Friday, July 06, 2007

Your chance to diagnose

In my practice 50% to 75% of my caseload are from my Regional Center contract to provide early intervention services to children up to the age of three. Monday I had a new evaluation. So for you out there, here is an exam for you. Parents and therapists alike are invited to participate. If you are a Mama in my tribe you're likely to score better that many of the therapsits out there.

Read portions of my evaluation below and write a brief summary, include your clinical impressions and recommendations.
Client:A two, nearly three, year old boy.
me,"Tell me about his talking."
Mom," Well, he use to have some animal sounds, but he is not making them any more."
me, "What does he say or what sounds do you hear.?"
Mom, "ma or mamamam, ba, da, yi, raspberries, humming, squeals."
me,"Does 'ma' or 'da' ever mean 'Mama' or 'Dada' or is it just a babble?"
Mom, "I think sometimes he does, if he is really mad."

me,"How does he let you know what he wants?"
Mom, "He takes my hand and pulls me, or pushes me, or pushes my hand in the direction of what he wants."
me, "Does he ever point to what he wants?"
me, "Does he point to pictures, like in a book."

Mom,"He really likes having things in order. If he picks up something off the table or his plate, he puts it back in exactly the same place. He's very neat, if cat chow comes out of the bowl onto the floor, he picks it up and puts it in. He loves to close doors, turn lights on and off and flush the toilet. We hope he'll still be so tidy when he is older!"

me, "What toys or activiteis does he enjoy?"
Mom,"He loves puzzles and is really good at them. Also, balls and cars. His favorite toy that plays music and lights up when you press the alphabet letters. Oh and he loves running. He could run all day. He has a lot of energy. He loves wrestling with his Dad."

me," How is eating for him? Does he have specific likes or dislikes?"
Mom, "OH Yeah! He is a very picky eater! He will only drink milk and it has to be in one of these 3 cups that are the some. He's chewed the straws down on the cups. I changed the straw, but then he wouldn't use the cup at all. He loves, pizza, and pasta-but only if it is filled pasta. He'll eat meat only if it is ground. He won't eat fruit unless it is babyfood. Even if I put in little chunks of banana in the baby food banana, he spits out the chunks. If I spill something on his tray, he likes touching it-like yogurt or milk. But he doesn't like hacing his hands dirty. He didn't like the playdough at school. I don't think he knew what to do with it so he just poked it with the little knife they gave him. He liked playing in the rice though, because he could pour it."

me,"I notice he is sitiing in your lap facing you. He did look at me and wave hello. Will he sit on the floor with you?"
Mom, "This is what he usually does when we are anywhere but home." She attempted to turn him to face away from her chest, and he refused both physically and by vocalizing. "He likes really tight hugs in situations like this, it seems to calm him. He is very afffectionate"
me,"Well, our first goal will be to get him use to tolerating being here. Our first step will be to see if he can tolerate facing out whiole you hold him. Then we'll see if he will tolerate sitting on your lap on the floor. At that time we'll have you sit further back on the carpet, in the corner. That way he won't consider that you might stand up and go out the door.This will also become a safe place for him"

Other things to consider:
I do not yet have any forms with history from the family-as they weren't able to get them until the day of the evaluation. (Does that matter?)
He is an only child. (why does that matter?)
Family (both parents present) never asked about prognosis or diagnosis.
They clearly adore him and do not appear overly concerned.


  1. whoa.. that is my first response.. more later... wait, but does the kid like to tap sticks? Flap his hands? I think we are missing like two items on the fifty point ASD checklist.

  2. oh crap.

    his mom has no idea, does she?

    yikes. but if he is a referral from the regional center, perhaps they have made a diagnosis? you'll find out, soon i hope, when they get the history forms to you.

    i remember GGRC was SOOOO low key with me, they practically denied my daughter had anything like autism. while mentioning PDD! i was fooled, but only for a few weeks. i enjoyed those few weeks... but it was time lost for her.

    i know i'm rather autism-oriented, but... this child's behavior/speech/affect... it just doesn't look good. not for typical. good luck.


  3. Sounds like someone needs to clue these parents into the services that their beloved child needs, like ABA, in order to have the best chances to reach his fullest potential, whatever that may be for him. It's not necessarily about giving them a diagnosis, but helping them to understand what typically developing 2-3 year olds are doing, compared to what their son is doing, and then what kinds of services, in addition to 30 minutes of speech therapy, he could use in order to make significant progress while his brain is still developing.

  4. Sinking feeling. It never gets any easier to hear about the newest kids, does it? Are you allowed to push them or poke them? (Diplomatically of course.) I remember how virulently I hated Leelo's first teacher who told us something was going on with him; a few months later I couldn't thank her enough. It's hard enought to find the right services (lucky family for already having found you); I would prod as much as you are able. Or find someone else to do it. Even if they stop coming to you, they will have made necessary progress. And I agree with MB that the regional center can be very low key with ASD diagnoses -- they told us that all Leelo needed was a bit of the ol' ALSO group language classes twice a week. I had to find out about ABA and everything else on my own. I so wish that it was in my power to help other families not thrash around in the darkness as much as we did. Um, not to pressure you or anything.

  5. Yeah-this is a new experience for me. I haven't yet been "on the front line" where there was no "diagnosis" and the family had no idea. The combo of symptoms related to ASD, OCD and significant sensory processing disorder is striking to me. The good, and bad, news is that he is almost three. I'll give a follow-up after I meet with Mom (and Dad?)to go over evaluation and start therapy. It could be a few weeks for them to return paperwork, me to write eval and then to get approval for therapy to start. As Squid points out I may take the hit on this. I have learned that for many families the bearer of bad news is often disliked, discounted, distrusted. It is how we cope. I still don't like the SLP that told me that my angelic curly blonde 2-year-old boy had the language skills of a 6 month old. (But of course she was an insensitive unprofessional wench.) I hope I will be able to make a difference for this family on their journey. This has been my passion and goal when working with young kids. I have my kids to thank for that, in particular AJ.

  6. you know Sage, I only wish I had had someone like you talking to me about my child's potential and potential disabilities when we were first starting this little journey. Our Regional Center doctor gave us such a bad initial diagnosis.. then years later wondered why we hadn't done ABA when he was younger because clearly he was autistic. Better to be the one who is proved wrong later than to have a kid miss out on those early opportunities. I emailed you this, I think. I always wanted more words...maybe this family will too.

    A checklist for Early Indicators of Autism in the Second Year

  7. Oh God! the mother so much reminds me of myself about 3.5 years ago.
    I think that denial is good if protects your sanity. The trick is to not go insane and get appropriate help for the kiddo.

    To me, diagnosis are only good for the services that allow your kid to access.