Hi APToddlerMama, Thank you for the welcome. I've been around here under different names a couple of times, about 8 and 9 years ago when my son was a baby and toddler. I would always forget the name I used so had to re-register! I have always loved coming here for good information and I recently picked up some information on another thread, a dietary supplement that I had never used, or realized it's potential to help, and it was just what I needed to know. Both my children are on it now and it has been incredibly helpful for them!!
Sigh...about teasing out a diagnosis, I would stop talking to your OT/SLP about what they think his diagnosis is. They are seeing symptoms but even they know that they are not qualified to diagnosis your child. Neither am I.
So many people tried to tell me what they thought was going on for my son. It used to bug me.....so MUCH!! Mostly, because I knew that they were wrong. My hunch was it was always more, more then ADHD....I just KNEW he spent most of his life confused about what was expected of him. His school psychologist who gave him his first two neurospychs refused to diagnosis him because he was "two young and his picture too complicated". One outside evaluator said it could be ADHD or NLD or both and also refused to diagnosis anything specific. I didn't even submit this evaluation because I knew it was so off base. (my son has had inattention but due to confusion about what he's supposed to do and why!) I didn't get a diagnosis until my son was eight, three weeks shy of his 9th birthday. And, only because I took him to the foremost neuropsychologist in the state. She made it clear that the PDD-NOS diagnosis over rides any other. Now, some professionals disagree with this take and say that multiple diagnosis can exist simultaneously. Now, people can argue this point....but I happen to agree with her take. When someone has a spectrum diagnosis their anxiety stems from confusion, lack of constancy and routine, and should be addressed with behavioral supports not medication. If medication is used it shouldn't be used first. (and I wouldn't choose to use it at all if I could help my child without it....my belief system, yes, not everyone's, but is why I search so hard for other options)
I am not making my child out to be special or any more complicated then anyone else's child. I'm afraid that many children look a bit spectrumy for a long time but are too funny, or too social, or too smart so they adapt enough, and red flags don't go up sooner and then if the flags go up it already looks like so many other things you need someone highly skilled to tease out what they see and even good professionals miss it.
That is why, it is worrisome that the DSM will change soon to eliminate PDD-NOS because it fits so many children who have social and pragmatic difficulties but are smart enough to compensate for their issues, until, it is too hard to do so any more. Just because they are at the higher end of the spectrum doesn't mean their issues do not impact them severely. We, as parents though, will have to fight harder to get their needs met, because autism mandated insurance reimbursement will no longer apply. Sucks....but I'm hijacking this with my current frustration.
About your son's anxiety and OCD like behavior, again, sounds like my son. His anxiety was due to confusion. Things were not routine enough for him, not consistent enough for him and the amount of his anxiety diminished (and is now gone) when his school and we as his parents worked to provide him consistent expectations. (we called it good words and good deeds....we laid out everything that was expected of him and we rewarded everything he did that we expected him to do with a monetary amount. When he was six it was pennies, older dimes....anything he did not do we didn't punish him we just did not reward him. ) His school used an IF/THEN approach....if you do three pages of work, then you can take a 10 minute computer break. OCD like behavior is probably a way your son is using to cope with his anxiety and need for routine. My child didn't show this much....but, he did have large melt downs, to the degree that he would scream at me at least once a day, at the end of the day at home, and later, at older ages, he would hide under the table at school.
Yes, anxiety and OCD can be co-morbid with spectrum disorders. It is highly likely that you can treat these symptoms just purely with behavioral interventions and with changing his environment to make it more predictable. If you cannot reduce his anxiety this way you'll cross that bridge when you get there.
And, I'll add my plug for dietary changes, homeopathic medicine (specifically isopathy and the CEASE method of autism treatment) and nutritional supports. We are almost two years into using these as supports and my son no longer uses incentive plans....he has an allowance for doing his homework. He is no longer anxious, is in the classroom all day, no longer needs incentives like the if/then approach to do his school work during school and has better memory, organizational skills, emotional control, social skills, etc etc. I am AMAZED.
I hope that this helps. I would suggest you research the best evaluator in your state and use them. Firm up the diagnosis. Encourage them to use the atypical autism diagnosis if they are unsure if autism applies, even if they prefer a wait and see approach, because the benefit to your child is support and services. He can always "out grow" the diagnosis and have it no longer apply when or if it no longer does. Having a diagnosis will firm up in the school's mind what has to be done for him and make sure that proper supports are in place. It also in some locations allows a home based therapist to work with you to set up behavioral plans so you don't have to do it all yourself. If I could go back in time, I would have forced the issue, and gotten a firm diagnosis sooner. Not only did it pave the way at school for my son, but it firmed up in my mind, my resolve to make any and all necessary changes in our diet and health choices to assist him.
Sorry this is SOOOO long!!