Originally Posted by aspeechthx
I didn't have time to read every comment above but I saw you mentioned Floortime and Hanen, which tells me that you have done your homework!! Those are excellent programs and if you understand them and can carry them out then YOU are doing wonderful things for your child! James Mac Donald has another program that is similar (Communicating Partners, I believe). Just because a person is a therapist doesn't mean that they are a good fit for every child or for every diagnosis. If your speech therapist is working on eye contact with a 2 year old, it tells me that she is probably not targeting appropriate goals for him. A pet peeve of mine is therapists who only target talking and do not look at interaction and communication in general. There are prerequisites to talking (just as weight bearing, crawling and cuising furniture are prerequisites to walking) that have to be in place before talking. These include waving, giving/showing toys, pointing, pulling/pushing to communicate, back and forth interactions without words, joint attention...
Everyone has to weigh the pros and cons of private, out of pocket expenses. As a mom, I am sure you want it all for your child. My job is to train parents to be the best therapists for their child in early intervention and it sounds like you are doing a great job of that already. So don't feel that you have to pay a therapist in order for your son to recieve good services at this young age, with a diagnosis of mild autism.
I couldn't agree with this more!
I'll also add our experiences:
We currently pay for 2 hours a week of ST and our DS attends a cooperative preschool with typical kids (where he is def the lowest functioning kid).
Our DS was given almost the exact same informal dx at 2.5 (autism-like traits but not clearly on the spectrum). I was terrified by the experts who pushed for exactly the same things as your experts are. They wanted ABA (as much as we were willing) and a special ed preschool. After research, I completely refused the ABA. My research on ABA convinced me that, unless done in a naturalistic, and play-based way, can be counter productive for some kids. Of course, for some kids it can work, but for kids like my child, it would have been a total disaster. Anyone who says that a child has to sit still and make eye contact to learn language or any other skill is ONLY talking about kids fairly severely on the spectrum and has no clear idea how the vast majority of human learning takes place! My background is in neuro-anthropology and one of the things I study is how the human brain learns. I will say that some people do something they call ABA but that isn't what I consider "traditional" ABA. This new ABA is much more naturalistic and can be totally fine but I would still be cautious. I very much agree with Dr. Jim MacDonald in that the foundation of communication and learning is back and forth interaction learned in functional ways which is why I am always cautious about purely behavioral approaches.
Instead of ABA, I have focused very heavily on floortimey, play based approaches. Our insurance won't cover a private ST and we went through almost 6 different therapists until we found some one who works really well with our DS. Now it is making a huge difference! I would watch and see how your DS seems to react to any given therapist. In terms of therapy, no one can know what will work for any given child and so I feel like it is a little game of trial and error (with types of therapy as well as specific therapists). If it seems ot help, keep doing it! If not, look elsewhere.
In terms of the preschool, much like you, I was worried that our DS was too socially isolated and thought time in a preschool would help. DS was in that school for almost 4 months and I think it is literally the WORST thing we have ever done for our son. There was a variety of functional levels at the school but most of the kids were very non-social. After his time there with kids who never responded to his many, many attempts to interact, I believe he learned to think that kids just don't interact. It absolutely hurts my heart, but I watched him try again and again to engage the other kids in play and, after a while he gave up.
Which is why I think, when kids are so young, it is really, really bad to put them in an environment that assuming any specific diagnosis. The school we put DS in was very geared toward kids on the spectrum and for some of them I think it really was the right place. However, I also believe that, for the vast majority of kids, an environment where they can be around typical, natural communication between peers and with adults is essential.
The preschool we are in now has been amazing! It is a coop so I work there once a week and can be there as often as I like if I feel like DS needs support. The teacher is certified in special needs (even though it is a typical preschool). My DS loves it and is learning more there than any other place. So in our experience preschool has been a huge help, but it had to be the right one. Anything less than great is NOT somewhere I would send him. (We ended up looking at almost 9 preschool until we found this one).
So my advice there would be to definitely go see any school you are considering. Ask about their approach. Ask how they facilitate and encourage social growth and interaction. Sit in on a class and see how the kids interact. If they talk about long, required circle time and sitting at a table for extended lengths of time, I would look elsewhere.
Part of our journey has been getting a better picture of what's going on with DS which has made a huge difference for us. Which is why my ultimate advice would be to go see a developmental pediatrician and get a good evaluation. It was crazy expensive but worth every penny because we found out that our DS is not on the spectrum at all. Instead he has a severe language disorder - which can look very much like ASD in some ways (especially low eye contact and not responding to someone talking to them). I'm not in any way saying that this is what's going on with your DS. But I do believe that kids in the grey "may be on the spectrum, may not be" are often pushed into treatments geared specifically for kids on the spectrum which I also believe can be counterproductive.
For example, we now know that our DS has auditory processing problems and so, until recently, language sounded like white noise to him. As a direct result, his eye contact was poor. When you can't understand what's being said, why would you look at someone's face? One of therapists we worked with was incredibly determined to "work" on eye contact. She held things by her eye, even turned his head sometimes or demanded full eye contact before continuing with a game. Now we understand that the real, core issue is receptive language and working on eye contact before his receptive language improved would have been frustrating and probably really annoying for DS. Now that we know the real issue, we have a road map for the issues we really need to spend our time focusing on.
Trust your gut, you know your DS better than any expert!