psychiatric evaluation was today!

Discussion in 'General Parenting' started by Ktllc, Dec 20, 2011.

  1. Ktllc

    Ktllc New Member

    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    On the other hand, V shows a lot of marker for Anxiety (withdrawn, tantrums...).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!!!
  2. buddy

    buddy New Member

    Wow lady! Sounds like you feel comfortable in your gut with what he is saying and I think that is the measure of success. Glad you have a plan to start from at least. Will be great to hear how he is going to guide you with this information. Keep sharing! Congrats on his doing so well during the evaluation.
  3. TeDo

    TeDo Guest

    I feel very relieved for you. It is so nice to have a professional that listens, sees, and follows through. YIIIIPPPPPEEEEEE
  4. DDD

    DDD Well-Known Member

    Awesome. I'm so glad that you are happy with the meeting. DDD
  5. Malika

    Malika Well-Known Member

    Ktllc, I echo the others and am obviously pleased that you have answers and that you feel satisfied by the evaluation. As an outsider, though, reading your account left me with some questions... Not to be troublesome, but just to be honest :) The doctor seems to be avoiding conventional labels and diagnoses at the moment, which for a 4 year old, is probably quite wise. However, when he spoke about medicating V, on what basis would that happen? I mean, to medicate don't you have to have a diagnosis? I feel a little confused by the communication delay, at V testing at the level of a 2 year old - isn't that quite serious? Would anxiety alone account for that?
    Just wanting to understand more. I am sure you couldn't go into all the complexities in a brief post and maybe the evaluation as you received it is a coherent whole.
  6. Ktllc

    Ktllc New Member

    Well, I still have to wait for the full report and complete recommendation.
    But as far as communication delay (which he admitted was quite significant), he believes that anxiety alone could account for it. Kind of you are on stage in front of 100 people: you know the words, but anxiety takes over and you can't carry a conversation any more.
    As far as medications: that would allow him to relax a bit and make behavioral intervention more effective.
    If all problems disappear after a certain amount of intervention, then no reasons to worry anymore.
    But there is a possibility of the language delay sticking with him... I guess we won't know until we take care of the anxiety.
    I agree that it leaves me with some questions, but I don't think there is any "miracle" answers. Right now, that is the best hypothesis and we have to put it through the test.
    V will be tested by the school again in May. It will be a good time to re-evaluate the communication delay.
    Even if it is a "real problem" and not just a side-effect, I sure hope the school district can tackle it. Communication issues are not that seldom and seems to run in our family after all.
    It will take time no matter what, but the doctor assured me that V had the cognitive ability to do it.
    We are also waiting on the sleep study results to come back. It might be another piece of the puzzle (sleep issues run in the family as well: husband has sleep apnea).
  7. InsaneCdn

    InsaneCdn Well-Known Member

    Some things are a bit chicken-and-egg, and really hard to say which comes first...
    Anxiety and speech delay would be a pair like that...
    Yes, anxiety can cause speech issues.
    And speech issues can cause anxiety.
    ... until the poor kid doesn't have a clue what started it.

    But no matter what the doctor says... its been going on so long, that its more likely that speech delay is feeding anxiety (which then makes speech worse).