ADHD to autism...?

[forkeeps251]

First some quick background: difficult child is 7, speech delayed, ADHD, and has anxiety. Thats what he has been diagnosed with, we can also add to that depression (wants and tries to hurt himself), low self esteem, and is behind in most subjects. Kindergarten was rough for us, he threw chairs, hit kids, bit kids... you name it. He would hide under tables and behind doors, not participate, and chew holes through his clothes. This year has been better for the most part but he still has problems, mostly refusing to do work and banging his head on stuff when he is upset. End of last year when he got his daignosis, he started medications... for adderall, then intuniv, then adderall and intuniv... now they have swiched and his is not taking Focalin XR, intuniv, and prozac. Thank goodness, the medications seem to be working now for the first time ever!! Althouh I have noticed that he tends to spend long, LONG periods of time to himself, in his room playing with Lego's or something.

Anyway, we started with a regular family therapist a month or so ago for him. I met with her yesterday and to summarize what she said, she said that she sees a lot of behaviors just from her two sessions with him that she also sees in her clients that have an autism diagnosis. Some interesting things she pointed out:

1) when asked to draw a picture of his family doing something they enjoyed (which we do a lot of stuff together, so there should have been plenty of material), he instead drew a picture of himself, alone in his room and playing with legos. (it was actually a really good picture!)

2) He spent a lot of time setting up the doll house but didn't want to play with it when he was done. Interesting because that is what he did with his "long" evaluation last year. She said he also gathered up other objects in the play room to make the furniture he wanted in the doll house since it wasn't already in there.

3) She asked him if he had friends, and he said he had a lot of friends, but was only able to name one.

She beleived that his problems aren't just related to ADHD. She isn't a specialist, but she said it is more than ADHD.

Same thing that people on here have said too.

Also, when he had his "long" evalutation last year, they wrote the following things:

He took this WISC IV test... I have no idea what that means but he scored "borderline" for verbal reasoning of 75. He had difficulty with word knowledge and would give answers that didn't make any sense. He scored in the "high average" range for "perceptual and fluid reasoning, visual spatial processing, and visual motor intergraton", a score of 112. Then it says this: "The 37 point difference between his VCI and PRI scores is significatn at the .05-level and is seen only in .4% of the population. This difference confirms the severity of difficult child's speech and language problem and supports the necessity that accomidations be in place at school.."
**Side note: If someone could put all that in laymans terms I would greatly appreciate it!!**

Also in the summary of it they wrote:
"difficult child's attention problems and anxiety combined with some other behaviors are also suggestive of possible autism spectrum disorder (Autism Spectrum Disorders (ASD)) such as Aspergers. difficult child's mode of play is generally repetitive and while he wants to interact with others he does not seem to know how. His over-sensitivity to noise is also commonly seen in children with Autism Spectrum Disorders (ASD)'s. His extreme difficulty with berbal skills and above aberage nonverbal cognitive skills are also common in children with Autism Spectrum Disorders (ASD)'s. However these supotoms can appear independent of Autism Spectrum Disorders (ASD) and may be explained by his language disorder and ADHD. At this time a diagnosis of ADHD and Anxiet Disorder not otherwise specified is made with note to continue to monitor for Autism Spectrum Disorders (ASD)'s."

Soooo, I've got quite a few indications that he may be on the spectrum and I should probably get him tested. The question is, what next?

There are several centers where I live that do all the testing and offer therapy, and specialize in autism. I know most of them have a waiting list and I'm not sure if they take insurance.

His therapist recommended we try to get it done through the school district, since they will likely want one of their on psychiatric's to diagnosis it in order to make accomidations (note: he already has an IEP but is not 504, whatever that means). He has already had one evaluation done through the school and they stuck with the ADHD diagnosis and depression. She seemed to think he had enough age appropriate behaviors to not put him on the spectrum, or at least that's what I gathered from it.

So I could go to a specialized place, I could push the school to do it, or I could wait till his current doctors (psychiatrists) feel like they should do another evaluation. That may be some time though since his last one that I quoted above is just a little over a year old.

Suggestions????

 

[buddy]

HI! I'm so glad your therapist is seeing the bigger picture because those multiple symptoms often do come under the Autism Spectrum Disorders (ASD) umbrella and very often therapy is just much more tailored to meet a difficult child's needs when people who really are trained to work with people who think like a person with Autism Spectrum Disorders (ASD) thinks, things start improving so much.

First, over simplified laymans terms for the testing......the tests are broken into two big categories here....the things we do using language/verbal skills and the things we do using non verbal skills. Your difficult child does much better using his non verbal skills. That is quite common in Autism Spectrum Disorders (ASD) as is a varied pattern of higher scores and lower scores on testing. People with general delays tend to be low across the board (in general) and people with Autism Spectrum Disorders (ASD) tend to have some high areas and some lower areas.

In terms of where to go...

Schools do not medically diagnose. What is done for an IEP/special education is to test areas and that can include analysis and consideration of outside medical testing....then they must use criteria for each of several special education categories. There is an Autism Spectrum Disorder category in special education. That is why it gets confusing...but it is not a medical diagnosis even if the district has a marvelous autism team and does a better evaluation than a medical team (that DOES happen, it just depends where you live and what is available). In our area it is very common to hear a parent say, my child has a school label of Autism Spectrum Disorders (ASD) but not a medical label or for my son, he has both the school and medical label of Autism Spectrum Disorders (ASD). Your son was put in an educational category (and if it is adhd then that means the medical information that says he has adhd was considered in his placement)...so he is likely in the educational category of OHI (other health impairments..sometimes worded a little differently among states) or EBD (emotional and behavioral disorder.....again can vary a little in the terminology) if the anxiety diagnosis was considered....
You can call an IEP meeting at any time and you can request assessment at any time. Does your district have an autism team? Or an autism specialist in the district that travels to schools for assessments when autism is suspected? That is a good first question and then when you make your request for re-evaluation to consider placement under the Autism Spectrum Disorders (ASD) category and Autism Spectrum Disorders (ASD) programming....you can specifically ask for those people to be a part of the team.

Autism Spectrum Disorders (ASD) has been used as the category for all kids on the spectrum in the schools, no separation between non verbal very delayed kids versus kids who have Asperger's. But then when it comes time to develop the IEP individual levels and skills are used for placement into a specific program and many schools have separate programs for students depending on their functioning level.

Soon the medical diagnoses will be changing too....so it will match the term the schools use....the general Autism Spectrum Disorders (ASD) (autism spectrum disorder) diagnosis. It hasn't happened yet but it will soon. Until that change, in a medical or private center the terms are Pervasive Developmental Disorder (PDD) (pervasive developmental disorder) as the broad term and under that the separate categories of Autism, Aspergers, Pervasive Developmental Disorder (PDD)- not otherwise specified (not otherwise specified) and a couple of others that are not your situation. So do not be confused....it all means Autism Spectrum Disorders (ASD).

If he has an IEP it is a good thing. A 504 plan is another plan for people who have special needs but it does not involve making goals and objectives and accommodations that are measured and monitored by special education professionals. People dont have both. In your case it is good you have the IEP so that you have specific rights and they must work to individualize his educational plan as well as to help work on his social and behavioral needs in a way that develops/teaches appropriate skills. You do not need to consider anything to do with a 504, so take that off your plate.

So, you ask what to do???

in my humble opinion, you will need to do both, approach this on the medical/private front and the school front.

It often helps to have the medical front approached first because that information is powerful in a school setting. If you have specialty clinics near you absolutely use them. Get your name on the list asap. If they say it is years of course that is too long. But at this point you likely wont get it done before the end of school.... Very often insurance does cover the clinics like this if they are medical clinics with MD and PhD people leading them. If you can't find one then there is also the neuropsychologist route. That too can be a long wait. With the evidence you already have, I'd want personally to connect to an autism specialty clinic because then you will have connections for therapy too.

You can decide, you can wait until this is done or you can start now and submit an evaluation request to the school. Since he is already in Special Education, if you feel things are going better this year, you might want to get all your ducks in a row and be able to have all of the medical evidence you can to bring to that evaluation. Maybe work on that now and through the summer and then right away, at the beginning of the year turn in that written re-evaluation request for purposes of changing the educational category.

Will he be going to ESY? (extended school year....which is special education that goes on during the summer)?

His play and language and social skills as well as behaviors do sound very much like they are on the spectrum from afar, across the internet....of course that is just an informal opinion. But how many times do we see this on the board??? Kids start out with the ADHD, plus anxiety or ODD and often the sensory processing disorder (SPD) diagnosis..... and all of these things are very common symptoms under the Autism Spectrum Disorders (ASD) umbrella.

The bottom line is that (hopefully, we all know of exceptions) Autism Spectrum Disorders (ASD) programs already are set up and planning ahead that their students have these challenges. Their whole method of operation is to address these kinds of things. For example, in the autism classes, if there is a surprise fire drill....the principal knows to alert those teachers and ear protection is given to all of the kids and often they are told of it so that there are not meltdowns. The class is set up to provide appropriate visual supports since so many of the kids have trouble with verbal language and communication. They explain things in a way that goes step by step directly teaching even the parts of school rules and activities that other kids are not told about like not just walking in line but how far away your body needs to be and then they practice that to learn the skill. They know they often have organizational challenges so it is just a common part of the whole class to arrange things and keep it very very routine.

So, even if the thought is...maybe he does not have Autism Spectrum Disorders (ASD) but he has all these challenges that many Autism Spectrum Disorders (ASD) folks have....well,would an Autism Spectrum Disorders (ASD) program be a good learning fit?

That is what I decided...it didn't matter to me if someone wanted to say it was all the brain injury stuff. He met the criteria for Autism Spectrum Disorders (ASD) and he learned best in an environment that addressed those learning needs and styles so Autism Spectrum Disorders (ASD) was a fine category for him to be in on his IEP. (he happened to also meet medical criteria so has both the school label and medical diagnosis too, I just didn't want to accept it at first, that quickly went away when I saw how much better thing went and was able to get therapies for him that really were effective)

I hope I didn't make things more confusing....you have a lot on your plate but all in all, in my humble opinion this is good news because each little crisis and behavior and skill deficit wont have to be looked at individually...if it comes out he has the Autism Spectrum Disorders (ASD) category my hope for you and him is that he will be with people who really get it.

 

[BusynMember]

Sounds Autism Spectrum Disorders (ASD) to me. I was probably one of those who said so...lol. OMG...DON'T GO THROUGH THE SCHOOL DISTRICT!!! Please, don't!

I always prefer a private neuropsychologist. He sounds pretty autistic, not just a little bit. He is high functioning, but he sounds pretty typical. He needs the diagnosis to get help, especially in school, and, at least for us, the school offered Occupational Therapist (OT) and PT and social skills training and special education where he needed it. He had a speech delay too and banged his head and scratched himself, but he was sort of over doing that by about five. But he was also getting a lot of help.

We had trouble getting a diagnois too, but we knew a lot about autism so we made the school give him Autism Spectrum Disorders (ASD) supports, even without the diagnosis. He didn't see a neuropsychologist until he was 11. I had never heard of them. That's when he was finally diagnosed.

I am sure your son can get tons of help and soar as well. I'd do the neuropsychologist though. Whoever else you see, I would not leave out the neuropsychologist. If the autism specialist isn't a neuropsychologist, I wouldn't go there. Professionals who say that they specialize in, say, ADHD see ADHD in most behaviors. I think it's better to see somebody who is not biased toward any diagnosis. I mean, we could be wrong and he could have something else.

Hugs. You're on the right trail.

 

[InsaneCdn]

I mean, we could be wrong and he could have something else.

Or... we could be right but not "complete"... for example, it could be Autism Spectrum Disorders (ASD) plus... (just for argument here, not that YOUR son has any of these) Auditory Processing Disorders (APD), or a MI...

Welcome to the long winding road of getting answers!

 

[BusynMember]

Auditory Processing Disorders (APD)'s are a common part of autism too though.

We'll see what neuropsychologist says. I'd be surprised if he's not on the spectrum. All the markers are there.

 

[InsaneCdn]

Yes, APDs are common on the spectrum... also not uncommon in ADHD kids. But... in our experience (including the PhD Audiologist who does this testing here...), unless it's the "language processing" type of Auditory Processing Disorders (APD), it doesn't usually get recognized in Autism Spectrum Disorders (ASD) kids. Some of these things are just worth testing separately.

 

[BusynMember]

Believe it or not, they tested Jumper in school and got her auditory processing disorder diagnosis. I don't remember who did the testing. She is ADD, and definitely not on the spectrum. But she doesn't have any Autism Spectrum Disorders (ASD) symptoms either. It's hard to get schools to pay attention to APDs so we got lucky. They think that Jumper's inability to learn to read until she got help was because of the APDs, but who knows? (sigh)

 

[InsaneCdn]

They think that Jumper's inability to learn to read until she got help was because of the APDs, but who knows? (sigh)

For difficult child, it was.
They didn't catch the Auditory Processing Disorders (APD), though... what they did was inadvertently handle him as though he had Auditory Processing Disorders (APD)... and pulled him from class for one-on-one reading instruction (separate, quiet, mini-classroom).

APDs are highly under-diagnosed.

 

[BusynMember]

I believe it. Sadly, for the most part here, I don't think the child would even get supports for it. The only reason Jumper did was because the school's Occupational Therapist (OT) they brought in caught it. If it had been somebody outside of the school, who knows? Interestingly enough, that was why she couldn't learn to read or put sounds together to make words. She learned to read very quickly once she got help. Grrrrrrrrrrr!

 

[forkeeps251]

I'll have to look up Auditory Processing Disorders (APD) too... is that something that a trip to the neuropsychologist would cover?

The therapist yesterday isn't a speech pathologist, but she thought one thing that I told her was interesting, and that is that difficult child will sometimes mix up words... like we were at the eye doctor, and I bumped my elbow on something and said "ouch", and the eye doctor said "you ok mom?"... you know, calling me Mom because I was there with difficult child. difficult child looked at her and said "what? You aren't her husband"... obviously he meant child, but said husband instead. He does this with a lot of stuff, he will say a word that is related but not exactly right. I told the therapist this, and she said she thought it was apraxia. I looked that up though and wasn't really able to make sense of how that could be related to what difficult child does. She did ask me to tell his speech teacher at school about it though.

 

[buddy]

Well, apraxia is a motor disorder where the words and sounds are not clear sounding. (uncoordinated).....
But there are language issues where words are mixed up. It would take assessment to find out why and if it is a problem.

The speech path can screen for Auditory Processing Disorders (APD) but only a small number of audiologists are specially trained for testing to see of there is an auditory processing disorder. It takes special equipment. Do if that is a concern you would need to call around to find an audiologist like that.

 

[Jamieh]

I do not have much advice as I am just starting on the whole journey of getting my son evaluated for Autism Spectrum Disorders (ASD) as well. But I can relate to you. My oldest has ADHD and sensory processing disorder (SPD) and all the therapists think that he falls somewhere on the spectrum...possibly asperger's. I hope you are able to get him in to be seen by someone

 

[InsaneCdn]

You aren't her husband"... obviously he meant child

Read more: http://www.conductdisorders.com/for...activity-disorder-autism-53246/#ixzz2PMswfdhB

Try dysnomia (sp?) - which is difficulty retrieving the correct word for the situation at hand. They know the words, and they know what the items are (for example) - but might pull the wrong word some of the time. Often, as they get older, can substitute other words correctly but can't land "the" word they are looking for. Like "that thing you step on at the bottom of the door" instead of "threshold".

 

[forkeeps251]

difficult child is in the principal's office today for the third time in a row, for hitting his head against stuff (hard). This started before the prozac however it has become more and more frequent, so I'm not sure if it is related or if I should be worried. difficult child said himself that he didn't want to go back to class. I think, and the school agrees, that he is doing it to get out of class. He really hates being in class that much.

I've told him if he doesn't stop I'm going to make him wear a helmet to school. Does anyone know where a safety helmet... not like a bike helmet... can be seen online? I'm going to show it to him tonight and tell him that if he doesn't stop, that is what is going to happen.

 

[buddy]

Try dysnomia (sp?) - which is difficulty retrieving the correct word for the situation at hand. They know the words, and they know what the items are (for example) - but might pull the wrong word some of the time. Often, as they get older, can substitute other words correctly but can't land "the" word they are looking for. Like "that thing you step on at the bottom of the door" instead of "threshold".

There are many issues that can result in this including semantic challenges like difficulties with categorization, or aphasia, word finding issues, etc....Sometimes it is just developmental....(not age related but developmentally related)

Really, it would take an assessment to see, in my humble opinion...... dysnomia describes an issue but again, not why.

 

[InsaneCdn]

dysnomia describes an issue but again, not why

Just like... how many of the various issues and challenges our kids see?!

 

[buddy]

difficult child is in the principal's office today for the third time in a row, for hitting his head against stuff (hard). This started before the prozac however it has become more and more frequent, so I'm not sure if it is related or if I should be worried. difficult child said himself that he didn't want to go back to class. I think, and the school agrees, that he is doing it to get out of class. He really hates being in class that much. I've told him if he doesn't stop I'm going to make him wear a helmet to school. Does anyone know where a safety helmet... not like a bike helmet... can be seen online? I'm going to show it to him tonight and tell him that if he doesn't stop, that is what is going to happen.

I used to say that I would come to school and hold my son's hand in places where he had an issue, and I meant it. Problem with threatening a helmet is that if you come to a point where you find that he really is not doing it completely for escape purposes, you may have to follow through. I think personally that if he really needed it, that would be one thing, if you mean for him to be embarrassed by it, then ...will you really follow through? And how would you make him keep it on? What if the threat doesn't work?

I only bring that up because I have been there....sigh. truly, it seems like a little thing then it ends up being a chance that he will learn that your threats are not credible.

If he is doing this to escape then it is time to do a functional behavioral assessment. If this is a pattern of behavior then that is the standard.

They need to analyze when he does this, how many times, how intensive, etc...what happens before and after....and then come up with a theory based on the data saying what is triggering it and what is the function of the behavior.

For my son, often one thing starts a behavior (like hitting his head or swearing) and another thing (maybe the attention that he gets even if negative) continues or increases the behavior. The answer is not always as simple as just wanting to escape or to get attention.

So just a random example...maybe at that time of day his blood sugar is low or he just ate or kids in the hall are making more noise or whatever.....and so he does it for sensory reasons or because of a headache or whatever....

Then, he finds out that ..wow , this is getting me out of that situation (again we really dont know why he wants out) so, true, I don't want to go back and it seems to work. (Now we maybe have accidentally increased or reinforced his behavior)

After the analyze the behavior (you may have to again ask for this evaluation in writing and send registered mail)....a POSITIVE behavior plan to help increase appropriate behaviors of staying in class, staying on task, using another more appropriate coping mechanism like asking for a time out pass to go to a sensory room....would be developed.

Does that make any sense??? I am getting ready to pick up Q but wanted to respond because I have been in your shoes so so so many times.

 

[buddy]

Just like... how many of the various issues and challenges our kids see?!

exactly!!!

 

[InsaneCdn]

If he is doing this to escape then it is time to do a functional behavioral assessment

Read more: http://www.conductdisorders.com/for...activity-disorder-autism-53246/#ixzz2PQgB5KoM

Whether he's doing it to escape or not... there will be a reason, and you need to find the reason.
Like that common quote from The Explosive Child... "Kids do well if they can"... i.e., not "if they want to". SO... why does he do this?

That is, of course, the big-$$$ question... and the answers are not always obvious!
But you're better off to assume that HE doesn't really want to be doing this either - and taking a different approack.

 

[SuZir]

I've told him if he doesn't stop I'm going to make him wear a helmet to school. Does anyone know where a safety helmet... not like a bike helmet... can be seen online? I'm going to show it to him tonight and tell him that if he doesn't stop, that is what is going to happen.

I would be extremely cautious with this. If you make a threat you have to be ready to follow through or you will lose tons of credibility. And if he hates being at class so much he is ready to hurt himself to get out, do you really think embarrassing him and making him a subject of teasing from other kids for years to come (and kids do not forget, when I was at High School, there was a guy called Puke by everyone because he had been so scared on his first day of Kindergarten that he puked in class...) Because lets face it, helmet will not make him stay in class. Even if teacher allows him hit his head in peace with helmet, he will find another way to get himself out from there. He can bite himself, throw a chair, hit the kid next to him or scream from the top of his lunges. He will get himself to principal's office if he wants to. By the way I have embarrassed my kid in front his peers to make him stay at school. Really didn't work. I would love to take those times back.

Your problem is not that he hits his head to get out of class. It is that he hates being in class so much. 6-year-olds don't cut class to get to have a cig in restroom, or to appear cool to their friends, or because they are lazy. 16 would be a different matter, but if 6-year-old hates school so much that he does anything to get away from it, problem has to be solved in some other way than punishing the child (again, been there, done every possible mistake on that, not feeling too proud of myself nowadays because of that.)