Still struggling with social skills.

Discussion in 'General Parenting' started by Chantillylaceo, Jun 9, 2013.

  1. My 5 year old has ADHD and sensory processing disorder (SPD). He's in Occupational Therapist (OT) and is medicated (please, do not judge me for medicating my child so young when you don't know the whole story. He is impulsive to the point that he puts himself and others in danger).

    About a year ago, I was concerned about his social skills and started working on them. I'm a speech path, so he has had a lot of social skills training that includes picture schedules and social stories in his daily life.

    The psychologist that tested him 9 months ago before I medicated him said that he thought the ADHD medication would help his social skills, but even with the medication and my home-made "pragmatic therapy" he still hasn't made any progress.

    For example: Last week he went to the dentist and when the dentist told him "hi" he barked at the dentist (not in an aggressive way). Seriously. When people tell him "hi" he usually ignores them. I have to stop him, ask him where he's supposed to look (to which he replies: "at their face") and tell him to say hi. We've been working on this FOR A YEAR! He also says a lot of things with just one word. When he wanted to tell his teacher that he brought a book to school he said, "Book" and just looked at her that she should know what he meant. I have to tell him all the time that people don't know what you mean... you have to tell them, "I brought a book." He does not have a language delay though. He's actually pretty advanced in his language skills. I've tested him myself.

    The psychologist said that he doesn't think my son has Asperger's. He said that he's not a expert in that area, but he didn't really register much on the Autism screening tool he did. I'm still concerned though. Here are the symptoms of AS my son has and the ones that he does not have:

    Symptoms he has:
    Delay in empathy (he shows some empathy for family... on occassions)
    Poor social skills
    sensory processing disorder (SPD)
    He likes things to go a certain way and doesn't do well with change
    Tantrums easily
    Coordination delay
    Trouble regulating his emotions
    Does things that he thinks other kids think are silly over and over again (I heard one kid tell his mom "He does that all the time" when my son was repeating "Boo!" to him and jumping from behind the door over and over again)
    Doesn't seem to make an effort to learn his friends' names when they all know his name (He's been at this new place about 5 weeks)

    Symptoms he does not have:
    He is very expressive in his speech
    He seems to understand facial expressions and body language - at least he does mine - maybe not so much with his friends
    No repetitive behaviors (with the exception of "silly" things like above)
    He seems to understand humor... he sometimes goes overboard and laughs too loud or too hard
    I'm not sure that he has something he obsesses over. He loves mowing, lawn equipment, and tractors of all kinds, but it's hard to say if it's a normal 5 year old interest or excessive

    I'm sorry this is so long. Five is a little young for an AS diagnosis, but I'm concerned that he's not progressing in his social skills - even with the ADHD medication. Also, my dad has poor social skills and I strongly suspect that he has a mild asperger's. What do you think? How should I persue this if I believe he does have AS or should I just wait until he's older?
  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi there. I'm sorry your son is having such a hard time. And you.

    I would take him to a neuropsychologist. I disagree that he doesn't have Autism Spectrum Disorders (ASD) traits. I live with a child with Autism Spectrum Disorders (ASD) and it could very well be a part of the picture. But a regular psychologist is not the one who knows how to look for it. in my opinion he has more than ADHD going on. I never heard of any medication helping a child make friends. Socially-challenged children usually need to learn social cues sometimes in a text book way and they need to understand how two people interact in a socially acceptable way. Often, they do not learn just by watching other children play with each other. They seem to have a "blindness" to picking that up.Sometimes the socially challenged kids are very oblivious to other kids. Sometimes t hey desperately want friends and go up to anyone or certain kids and get in their faces making loud noises or standing too close and laughing loud or even hitting as way to get attention. Repeating phrases or words is a very Autism Spectrum Disorders (ASD) thing to do. Not saying he has it, but it is very common, as is liking to recite commercials and cartoons verbatim. They have wonderful rote memories! The coordination problem can be Developmental Coordination Disorder (DCD), which is also common in Autism Spectrum Disorders (ASD). Not all ASDers have son didn't...but it is a big one. IC hopefully will come here and explain it Been there.

    Sensory Integration Disorder (SID) usually does not stand alone and is common in certain disorders, which only makes things worse. I saw an autism YouTube video (but could apply to any child with Sensory Integration Disorder (SID)) where the child was walking around the playground and the other children's playing made so much noise to him that he kept trying to escape to a quiet place until he was standing alone where nobody was making loud sounds. It was sad...and fascinating.

    Five is not too young to seek help for your child's problems. My son was adopted out of foster care. As an infant, he had tight muscles and had been exposed to substances and they put him in speech as an infant!!!! That was because he did not use his tongue correctly! His early interventions helped him A LOT as he is now a very caring and capable young man now.

    by the way, my son, who was first diagnosed as Pervasive Developmental Disorder (PDD)-not otherwise specified, has a GREAT sense of humor. He always has. It is not a universal trait that ASDers don't get jokes. My son not only has a great sense of humor but he is a master at cracking especially very dry jokes with a straight face and then he bursts out laughing. He always was a happy kid who laughed a lot, but he was obviously very different and had social deficits and speech delays (this is not necessary either, at least not for Aspergers) and he did throw monster tantrums, which he outgrew.

    I wish you luck in getting the school district to help you. They are a remarkable resource if you can get your son an IEP. I would have him tested by the neuropsychologist first, then have the school test him and try to get that IEP. Socially inept children need a lot of help once they get into school! (((Hugs)))!
  3. SuZir

    SuZir Well-Known Member

    I would also start to seek full evaluations. If I have understood correctly in US the best way is neuropsychologist with some additional evaluations from Occupational Therapist (OT) and speech path to have a fuller picture (I'm not sure how psychiatric side is covered with that. Around here full evaluations tend to mean hospital evaluations made under neurologist and psychiatrist and neuropsychologist is only a part of it like also psychologist, Occupational Therapist (OT), Speech path, physiotherapist and few others. But here only MDs can diagnose anyway.) Your son is old enough that they should be able to have more nuanced picture than before. I know practises vary, but even here, there they tend to be conservative in diagnosing, they start to diagnose asperger and ADHD and other more subtle diagnosis around 5 and 6.

    Of course lack of repetitive behaviours and obsessions may end up disqualifying him from Autism Spectrum Disorders (ASD) spectrum diagnose, but maybe evaluation results would still help to point you out to right direction on how to help him. And if services do need diagnosis, maybe you would be able to 'collect' enough of separate, smaller diagnosis to get him services he needs.

    Mine is one of those, that have always had traits of this and that and never enough to qualify to diagnosis and there are plenty of kids like that. But often the approaches used for kids with diagnosis one only have some traits of, do work also work with these more evasive kids when it comes to diagnosing.
  4. InsaneCdn

    InsaneCdn Well-Known Member

    Lack of repetitive behaviours?
    I didn't see those at all, until I started reading biographies of Aspies.
    Also look for serial interests (rather than parallel)... i.e., interests may change over time, but at any one point in time, a school-aged Aspie tends to have ONE interest, whereas a neurotypical school-aged kid can have several.
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    You don't have to have every symptom to have Autism Spectrum Disorders (ASD).

    Also, repeating words is a repetitive trait or a stimulant. Only low functioning ASDers tend to flap their arms or run in circles. It is a spectrum...whichever part you are on though you do need to get interventions.

    No Autism Spectrum Disorders (ASD) child will have every symptom listed in the DSM.

    It is true that Aspiers/ASDers of all stripes tend to have ONE focus. It can change with time, but they are not likely to be very well balanced with tons of interests like typical kids. Some focus strictly on dinosaurs or train schedules...with some it's computers...some videogames (my son knows when every videogame he likes was launched, the ages and names of all the characters, etc. and has it all written in a log)...and he likes certain movies and cartoons and can watch them 100 times. When he was little he wanted to watch the same ones over a nd over again (can we say Mom went nuts?). He liked to memorize them!
  6. My son has always like to watch the same shows over and over again. Is that not typical? He's my oldest, so he's always been my normal.

    *His interests do seem to change over time. It used to be only tractors, then it expanded to lawn equipment, and now it's a little more focused on lawn equipment (if someone is mowing there is NO WAY I'm going to get him to come inside for dinner. He begs me to let him sit outside and watch them until they're done mowing. Right now he's also really focused on rollie pollies (pill bugs). He spends hours every day looking for them and catching them. Part of that is typical 5 year old, and part of it might be that he loves to be outside, but he doesn't like playing with the typical things on the playground that most kids like to play with. His sensory issues affect his vestibular system, so he doesn't like his feet to leave the ground.
  7. Thanks. I think I'm going to talk to his Occupational Therapist (OT) about it and then take him to his pediatrician with my concerns and then she can make a referral from there if she agrees with me. As for the poor coordination - his Occupational Therapist (OT) says that is common with sensory kids because they avoid certain muscle groups in their sensory avoidance and they are less aware of where their body is in space.

    The problem with getting an IEP is that he's a very bright kid. He will probably qualify for a section 504, but his sensory issues don't affect his learning... yet.

    Also, what will the neuropsychologist do that the psychologist did not? We know he has a typical IQ and there is no learning disability or anything. I guess I'm just concerned about paying for another full evaluation. We already pay almost $250/month for Occupational Therapist (OT) and $60/month for his medication and we just paid for the psychiatric evaluation 9 months ago. Our insurance really doesn't cover all that much, if you can't tell.
  8. My son has always liked to watch the same shows over and over. I assumed it was typical? He loves lawn equipment to the point that he will beg me to let him leave the dinner table so that he can sit outside and watch the neighbor mow. He's currently really into rollie pollies right now (pill bugs - to those not from my area). He spends hours every day finding them. I'm not sure how much of that is typical. He's my oldest, so he's always been my normal.
  9. InsaneCdn

    InsaneCdn Well-Known Member

    He's 5.

    Starting school may send him over the edge.
    Next major cliff is about grade 4.

    If he's just had a psychiatric evaluation... I'd hold off for at least another year. Let him get into Grade 1 at least, and see what the teachers can tell you about his behavior. Watch out for anxiety, in particular.... it's a flag that other things are causing problems, such as motor skills, social skills, sensory, auditory processing, and so on.
  10. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    IC, I think he just was tested for school stuff.

    A neuropsychologist tests for 6-10 hours and covers all areas of function, not just IQ and LDs. I think a neuropsychologist evaluation is superior to other forms of testing. Short one hour evaluations are not intensive enough nor are evaluations that only cover IQ or Learning Disability (LD). If it were my child, I'd have the neuropsychologist. It is very different from the types of evaluations regular psychologists give. Also, if you want to make an appointment. and just think about it, you'll have plenty of time. Neuropsychs are very popular and it's hard to get in to see one! I had to wait for six months.

    My son had terrible sensory issues (covered his ears all the time and would throw up on certain textured foods and wouldn't wear a tag on the back of his shirt..the usual stuff), but he was actually and still is well coordinated. Interesting that Sensory Integration Disorder (SID) kids usually aren't.

    If it were me, I'd rather get the help in kindergarten than wait until the learning kicks up a big notch in first grade. IQ alone does not predict ability to perform in school.

    Just take whatever you like from us and leave the rest. We are here to try to help, not to tell you what to do.
  11. SuZir

    SuZir Well-Known Member

    MWM: Neuropsychs are not miracle makers and with kids with more subtle problems are often not that helpful especially when younger. With four, five or six year old the line between normal range and neurological disorder can be extremely thin. Often the things like Occupational Therapist (OT) and speech can be more helpful at early age, because they deal with that situation there and don't have to decide if kid will have a lifetime disorder that is still there 30 years in future.

    Of course, like I said, neuropsychs are not allowed to diagnose around here, but when I remember my son's evaluations (which were rather extensive, first, if I remember correctly was 8 full work days hospital stay for testing plus one overnight for some more testing for sleep etc. Of course he did have time for free play there also, but that too was observed and evaluated. During the second one he was turning a teen and they could do all the testing in shorter time, maybe four work days and one night. Not sure any more though, it was years ago.) the actual neuropsychs' reports were not that helpful. Of course he wasn't diagnosable so it was just traits of this and that in also neuropsychologist's testing like also with other pros who tested him during that evaluation. In many ways Occupational Therapist (OT), speech and FT evaluations were more helpful for us. So was psychiatric's testing, not that it revealed any clear diagnose either, it was very helpful in understanding what made kid to tick and how to try to handle him.

    But of course every family will have slightly different experiences with these depending both in what the kid actually does have and how good pros doing the evaluations happen to be.

    I understand well not wanting to use more money to one more evaluation so quickly. Especially when you seem to have some most important interventions already going. If you have to choose between continuing Occupational Therapist (OT) or doing another evaluation, you definitely should continue therapy. One evaluation doesn't help or teach any skills to your kid. And with kid so young and rather subtle symptoms the evaluation could easily end up rather inconclusive and not helping at all in getting services. These evaluations tend to become more reliable when kids grow older and difference between 'normal' and 'disordered' gets wider.
  12. Thanks for your help. :)

    My son's sensory issues are a little different than the norm. He isn't a picky eater, his clothes don't bother him, and he only covers his ears when it's really loud (like a vacuum or blender). His main issues are touch (for instance, when I wiped some dirt off his arm he told me I jabbed my nail into him and when I gently put my arm around his shoulder he said I was choking him when I wasn't even touching his neck) and movement. He has poor proprioceptive and vestibular skills. He's terrified of heights and has been since he was a baby. He didn't like to swing or rock. The Occupational Therapist (OT) says it's because his brain is telling him that he's not safe with the movement when he really is safe.
  13. confuzzled

    confuzzled Member

    I tend to agree with suz that neuropsychs aren't the be all end all, especially for a biological 5 year old of whom you know the hx of. while they have value, typically its an expensive option and its doubtful you'd gain enough information from it at this age.

    (I assume you have some insurance)
    what I might do is ask your pediatrician for a referall to a developmental pediatrician that is well versed in spectrum disorders. they can also do some testing and can be a valuable resource for the younger set. if your pediatrician doesn't know anyone, maybe try a big local autism organization--they should be able to refer you, or the nearest university hospital.

    regardless of his diagnosis and his intelligence, I would start the process for a full educational evaluation to include social, Occupational Therapist (OT), speech and pt and hone on which of these related services the SCHOOL can provide for you....Sensory Integration Disorder (SID) can be rough to get covered--you'll need to show the edu impact so get creative on other Occupational Therapist (OT) needs that overlap (proper pencil holding, handwriting, scissors, etc). since you are a spT you should easily be able to come up with goals/objectives/needs/mods that impact his learning, *INCLUDING* pragmatics and socials skills development.
    he can be classified as OHI or speech impaired for the time being if needed.

    one can be of normal intelligence (even genius level intelligence) and be eligible for an IEP...don't let them snow you.

    good luck to both of you ;-)
  14. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Suzir, I honestly, truly think all countries do it differently. That's why if somebody from the uk comes here for help I would never say to go to a neuropsychologist...that isn't how it's done there. I can only speak for what I know and my own experiences (of which I've had I have issues too). I do think that is where you get the best results in the US and it doesn't hurt to see an Occupational Therapist (OT) or PT as well.

    Although the school diagnosing helped us get my son into early education, which helped him a lot, their testing was some of the poorst and least comprehensive of any we've had and it didn't come close to finding his issues. I don't recommend relying on school testing. Never once did the school even "get" that Sonic had social issues nor do I believe they even tested for him, although it was pretty obvious. All they did was rote academic testing and some Learning Disability (LD) testing.

    Now a neuropsychologist evaluation IS expensive. We were fortunate to have insurance that covered both of them. A neuropsychologist would have caught my son's Autism Spectrum Disorders (ASD) very young and we would not have had to fight the school for years for his interventions. As it is, we were given a ton of wrong diagnoses...including ADHD/ODD and bipolar and our poor kid was put on bipolar antipsychotics and mood stabilizers that he didn't need. A neuropsychologist is much less apt to try to push medication and, in fact, can't order any, thankfully. If this interests you, find a neuropsychologist who works in a university hospital. If you go for the team approach, there will probably be one as part of the team.

    I found psychologists without the neuro, plain therapists, and a psychiatrist to be very unhelpful for us as far as getting on the right track diagnosis-wise. I guess part of it is the luck of who is doing the diagnosing. The main thing is to understand our children and to parent them in a way that is compatible to them and to make sure the school does not pretend there is nothing wrong because they don't want to spend the time and $$$ on a child who needs interventions.

    JMO, as it always is :)
    Last edited: Jun 10, 2013
  15. InsaneCdn

    InsaneCdn Well-Known Member

    I don't think there is any "norm" on sensory issues, lol... either you're "normal", or you're not, and if you're not, that could be in any number of different directions or forms. My difficult child is generally "hypo-sensitive" - as in, he has to use his eyeballs to avoid getting burned while cooking etc, as his hands don't register "hot" (or cold) the way most of us do. It's still a sensory issue. Our Occupational Therapist (OT) (not sure about the general consensus) splits sensory processing disorder (SPD) from Sensory Integration Disorder (SID)... and says that Sensory Processing Disorder is more an over-reaction/overload type of situation (can't handle loud noises, labels on clothes, that type of thing) and Sensory Integration Disorder is abnormalities in processing sensory information including vestibular and proprioceptive. ALL of it is "sensory disorders".

    My experience... skip the developmental pediatrician. All we got from that was "adhd"... should have caught WAY more. Two better alternatives to neuropsychologist-type evaluations are PhD-level "testing specialist" psychologists, who spend years learning how to test for and recognize a wide spectrum of disorders, and child behavioral/developmental teams out of childrens' or teaching hospitals, where they bring a group together to evaluate, and reach a team consensus.
  16. confuzzled

    confuzzled Member

    you do NOT need a bona fide diagnosis of anything to get services through school--there is an educational classification system that is not exactly the same as a medical diagnosis.

    if there are issues getting in the way of a childs education, they are entitled to services. conversely, you can have an alphabet soup of diagnosis's...if they don't impact education, no soup for you. (it would be unusual of course, but it can and does happen)

    "Other Health Impaired" is a catch all category for those that don't specifically fit in a neat little box.
  17. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Confuzzled, that has not been my experience AT ALL. My experience has been that if your child has no diagnosis, he is considered "Emotionally Disturbed" and eventually ends up with those other undiagnosed children. Now there may be some very progressive schools that go by symptoms alone, but I did not see that AT ALL.

    I'm not saying that your school district won't do that, but I think most school districts prefer to have a diagnosis. In fact, many don't even want to make any sort of accommodations for our kids. I don't want to go into detail, but you can read about it every day on Special Education 101. It is often a real struggle to get your child any help even WITH a diagnosis. With "Other Health Impaired" which my son was in until his Autism Spectrum Disorders (ASD) diagnosis., we had to produce what that other health problem was that caused him to be "OHI." His doctor had to put something down, even though it wasn't the reason he needed extra help.

    I suggested a neuropsychologist. She doesn't need to go. It's up to the poster. But I certainly have to discourage her from simply using school testing. But, again, that's up to her as well.