Phew... I'm tired and the doctor's words still spin in my head. But it all made sense. Nothing came as a huge surprise which is good. He, for sure, said it is not autism. He explained that a lot of behaviors could look like it but the core problem of autism is the inability (to whatever degree) to read non verbal social cues. The doctor said that V is a "rock star" at reading non verbal social cues. No problem there. We talked quite a bit, explained my concerns, went over what we have done, etc... I liked that he said that we did 50% of the work by changing his environment and our attitudes towards his behavior. But I also like that he said we are now missing the other 50%: teach V his lacking skills instead of just responding to the behavior. I admitted I did not know how to do that and that was the whole reason we were here. So, basically, we were on the same page from the start. He then took V and did a bunch of test. I had preped V so he would be cooperative and he was! So proud of my little man. The doctor thought V did a very good job and V was still in a good mood afterwards. While they were together, I filled out more forms (VERY long). He then took a good 40 minutes to review everything and we talked about his findings. His cognitive skill are good and so are his verbal skills (at one point, we were wondering if was intellectually limited...). So all clear there. On the other hand, V shows a lot of marker for Anxiety (withdrawn, tantrums...). The doctor sees it as the primary issue. He also shows a significant communication delay. V is 4.5 and it tested at a 2 year old level... But the doctor is not sure if it is an actually language delay or just a consequence of his anxiety. I did point out that the Speech Language Pathologist (SLP) had not found a language delay and I describe what the test was. doctor explained that communication/language is very different than verbal skills. Yes, he is verbal: good grammar, good vocabulary. But V is delayed (or appears dealyed) when put in the situation of a social conversation. His social skills are delayed as well which, according to doctor, is a direct consequence of his anxiety and communication issues. V also shows a small delay in pre-academic skills. The doctor admitted not knowing what to do with this information at the time. Yes, it raises concerns, but he is only 4. He does not want to jump to the conclusion of a Learning Disability (LD). I also asked about sensory processing disorder (SPD) and the fact that Occupational Therapist (OT) doesn't seem to work and looks pretty senseless to me. He actually does not believe V has any issues in this area. He thinks V's anxiety completly flawed the Occupational Therapist (OT) evaluation. I want to agree with him on that. I don't and doctor does not see any motor skills issues. Finally, he mentioned some mild red flag for ADHD, but nothing to concerned at that point. Just something to keep in mind for the future, just in case. I talked to him about V's ability to focus (he can quietly play with his toys for hours, litterally, as long as he is not bothered by his siblings). doctor nodded and said that's why we should not worry about it, for now at least. He will be writting a full report with all of his suggestions. He gave me, already, a few tips on how to teach V to cope with his anxiety. It seems to make sense but it also sounds like a lot of work! Of course, the question of using medications was discussed. I'm almost tempted, so is husband. This doctor made a lot of sense and he talked about medications helping make it easier for V to acquire those new skills just because his "fight or flight" reaction won't be as intense. He also said that V was definitely smart enough to benefit from behavioral therapy, but that any kind of talk therapy would be/is a waste of time for V. I asked about Auditory processing issues and he said that V won't be able to be tested until his language skills (=communication skills) are a t a 7 year old level! V is far from that!! Since he tests at 2 year old level.... So the plan: treat anxiety and hopefully the rest will fall into place. If not, we'll have to look into speech and language therapy. Wow! Some much to think about!!!