Not understanding that a question is a question. What does that sound like?

[APToddlerMama]

So my 27 month old DS has a host of issues going on but no real diagnosis though we are set for genetics and follow-up neuro and developmental pediatrician apts and also an MRI of the brain. Known issues are gross motor and speech delays, hypotonia, food allergies/sensitivities, SPD, some neurological soft signs. He is suddenly making huge progress in speech and now has over a hundred words and is combining many words, etc. He has suspected apraxia of speech as well.

The weird part is though, that it almost seems like his expressive skills are starting to be at a higher level than his receptive skills (which I know doesn't make sense). His speech therapist has given me no explanation for this and I know this is not in line with typical apraxia. In particular, he does not understand that questions are questions. For instance, "how old are you" "what's your name" "do you want this or that" etc are all answered by "yeah" even though he can say all those words. If you ask him if he wants for instance an apple or an orange, he'll say "yeah" but doesn't understand it is a choice. If you ask him if he wants to go to bed, he'll frequently say "yeah" but once you pick him up and say "okay, time for bed," he freaks out and clearly doesn't want bedtime. Just wondering if anyone has thoughts on this... TIA!

[Fay]

We are still dealing with this particular speech issue with my autistic 9 year old. It is more accurately described as a LANGUAGE delay, not a speech delay. His tendency is to use language in a metaphorical/symbolic way, not in a functional/social way. He never had apraxia, his speech developed "on time"...but his words were all scripts that he memorized from books, which he applied to situations metaphorically...he is unable to use language to communicate with other people.

One way to help with the issue is to teach the functional use of language with pictures. When you say "Time for bed," show him a picture of a bed. Instead of asking questions all the time (my DS1 HATES questions!), use declarative language. Instead of "do you want your blue shoes or your red shoes?" say, "You can choose between your blue shoes or your red shoes." Declarative language is more relationship-based, so your child will tend to use more eye contact and think more about his responses. Many of the questions that we ask our kids, (such as "Are you ready for bed?") are in fact disguised commands, which can be confusing and stressful for a kid with language issues.

[journeymom]

Saw this thread on the New Posts function, but I just wanted to add that this:

Originally Posted by Fay

Many of the questions that we ask our kids, (such as "Are you ready for bed?") are in fact disguised commands, which can be confusing and stressful for a kid with language issues.

is a really great observation and distinction, and it's something all parents should keep in mind.

[sbgrace]

My spectrum child did that. It is a receptive delay but in certain conditions it's not unusual for receptive to be below expressive language.

[Lollybrat]

My son (age 6 with ASD) has issues with questions and answers as well. He has a lot of difficulties with pragmatic language (the social use of language).

Originally Posted by APToddlerMama

If you ask him if he wants for instance an apple or an orange, he'll say "yeah" but doesn't understand it is a choice.

Here's how we handled teaching something like that [this is based on a ABA/VB (Applied Bahavior Analysis/Verbal Behavior) approach, so it's not the best route for everyone, but it was a very good fit for DS. ]:

First, we made sure that DS understood what an apple and an orange were. We would show him several picture cards of different objects and tell him, "Pick the apple". If he couldn't do it, we would guide his hand to the correct picture and tell him. "Look, this is the apple." Same thing for orange. Once he could pick out different pictures of different apples/ oranges (both whole and cut) from different sets of pictures, we knew he understood the connection between the word and the object.

Then we had to teach him to make a choice. I would have DH and DS sit at the table. First I would show DH a pciture of an apple and a picture of an orange and ask him, "Do you want an apple or an orange?" Dh would touch the picture of the apple and say, "I want an apple." I would give DH an apple and say to DS, "Look, Daddy picked an apple. Your turn." Then I would place the same picture cards in front of DS and ask him, "Do you want an apple or an orange?" Whichever card he touched, the appropriate fruit was immediately placed in front of him. We also prompted him to say "I want ______" as he touched the card. It took a while for him to realize that touching the card was choosing the fruit. As he got better at making his choices, we faded the use of the cards.

We taught nearly all verbal language in a similar mannar, although actually we used written words instead of pictures for many things, since DS has hyperlexia (early reading combined with poor verbal language).

[APToddlerMama]

Originally Posted by Fay

When you say "Time for bed," show him a picture of a bed. Instead of asking questions all the time (my DS1 HATES questions!), use declarative language. Instead of "do you want your blue shoes or your red shoes?" say, "You can choose between your blue shoes or your red shoes." Declarative language is more relationship-based, so your child will tend to use more eye contact and think more about his responses. Many of the questions that we ask our kids, (such as "Are you ready for bed?") are in fact disguised commands, which can be confusing and stressful for a kid with language issues.

He doesn't need a photo to know what "time for bed" means. He understands exactly what it means. He just doesn't understand it when posed as a question that it is a question and a choice. And, for the record, at our house it is not a disguised command...it really is a question most of the time. In most settings, other people asking him questions and giving him choices are doing just that, so declarative language is not what they are using. I'd like him to be able to answer their questions as well because obviously this is a skill he'll need in life and I cannot restructure the world's use of language.

Lollybrat--lots of good strategies and I will try that.

Sbcgrace--what conditions are typically seen with expressive language skills surpassing receptive skills?? I am really curious about this. This was really my question initially more than anything. The SLP is able to give me strategies on helping him understand how to answer, but I am very much wondering the cause or what this could potentially mean in terms of diagnosis and also treatment strategies as we are still hanging out here with no diagnosis or direction.

[firsttimemama]

My son is 32 months and his language is similar. His diagnosis is autism. He has well over 100 words.. most of his language is "labelling" (car, truck, pink, A-Z, 1-20, animals, etc etc etc) or "requesting" via one word (up, down, help, snack, drink, etc etc). 90% of his phrases are scripted (copied verbatim from tv, me, or his dad, or a song he heard, etc). You might want to ask if they can evaluate your son for autism. My son was given the ADOS test.

My son needs a visual to answer a question. If I asked him Do you want an apple or an orange? He probably wouldn't say anything. If I held them in front of him and asked him he might pick one, or say no. He can't answer "what is your name" "how old are you" etc etc. In order to teach him these answers we will have to script it/teach him.

[APToddlerMama]

Originally Posted by firsttimemama

You might want to ask if they can evaluate your son for autism. My son was given the ADOS test.
.

Thank you. ASD was our initial thought, but he was seen by an expert in the field and she is holding off on saying for sure until he turns three, but didn't think he was looking like he'd meet criteria. I guess we may just have to wait and see.

[Sierra]

APToddlerMama, if memory serves, my son around the same age had similar issues in language and other areas. He has many characteristics of the spectrum, but not a spectrum "diagnosis." He has a much broader label of "developmental delays." When he was your son's age I really wanted more answers, but they never came. I could have expected that because they never came with his birthmother either, but it still was frustrating for a long time. His challenges are something of a "mystery." MRI didn't show anything significant. Genetic testing shed no light even though his patterns seemed to be genetic of unknown origin (birthmother, birthfather, and half-brother all have similar issues in differing degrees...BUT there is not a history in the extended family past his birthmother, so for her parents it was a surprise). I have since found out that in more cases than not, a reason for delays is not found.

[sbgrace]

Well, what you're describing is very common in kids on the spectrum. But I can't imagine a competent autism assessor not being able to figure out whether your son is on the spectrum for sure prior to age three! So that makes me wonder what's going on! How does he score on this assessment?
http://www.childbrain.com/pddassess.html

I think I've mentioned before that your son has metabolic condition markers. Many of those kids will present with atypical autism (so fits but doesn't). My son is one and has a pdd-nos diagnosis. He's got some pretty significant weaknesses in areas that are seen exclusively on the spectrum (like social referencing for example and nonverbal use) but in other areas he doesn't have markers that you would typically see.

Kids with cognitive issues will often have receptive language below expressive as well so that is another thought. But the the type of thing you're describing is really in line with spectrum with my experience.

[APToddlerMama]

Originally Posted by sbgrace

Well, what you're describing is very common in kids on the spectrum. But I can't imagine a competent autism assessor not being able to figure out whether your son is on the spectrum for sure prior to age three! So that makes me wonder what's going on! How does he score on this assessment?
http://www.childbrain.com/pddassess.html

I think I've mentioned before that your son has metabolic condition markers. Many of those kids will present with atypical autism (so fits but doesn't). My son is one and has a pdd-nos diagnosis. He's got some pretty significant weaknesses in areas that are seen exclusively on the spectrum (like social referencing for example and nonverbal use) but in other areas he doesn't have markers that you would typically see.

Kids with cognitive issues will often have receptive language below expressive as well so that is another thought. But the the type of thing you're describing is really in line with spectrum with my experience.

Well, the developmental pediatrician said she doesn't officially rule out autism until three because there is still a chance his behavior could change between now and then to meet criteria for autism. She is actually probably thee leading developmental ped in our state, so I tend to trust her as much as any doctor (which is not very much). She is not really seeing autism like characteristics, nor am I really now, although I sometimes still wonder a little. She did mention cognitive, but for whatever reason (perhaps denial...) it doesn't really seem to fit either. I am VERY much wondering about metabolics, and luckily we are going to the "genetics and metabolics" clinic but not for a couple more months. I am also wondering about auditory processing as there are times...some times...when he clicks a little better than others. That is with everything though. One moment he can do a puzzle very quickly, and ten minutes later, he'll try to do the same one and it is practically impossible. It just doesn't add up... He is consistently inconsistent with almost everything.

[firsttimemama]

My son was consistently inconsistent too.. still is. He passed the MCHAT at his 2 yr appt.. his ped didn't catch his autism.. I did, a couple months later..

Which characteristics of autism is he not showing? the social piece? the behavior piece?

Dr Sears (of the vaccine book & the autism book) has some really strong feelings in the autism book about not waiting to treat when autism is suspected/possible.

[sbgrace]

Originally Posted by APToddlerMama

Well, the developmental pediatrician said she doesn't officially rule out autism until three because there is still a chance his behavior could change between now and then to meet criteria for autism. She is actually probably thee leading developmental ped in our state, so I tend to trust her as much as any doctor (which is not very much). She is not really seeing autism like characteristics, nor am I really now, although I sometimes still wonder a little. She did mention cognitive, but for whatever reason (perhaps denial...) it doesn't really seem to fit either. I am VERY much wondering about metabolics, and luckily we are going to the "genetics and metabolics" clinic but not for a couple more months. I am also wondering about auditory processing as there are times...some times...when he clicks a little better than others. That is with everything though. One moment he can do a puzzle very quickly, and ten minutes later, he'll try to do the same one and it is practically impossible. It just doesn't add up... He is consistently inconsistent with almost everything.

Not to beat a dead horse but the inconstancy is often seen in metabolics too. Have you read up on mitochondrial particularly? Most doctors (unless you're in specific areas) are just not aware enough to adequately look into mitochondrial issues. That's unfortunate since it is one of the more common metabolic conditions (none of course being very common).

[APToddlerMama]

Originally Posted by firsttimemama

Which characteristics of autism is he not showing? the social piece? the behavior piece?

Dr Sears (of the vaccine book & the autism book) has some really strong feelings in the autism book about not waiting to treat when autism is suspected/possible.

Other than language, he just isn't really showing anything anymore (since doing GFCF and some other things). He also comes up as "No PDD" on the scale sbcgrace posted. As far as treatment, he is in OT, PT, and speech and we basically do a ton of floor timem type stuff all the time. He is really social and very good at engaging other adults and kids. It isn't that I am 100% sure that will never be the diagnosis, but I'm very much doubting it.

And sbcgrace...I am going to go look up your links again and study up. So daunting to think about having to educate the doctors!

What about auditory processing? Maybe it is related to that somehow??

[Sierra]

Originally Posted by sbgrace

Not to beat a dead horse but the inconstancy is often seen in metabolics too. Have you read up on mitochondrial particularly? Most doctors (unless you're in specific areas) are just not aware enough to adequately look into mitochondrial issues. That's unfortunate since it is one of the more common metabolic conditions (none of course being very common).

So I just found this: http://www.mdausa.org/publications/m...yopathies.html. Is this the kind of thing to which you are referring?

That "brochure" indicates that a doctor specializing in neuromuscular disorders would be able to make a diagnosis. Would you agree with that? How do you find a doctor who is educated about mitochondrial disorders?

[sbgrace]

Originally Posted by Sierra

So I just found this: http://www.mdausa.org/publications/m...yopathies.html. Is this the kind of thing to which you are referring?

That "brochure" indicates that a doctor specializing in neuromuscular disorders would be able to make a diagnosis. Would you agree with that? How do you find a doctor who is educated about mitochondrial disorders?

No, unfortunately. I hope at some point that is true though. I think part of the problem is simply awareness as in the scheme of metabolic conditions this is one is later discovered so they are still learning and awarness is still spreading. Some doctors would still believe that unless a child is very severe as in life threatened they can't possibly have mito. And beyond that at this point this isn't easy to test for compared to other metabolic conditions. It's not like you can get a blood test or skin bx and rule in or out like other conditions. I hope that is changing as well as technology improves.

As far as I know the mito aware doctor areas are:

Cleveland Clinic
Memorial Hermann (Houston)
Riley Childrens Hospital (Indianapolis)
There is a well known doctor in Atlanta that does muscle bx. and research/I don't know if they do primary patient care or initial workups. There may be another dr. in Atlanta as well. I'm unclear.

I had notes on the following from lists I've seen I think at parent2parent though I can't remember. I don't know anything personally about the quality in most cases.
Cincinnatti Childrens Hospital (note: at the time my son was dx'd we had a very poor experience with metabolics there in the mito area; that may have changed)
New England Floating Children's Hospital
Childrens Hospital of Pittsburgh
Childrens Hospital of Philadelphia
Childrens Hospital of LA
I've seen some mention of Denver

That's not very many! I hope that's changing.

[RiverTam]

We need better scripts.

I'm cross-posting this as seperate thread, but I'm leaving it here, because this post is what spurred the question.

My oldest is almost 8 and has a diagnosis of Mixed Expressive/Receptive Language Disorder. He also has some semantic and pragmatic language deficits. (Our pediatrician and our psychologist has ruled out an ASD diagnosis.)

He uses scripting to get through some social situations. The trouble is that I don't always like his choice of scripts. For example, last spring he read all of the Diary of a Wimpy Kid books. He loves them because they're funny. I hate them because he will take language scripts from the book to use socially, and doesn't seem to get that they not socially appropriate. (Diary of a Wimpy Kid is pretty obnoxious.) It's not the scripting I object to so much as the choice of script.

We need better scripts. Does anyone have any suggestions for books or movies that might interest him that have better social role models in them?