Okay my dd is *barely* 3, and had to switch preschools a month ago due to the old one moving across town to a bad neighborhood.
At the old one, for the year she was there, she had two teachers. One said she was great, liked the other kids, did imaginative play (put on a dress and pretended to be "mommy," had a teddy bear "baby" she would show the other children) perfect in every way, except she should get her speech evaulated at age 3. The other teacher was overall happy with dd, but when I pulled her out of the school she suggested a psychological assesment in addition to the speech assesment/therapy.
We've started the assessment process with IEP, but her new school is having so many problems with her, she has been there 3 weeks and she isn't really connecting with the other kids or teachers. She plays outside - physical play- with the other kids from time to time, but she isn't talking to the other kids, and she isn't self-motivating to play with the other kids when there are group activities or toy-focused playtime, unless it is painting or music. She likes toys, all kinds, but she is hesitant to check out toys other kids are playing with. She doesn't talk much to the teachers, and sometimes she echoes back a word or even the complete phrase when they talk to her. Also, she doesn’t seem to be initiating conversations at school.
When I visit the school, I see her playing with the other kids, or sitting at a table doing activities with the other kids, but I haven't seen her talk to the other kids yet. She does talk about the other kids at home a bit, even going so far as to bring her friend Gaby breakfast one morning. She can have a pretty soft voice, we wonder, in a noisy classroom, perhaps she is talking some to the other kids and the teachers, standing a bit away, just don't hear her.
At her old school, she took a while to warm up to everyone, but after a month or so she was playing just fine with the other kids, having conversations with the teacher and kids, etc. I witnessed this a few times there, and it is backed up by her teacher.
There are certain activities she likes to do, but that seems to change, like she will have “phases,” but they don’t last for more than a few weeks, for example at the new school they let her cut with scissors, use paint and glue, things we don’t have at home and were not available in the old school, so she is doing a lot of that at school, but I don’t get the impression that it is obsessive, when I drop her off it’s not the first thing she runs to. In general she has a decent attention span, but does move between toys and activities pretty quickly.
Her teachers say overall she is always in a happy mood, and follows directions pretty well, although they say they have to get in her face and ask her to do something. This does seem to happen with people she doesn't know too well, with me, I can ask her to do something from across the room and it's not a problem.
They did the ASQ thing, she scored above the cutoff for everything except communication and problem solving. When we did the ASQ at home, she scored above the cutoff for everything, but we really were fair about it, I hope we weren't biased. They did the social/emotional ASQ at school, but never allowed us to do one at home (although they are offering now).
The thing is, at home, at the park, at family gatherings, disneyland, you name it, she is outgoing, curious, communicative, etc. Her echoes outside of school are rare, and usually only confined to learning new words, she is learning new words every day, and very excited to increase her vocabulary, even though we haven't started speech therapy yet (but we will soon). In the course of, say, five hours, she might only echo once at home, and it is usually a word she is unfamiliar with, and it's with joy, like "cool, I know a new word!"
I took her to a new park yesterday, new kids, new surroundings. She ran around trying everything, and eventually did self-motivate to play with other kids on the teeter totter and this spinny thing that can hold two kids at a time. When she played with other kids at the park, she locked eyes with them and laughed, and when I asked her to say hi, she did so right away to the other kid, smiling and maintaining eye contact.
At home, even with unclear speech, you can't shut this kid up. I've seen her patiently say the same garbled phrase to me, trying to communicate, a few times before giving up and moving on to another activity or toy, I think she's accepted that people won't understand her all the time, but she still talks a lot.
Imaginary play:
<dd is jumping on the bed in my bedroom, smiling>
Mom: dd, what are you doing?
dd: I jumping out the sky!
Then, about an hour later, dd starts jumping on the bed again:
Mom: dd, what are you doing?
dd: I jumping on the bed! (laughs)
She also makes jokes, points, eye contact, etc. She is shy around new people, but warms up eventually. I would say overall she is introverted.
Her school, from day one, took notes on her "red flag" behavior, such as the echoes, and they mention eye contact, which I could see, she looks down when she feels insecure or shy, but she will look you in the eye when she talks to you, at least she does with everyone outside of school. At the park yesterday she made eye contact with adults she didn’t even know. They also say she washes her hands a lot, but she likes playing with water, she hasn't washed her hands at home in ages, mostly because the sink is no longer a "new" toy to her. I think the new sink at school is just interesting to her.
One thing they point out: dd doesn't answer open-ended questions very well, this is true at home. So if you ask her, what do you like to eat? She might answer nothing, or just get confused. Also, they are saying that she sings "gibberish" when they play songs she hasn't heard before, although she can sing many songs well, like twinkle twinkle, etc. She also makes up songs on occasion.
She answers yes or no questions very well, and constantly initiates conversations and activities in the home. Also, when I was crying last week, she asked me if I was okay. Other times, when I have been sick, I will say something like my tummy hurts, and she will also give me comfort and ask me if I’m okay.
No one in her life, her babysitters, family, or friends experience what is going on at school, and when I told the school she was just getting used to the school, give her more time, they said, no, that wasn't it, she has some kind of delay, most likely pdd or asd. I handed over all the school notes to everyone who knows her, and the reaction is usually disbelief, this is just not the kid they know.
She has friends from her old school she still meets for play dates, she is very friendly with them but doesn't talk directly to them too much, I would say she still does parallel play, but also plays one on one with other kids, right down to the occasional toy tug of war. She also likes to give other kids food and show them her toys.
My main question:
What can I do to provide enough information on dd to help psychologist make the most correct diagnosis in this odd situation? My first thought is to make videotapes of her at home, in the park, on play dates, just put the camera in a corner and let it record for 45 minutes, no cuts or interruptions, it can capture the good, the bad, and the whatever. Do you think a psychologist would want to see this type of stuff, and take it seriously? I ask because she is simply not doing any of the stuff they describe at her new school in front of me.
I just want to make sure that the all the school observations are balanced with a good sense of how different she is outside of school. I have the camera already, it's almost no effort to make the videos.
Also, I have asked her babysitter to look through the school observations, and tell me if anything rings a bell for her, I am trying to find something consistent between school and outside of school. I have asked all of dd's family and friends to write about any problems they have with her, especially language and engaging with people.
Finally, I will ask the psychologist to talk to the teacher at her old school, although my mother mentioned that it could be seen as digression if dd did well there socially and is doing poorly at her new school.
I could really use some advice, I am deeply confused. Should I get two assessments, just to be sure whatever is going on is easy to diagnose? Is it possible for a kid to be pdd or asd in only one place?
I am very interested in hearing what you all have to say.
Thanks,
Confused Mom
We've started the assessment process with IEP, but her new school is having so many problems with her, she has been there 3 weeks and she isn't really connecting with the other kids or teachers. She plays outside - physical play- with the other kids from time to time, but she isn't talking to the other kids, and she isn't self-motivating to play with the other kids when there are group activities or toy-focused playtime, unless it is painting or music. She likes toys, all kinds, but she is hesitant to check out toys other kids are playing with. She doesn't talk much to the teachers, and sometimes she echoes back a word or even the complete phrase when they talk to her. Also, she doesn’t seem to be initiating conversations at school.
Wow! You're a great mom for doing all that observing and enlisting the help of other people who interact with your daughter. You're absolutely right that the diagnostician will need good information to make the right diagnosis and identify any delays. Videos are a good idea, after all a picture speaks 1000 words -- my son's diagnostician asked for video at various ages. This PDD-NOS quiz can also help you anticipate what kinds of questions the diagnostician will ask, so you can make any necessary observations beforehand.
http://www.childbrain.com/pddq6.shtml the ever popular childbrain quiz
That said, your daughter sounds very mild and a lot like my younger son, who was identified with social delays at the age of 5-1/2. I just wish that my son's preschool had been as proactive as your daughter's new school. Hopefully the new school doesn't think they have all the answers. What they observe at school is an important piece to the puzzle, but not the whole puzzle. The strengths that you've identified are also very, very important pieces.
It's normal for a child to need some time getting used to a new school, but when your daughter got used to her previous school, she was younger and they probably had lower expectations. Now she's older, and the new school has higher expectations. With both my kids, the older they got, the more expectations and demands were placed on them, and it because clearer that they were delayed in some areas compared to their age peers.
Another factor that might be influencing the transition to the new school is the classroom organization. My youngest son did fine in a small preschool with a dozen kids. He did not do well in a large preschool with 100 kids where only part of the day was spent with his class, and the rest of the day involved free play in whatever part of the building he wanted. He had so many kids and adults to interact with, and had a hard time building relationships.
A third factor might be the sensory environment at school -- is it louder, more visually cluttered, and/or more crowded than the old school? Are there cooking smells to deal with? To chart out your daughter's sensory issues, you can use this checklist:
http://www.sensory-processing-disorder.com/sensory-processin g-disorder-checklist.html - for identifying sensory symptoms
As far as echolalia goes, it is normal for 0 to 3 year olds to use some echolalia in their language acquisition. They learn by repeating what they hear. Later they learn more analytically. For example, a child will say "I goed to the store" instead of "I went". They have never heard an adult say "I goed" -- this is not something they heard and repeated. They internalized a rule.
I do think it's a good idea to monitor the use of immediate echolalia (parroting back) and delayed echolalia/scripting, though, especially since there are other language delays. Since she might use words and phrases in an appropriate context, it is not always easy to identify (a) if it's scripting and (b) if she really understands what she's saying. Check her understanding often.
For example, my son told his teacher "I don't want to live anymore!" He was upset, so it was an appropriate context and it sounded to her like he meant it. However, since I knew about his scripting, I suspected that it was scripting and that he didn't really know what he was saying. He didn't. He had no idea it was a death wish. He was only using it to express a desire to escape from an intolerable situation.
My kids also have trouble processing questions and following commands if they're not said to them directly (especially in a busy environment). It's important to get a good hearing test. Some audiologists have special expertise to diagnose auditory processing problems.
Finally, I'm going to give you the link for how to find experts, autism chapters and support groups in your area. They might help you find out which diagnostician is worth going to. Some diagnosticians aren't good with mild cases.
http://www.autism-pdd.net/forum/forum_posts.asp?TID=19141&am p;KW=expert
Good luck with everything!
Thanks for all your help, there have been a couple interesting developments:
1. My daughter does have at least one friend at school who she talks to and plays with, I have seen this myself on two separate occasions, when I asked the teacher to indicate this friendship in her observations, she refused, saying that the majority of the time my daughter is in school she does not play with the other kids, and that she does not play with her friend "interactively." I'm not sure what this means, she talked to her friend about the toys they were playing with, then she saw a new toy, got her friend to come with her, and they played with the new toy for a bit. This is the same friend Gaby who she brought breakfast for one morning, so now I have seen them talking together, I am very confused.
2. My dd has a good friend from her old school who she plays with very well, they talk and play quite a bit together. I watched these two girls keep each others' company for two hours straight. It was mostly physical play, but they also ate together and played with toys together.
Can anyone think why my dd's teacher won't write in her file that she has a friend at school? I am starting to feel scared for dd.
I am also going to be spending as much time at the school as possible.
Thanks for all your help and support, it is much appreciated.
My experience was that the teachers knew something was up with DS at age 2.5--way before the psychologist or I did. DS did not get diagnosed until age 4. My initial reaction to the teachers was to prove that they were wrong. I also did not see the behaviors at home. My son's impairment was not at all apparent to me--everyone says trust your gut, but in my case, my gut was dead wrong because I just didn't really know very much about ASD and how subtle it can be. I think in girls it is even harder to see because they have some additional maternal genes that I think counter some of the ASD symptoms (my pet theory). I would go with the assessment--I would get a 2nd opinion and a 3rd and I would have her assessed annually. If she is truly on the spectrum, you will see a pattern. If she tests with any communication issues (expressive language for example) and some social delays, to me, this is a risk factor for ASD and I would start getting support. It's probably going to be really obvious in a couple of years whether or not she has ASD, the point is, you want to get the help now: if you get the help and she has no ASD, no big deal--but if you don't get the help and she gets a diagnosis later (my case), you'll have regrets. My son did not start hand-flapping until 4.5 years! He met all communication benchmarks at 29 months--but it's just that the social benchmarks are so low for a 3 year old, but extremely high for a 5 year old. That is why this can happen. I think it is fair to observe your child at school with the teacher who has the concern and ask her to point out what she is seeing. But it is MUCH easier for a teacher or professional who sees dozens of 3 years olds to recognize the behaviors than a parent. Also, children with autism can present quite "normal"--it is often only in the social context that they have issues. With my son, 1-on-1 with a psychologist, he does great--you really see it much more with a group of other children. Hope this helps.