Need help with a child who is speech delayed and could be on the spectrum ?

[sanam]

Hello Everyone ,

This is a repost , i had posted in another forum and was advised to post it here as well .

I am a SAHM to a 3 and a half year old who is speech delayed , he has just started getting therapy and tomorrow will be his second session with his therapist. We have also completed the first round with the state board to have him get therapy through the public school, its been 2 weeks and we are still waiting to hear from him .

So he has been having issues at school , its a montessori school which he has been attending for the past 3 months , hasnt really picked up any words from there and hasnt learnt anything . We always used to wonder why and were quite sure abt him moving to the special school . So we always heard from his teachers that he is aggressive and pushes kids around and just doesnt understand when the teachers tell him not too . They still wanted to work with him first and try and get him to stop , one month later they still havent gotten around to him and we were finally called in today to observe him today . this was our observation of him and i would like some help in order to sort these issues out . i have written to his therapist as well about our notes but since Moms are better judges im seeking helps from you all to give me some insight how we can stop all this .

1. Doesn’t sit in groups, as soon as he does, its only for a matter of seconds and then he starts pushing children without any reason
2. He has zero attention span .
3. Does very well individually on tasks when he sits alone. His favorites in school is blocks , building towers .
4. Doesn’t do circle time at all and every day sits alone in class to do tasks and never in a group .
5. is very aggressive in the playground and doesn’t listen to his teachers. He does understand the word no, but that doesnt deter him from doing it again. I think more than seeking attention its becoming more of a habit for him. He definately wants to be around kids and wants to play with them but doesnt know how to .
6. The teachers were of the opinion that he is very bright and very independent and definitely does understand what he is being told .

We were having a conversation with the school owner who was of the opinion that aaransh doesn’t know how to interact with kids and doesn’t understand that when he is aggressive he is doing something inappropriate . we asked the teachers to have him around kids in class he started pushing kids as soon as he sat down with them , we intervened and told him not to do so . But he still did it 4 times, at all times we intervened and stopped him .

He was not interested in being with kids in his class but definately wants to play with them and communicate with them , he would from time to time go and try and talk to his class mates . In the playground today he was submissive because we were around but the teachers told us his aggression is increasing and it doesn’t bother him when kids retaliate  .He was playing with kids on the swing , but in class he was a loner who definitely lacks attention span .

The teachers also told us that the way he reacted when he told him not to push was very different , for example with us when we told him not too , he started crying, he has never cried in school and they were amazed to see his reaction . Because with them he just doesn’t seem to understand when they try to tell him .

Secondly he is definitely not intimidated by kids elder to him . He was still willing to push them around .

Also just to give you a bit of a background about us , I lost my parents in the past 2 years which involved us travelling back to our home country for a year and that made DS's education take a back seat . He attended about 2 months of school in back home and now he is in this Montessori for the past 3 months .

How do i help my child , i have already gone thru so much myself this past 2 years that im on the verge of a breakdown myself .

thanks and sorry for the long long post but im helpless and seeking fr help !!!

His initial evaluation was that he has a expressive langauage delay and now the therapist talks that he cud be on the spectrum but isnt 100% sure bec he is severely speech delayed . She did say he has all the right sounds , the problem is with articulation . 

The school has also termed it as ''Speech impairment '' in their report when they examined him for qualification into the PPCD program .

**UPDATE** DS did qualify and is now attending the PPCD(Pre school program for children with disability) program. He is doing much better but his aggression is still there and they are working on it . The teacher told me he definately wants to play with children and because he has no verbal skills he doesnt know how to play with them .

What i wanted to know his speech pathologist says he does show signs of being on the autism spectrum , but is not 100% bec she feels his speech delay is so severe that it shows signs of being on the spectrum . what i wanted to know what is the difference between austism and being on the spectrum .

DS is doing alot better now , he has started making progress now , does form sentences with i want ... and is slowly catching up ... 

Wanted to know your take on what is the difference between being on the spectrum and being autistic . 

Also how does one communicate with teachers in PPCD classes , is it through emails or calls because i see when i leave DS they arent in that chatty mood . 

Any help will be appreciated .

Edited by sanam - 9/11/11 at 10:44pm

[Emmeline II]

I think that when providers say "Autism" they mean AUTISM -- and when they say "on the spectrum" they are referring to Asperger's (if it is presented as an either/or), but if they just say "on the spectrum" they may be saying it because they are not qualified to diagnose or are saying that the child is too young to tell yet. Though a speech pathologist isn't qualified to diagnose Autism/Asperger's. Normal cognitive and language development is required for an (eventual) Asperger's diagnosis--an Asperger's diagnosis is usually not made until after 7 years old because the symptoms can overlap with other diagnoses and there is so much variation in development until around that age. But...there are things other than neurological that can affect language (illness, structure of the ear) so what exactly caused the language delay should be more clear by that age (7+) as well. 

Other than the speech delay, his behavior is a lot like my ds at that age. Ds' primary diagnosis is ADHD; he was evaluated for Asperger's but 1) the ADHD and the SPD complicated the issue, 2) what put him most in the spectrum may improve with maturity and therapy, 3) he didn't have the narrow/obsessive interest. He has a reeval in February with a behavioral clinic at a children's hospital; if you are able, I would schedule an eval with a developmental-behavioral ped led team--it can take 9-12 months to see one so I'd start on that now.

I noticed that you said the teachers said both that he understood what they told him and that he didn't understand what they told him -- and they probably believed both when they said them, but I'd be concerned if they continue to think he is just being willfully defiant/stubborn.

As to how to communicate with them I'd talk to them about it -- though it would probably be preferable to them to have a scheduled meeting initially. When ds was in first grade he started at a school with no buses so I picked him up from his teacher directly and she was great about giving me a run-down of his day; I get that this year as well from his new teacher, though he isn't having as much trouble as last year. So maybe they would agree to that if they expect it; or maybe they would agree to sending a daily e-mail, perhaps in a prearranged format with categories to make it easier. If he ends up with a 504 or IEP you could include that sort of thing in there.

Edited by Emmeline II - 9/12/11 at 8:10am

[fizgig]

It sounds to me like there is a lot going on!  First thing I will say is that you should take a deep breath and don't blame yourself for any of this! (You said his education "took a back seat" but he is so young all he really needs is you.  A language delay is not created by parents unless you just never talked to him!). 

My first reaction is to also question the contradictory "he can understand" but he "doesn't understand" thing. Based on our own ongoing experiences with EI, speech therapists and preschools for our language delayed DS (2.5), I would highly recommend two things:

1. Get his hearing checked asap.  You just never know and I've meet many speech delayed kids who had inner-ear fluid that was causing all kinds of language problems.   

2. Get him to a developmental pediatrician to figure out exactly what is going on.  I might be expensive, but I think it is SO important to get an evaluation to understand what is really going on.  Therapists, teachers, and even child psychologists mean well but they often don't have the range of experiences or tools to see the big picture or diagnose your child. 

I say this based on our own experience which sounds somewhat like yours actually.  Our son is very language delayed both receptive and expressively and he does exactly what your son does (sometimes he seems to understand and other times not at all).  He is very immature socially and can seem autistic at times.  Our speech therapist and the EI folks both said they thought he was on the spectrum and that he had massive sensory issues  We are just now starting to see the right specialists but so far we have already ruled out autism.  It turns out that he most likely has MERLD (mixed expressive, receptive language disorder) and so he just cannot understand or produce much language.  This has impacted all other aspects of his development because he doesn't understand what is happening much of the time.  So, for example, he is behind socially but only because he can't communicate very well.  He also sometimes tunes out the world and we think it is because he has some audio processing issues.  That your son seems to want to engage with other kids (even if it is through aggression) suggests to me that you might want to avoid labels until he is a little older and/or you can get a good evaluation done. 

That our DS probably isn't on the spectrum and instead has a language disorder can matter in terms of the kinds of therapies/support he needs.  We have experienced first hand the tendency for many people to just lump everything as "on the spectrum" and I feel very strongly that accuracy in diagnoses are essential to really getting our kids the right kinds of help. 

All that said - I will also say that I think all language delayed kids would benefit from a play-based, interactive form of regular therapy.  I would make sure your speech therapists isn't using any ABA/withholding type therapies and is entirely play based.  I also recommend reading "Play to Talk."  Its a nice intro to the best ways you can interact with your child at their level to encourage back-and-forth communication.  It really helped me communicate better with our DS.

I hope that helps!

[Peony]

 Reading with interest because my 2y is looking like he is going down a very similar path.

[sanam]

Thank u all for yr response , well yes the contradictory statement was because when he initially started attending montessori he didnt know what to do and so they just assumed he wasnt understanding anything , as a month passed by they were of the opinion that he does understand what is being told to him . Even his therapist thinks he is definately an intelligent boy bec of the skills he has with the laptop and some of the games that he plays which require a very high amount of intelligence compared to what austistic children have,

I definately do agree in having a full eval done , that was what our ped had recommended too but then the therapist wanted us to wait on that for a few months and see , but since i am gonna have an appt for his 4 year check up , i think either she will bring it up or i will . 

The therapy has helped him for sure , bec it does show from what he was 4 months before to what he is now , which is a boy who had zero words in his vocabulary to a boy now who can atleast tell us what he wants . 

TBH I dont think my son is austistic bec i have been reading on austism and he doesnt exhibit many traits that a autistic child might have , he is definately behind than what a 4 year old cud probably do but we are still not able to know what exactly it is , for now its been labelled as langauage impairment and speech delay . 

[sanam]

Fizgig- We had his earring checked first and he did allright except they did see some fluid in his right ear which will be one of the things to discuss on when we meet the ped. but it wasnt a cause for concern when they told us abt the fluid and also at that time DS was suffering from a ear infection .

I definately do agree with u on that i am not going to label my son just yet bec he has shown remarkable improvement , his speech has improved , he is forming words very basic sentences for 3 words , know ABC very well , can count from 1-20 . So i am not ready just yet to label him on anythg .

thanks for ur help !!

[Linda on the move]

Originally Posted by sanam 

Fizgig- We had his earring checked first and he did allright except they did see some fluid in his right ear which will be one of the things to discuss on when we meet the ped. but it wasnt a cause for concern when they told us abt the fluid and also at that time DS was suffering from a ear infection .

I

Did you know before the check that he had an ear infection? Have his ears been rechecked? Some kids have chronic fluid, and some of those kids can have minor ear infections off and on and not show a lot of signs. Without knowing how typical what you saw was *for him,* you can't rule out "hearing problems" as part of what is going on with him. I'm surprised they are watching this VERY carefully because a lot of what is going on with him could be caused by fluid in his ears (even the behavior stuff).

[Emmeline II]

Quote:

Originally Posted by fizgig

Therapists, teachers, and even child psychologists mean well but they often don't have the range of experiences or tools to see the big picture or diagnose your child.

Ds' school told us "they" didn't consider ADHD before 2nd or 3rd grade and his first therapist wanted us to wait until ds started first grade to even see a psychologist or psychiatrist. Listening to them was a HUGE, HUGE, HUGE mistake.

[FarmerBeth]

About the "on the spectrum " thing.  My son was just diagnosed and I was told that there has been a definite move away from defining Asperger's and autism separately, and that they won't be separate in the new DSM.  The idea is to move away from getting concerned about particular names for variants on the spectrum, and just define whether the child is on the spectrum and then deal with their individual strengths and weaknesses from there.  For example, my son's diagnoses was ASD (autism spectrum disorder) with significant strengths in verbal ability and deficits in social interactions and difficulties with compulsive thoughts.  By the old system, this would be Asperger's, but it wasn't named this way, now.

As far as the ears go, that bit of fluid can effect a lot, and you might have to wait and see somewhat if some of the language problems clear up if the ears get better.

I can only say from my experience, and kids vary a lot, so take this with a grain of salt, but I have a youngest son with a serious language based learning disability, and it looks and feels different than any of the ASD things I have seen with my son or working with other kids.  His grammar is disordered, he has a horrible time finding the word he wants (it resembles aphasia from a stroke a lot), rapid directions confuse him, BUT he still consistently seems to follow non verbal cues, has great eye contact, gets what he wants to communicate across through other means when he can't find the word, has a broader scope of imagination than my (still fairly imaginative) ASD son, isn't as rigid, etc.  But he's 7, not 4, so some of these other strengths have had a chance to come out.  It may be awhile with your son until he is old enough to make the differences between a language problem and something like ASD clear.  And if he's having trouble with language, his social skills could just look worse for awhile, because it is hard to be sociable when you can't get your words out easily.

It's sounds like everyone is on the up and up keeping an eye on him in case there's any concerns, and you've got the speech therapy going, so really, your son has what he needs right now.  Just relax continue getting him help with his speech and see how it goes.  By the way, my younger son with the language based learning disability (officially expressive language disability as of right now) started off about where your son was at at the same age, and he speaks well enough to be understood and to do well in school, needed some reading help at first but is now one of the stronger readers in his class, and overall does fine.  His grammar is a little strange, and sometimes he has trouble retrieving a word and has to describe it with other words (he's getting pretty good at this), but overall he's OK.  Speech therapy did wonders!  There was so much worry from professionals when he was 4 and 5, and now there's hardly any worry at all and everyone just says what a friendly, pleasant kid he is to work with.  He did way better than I ever imagined, and he's just very happy for the most part.  Anyway, be hopeful and go with the flow,  It could be the same with you.

[sanam]

Yes we have an appt tom and i will definately bring this up tom . thank you for ur help ....

[sanam]

Thank you for all your help and letting me know ur side of the story . There is no doubt speech therapy has definately benefited him in the past 2 years , his vocab has deifnately increased and we are slowly making progress with sentences as well . I am not in a rush to label him anythg right now as his therapist still thinks its just a speech delay , but i will definately look into getting a full evaluation done , even if its takes 9 months from now , DS wud have recieved a year of therapy so the picture cud be a bit clearer by then . 

thank you all for ur help and insight , i appreciate it alot !!