tends to move off to the side and do his own thing during playgroups, and just observe his friends (but he does watch them) rather than join in
- he has to wear his shoes/sandals or he fusses (in the bath and to sleep, etc)
- he tends to get on kicks with things - like for awhile he was obsessed with tractors (had to climb on them if he saw them, always pointing them out - he could find the tiniest picture of a tractor in a store from across the store!, then it was construction stuff, and now Bob the Builder - you can't even mention it or he has to watch the video)
- with tv/videos he likes, he get's very upset when they are over or go to commercial (goes up to the tv and bangs his head or throws himself on the floor crying - thank goodness for continuous play DVDs!)
- he does seem to be more sensitive and have more tantrums than most kids his age that I've been around (but maybe it's just because I'm the one that has to deal with them).
- he has a hard time with transitions - but does better if you give him a five minute warning of what's next.
- at home he tends to play by himself most of the time, only coming to me if he's hungry or if something is stuck, etc. - but he'll respond if I comment on something he's doing - he'll usually just smile.
- he could sit and watch videos all day long if you let him, but once the tv is off and his fit is over he'll be off playing something.
- he often seems very serious when he plays - just a straight face, but if he sees you watching he'll look up and smile occassionally.
- he does have an awfully hard time sharing any of his toys (he'll pull it away and hit, or throw himself on the floor and cry, and you can not redirect him from that toy no matter what !)
- his tantrums consist of slumping on the floor in a heap with his blankies and crying or screaming, sometimes he bangs his head on the wall or floor, or whatevers handy, and sometimes he lashes out and hits or bites or pinches, etc (to me or friends, or whoever), and you can not get him calmed down without his blankies - they are completely essential!
- he also tends to get upset if I leave him anywhere - but when I come back he's just like hey - no mommy mommy and running to me with a big hug (I am so jealous of people who get that! :))
- he's also very easily frustrated and will throw a fit pretty easily if he can't get a toy to do what he wants or if something is stuck, etc

So there's most of it, I think..... What do you think? Normal two year old boy? PDD? Sensory processing disorder and apraxia (which is his current diagnoses as per EI)? I'd love to hear your opinions and I promise I won't hold anyone to their "diagnosis" :) Thanks so much.

Jen

Avatar for googolplex
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Registered: 03-31-2003
Tue, 09-27-2005 - 1:50pm

Hi Jen,

I really think your best bet would be to print out what you wrote to us and take it along to a developmental pediatrician, or Jake's regular ped. Each kid is so different, and I think it's too easy for us, as parents, to project our own experience on to others. My general feeling from what you write is that Jake could use some help with sensory issues. What do you think? About the lining up of toys...I think a lot of small children do this as a way of learning to categorize and organize. It's not necessarily an autistic trait.

I think that if you feel concerned, you really need a professional to talk in depth with you, and then to meet with and observe Jake for a while. I think typically you should expect to have several appointments (parent and Jake, Jake alone, parents alone) and a couple of questionnaires before being given a dx.

I'm glad speech therapy is going well. I've known a number of people whose kids have trouble with speech and being understood, and I think that contributes a lot to the tantrums and general frustration level.

I know, this probably isn't what you wanted. Sorry! ;)

Evelyn

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Registered: 06-25-2003
Tue, 09-27-2005 - 1:52pm

Jen,

Ya know, so many of thesse things can be interperted so many different ways. Even in some of the positives you mentioned, I was thinking "that could be due to X". So much of it come down to *degrees*, and degrees of stuff are impossible to ascertain over he internet.

Peter did several of the things you mentioned. He went crazy if I left him anywhere, but when crazy when I tried to pick him up, too! (forget "mommy mommy" or even a smile. He ran screaming from me!)

Many, many of the things you mention are sensory; -the shoes, going under the table, even the chasing/tackling could be sensory (degrees again). However, IMO if SID is found then hey should aways test for an ASD. The two so often go hand-in-hand.

Some could be interperted either way: Reversing in for hugs. Peter does this. Is it his SID or his Autism? ...Or both? I don't actually know. I just know he does it. (and that it kills me)

Lining and obsessions -they are red flags for a specrum disorder. So is avoiding eye contact, bot responding to his name and not joining in with friends -depending on what age he is (or he could just be shy! Degrees again). However the spacing out could be a red flag for absence seizures.

Follow your gut. If you think the DX is wrong, you need to keep pushing it. Print the list of strengths and concerns you just posted and call a meeting with EI. They not have seen all of them. We often see kids here who behave very differently (say) at school than at home.

You can take it through medical channels too, and have a full neuropsychological eval performed privately, then take *that* to EI.

If you suspect absence seisures, he will need to see a neurologist.

HTH

-Paula

-Paula

visit my blog at www.onesickmother.com
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Registered: 12-24-2004
Tue, 09-27-2005 - 4:02pm

Sounds like PDD-NOS to me, but with a good chance of coming off the spectrum with therapy. Before I read the diagnosis at the end of your note, I was going to say that much of his spectrum behavior seemed to stem from sensory issues. He also has a rigidness to his personality and some obsessiveness that you can work on to make him more adaptable at later ages.

Looking at eyes can be disturbing and difficult for kids on the spectrum. This is like a sensitivity issue for many of them. Some high functioning adults on the spectrum say they still can't look at eyes much. They prefer to look at the nose or forehead because these areas of the face do not move. These adults report that looking at eyes is disturbing and often distracting to them.

The attachment behavior you describe is typical of many ASD children. They fuss at transition and loss of control, which is what having your Mom leave is to them. However, they do not engage well socially as a habit, so when you return, they don't respond with great jubilation. Often I think they warm up so slowly that they show their happiness at having you back in a different way and probably with more of a delay than NT kids. It's hard for them to withdraw from what they are doing at the moment, so you cannot expect an immediate enthusiastic response, like "Oh Mommy Mommy Mommy! You're back!" Personally, I think a more inclusive test of whether the child is securely attached would be to watch them for about 5 mins after the mother's return and to count any subtle overtures toward her.

That's my 2 cents.

Suzi