Development Question...

[fallenangel811]

Please accept my appologies for the length, I didn't want to leave out anything important...

When my son was 12 months his pediatrician unoffically noted he was at an 18 month level across the board...His motor skills were all right on target or ahead in his first year - holding head up at birth, sitting without support about 5 months, crawling 6 months, walking 9.5 months. Fine motor skills were good too. He would even cross midline to grab something with his left hand as he was pretty obviously a lefty at about a year old.

At 3.5 he was formally evaluated and his fine motor skills were at best at 33 month level and his gross motor skills were around 36 months. Also during that evaluation he was noted to have residuals of the symmetrical and asymmetrical tonic neck reflexes. Was diagnosed with Developmental Coordination Disorder and sensory processing disorder at this time and OT was prescribed but we couldn't get it covered by insurance and can't afford out of pocket.

At 5.5 he was again evaluated and this time gross motor skills are at 48 months, fine motor skills are less developed than gross motor. Hypotonia (moderate?) was noted. Below are some excerpts from his recent OT and PT evaluations:

-"he tends to walk the joints and lean on ligaments"
-he has inability to demonstrate left and right discrimination
-his righting reactions and self-protective reflexes are delayed
-his ability to follow verbal instructions with auditory processing is delayed
-his is performing below age range in motor skills that require larg mm coordination, strengthm and stamina as well as postoral reactions, balance, and motor planning
-unable to perform symmetrical bilateal tasks
-Movements on right were different from movements on the left
-He would change position to avoid crossing midline with his hands or eyes
-He had difficulty making smooth eye movements in all directions and following objects that are moving in all directions, near and far
-He monitored his hands during fine motor tasks and moved his head rather than move his eyes for tracking and scanning tasks.
-Difficulty with smooth and automatic midline crossing, bilateral integration and hand dominance indicate a lack of communication between left and right side of the brain. This results in tasks being difficult and frustrating when they should be effortless and automatic.

As a side note, the OT eval did note that his ability to understand visually presented information is a definite strength. His IQ is around 115, and he has Asperger's. He has sensory issues, under-responsive to proprioceptive and vestibular, over-responsive to auditory (for the most part), slightly over-responsive with visual, no issues with smell and taste, mixed issues with tactile...

I am honestly getting a little concerned since he was ahead so much at 1 year and has lagged and the gap seems to be getting wider...Does anyone have any idea how to make sense of all this? He never had any illness or injury that could explain the slowed development. The evaluations were done by the school this time, so I don't know that we will be able to get much explanation there...On a good note, he has now qualified for an IEP and will get PT and OT
through the school.

Has anyone else had a little one in a situation like this, and if so how did everything turn out?

Thanks in advance and sorry this got so long!!

[LoriAtYCT]

Hi Lori - 

I'm another Lori, I'm also a speech therapist!

Both Asperger's and SPD are often diagnosed later because the sorts of challenges (movement-wise, language-wise, information processing-wise, socialization-wise) where they show up don't happen until a child is a little older. While some parents in retrospect will recognize signs that didn't quite register at the time, in less severe presentations both of those problems can sometimes go undiagnosed for a very long time simply because a child is keeping up. (Although there are children who have these problems in their more severe presentations and then problems are evident quite early.)

There are many adults who are diagnosed with Asperger's because as children they were functional, although often "different," sometimes in sort of vague ways. I've read these adults stories and many of them find tremendous relief with the diagnosis because they always knew that something was not the same about them.

So it sounds like your little one was doing great with the early developmental stages, then as movement, language, interaction and things became more complex and advanced, the limitations that were imposed by his challenges were finally able to be seen. 

And the most important thing is that you've gotten him qualified for the services he needs. And my suspicion is that since early development was so successful for him, that he'll respond well to the services that are being offered now.

Love and good thoughts!

[sbgrace]

Have you seen loss of skills in any other areas over that same time period? Decrease in energy?

Hypotonia/low muscle tone--it is low right?? and autism together make me think you may want to look into metabolics and/or genetics honestly. I'll link a post I made a long time ago to see if anything rings bells for you. http://www.mothering.com/community/forum/thread/734501/mitochondrial-disorder-information-and-video

Early handedness can be a sign something is amiss actually. He shouldn't have handedness at one normally. That may have been an early sign there was something going on and now you're getting later signs. His early advanced motor milestones could have been an over-compensation (rigid) for the low tone. I can't see a child with moderate low tone, though, holding the head up from birth! So I would be confused in your place too if he's got moderate low tone now and was doing all that then. So you could, indeed, be dealing with a decline--especially if something like metabolics is behind the issues. That said, I'd expect you to see more by this point in that case. So I'm a bit stumped. My mildly hypotonic child was delayed in all those early milestones and noticeably floppy.

You're mentioning delayed reflexes along with some symmetrical stuff and the handedness make me wonder about neurological stuff going on. Mild CP or things that mimic CP could do that but so could all kinds of things lesser. For example, a lot of what was mentioned (not all--like the delayed reflexes) may be that you're dealing with major visual processing issues. My son was assessed by a vision therapist (optometrist who specializes in vision therapy, not a regular old eyesight check) and there were major issues. I see flags in what you wrote I saw in my son. ct.

But you've also got the hypotonia and gross motor issues which would make me want to talk to a medical person to see if there is enough to warrant looking at what might be going on neurologically. I don't know if there is or isn't. Maybe the PT/OT could tell you if you need further consult or this is just how they write up a kiddo who isn't coordinating left and right hemisphere well. They stuff they wrote may sound big but is really meant to describe something that might be as "minor" as sensory stuff or visual processing.