Dyspraxia + Anxiety = ASD????

[encinc]

We had a meeting at DS1's school yesterday. He has been diagnosed with Dyspraxia and AD/HD. Has had OT and PT for the dyspraxia since he was 3. Has responded well to Concerta for the ADHD. Add some anxiety to the mix (trouble coping with changes in routine) and school staff think that he should be referred to the school boards autism diagnostic team. They acknowledge that he's far more sociable than most kids on the spectrum (he has good perpective taking and empathy), but with his "complex" presentation, they don't know what else to do for him. The waitlist for a full psychological workup is years long. He can be seen by the autism diagnostic team "soon" (I'd expect sometime in the fall).

I don't know what to do. DS is having a great year this year in Grade Two, in part because his teacher is phenomenal. I doubt he'll run into another teacher this good. But, I want to make sure that things are in place to make sure that his needs continue to be met. He doesn't have an IEP, mainly because he is so bright that he is meeting curriculum standards without one. His current teacher has made some accommodations (mostly making expectations clearer and allowing him to use a keyboard for written assignments), which can be done here in Canada without any kind of a formal support plan. Do I follow the school's advice and refer him for this limited assessment with a team that may not know much about dyspraxia? That approach seems a little bit like "when all you have is a hammer, then everything is a nail." Or, do I spend the big bucks to have a comprehensive assessment done through a private psychologist and hope that the school will follow the recommendations that come from that assessment?

Any suggestions would be welcomed.

 

[Maggie'sMom]

We had a meeting at DS1's school yesterday. He has been diagnosed with Dyspraxia and AD/HD. Has had OT and PT for the dyspraxia since he was 3. Has responded well to Concerta for the ADHD. Add some anxiety to the mix (trouble coping with changes in routine) and school staff think that he should be referred to the school boards autism diagnostic team. They acknowledge that he's far more sociable than most kids on the spectrum (he has good perpective taking and empathy), but with his "complex" presentation, they don't know what else to do for him. The waitlist for a full psychological workup is years long. He can be seen by the autism diagnostic team "soon" (I'd expect sometime in the fall).

I don't know what to do. DS is having a great year this year in Grade Two, in part because his teacher is phenomenal. I doubt he'll run into another teacher this good. But, I want to make sure that things are in place to make sure that his needs continue to be met. He doesn't have an IEP, mainly because he is so bright that he is meeting curriculum standards without one. His current teacher has made some accommodations (mostly making expectations clearer and allowing him to use a keyboard for written assignments), which can be done here in Canada without any kind of a formal support plan. Do I follow the school's advice and refer him for this limited assessment with a team that may not know much about dyspraxia? That approach seems a little bit like "when all you have is a hammer, then everything is a nail." Or, do I spend the big bucks to have a comprehensive assessment done through a private psychologist and hope that the school will follow the recommendations that come from that assessment?

Any suggestions would be welcomed.

If I were you, I'd go to a private psychologist if you can afford it at all. It seems they are trying to pigeonhole him into a diagnosis that they want when it might not be the right diagnosis. I'm skeptical of schools making correct psychological diagnoses.

My DD was diagnosed by a private psychologist as bipolar with comorbid ADHD. My ex and I are very comfortable that this diagnosis is correct for a number of reasons. When DD was going through the evaluation process for the schools leading up to her IEP, one of the coordinators on the MFE team flat out asked me if I could ask DD's psychologist if DD could in any way be considered on the spectrum because there was more money available to the schools if she was. I was taken aback, but I did raise the question with DD's psychologist and the response was an emphatic "no". DD in no way fit the criteria for a ASD diagnosis.

I'm not saying that's what's going on with your DS and his school, but I have severe reservations about accepting a diagnosis from a school that might have more interest in what funding they will get than in making sure your child has a correct diagnosis.

 

[encinc]

I'm not saying that's what's going on with your DS and his school, but I have severe reservations about accepting a diagnosis from a school that might have more interest in what funding they will get than in making sure your child has a correct diagnosis.

I hear you. DH and I are leaning the same way. I think that DS shares some features and characteristics with kids on the spectrum, and that many of the strategies used for kids on the spectrum might be helpful to him. But, I worry that an assessment aimed at one particular diagnosis might overlook other important parts of his presentation.

We can afford private testing if needed. It might mean putting of the next vacation for a little longer, but we can do it. I just want to make sure that what we do is in DS's best interest. He would definitely get a more thorough assessment for ASD from this team than from a private psychologist, but I think that a more thorough overall assessment is most important.

 

[clanmcculloch]

IMO it comes down to how much you trust your school district to have your child's best interest at heart. Many people can not trust their districts for plenty of good reasons. I'm truely blessed that my district has bent over backwards for us and has offered us even more than I was prepared to fight for in the beginning and ever since has treated me like a fully active and functioning member of the special ed team. They did the initial evaluation. They actually asked me t sign a waiver allowing them extra time to complete the evaluation becuase they contract out to a specific psychologist when they suspect autism and they really wanted her to participate in the evaluation. I agreed and I have no regrets. When I got the extremely comprehensive report from the team I then took it to her pediatrician who refused to have anything to do with a diagnosis saying he's not a specialist and then to a pedi-neurologist who pulled out his DMS-IV to find out what the criteria for a diagnosis was because he wasn't familiar enough with Asperger Syndrome to make a determination. Yeah, that gave me lots of confidence. At least he agreed to write the letter I needed for the school district to give the services. The school was ready to offer her every tool they could think of to help her succeed.

Some districts are about the money and some are about the child. Know which your district is and base your decision on that.

But, I worry that an assessment aimed at one particular diagnosis might overlook other important parts of his presentation.

What types of things are you concerned will be missed if an ASD unit is evaluating him? Many different kinds of issues have many of the same issues found among kids on the spectrum. Even if he's not on the spectrum, they should be doing a comprehensive sensory, obsessive compulsive and social interaction/language profile in addition to the academic profile. Good ASD testing includes a lot of stuff not necessarily to rule IN ASD but sometimes also to rule OUT ASD. Identifying these types of issues, whether on the spectrum or not, will get him the services needed to cope with these issues. Assuming of course yours is a district that you can trust to have his best interests at heart. Again, you have to know your district.

 

[Piper]

I think that I would get the private assessment before school starts--and then let the school "do their own thing." I would compare the findings. If they are grossly different, then you have to go with the one that is the most "unbiased." You might find a lot of similarities.

 

[bookwormde]

95% of educators and clinicains are not hightly qualilfied with ASD so everything has to be taken with that perpsective until you can get to a highly qualified clincal group to know.

There is not a standard ASD kid, many have a strong desire to be social, but there presentation no mater how well self adapted tends to appear atypical, inefficiant and does not generalize easily to new situations.

The Executive funtion component is relitively easy to differentiate since it is sources on a non linear processing preference and a non discriminatory nature for informatin, storage and organization. One of hte best ways to tell is if the ability to hyperfocus on areas of interest is exceptionally stong.

Sensory differnetials are also very common and can be quite pronounced, particularly when anxiety is elevated.

If you are on the east coast I would recoomend Kennedy Kreiger (johns hopkins) or yale child center as a starting point.

Whenever a clinician definatively decides a child with significant characteritics is not ASD without a comprehesive highly qualified evaluation you can be sure that they lack compitency.

In the end a label is just a label, it is finding our what your child needs to flourish that is important

 

[LMC]

From the parent of an ASD, dypraxia, ADD, anxiety diagnosed DS, get private testing and get very good, PT and OT. The more the better.
Seriously, you can't afford to waste time with bad diagnoses so you want to make sure you get it right. The earlier the therapy the better so even though your son is already in therapy he may be able to get more services with other diagnoses. I wish you well.

 

[encinc]

Whenever a clinician definatively decides a child with significant characteritics is not ASD without a comprehesive highly qualified evaluation you can be sure that they lack compitency.

In the end a label is just a label, it is finding our what your child needs to flourish that is important

I agree completely with both of these statements. I also agree with the flipside of the first one. I think that some professionals around here are too quick to put an ASD label on any child who presents as different from the norm. I think that a comprehensive evaluation is most important, and that's why DH and I have 99% decided that we're going to go ahead with private testing.

I think the second statement is the main reason why I worry about having testing done by the ASD team at the school. They are using good measures, so I know that the diagnostic info they give will be good, but I'm not sure that the recommendations that come out of the assessment will be as tailored to our son as we might like. I'm a little bit afraid that they might take a "this is what schools can offer to kids with ASD (if he indeed does meet the diagnostic criteria), so this is what your son needs." I also wonder (and have asked the VP this very question) what sorts of recommendations this team can make if it turns out that he does not have ASD. I have no doubt that many of the strategies used for kids with ASD would be helpful for our son (as they would for other kids with dyspraxia, AD/HD, or anxiety), but I don't know that this team would make the connection that he still needs these strategies even if he doesn't have ASD.

Thanks everyone for your input.

 

[clanmcculloch]

I absolutely agree that a comprehensive evaluation is extremely important. The thing is, OP said there's a year wait to get it done privately. The school is willing to at least get things started now. If some of the services can begin sooner while waiting for the private evaluation, IMO it should be done now.

 

[encinc]

I absolutely agree that a comprehensive evaluation is extremely important. The thing is, OP said there's a year wait to get it done privately. The school is willing to at least get things started now. If some of the services can begin sooner while waiting for the private evaluation, IMO it should be done now.

I wasn't entirely clear. We can get a comprehensive evaluation privately within the next few months. The waitlist for a psych workup through the school is much longer (probably several years). We're not even sure how soon he would be seen by the ASD team - all they told us is that it could occur sometime within the next school year.

DH and I have decided to go with a private assessment. We're just waiting to hear back from the VP about what questions the school would like addressed (what behaviours they're finding difficult to manage etc). DH and I have our own goals for the assessment, but we want to make sure that whatever we get done privately also meets the school's needs. The whole reason this process got started is because I said that I wanted to formalize the support that he is currently getting at school, so if the recommendations don't address the school's needs, there's no point in going ahead.