Evaluation Questions | Autism PDD

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Stephie1,

My son (27 mos) also HATES doctors, but he did fairly well at the hearing test.  I agree that there's room for concern and that's why the NP wants your son to see the doctor, but try not to get too worried about it.  Either way, your son is still the same cute little guy you love now and having a diagnosis (or not) won't change that at all.   My husband, too, didn't want to think that anything was wrong with our son, though now that we have a diagnosis he accepts that there's a problem.  From past discussions we've had on this board, it seems that often (though not always) it's the father who has the hardest time accepting that there's a concern.  Anyway, we're happy to have you on this board with us!  Best of luck and feel free to ask anything you'd like here.

Kellie

my son hates the doctors also that is a big battle. when you go to the heargin dr. hopefully they will put in a sound booth and your son on your lap for support. and they will make different pitched sounds and they will look at the which way the sound came from.  my son did very well at this test and did not throw any fits cuz the dr. did not touch him during this process.

my son had had 2 sets of tubes one at 6 months the other at 2 1/2 and he passed all 3 of his hearing test.

Tammy ~
Do you know is it always high-pitched noises that the kids don't like/hear?
Riley was the same way...I remember he used to perk-up though everytime he heard Barry White, Isaac Hayes and the like.  Quite frankly it used to crack me up...what kid likes Barry White?!?! 
~Lesley

horanimals38519.6466666667

With Gabe it was, still is to a degree.  As it was explained to me , women tend to have high pitch voices.  And with Gabe, lol, its like when you say "don't go out in the street"  all he hears is "go out in the street".  Lol, which doesn't make sense really.  I mean I am gonna tell him to go out into a busy street?  But Gabe is very impulsive.  One day when we were waiting for the bus he asked me could he wave at the cars.  I said no. Then I made sure I had eye contact with him and asked him "if I said yes, would you not do it?" 

Tammy

Tammy

THANK YOU so very much for the support, I was feeling alone, I am so glad that I have found this forum and all of the wonderful people in it.  I am still pretty uneasy about going to the hearing exam

Stephanie

Stephanie!!!

I am in SC too!!!!

Karrie

Yesterday I took my 2 year old son to be evaluated.  We saw the Nurse Practicioner (Our case worker told us it was to weed out kids w/problems vs. kids w/out problems).  At the beginning of our session just by talking to me and my son's case worker she wanted to start off on all sorts of tests mri's, hearing, vision, etc... and yes she thought he had a serious problem.  After testing my son she wanted to hold off on the mri & the problems wasnt as bad as she thought at the begining.  She says that he is 25 month old which he will be 26 mo's old next week and had development of a 21 mo. old.  She felt that his problem really lies in his speech and language (which he has neither - he lost both around 18 or 19 months of age), yet we have an appointment with the actual Autism Dr. at the end of August.  What is the difference between a 25 or 26 month old childs development from a 21 month old childs development?  I truly hope there is nothing wrong with my son, yet I see that there is everyday and night (sleepless nights).  Would the nurse prac. had set us up with an actual Dr. if she thought that there was nothing wrong with my son?  Am I crazy seeing things that normal 2yr olds do, my husband doesnt want to think that there is any thing wrong with him.  He constantly closes doors (he cant turn the knob to open them), throws violent tantrums, wont sleep and when he does wakes in the middle of the night with nighmares, toewalks constantly thru the house, is very repetitive, tunes us out on the whim of a hat and the list goes on and on.  We have to go to a hearing screening next week which I dont think that it's going to go well (anyways he hears just fine when he wants to listen to you), he doesnt even like to be in the exam room @ the dr.'s office.  Please help I dont know what to think!!! 

Stephanie1,

First of all....WELCOME!!!  My son is 3 1/2 and was not diagnosed with Pdd-Nos until he turned 3.  At 26 months even NT children are not expected to have MASS amounts of verbal language so this would explain there not being a huge delay or gap.  With my son.....the gap in the delay became worse as he got closer to 3.  At first it was simular to your child.  This is because of language.  It became more and more apparent as he got older.  As far as you being crazy...i don't think this is the case..LOL  I always tell people that with my first 2 NT children that I never once questioned their development EVER.  They both grew with no thoughts about development from me....This is because there was nothing wrong.  It's when we see or sense that something is wrong that we start questioning everything they do.  Your doing the right things for your child by getting evaluations done.  True...it may not be autism.....but you are questioning your chlds development for a reason....and by getting those evaluations done you can find out exactly what you are dealing with and how to better help your child.  Good luck.

Karrie

 

Vision and hearing are pretty standard tests for kids getting evaluated for autism. A hearing test was the first test my twins had. If you're not developing language, it is a good idea to make sure that you are hearing well enough to learn it. One of my twins, actually was only hearing about 60% of what he should have been, and needed tubes in his ears. So, a hearing test is a good idea.

I think the reason she thought he might need an MRI is because of the loss of language. Loss of language is fairly common in kids with autism, but it is still concerning. They might want to make sure there are no major changes in the brain causing the language loss. However, most MRI's done on kids with autism don't show any abnormalities, because whatever brain changes there are, aren't detectable on MRI.

I think you have reason to be concerned, and your son needs further evaluation. As far as the hearing test goes, it is not bad, so don't worry too much about it.

Your child could also have a hearing processing delay.  So the autism doctor would want a very thorough hearing test to be able to determine that.  Gabe can't hear high pitch noises.  He also has a hearing processing delay, along with the pdd-nos, allergies, and asthma.

Tammy

Hi Stephie~ Welcome!!! I think you are doing the right thing at least investigating a POSSIBILITY that something MIGHT be going on with your son. Always better safe than sorry. Its good the nurse didn't seem to think he was as "bad off" as she had first thought.

I am sure you have investigated into signs and symptms of the 5 different Autism Spectrum Disorders but I have included the DSM IV criteria for them

The DSM IV criteria for the autistic disorders

The full diagnostic criteria for the pervasive developmental disorders are outlined below. As mentioned above, the diagnostic criteria for the autistic (PDD) disorders are defined by the DSM IV criteria.

  1. Childhood autism
    1. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

      1. Qualitative impairment in social interaction, as manifested by at least two of the following:
        1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
        2. failure to develop peer relationships appropriate to developmental level
        3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
        4. lack of social or emotional reciprocity
      2. Qualitative impairments in communication as manifested by at least one of the following:
        1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
        2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
        3. stereotyped and repetitive use of language or idiosyncratic language
        4. lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level
      3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
        1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
        2. apparently inflexible adherence to specific, nonfunctional routines or rituals
        3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
        4. persistent preoccupation with parts of objects
    2. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
    3. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

  2. Asperger's syndrome
    1. Qualitative impairment in social interaction, as manifested by at least two of the following:
      1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
      2. failure to develop peer relationships appropriate to developmental level
      3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
      4. lack of social or emotional reciprocity

    2. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least of one of the following:
      1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
      2. apparently inflexible adherence to specific, nonfunctional routines or rituals
      3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
      4. persistent preoccupation with parts of objects

    3. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
    4. There is no clinically significant delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).
    5. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.
    6. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

  3. Rett's disorder
    1. All of the following:
      1. apparently normal prenatal and perinatal development
      2. apparently normal psychomotor development through the first five months after birth
      3. normal head circumference at birth
    2. Onset of all of the following after the period of normal development:
      1. deceleration of head growth between ages 5 and 48 months
      2. loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., handwringing or handwashing)
      3. loss of social engagement early in the course (although often social interaction develops later)
      4. appearance of poorly coordinated gait or trunk movements
      5. severely impaired expressive and receptive language development with severe psychomotor retardation

  4. Childhood disintegrative disorder
    1. Apparently normal development for at least the first two years after birth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior
    2. Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:
      1. expressive or receptive language
      2. social skills or adaptive behavior
      3. bowel or bladder control
      4. play
      5. motor skills
    3. Abnormalities of functioning in at least two of the following areas:
      1. qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)
      2. qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)
      3. restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerisms)
    4. The disturbance is not better accounted for by another specific pervasive developmental disorder or by schizophrenia.

  5. PDD NOS
    This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behavior, interests, and activities are present but the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder, or avoidant personality disorder. For example, this category includes "atypical autism" – presentations that do not meet the criteria for autistic disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.

Also this other information may be helpful............ there is more on the bottom of each page but this is the main, general, information which may help. Keep in mind 2 is still pretty young,.... alot of what our kids do can appear like the same thing a NT kid does except keep in mind our kids do it to the extreme!
1. What is PDD or autism?  
2. How is PDD or autism diagno sed?
3. The DSMV IV criteria
4. Review of the different PDDs
5. How does a typical child with autism present?
6. The PDD assessment questionnaire
7. Who should be evaluated for PDD?

Here is a page to some milestones that might help http://www.cdc.gov/ncbddd/autism/actearly/milestones_3months .html

OR

http://www.thenewparentsguide.com/baby-development-month-19t o21.htm
Toddler Development Month 19 to 21

Month 21

Most toddlers should be able to . . .

  • Start to learn up to 5 or more words per day

  • Walk up stairs with some assistance

  • Make structures out of toys or blocks

Some toddlers will probably be able to . . .

  • Start to learn up to 10 or more words per day

  • Show good signs of bladder control

  • Throw balls overhand

  • Open doors

Some toddlers could possibly be able to . . .

  • Name people and pets when shown a picture

  • Form short but complete and understandable sentences

  • Walk down stairs with some assistance

  • Open and close doors

http://www.thenewparentsguide.com/baby-development-month-22t o24.htm
Child Development Month 22 to 24

Month 24

Most children should be able to . . .

  • Name at least 5 or more parts of a dolls body or their own body

  • Half of their speech is understandable

  • Form three or four word sentences

  • Put on and take off clothing alone

Some children will probably be able to . . .

  • Walk down stairs unassisted

  • Talk about themselves; likes and dislikes

  • Arrange things in categories

  • Start asking “why” to everything

Some children could possibly be able to . . .

  • Start to understand gender differences

  • Start to understand concepts like better or worse, sooner or later, etc.

  • Like to sing and jump

And FINALLY............
Here is a poster of symptoms of a child with autism http://www.autism-biomed.org/poster.htm

From  http://www.dars.state.tx.us/ecis/resources/developmentmilest ones.shtml and http://www.eci-lps.org/is_this_typical.html

I'm 21 months old! I...

I'm 24 months old! I...

Here is typical development from Birth to age 12 http://www.todaysparent.com/toddler/behaviordevelopment/arti cle.jsp?content=3237&page=1

MsSteelersFan38522.3333217593LOL..you better watch your wording Amber or Tammy will be all over you like wet paint!

lol. Well I meant resisting eye contact. You'd have to see it. It's avoidance of direct contact when nervous in his case. Perhaps I didn't describe it correctly.

Amber

Many of the signs you listed sound a lot like autistic signs, but it's always good to do other tests to rule out other things. Most husbands are going to be cranky and in denial. You just follow your instincts, which by what you wrote sound very vaild. My son is same age as yours (just turned 2 last mth) and has speech of 17th mth old. He is in the process of evaluation also. He doesn't even have some of the signs you listed. I am thinking he might be pdd-nos at this time. But he loves to close doors also. He, like your son, can't open them either and so he gets locked in rooms all the time. Other little things like sideways glances, tantrums, self biting when upset or excited, being easily overstimulated, picky eater, etc all can add up to the disorder. Be aware that many will not see it and say he's fine. You just follow your heart. Welcome to our board!

Amber

When was sideway glances made a characteristic of pdd-nos?  Most people do sideway glances.  Parents do it all the time.

Tammy

Not to backtrack, but I found what I was talking about w/ the corner of the eye. I couldn't explain what I meant. It was from the post of DanielleandOwen about the stimming check list and one of them is "looking at things out of the corner of their eyes" and "looking at things at unusual angles" which is what ds does. LOL I was just happy to find what I was talking about! It is post: http://www.autism-pdd.net/forum/forum_posts.asp?TID=1101& ;PN=13


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