Is Autism being MIS-diagnosed?

[stellablue]

DISCLAIMER: I am NOT referring to that aweful & ignorant discussion that was out there a while back about "kids not being autistic, they are just being brats" thing

I am strictly talking about doctors MIS-diagnosing.

I am a special ed preschool autism teacher in a large district. I have been working with students with autism for 10 years now-the majority of these students were diagnosed by a neurologist &/or psychologist who ran extensive diagnostic tests to conclude this diagnosis.

Over the past year though, we have been getting a flood of kids with a autism diagnosis entering the preschool. Several of these students' diagnosis has consisted of a 3 sentence letter from a pediatric psychologist diagnosing this child with autism & no documentation to support the diagnosis (test scores, report, etc..). In addition, it is actually always the same specific doctor who is writing these letters. Many of these students exhibit no atypical behaviors, except for communication delays or behavior problems.

In addition, there have been several students in elementary school who are all of the sudden receiving autism diagnoses (from the same doctor in the same format). They were previously diagnosed with ADD or conduct disorder, but now they are all of the sudden autistic. Again, no atypical behaviors except for behavior issues.

My MAJOR concern here is that a child's diagnosis is directly related to their treatment plan. In our district, if you have autism, you enter the "autism program." If you have a conduct disorder, you enter the "behavior program." If you have a mental illness, there is a program for that as well. I sat at a meeting just this week for a second grader who was previously diagnosed with ADD & conduct disorder. Almost grade level academically, no communication/ language issues, age appropriate play skills, typically developing social skills but very severe behavior issues that impeded on his socialization, ability to complete work, & entire day. Poor little guy had such anxiety, low self-esteem, compulsive behaviors, difficulty de-escalating. He lives with his grandmother and brother (brother has mental illness). Nothing pointed to autism with this kid & he would benefit so much from having a school psychologist & a behavior classroom, with staff who could directly work on his behaviors. BUT, this same doctor sent a note in saying "presto! he has autism!" So, now this child is going to enter the special autism program the district offers for students his age. The problem is this program is NOT going to be appropriate for his needs. & it makes me sad for this student because the last thing this student needs is to fail in yet another environment.

As for me, as a preschool teacher in an autism classroom, I feel like the kids who are getting misdiagnosed and receiving autism services are not only not getting their actual needs met, but they are taking time & space away from the children who actually have autism & need these services.

All of these students I am mentioning DO clearly have an impairment of some sort-I am just not so sure they all have autism.

I wish my district had tighter guidelines on what qualifies as an autism diagnosis. I do not feel it is sufficient to accept just a 3 sentence letter from this one doctor with no documentation or test scores to back it up.

In conclusion, I do think that autism is often getting MIS-diagnosed. NOT by parents, but by doctors who don't take enough time to properly screen a child, or see a behavior problem or language issue & immediately classify them as autistic. I am ALL for getting children services, as long as they are the right services to best suit their needs.

Just needed to vent. Please no flames & if you want to respond, please do so respectfully.

 

[mechurchlady]

It is frustrating for me to see myself, relatives, friends, and people and their families on this board being misdiagnosed or diagnosed and left to fend for themselves. I has SID and never was diagnosed for anything but poor sociallization skills. My aunt had a doctor who for years never diagnosed her diabetes. On this board I read about people being rubber stamped with a diagnosis with enough information.

I can understand your frustration at seeing kids rubber stamped with a diagnosis without lots of testing. Go ahead and scream and rant as you are not alone in the frustration with doctors as well as some school systems. Recently on this board a lady said her son was labeled a troublemaker over a little incident so now he is bad. A simple change in diet turns a troubled child to a model student and citizen.

After reading your post you need lots of flaming and roasting.
I present you with lots of flaming desserts , firey chilli, roasted taters, pot roast and barbecue ribs. A banquet in your honour for caring about kids.

 

[kaffinito]

I think in some cases that's true. Several years ago I noticed that the therapists and psychiatrists at the clinic I was taking my oldest son to were giving him the diagnosis of what ever was on the cover of Psychiatry Today magazine. (Not its' actual name, it's the professional magazine.) So Ben had a lot of interesting diagnosis that changed every month.

When I called them on it after 6 months or so of this alphabet soup of mental disorders, I was told that they didn't have time to run tests, etc that would give them a definite answer.

I understand and share your frustration. There is a flip side to all of this however, and that's when a district states that a child is not autistic because they don't meet the districts requirements for autism. That means for me that unless I can get my youngest out of his new school district, he will be labeled as having a learning disorder and will not get the special services he needs.

I think that with the prevalence of autism in our society now, that doctors, mental health professionals, teachers, and special services coordinators need to be careful when trying to label a child as anything. A lot of kids are being over diagnosed, while there are others (in budget minded districts) that are being under diagnosed.

I hear your rant, and sympathize with your frustration.

 

[bookwormde]

There are certainly problems both from misdiagnosis of autism and missed diagnosis of autism.
There are 2 major problems at the moment. First is the fact that the diagnostic criteria does not match the current state of the art in the science of the neurovariant Austism spectrum and the situations that clinicians are trying to provide clinical “help” for individuals they know are significantly affected by spectrum characteristics but do not meet the stone age standards. Second is that there are a large percentage of clinicians doing diagnosis’s who are grossly inadequately trained in this area.

The good news is that I relatively qualified group is in the process of developing a new set of diagnostic procedures standards which if followed should help a lot. In the end the DSM-iv needs to be revised.

Right now there are about 100 characteristics, which are used by “world class” clinicians to diagnosis HFA and Aspergers. The threshold for a formal diagnosis generally about 80 of these. The child with 79 may be as or more affected by the characteristics than the child with 81 and this is why the system is a poor one. At the core it is driven by the “bean counters” at the insurance companies (and cost departments of education departments) need for a black or white answer as to whether they are going to pay. It would be much more clinically appropriate to simply apply a rating number to the characteristics an individual has and then score the impact (plus or minus) on the individual. This would not only improve the available specificity of treatment but since the manifestation of many of the characteristics are variable depending on levels of clinical and educational support it would provide a good measure of the progress of an individual at reducing the impact of having Autism spectrum characteristics.

Since at it’s core this is a set of genetic variations there is hope that in the next 20 years the genes involved in this will be identified so then the focus can change to the impact of the manifestations of the variations and where clinical and educational support can improve quality of life and average societal contributory capability.

The reality is that everyone has a few (but not the same) characteristics the issue should really be an issue of impact on the individual. Even an individual with a relatively small number of characteristics may benefit from the therapies and education if the impact of the characteristics is significant.

It is funny, your example child is a good example, he may have many of the characteristics but be lacking a significantly reduced innate social skill ability (or have self adapted to the point where it is difficult to measure but the extra effort to do this is generating damaging level of anxiety). If the goal is to support the child clinically and educationally a diagnosis is not really needed except to get approved for services. What ideally should be done is to analyze his characteristics and supply the supports that the child needs.

This has or does not have Autism/HFA/Aspergers “bean counting” thinking is at the core of both the medical community and educational communities failure with these children.

And to be direct in what you describe any competent clinician would see overriding indications of Autism spectrum characteristics manifestations in the child you describe and would want a full evaluation to see if the core cause is truly Autism spectrum variations. Presenting relatively standard communication skills and social development in familiar environments is not a disqualifying set of characteristics. As a teacher with limited clinical study this is a very common misconception (this is not to be critical just it is just outside your area of expertise)

I do understand your frustration in meeting the needs of the most severely impacted children, but the real problem is inadequate resources to meet the needs of all children for an appropriate education and clinical support.

If you want to learn the basics I would suggest reading Tony Atwood’s book The Complete Guide to Aspergers c/2007 which should be available from your schools continuing education library, if not it is available on Amazon for about $25. He is the preeminent clinician in the area of HFA And Aspergers and the information extends well into the middle range of the spectrum.

bookwormde

 

[BeckyScott]

A few things:

Yeah, autism is kinda trendy right now. Apparantly where you live it's really trendy. The debate rages on-- is it overdiagnosed, is it an epidemic, blah blah blah. The answer depends on who you ask. There is a group of kids about a year younger than DS, all from the same small outlying town near us, all diagnosed. The size of the town and the amount of kids with autism the same age, something wierd happened. Nobody is questioning the appropriateness of the diagnosis, but everyone is questioning how it happened.

As far as the school goes, I don't know the details but other posters have mentioned it too, there is a medical diagnosis and an educational diagnosis. Great if they match, but they don't need to. That's why the school does it's own testing. So the kids in question could have the medical diagnosis and not the educational one, and services provided according to their educational diagnosis. Will the parents protest? Maybe. But you'll have test scores, and their doctor has nothing. You could fight it and probably win, but it would be a battle. The safer thing to do is to convince the parents to seek further evaluation. After the diagnosis, to tell them they should consider taking the child to a specialist, make a list of resources available along with what insurance they take. (sort of like the "independent evaluation" list you're supposed to have if a parent doesn't agree with you) So you're sticking someone else with telling them the truth, but you haven't crossed over any no-no lines. Another option might be to set up someone that's an "expert" to come speak about autism, and open it up to the parents.

The DSM uses the words "significant impairment" (I believe) and probably everyone in the universe has a slightly different definition of that, along with exactly what "interfering with daily life" means. The doctor I guess has a pretty wide definition of "significant". Like let's say, for example, you're talking about mosquito bites. A colleage might see a kid with 5 bites and say that's significant. You might think, nah, to be significant they need to cover half his body. Some really cranky person standing there might say, nope, 90% is significant. In other words, there is plenty of mushing around that can be done with the DSM, even though it's the standard and well-respected, there's wiggle room in there for interpretation, typical of the English language. On top of that, the autism umbrella has some wiggle room too. We had two different psychs at the same (good) hospital give DS two different diagnosis, and the second one even told us she could have gone either way with it. So sometimes it's not easy even for someone very knowledgeable.

Also, if Mechurchlady gave you any roasted marshmallows, I'd like a few please.

 

[koolaidmoms]

I wish my district had tighter guidelines on what qualifies as an autism diagnosis. I do not feel it is sufficient to accept just a 3 sentence letter from this one doctor with no documentation or test scores to back it up.

I know in our school district even if you had a letter from God himself saying you had autism you would need to have back up testing done at an approved center. They do not want to hand out any services they do not have to.

That is another whole issue.

 

[KirstenB]

Our dd is 3 and attends special ed preschool. Our county is rural, and the school system is small, so they don't break out children into separate classrooms by disability. Meaning, Zoe is in a class with another child who was dx'd with high functioning autism, a child with Down Syndrome, a child with hearing loss (and maybe other impairments, not sure), a child with physical and learning impairments, maybe cerebral palsy or MD, and a child who I don't know well enough to say.

Anyway, her school asked for the paperwork from UVA Children's Hospital, but at the end of the day, it was a small part of the acceptance process. She was tested at school by the PT, OT, SLP, and her classroom teacher, plus a school pyschologist. As the SLP explained to me, the official diagnosis is not so relevant. For example, if a parent tells her the child has Rett's Syndrome, the SLP will research Rett's, to better understand the child, but the focus is on what the child's NEEDS are.

I wish our district was big enough to break out classrooms by disability. Having said that, I love Zoe's teachers/aides/therapists. They do a lot with few resources. They have already conquered her sensory issues with touch, merely by having her finger paint, trace pictures in shaving cream, etc.

 

[tw1nsmom]

Do I think there are some doctors who over diagnose? Yes. Do I think that there are many many misdiagnosed kids who aren't on the spectrum? No. I think the rise in autism cases is directly related to the broadening of the criteria of what is considered autistic behavior. Having said that, I think there's a potential for Aspergers to break off from Autism and be a category on it's own along with Nonverbal Learning Disability.

The thing that concerns me in your post, is that your district is basing the educational needs only on the diagnosis. An autism diagnosis shouldn't automatically put a child in an autism classroom if that isn't the best placement to meet their needs. If they would benefit from the behavior classroom (or even better a mainstream classroom with supports), then they should be placed there regardless of the diagnosis.

The interventions should meet the needs of the individual, not the diagnosis. My son has Nonverbal Learning Disability. You know what they say about kids with NLD? "If you've met one kids with NLD, then you've met one kid with NLD." Every kid on and off the spectrum is different and a cookie cutter approach to interventions really isn't appropriate.

 

[KirstenB]

You know, after reading Twinsmom's post, I'm going to take back my comment about wishing dd's school sorted classrooms by disability. You brought up some very good points, and I need to give this more thought. My first thought was that an autism classroom could better serve Zoe's needs. But at the same time, the kids do present so differently across the spectrum. And, I'm not sure she'd be well-served with being only around kids with her same diagnosis.

Once again, I love my friends on this board. I learn so much from you guys without all the drama on some of the autism boards on other sites.

 

[jodifla]

OP, absolutely, YES! It's gotten totally out of hand. Too many children are being diagnosed WHO DO NOT MEET THE CRITERIA!!!!!!!!!!!!!!!!!!!!!!!

I'm on a late talker message board and many of those parents have HORROR stories to tell about being railroaded into taking an autism label when their children are NOT autistic. It's normally the schools that are gung-ho to slap a label on the kid, although there are plenty of "professionals" who aren't doing their jobs as well. Instead of the HOURS AND HOURS of testing it requires to diagnose autism, these WACKO QUACKO doctors pace the label out like candy because "what difference does a label make as long as you ge services."

Many of these parents now have older children and it's clear their children were NEVER autistic but had other issues. all languge based. Many hid out from the school system by homeschooling them until their children's language came in, the viola! put them in school, and all the bogus "autism" claims disappeared. Many of them took their children for second opinions, and the autism diagnosis was overturned. TOO MANY ASSESSORS HAVE NO IDEA WHAT THEY ARE DOING!!!!!!!!!!!!!!!!!!

And with the meaningless ASD label, kids way too young are being slapped with a life altering label leading families to divorce and bankruptcy and all kids of terrible consequences. It's a national nightmare and a national disgrace.

These leads to all kinds of wrong services and placements for our late talkers, and dilutes the services that truly austic children need.

My son has been through 5 thorough assessments for autism, and all came back nonautistic. Two were at one of the leading research universities in the U.S. -- one was even BEHIND MY BACK at the school district. But that doesn't stop the school district from pushing that label, because that's the blanket label they slap on anyone with a severe communication order.

Here's why the "spectrum" is so dangerous: People assume that it runs like a zero entry pool, from very deep (severe) to shallow (just "a little bit" autistic.) In reality, to get a true autism or even PDD-NOS diagnosis, symptoms have to be SEVERE and impact day-to-day living.

 

[disneydeb]

what about going to a board of education and trying to change the policy? maybe the district needs to know your concerns and you can invite the doctor and ask him what criteria he is using and explain to him what is happening.
Isn't there usually a team to help with diagnoisis, iep, and such and isnt it called a team because everyone should be working together including the doctor?

 

[Matt'sMom]

The thing that concerns me in your post, is that your district is basing the educational needs only on the diagnosis. An autism diagnosis shouldn't automatically put a child in an autism classroom if that isn't the best placement to meet their needs. If they would benefit from the behavior classroom (or even better a mainstream classroom with supports), then they should be placed there regardless of the diagnosis.

The interventions should meet the needs of the individual, not the diagnosis.

I so agree with this! Enough with the labels & pigeon holing. School districts would better serve their students if they placed more emphesis on actual 'needs' as opposed to simply focusing on a 'diagnosis'.

 

[jodifla]

what about going to a board of education and trying to change the policy? maybe the district needs to know your concerns and you can invite the doctor and ask him what criteria he is using and explain to him what is happening.
Isn't there usually a team to help with diagnoisis, iep, and such and isnt it called a team because everyone should be working together including the doctor?

The problem with the IEP team is a lot of times everyone sitting on it has NO BUSINESS labeling someone with autism. There's not doctor, and the school psychologist MIGHT be great....or might bey abysmal.

So basically, it's a committee of NON-QUALIFIED people sitting in a room and saying "Yep, he seems autistic to me."

And THAT is the bottom line of the autism "epidemic."

 

[ireland_nicole]

We have the opposite problem. Our child clearly has HFA, w/ support of numerous tests incl. ADOS, etc. given by qualified psychologists, neuros, neuro psychs, etc. And the school district is still telling us that it doesn't matter, at school she's "fine." This is my kiddo who went from high 90's avg. in 2nd grade to barely 70 now (9 wks later- gee, ya think she had issues w/ abstract reasoning?), the one who nas NO friends, who can only follow a sociial scropt of approx. 5 minutes, and then move on to another group, etc. The one with a documented visual perceptual processing disorger which they are also refusing to do more than add a place marker into her IEP for. Her psychiatrist even came to her last ARD and finally said to us after, I think you may have to have to talk to a professional advocate. UGGGHHH! Like we have any money left for that? And we're not even asking for a lot- primarily social skills groups that incorporate typically developing peers (which are avail, but only w/ AU dx). The worst part is, the only "documentation" they have to support their position is the word of her general ed teacher I'm just letting ya know, there are issues on both extremes.

 

[jodifla]

We have the opposite problem. Our child clearly has HFA, w/ support of numerous tests incl. ADOS, etc. given by qualified psychologists, neuros, neuro psychs, etc. And the school district is still telling us that it doesn't matter, at school she's "fine." This is my kiddo who went from high 90's avg. in 2nd grade to barely 70 now (9 wks later- gee, ya think she had issues w/ abstract reasoning?), the one who nas NO friends, who can only follow a sociial scropt of approx. 5 minutes, and then move on to another group, etc. The one with a documented visual perceptual processing disorger which they are also refusing to do more than add a place marker into her IEP for. Her psychiatrist even came to her last ARD and finally said to us after, I think you may have to have to talk to a professional advocate. UGGGHHH! Like we have any money left for that? And we're not even asking for a lot- primarily social skills groups that incorporate typically developing peers (which are avail, but only w/ AU dx). The worst part is, the only "documentation" they have to support their position is the word of her general ed teacher I'm just letting ya know, there are issues on both extremes.

Oh, I COMPLETELY agree with this! School tend to put kids where it's easiest for them. If they have a big MR program, then you're mentally handicapped! If they have a big AU program, then you have autism! If they do the minimal for all disabled students, then hey, you're fine!

"The way we've always done things" makes a big difference as well. They get stuck in a mind-set and you can't shake them.

 

[Luv Bunnies]

I would have to agree that people are sometimes too quick to apply the autism label to some kids. I work with special ed preschoolers of different disabilities and several of them have autism diagnoses. One mom insists her daughter is autistic when no psych or therapist can find any evidence of it. Another boy was diagnosed as severely autistic. His write-up said his mom couldn't handle his behavior and let have his way to avoid his tantrums. As soon as he started in our class, his mom noticed a huge improvement in his day-to-day behavior. She asked what we were doing. We said we're giving him boundries and discipline to which he responds very well. Now that he's calmed down, the school psych is rethinking her diagnosis. The kid is very social and really wants to play with the other kids. He was just so wound up that he didn't know how to start.

The class next door to ours is a specialized ABA-based class for autistic preschoolers. One girl has a severe autism diagnosis. They brought in a behavioral consultant to work with her. The consultant is convinced the girl is not autistic. She said there are obviously lots of things going on with her, probably some major cognitive impairment, but not autism. Her diagnosis is also being reconsidered.

From what I've seen, I do think some clinicians are too quick to diagnose autism. On the other hand, a pediatric neurologist once told us our 4 year old son was definitely not autistic. He said he had severe ADHD but not autistm. He turned out to be wrong because our son, who is now 13, definitely is on the spectrum (Asperger's) and definitely does not have ADHD. I think as parents we need to be careful, do our research and follow our gut feelings when it comes to our kids.

 

[debbi801]

I know in our school district even if you had a letter from God himself saying you had autism you would need to have back up testing done at an approved center. They do not want to hand out any services they do not have to.

That is another whole issue.

This is the way it is here, too. So, my 6 yr old has been dx'd 3 different times but, all have come back with an HFA/Asperger's dx. LOL

His one doctor mentioned that he sees a lot of kids who have been dx'd with ASD that in his opinion aren't truly ASD kids, but have some other issue that demonstrates similarly. In addition, both he and another one of DS's doctors have said that at the younger ages, it is difficult to get a true dx. That as the child gets a bit older, the dx most likely will be tweaked some. But, that the ASD dx helps getting the child the services needed at an earlier age to do the most good.

Right now, we're in a different boat. We're currently fighting with the local school district to have DS moved from a mainstream 1st grade class to a school that is strictly for HFA/Asperger's kids and kids with emotional issues. DS is failing miserably at school; he is totally overwhelmed, over anxious, and over stimulated. His current school doesn't have a special ed class setting, so he would need to be moved to a different school. The school board is coming to observe him today.

 

[Emagine]

I know some schools have their own 'rules' for placing and handing out the label even if the child has had extensive testing. It is ok, by law, to reeval the child for the placement of the school and the childs needs. But they also have to provide similar services to benefit the child till they do so.

I was spitting mad this past year when I moved from Canada with extensive testing from a Behaviour Pedi, the school, and an IEP. The school droped the ball and as a result I went above heads. They disgarded everything saying its a Canada Dx and and he was now in the states that they wanted to do their own. Sure ok, but you have to accomadate the child.

By middle of Oct I had been blown off 3 times his re-evals. I was working with them but I was also finding out the laws! My DS behaviour regressed and he began to wet himself. Something he does not do. I found out thier way of handling him was to pretty much put him in the nurses room with books, puzzles etc. He fell through the cracks.

Now some say say Oct and think that was not that long. By law it is when I handed them everything in March to back up his move. Per the state he was suppose to have his evals done prior to entering the school in the fall. There is more.

DS was granted a written removal from school at my request when I sent them a detailed list of all the laws that were broken. It is ok to do things the school way but they must accomadate the child till then if there is a DX or even an IEP.

We moved to NC this month and I have been to the school Special Ed team Meetings 2 times. He will not enroll till second week of Dec as we want all resources in place before he attends. They agreed and have been super.

Sometimes I agree it is handed out, much like the pill for hyperness. I know some kids who need it and some who the teachers use it as a cop out. I have myself even heard a retired teacher said she always used this for those trouble kids.

I do not always agree with a label placing Johnny in a certain area. Every child is different even with the same Dx and with that they should be looked at as an Individual and not a label.

Anyways sorry for the ramble, guess my experience is fresh on my heart LOL... But if your child is on the spectrum and they need something - make some noise!

 

[DisDreaminMom]

Concerning the preschooler with autism with a group of Special Ed kids, it worked out OK for me when my son was 3 and I didn't know any better, but when he was 4 and there were some really behavior-challenged kids in his class, it was the worst year ever with DS (he's 6 now). He picked up every non-social behavior and thug like activity of the worst kids in the class, because those kids got the most attention from the teachers.

We moved to another state (from FL to KY) and got in a school where they actually understand autistic kids (for the most part!) and it has been like turning on a light bulb for DS. He is in a normal class for "specials" and lunch, recess, etc. He goes down the hall to his special teacher for reading and math and has OT and Speech (he stutters in social situations), too. The teacher his first year at the new school had a tent in the room in case DS got too stimulated, and they gave him a weight vest and a funny bead filled seat cushion to help him feel grounded. He had a squishy ball to squeeze to calm himself down, and they actually asked me for advice when he did bad things. He was walking up to kids and pushing them hard, so I told them to give him a stuffed animal so he could A) have something in his hands and B) show the kids what he was holding because he thought pushing was a way to say HI.

His behavior issues literally disappeared overnight. Now in his 1st grade year, he is scoring higher than average on tests and doing math like nobody's business! He loves it because he gets to be different and have lots of adult time (loves adults, they love him- knows every single teacher's first and last name in the school and what grade they teach- can't deal well with kids at all-just so socially awkward).

In preschool he was chained to the wall with the rest of the bad kids, and really thought he was one of "them". If I had met my son back then (as a 4 yr old), I would have thought he was just a behavior case, not actually ASD. I had to fight hard and go to a big university hospital to get the Asperger's diagnosis. The school just said he was PDD-NOS. Now that the behavioral influences are gone, he is a textbook Aspie.

Is autism overdiagnosed? You betcha. Are those kids with behavior problems taking away from kids that really need help? Absolutely. Can you caring about our kids make the difference in a family's life? Yes.

I say that life with my son before this new school was like living with Helen Keller before she met "Teacher". It was that bad.

Concentrate on what you can help, and pray that calmer heads prevail soon. I, too am getting sick of this every-kid-has-autism trend. It's like ADHD a few years ago. My DH thinks DS is just a quirky kid, but even he agrees that there are just some things DS just can't help and these services he gets at school are really working to make him more confident and a better individual.

 

[BeckyScott]

I have noticed, though, that both of my kids act differently at school than they do at home. A good evaluator will take into consideration both, and not just what they observe in the office.

My oldest son (who doesn't have autism but something is going on) acts very differently at home. The teacher described a completely different child, I was actually laughing. I think he has a very difficult time and holds his act together during the day, but the second he gets in my car it all gets let loose. And of course the school was surprised at what I told them. Fortunately, the ped has seen my side, so I have back-up.

It also happens with youngest DS, but not as much so.