Evie has definite signs of ADD - everyone keeps point that out :)
Other than that, they have some behavioral issues - they still throw extreme screaming tantrums over relatively minor things and tend to try to dominate people and bully them into getting their own way. They are also too self directed - not asking permission to do things, impulsive, sometimes hard to keep on a task, completing work in 'unique' ways, etc.
They have gross motor defecits that are being addressed out of school via private PT and OT because the defecits are not severe enough to warrant services in the school.
They do better at school, of course, and other similar settings. They've been through two days of NT summer camp and no problems so far. By the end of their preschool year, their teacher considered them to be quite well behaved, to my amazement and disbelief.
I asked about this because of what we went through with my oldest son when he was in Kindergarten. We were fortunate to be in a school that was very concerned about him. Early in the year, his teacher candidly told me that he would probably test out of services. His weaknesses (social skills- language pragmatics) would not show up on the tests, so we had to look for other "issues." He had a big eval done at our Children's Hospital, and the report indicated that he showed some signs of ADD. It also noted he had some mild signs of anxiety that were specific to situations and related to his perfectionistic tendencies.
From his recent IEP: "______ is receiving services in the EBD program for other health impairments. His inattentiveness and limited social skills qualify him to receive these services. _______ is also receiving services in the area of speech and language due to his limited pragmatic skills." They later note instances when he shows signs of anxiety (math tests, when he misplaces something).
If you are concerned about your girls possibly testing out of services, you may want to explore other issues prior to the big evaluation at the end of Kindergarten.
edited to add: My son actually doesn't have ADD. He just showed signs of it in Kindergarten, and it was noted in the report.
I just want to caution you that sometimes placement in an EBD class can be detrimental - as that is not really what your girls have. I was told to UNDER NO CIRCUMSTANCES let my child be placed in an EBD classroom for various reasons. First, they may learn behaviors you do NOT want them to learn (language, disrespect, etc.). Granted, they may learn this in ANY class - but it is more severe and across-the-board in an EBD classroom. Second, EBD is geared toward kids with emotional-behavior disorders and autism is not that. It is a neurological disorder. I think that an autism classroom would be a better fit - although I don't think your girls would qualify.
It is a VERY tough decision, fred. I would rather keep my ds out of the autism classroom and just use it as a "break" room if he needs to get away. That is an option for sure, thankfully. He has no para support (he didn't for 3 years of private pre-school either, though - except on the 2 afternoons a week that he went to ECSE, where there were 2 shared paras for everyone). I worry that he will slip through the cracks, so I vacillate between a totally mainstream classroom and having him sometimes pulled out and go to the autism classroom. I have to still talk to the director of special ed (who left me a message yesterday) to discuss options and his IEP from the previous school.
You may want to check into something that someone told me a while ago. If you have an autism diagnosis - the schools are REQUIRED to provide speech therapy - it is an automatic. That may just be in Minnesota, but I thought it was something to do with IDEA (again, I may be WAY off-base here). It makes sense, because all kids with autism have communication difficulties - whether they are purely social communication or functional communication or even just talking at all. My son's functional communication would test in the normal range, I'm sure. He can get his needs met and can ask for help in doing that (he doesn't always, but he definitely can and does so frequently). But, social communication - he definitely still needs some help. It sounds like your girls are in mostly the same boat.
What happened in ds' ECSE class was that the whole class would have speech and my ds would be the "role model" for articulation and how to model asking questions (he is a PRO at asking questions, let me tell you!
With their speech scores, they probably wouldn't qualify for speech unless you find some other test. They shouldn't have either of those tests either anyway - because it has been such a short period of time since they last had them. If your state has the caveat that all children with an autism diagnosis must have speech, then they will probably get the minimal amount the school is required to give. They won't qualify for school PT or OT (their drawings are WAY too good) either.
I don't know if your school would let you, but could you ask for a "limited evaluation"? Like just doing an autism diagnostic test - like the ADOS and also have a few classroom observations done along with a home observation (maybe at a playground)? That would give them an idea of the social piece and how important that is with your girls. My guess is the school would respond by saying, well we should just do the whole thing because we are required to do one at the end of the school year anyway. I think I would just call for a new IEP meeting. If you can bring any data you have on their social skills - including videos of them with other kids (if you can get that), that might be helpful.
Again, it's a tough decision. Personally, I think they are going to be young for kindergarten - but we've already had that discussion! We have never regretted holding our ds out a year - he made SO many improvements at Head Start and he also just plain matured. He is ready for kindergarten. I don't know if he's ready for ALL-DAY kindergarten (which is what this school district has) but we shall see. I would have preferred him to go to half-day so we could have another year of therapies, but part of me thinks he just needs to go and he will be fine. He is going to be taller than most of the kids in his class. He is going to be older than most of them (apparently here they don't hold out as commonly as they did in our old town). He will hit puberty earlier than most of them - although here middle school starts in 5th grade, so it may not be as much of an issue. Those were all things to consider when holding him out. But knowing that he was WAY behind socially last year and that he is doing fairly well with socializing with kids who are going to kindergarten THIS year - I know we made the best decision for him. But again, that's a whole other discussion and I know your decision is made.
I think you are fortunate to have a school district that is working with you. Our old one did not - which is why I had to "squeak" so much. They weren't going to qualify him for services even though he scored at the 1st percentile for fine motor skills and scored in the "autistic" range on the ADOS (not just the autism spectrum range - but the AUTISTIC range). Granted, the psych who did the ADOS was not good at all in administering the test - the dev psych even said that the ADOS score was WAY over-inflated (meaning they scored him way too high). But our dev psych was FURIOUS that the school didn't qualify him and wrote them a scathing note in his report. I had already gotten the "override" qualification - but all they were going to give him was 10 minutes a week of indirect consultation with his pre-school teachers. After our dev psych wrote the report - wow! The next day the supervisor called and offered that ds could go to ECSE twice a week, during which he would get direct OT and group speech (social skills) twice a week as well! I originally got the "override" by asking for an independent educational evaluation - which no school wants to do as they have to pay for it. So, they called a meeting first and decided to do the "override" instead of doing an IEE. I'm telling you all this to give you some tips on how to "squeak"! However, you should only do that if the school tries to pull services and/or is being very uncooperative. Our former school district was well-known for denying services where other school districts would have given them willingly. So, I knew I was in for an up-hill battle from the beginning.
Good luck on this!
Just to clarify - My son is NOT in a EBD classroom. He's in a regular classroom and has been completely mainstreamed since he was 4. Whenever he's been pulled for services like speech, it's always with the other autistic boy in his class. He has no extreme emotional behaviors, and his teachers have always said he's a joy to have in the classroom. He's never been to the principal's office or written up. He basicly passes as NT with quirks - talks on & on about his passions, poor eye contact.....
This all went down 5 years ago. At the time, I felt like my son was being over analyzed. I also was less than thrilled with an EBD classification in his IEP because it didn't really fit. However, it ended up being the way we were able to continue getting him services, like speech and social skills training, through the school.
Edited to add: At his last IEP, his teacher mentioned that she struggled with whether or not to recommend continuing services for him when he was re-evaluated. I think services will be pulled soon, and I'm not sure how I feel about it.
I've been having a think regarding the social talking and hope these might help.
1: Your girls' interests might be of no interest to others, but they are to them. Giving them the impression that they don't have the option of talking about these interests is more likely to make them unhappy,or withdrawn later on. You could start to implement times in which you say to the girls "ok, you can tell me all about the brontosaurus and then I want to take about macrame tea cosies" (or whatever else interests you). That way they learn that they have the right to be interested and talk about their stuff, but that others have the right to chat about what interests them. My husband and I have an agreement that I can talk about Doctor Who or Aspergers and he can tell me about his computer network system at work.
2: Putting things in context is something I still have difficulties with, not all the time but enough to be pulled up on it. All I can say is help them explain by asking relevant questions. EG:
"He broke the tail!"
"Who broke the tail?"
"The triceratops."
"The triceratops broke the tail?"
"Yes."
"Did he break his own tail?"
"No."
"Did he break something else's tail."
"Yes."
"What tail did he break?"
"The Tyrannosaurus Rex's."
"The triceratops broke the tyrannosaurus's tail?"
"Yes."
Followed by more relevant questions.
Thanks Snoop - going to read this all a bit later, but wanted to clarify that I'm considering an AU class, not EBD. The AU classes around here are good - TEACCH based (with TEACCH being literall in town). We're considering doing the AU class to get the girls a smaller class size and more 1:1 interaction and doing partial mainstreaming. I'm with you on a second year of preschool. I'd like to do that (heck, around here, even NT kids who are not yet five or barely five at the start of the school year generally get held back by their parents).
We already have the autism classification from the school. The girls, too, scored 'autistic' (not one of the milder PDDs) on the ADOS and the CARS at age 4.0, so they're pretty solidly in that classification. The reason I'm considering the AU class is that, with the TEACCH methodology, the girls would get whatever teaching method works best for them (probably small group instruction, but discrete trials, etc., could also be used), have experienced autism teachers, and have, as mentioned, the much lower student, teacher ratio.
EDITED TO CLARIFY - they're not required to have their trienniel review until next summer/fall, latest, but the IEP suggested that I could have it done early (as they are in the beginning of their 3rd year) to get a more current picture of their abilities. I was going to request this early review because they're different children with different issues than when they were last assessed, but I'm not sure if that's a good idea based on their latest private assessments.
-----------------
The girls had another language assessment - seems like a new one every month! At least it's easy to track progress. This was for their new SLP who started with a few weeks ago (same place they get their OT, so it was just more convenient). She couldn't administer the PLS because they've recently taken it, so she administered the TOLD (I wonder if she met the TOLP).
She wants to cut the girls therapy hours to 30 minutes/week (this is private pay) because she feels that's what they need because they are now well within normal range. All good news, but these tests don't capture social. She said that that's what we should advocate for in school - 30 minutes/week IN CLASS SL therapy.
I'm wondering if I should not schedule their triennial review at this point. I was going to - because I wanted to be able to advocate for MORE language therapy. Their IEP has them at 2X15 minutes (Evie) and 2X20 minutes language therapy (Abbie). I'm thinking that the way they're testing on paper, we might not end up qualifying for services anymore and that having the reassed might backfire. What do you think?
Here're the scores (in percentile rankings):
Evie:
---------------------
Picture Vocab: 50%
Relational Vocab: 27%
Oral Vocab: 25%
Grammer: 50%
Abigail
---------------------
Picture Vocab: 37%
Relational Vocab: 50%
Oral Vocab: 9%
Grammer: 75% <== HUH??
Grammatic Comp: 75%
Word Articulation 37%
The SLP, responding to no doubt leading questions from their mother, said that she felt that the girls do show 'autistic tendencies', but that they are doing very well and that, if she were her, wouldn't worry so much at this point. Of course, these comments are filtered through mom's rose colored glasses, so who knows what she really meant. Abigail had two additional tests that Evie didn't get because the SLP didn't think the things being assessed were a problem for her. I have no idea how Abbie scored so high in Grammer. Let's just say it's not her strong point, at least I don't think it is.
In class speech sounds wonderful..I never thought to ask for that? They tested pretty good~not sure what it all means but if the speech path says they are within normal range that is great!
Autistic tendencies..hmmm now that is a new one~sounds good!... I like it!
I am pretty sure that you can't NOT schedule the triennial review (how's that for double negatives?). The school is supposed to review them every three years. Are your girls due for this? If not, then I wouldn't have them re-assessed. What I would do is call for a new IEP meeting and try to get more social stuff and get a letter from your private SLP.
I was panicked before my son's review. His first year he qualified on an "over-ride" (read: I was a squeaky wheel so they qualified him just to shut me up!
However, if they had reviewed him ONE MONTH LATER - I have no doubt he would not have qualified at all for services. He made that much progress in that time. So, if your girls are in a cycle where they are doing well and making lots of progress - well, it's not an ideal time to have them re-evaluated for services if it's not necessary.
I'm sure there are others out there who have more expertise in the laws and IDEA - but I'm fairly sure that if they are due for a review, the school will have it done regardless. If you don't consent, then I think the girls might not get services? But someone else with more expertise can tell you that!
Hello-
If the social skills are the main area to be addressed, it probably would be best addressed at school as long as it is addressed within a functional environment. What I mean by that is that it is fine to do small group or "pull out lessons" on social skills but if your girls are truly ASD kids they would likely not automatically generalize these skills so would need to have "carryover" practice in the classroom or other real life type of environment. In my state, a re-evaluation can be done any time the parent requests. I suspect it would be fine for you to do either the re-eval or the updated IEP. If you choose the re-eval route and are concerned about the girls not qualifying for speech based on social skills alone (assuming other areas of language test within the average range) you could make the argument that inability to understand social language actually interferes with academic achievement. For example, if a child cannot understand how to interact in a group it is difficult to do group projects or experiments etc. If they can't read body language, understand inferences or understand unwritten rules than they will miss students who test fine for vocab/receptive/expressive language but have weak social language skills. Don't forget to check into problem solving types of skills and non-literal language comprehension when the girls are tested, if you choose a re-eval if the girls are at this high of a level. Hope all goes well for you!
Forgot to ask, what test did your SLP used (just curious)? Did you mean percentages or percentiles when you posted the scores? Just as a general comment, parents should ask exactly what skills the standardized tests assess because all tests do not assess all areas of language and some tests do a more indepth job than others. The tests should look at the areas that are of particular concern and should not forget to include the informal observations (which it sounds like your SLP has addressed). If I wanted to, I could give a child a test that he would score well on because it did NOT include the areas that were the real problem. I do think your SLP was smart to recommend the social skills training at school since there is no way she can replicate the same enviroment in the private clinic and am not implying that she did not test correctly. I'm just making these comments as an FYI
snoop, lol - good trick. I'll tell them that the assessor has a bug in a monster house. To clarify, the girl's are not DUE for their review until (latest) end of next year, but the IEP team told me I could request the review early as it is within the third year (just the beginning of the year rather than the end) and that they'd probably be ok with that. Like I said, I was thinking that I could use a re-assessment to demand more language therapy, but I'm afraid it may backfire if they do as well as they have been doing recently on these assessments. I'm not sure what the bar of entry is, but the assessment that they based their orignal IEP on was pretty bad compared compared to where they are now. It's nice to know about the squeaky wheel category, though!
Speechie - thanks for the advice on social skills. They've been language delayed for so long that we've been focusing more on language and less on social skills, but the time may have come to shift emphasis. It's hard to measure the social defecits, but you know them when you see them. I'm going to have to get pretty good at manufacturing social goals, I think - it's obviously more art than science, as objective measures are hard.
They were assessed using the TOLD (according to their mother - it might have been the TOLP - not sure). In the past six months, they've had a TOLP and a PLS-4 assessment. All assessments are now showing them at the low end of normal for when averaged out, but still lots of scatter in the subtests. This most recent test is their highest acheivement. When first assessed (at 3.0) their language was in the 'disabled' range, so they've come far. The scores I listed was their percentile, not the raw scores.
Hello-
If the social skills are the main area to be addressed, it probably would be best addressed at school as long as it is addressed within a functional environment. What I mean by that is that it is fine to do small group or "pull out lessons" on social skills but if your girls are truly ASD kids they would likely not automatically generalize these skills so would need to have "carryover" practice in the classroom or other real life type of environment. In my state, a re-evaluation can be done any time the parent requests. I suspect it would be fine for you to do either the re-eval or the updated IEP. If you choose the re-eval route and are concerned about the girls not qualifying for speech based on social skills alone (assuming other areas of language test within the average range) you could make the argument that inability to understand social language actually interferes with academic achievement. For example, if a child cannot understand how to interact in a group it is difficult to do group projects or experiments etc. If they can't read body language, understand inferences or understand unwritten rules than they will miss students who test fine for vocab/receptive/expressive language but have weak social language skills. Don't forget to check into problem solving types of skills and non-literal language comprehension when the girls are tested, if you choose a re-eval if the girls are at this high of a level. Hope all goes well for you!
[/QUOTE]5X30 minutes in class with a resource teacher is already in their IEP. Maybe I'll do this - NOT request the early review (i.e. do it at the end of the year rather than the beginning) and keep the 2X20, 2X15 sessions, but request that the sessions take place in class and think of some way to coordinate between the SLP and the resource teacher so that they're working on the same goals.
WiMom - I do not think that there are social skills classes here. In their developmental placement, the SLP came in and 'hovered' around the class for a set amount of hours/week and sort of worked on these things. This fall, though, the girls are scheduled for regular classroom, so the stalker SLP will be gone. I am going to take a look at the AU classroom (where they could get more specific skills training) and consider doing partial mainstreaming, but that's a long shot at the moment.
Besides social issues, do the girls have any other issues? - anxiety, signs of ADD?