Multidisciplinary Evaluations - Why they are important

Discussion in 'Special Ed 101' started by Sheila, Sep 16, 2006.

  1. Sheila

    Sheila Moderator

    This is specific to co-existing conditions most commonly found with sensory processing disorder (SPD), but the same principal applies for most of the disorders you'll see discussed on this site.

    From :

    Barbara Hanft, M.A., OTR, FAOTA, and "a concerned parent"

    Dear Barbara,

    We just got back more test results on our son, Pat. Along with sensory processing disorder (SPD), he has attention deficit hyperactivity disorder (ADHD), specific learning disabilities, mood disorder, and central auditory processing deficit. As I have progressed through this maze of testing during the last couple of years, it is amazing to me that, now, after the fact, the specialists are saying how common it is for all these to be present in one child. As a parent whom I think is pretty well informed and connected, I find it amazing that no one ever told me to look at these other afflictions!

    On my own, I started reading and pursuing the ADHD angle, with the school giving me false information and discouraging me from going down this avenue. Once, however, I started down this path of discovery of ADHD, the mood disorder was discovered, and I was told how common it is in kids with sensory processing disorder (SPD). From that direction, we found our way to the auditory processing people who, once again told us how common it is to have this condition co-exist with sensory processing disorder (SPD).

    While we feel very fortunate to have uncovered all this, be it a bit late, why didn't someone talk to us about this in the very beginning? Are there any other disorders that are closely associated with sensory processing disorder (SPD) that we should be on the lookout for? It is so frustrating for a parent to think that they "figured out" their child, only to find out, after the fact, that it was only a small portion of the picture.

    What can/should a parent do? How can we be expected to be experts in all fields? We have started Pat on Prozac to deal with the mood disorder. In a few weeks we will start him on something to deal with the ADHD. Hopefully, we'll see a change for the better. We are still going through the transition from school to summer vacation and things are a bit rocky. I constantly marvel at the everyday situations that most parents and kids take in stride, but how hard it can be for kids like Pat and their families. Am I on the right track? And, what are other areas to be looked at that are closely related to sensory processing disorder (SPD)?


    Barbara's response:

    I understand your frustration and bewilderment. We all want finite answers to our questions when it comes to our children, especially when things aren't going according to our plans. It would be great to think sensory integration therapy could be that one answer, but it isn't.

    Part of the problem you are referring to is one that arises out of disciplinary perspectives. For any individual child with learning and behavior problems, the M.D. may diagnose ADD or ADHD, the psychologist a mood disorder, the Occupational Therapist (OT) sees sensory integration, the speech pathologist points out an auditory processing disorder, and the teacher sees a specific learning disability and so on. Each discipline has a narrow focus and defines brain function by what they have been trained to see.

    In addition, these diagnoses are really only words used to define one aspect of brain function or dysfunction. It's similar to the parable about the blind men touching an elephant for the first time and describing it by the one part they come in contact with. There is a very large overlap between sensory processing disorder (SPD) and other disorders such as learning disabilities (Learning Disability (LD)), ADHD, executive function disorder, auditory processing, obsessive function disorder, and Tourette's syndrome, to name the most common. This is because the brain does not operate in discrete parts — there are connections, based in neurochemistry, throughout the entire central nervous system. If there is a breakdown in processing in one part, it affects other parts. The positive side to this equation is that different parts of the brain can "help out" when neural pathways are not operating efficiently.

    One of the "fuzzy" aspects of the disorders you mentioned is that they are processing problems based in the brain's biochemistry versus a specific factor, such as a tumor. For example, I have read of cases where medication for ADHD "unmasks" one of the associated disorders, such as obsessive compulsive disorder (Obsessive Compulsive Disorder (OCD)), because of the change in brain chemistry. The medication does not cause the Obsessive Compulsive Disorder (OCD), which is exacerbated with the biochemical changes in the brain.

    There are two books that I have found useful in understanding ADHD, Learning Disability (LD) and associated disorders:

    Dornbush & Pruitt. (1995). Teaching the tiger: A Handbook for Individuals Involved in the Education of Students with Attention Deficit Disorders, Tourette Syndrome or Obsessive-Compulsive Disorder

    Comings, D. (1990). Tourette Syndrome and Human Behavior

    Finally, and most importantly, go easy on yourself. The issue isn't pinning down what to call "it" as much as overseeing your son's progress in school and at home and asking questions when he isn't moving ahead. Of course, this includes securing services like Occupational Therapist (OT) or speech therapy or medication as needed. However, we can make ourselves crazy filling our child's day with therapy and educational activities and lose track of this: No one but a family member is going to look at the big picture and make sure a child is happy and fits into family life on a daily basis. Your son is a child, not a collection of diagnoses.


    Barbara Hanft, M.A., OTR, FAOTA
  2. SRL

    SRL Active Member

    Here's another one that came across another list I'm on:


    Mental Health
    Asperger's Frequently Confused with Other Psychiatric Disorders
    By Sep 4, 2006, 07:00

    Asperger's Frequently Confused with Other Psychiatric Disorders

    ( HOUSTON--Doctors often diagnose children with attention deficit disorders, learning disabilities or bipolar disorder when their patients actually have Asperger's—a developmental disorder that inhibits the ability to socialize well with others.

    Misdiagnosing the disorder prevents patients from receiving proper treatment and learning important skills for success in social settings, school and relationships. While a diagnosis can be made for Asperger's Disorder as early as 2 years old, most children are not diagnosed until they reach middle school or later (see sidebar for common characteristics of Asperger's Disorder).

    "There is a huge confusion over what Asperger's is and what it isn't because it has only been diagnosed by the present criteria for the past 12 years,” says Dan Hoover, PhD, a psychologist with the Adolescent Treatment Program at The Menninger Clinic and associate professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. "Asperger's is over diagnosed by some clinicians who are looking for it, and missed by clinicians who don't know what to look for, or who do not want to give their patients the label of having Asperger's Disorder.”

    A combination of environmental and genetic factors may contribute to the development of the disorder, but the exact cause is unknown. Mental health experts believe Asperger's disorder is similar to autism because it affects the areas of the brain that control communication. However, symptoms of Asperger's Disorder are not as severe as autism.

    Children with Asperger's disorder may be highly intelligent and can communicate with others---they just don't do it well. They are preoccupied with special interests like trains, motors, dinosaurs or Internet gaming. They also often speak in an idiosyncratic style that is hard for outsiders to understand.

    "Patients with Asperger's are limited in brain areas that enable people to understand subtle cues,” says Dr. Hoover, who treats individuals with the disorder. "They don't reciprocate in conversation and tend to lecture others about subjects, and they don't notice if the person who they are talking with looks bored or has no interest in the subject.”

    Because children with Asperger's disorder can't communicate well, they seem odd and may be singled out for ridicule among their peers. Over time, because of their negative experience with people, patients with Asperger's disorder distrust others and seek further isolation. Many people may misinterpret their behavior as rudeness, when in actuality, "almost everyone with Asperger's wants to relate to others,” Dr. Hoover says, adding that patients with Asperger's become depressed or act out when they can't connect with other people or make friends.

    While there is no cure for Asperger's, people with the disorder can learn social skills to help them better relate to people. Some therapists recommend patients use scripts that spell out exactly what to do and say in a social situation. Therapists and parents may also encourage children with Asperger's to dress in a way that helps them fit in rather than stand out. Persons with Asperger's often dress oddly, for example in mismatched or unfashionable clothes.

    Antidepressants can help patients with Asperger's deal with the depression that commonly accompanies the disorder. Physicians and psychiatrists may also prescribe attention deficit hyperactivity disorder (ADHD) stimulant medications to help patients with their impulsivity or disorganization, or antipsychotic medications for patients who act out or who are irritable and aggressive.

    Patients diagnosed early with Asperger's do best at learning how to adapt to their disorder, Dr. Hoover says. Parents who are concerned that their child may have symptoms of Asperger's should schedule a visit with a trained child psychologist or psychiatrist to rule out other behavioral or psychiatric disorders.

    "Many people think that patients with Asperger's are stuck that way, but I have seen real change in some of the patients I have treated,” Dr. Hoover says. "A big part of getting better is knowing what Asperger's is and doing something about it.”

    Common characteristics of child with Asperger's Disorder
    • Has difficulty interpreting non-verbal gestures such facial expressions, body language and gestures
    • Avoids eye contact with other people
    • Fails to make friends with children the same age
    • Doesn't share enjoyment, interests or achievements with other people
    • Often insistent on following inflexible rituals or routines
    • Not comfortable with own body; clumsy
    • Preoccupied with parts of objects and special interests

    The Menninger Clinic is an international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital.

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  3. tiredmommy

    tiredmommy Site Moderator

    These are incredibly wise words for all parents.