Speech/language comprehension in 4 year old dd. Thoughts?

[Nature]

(It was suggested I cross post here, from the childhood forum)

My dd is 4 years and 3 months old. Strangers can't understand what she says the majority of the time. They can pick out bits and pieces but often not the whole concept of what she's saying. dd also seems to talk fast, skip words or parts of words completely, trail sentences off without finishing them, and say incomplete thoughts and random sentences out of context all the time. We have gotten used to a lot of what she does, but it become quite evident when we're out with others that she isn't intelligible all the time. Its almost as if she expects that you know what she's saying. When she only gives a piece of the sentence.

She often has trouble with even one step commands, she seems confused and takes a while and many repeats. "Hand me the pink shoe." can take forever for her to comply. She stares looking for it. Spins around in circles. Looks but doesn't seem to SEE whats in front of her. Since the pink shoe is right there on the uncluttered floor.. So two and three step commands are near impossible for her. She is stumped on one step. She listens but often doesn't hear. kwim?

If I tell her, "Look! A dog!" and point to the dog that you can see standing in the street. She doesn't look at where I'm pointing no matter how many times I try to point something out to her, she will look in every direction BUT where I'm pointing. I have to physically get down to her level, sight my arm with her eye.. and *point* the dog out to her again. And it takes her a few seconds before she can finally see it. We're not talking about something far away here or hard to see. My 20 month old was yelling "dog! dog!" because she saw it. This isn't isolated either. This happens daily. She will say "Oh I see" when its clear she hasn't seen the dog because I can still see her searching.

So I decided to write down a few things that dd says in an attempt to see if others have 4+ year olds doing this kind of language thing.

I do believe my dd to have sensory issues and will be talking with her pediatrician soon as there are a lot of concerns in that area. However I am concerned about her language. Specifically her ability to understand what I'm saying and formulate a response. Having a conversation just doesn't happen with her. She can't stay on topic.. she interjects conversations others are having with something about herself.. she commands attention when she's talking by grabbing at your face and making you look at her..but then frequently babbles incoherently with a few words you can hear in the middle. Her most favorite topic is Spongebob and she can go on and on and interject spongebob into any conversation she hears.

Me: Honey, are you going to go to the store later? I think we need toilet paper.
DH: Yes, probably after dinner.
Me: Alright let me know before you go. Oh! What did you want for dinner tomorrow?
DD: Squidward iz a pickle!.. an goes up!! ..around.. an zzzzzz*makes noises* ok Mama? MAMA! OKAY?!?! he does a booobaaayhooowe.
Me: Whats a booobaayhoowe?
DD: *shrugs with funny look* Wat you say?

--------------------------------
(My 20 month old took off her diaper and was standing naked."

dd laughs, "Piper not gonna get some diaper!"
"He's cold"

(she helps put a diaper on sister by holding her legs.)

Me; What a great helper! What did you help me do?

"I do dis." *points to her sister*

Me: what did you help me do?

"I be.. uh..good girl?" *moves hands while makes strange uncertain face*

"I do.. dis." *points again makes swirling motions with her fingers, gets up and walks away*

Later I told her we had to leave to get ready to go to playgroup soon. I asked her if she remembered what we did at playgroup last week.

"Playground."

Me: Yes, its near the playground. What did we do when we were at playgroup with the other kids?

"..go..an pway..I no wanna bye bye yet..an wif kids.. an stories..playgwoup." *hand gestures* "I tell you!"

-----------------------------

She also has trouble copying words that we say. If I say a word or two, she tries to repeat them but they sound nothing like what they should. Even with practice she cannot copy the sounds I'm making if the word is a new one for her. If she does learn a new word she can say, she often doesn't remember it. Even 10 minutes later she seems to have forgotten the word entirely.

Does any of this sound like a typical 4 yo?

I can only go by what I know her oldest sister did, and she was talking to me and having coherant conversations when she was 4. I simply cannot even imagine talking to dd the way I did her older sister. The comprehension is just not there. From what i can see in her interactions with other kids.. she does seem to be behind. Younger children often look at her with a puzzled expression because my dd isn't exchanging a typical conversation.

Random 3 yo girl, a stranger: Hi!
My 4 yo dd: Hes my fwiend mama *gets very close to the little girl and pats her hair*
Random 3 yo girl, a stranger: My name is Jessica.
My 4 yo dd: Daddy is got one an its dangrus!!!
Random 3 yo girl, a stranger: *blinks* How old are you? I'm 3!
My 4 yo dd: *stares*
Me: (prompting) How old are you Ivy?
My 4 yo dd: I bigger dan dis mornin. I waked up..an I be big. an we go.. and.... *trails off with laughter*
Random 3 yo girl, a stranger: *starts backing away to her mother*

My instinct says that her interactions are not completely age appropriate. The way she gets close to others is similar to the way my 20 month old might go up to another baby. However, a 4 yo probably should realize that the other person is uncomfortable with their space invaded so much. My dd has no clue, and gets angry if I try to pull her back a bit or remind her of personal space.

Any thoughts?
Does this seem typical of a 4 yo? Or worthy of bringing up to her ped? Can these speech/language issues go hand in hand with sensory issues? Or something else entirely?

[Terabith]

Yes, that sounds significantly behind. I'm concerned both about articulation (have you googled apraxia?) and about the comprehension. The inability to follow a point is disturbing as well. I would definitely bring it up with the pediatrician and try to get her speech evaluated by the public school system, and possibly privately as well. I would also think about trying to have her hearing tested by an audiologist, both for acuity (poor hearing would explain a good bit) and for auditory processing. However, not all audiologists can do screenings for auditory processing, so I'd start with just a regular hearing exam.

[MyTwoAs]

The following a point thing is also something that I'd be concerned about in addition to the language. It sounds like she has articulation issues as well as receptive language issues and likely expressive as well. My daughter will be 4 next month and does a lot of the things your daughter does. However with the help of both speech therapy and occupational therapy she's come a long ways - she can now follow two-step directions. Her articulation has always been fine but her language skills are definitely lacking.

I would definitely bring it up to the pediatrician and perhaps even contact your local school district for an evaluation. Here it is called "Child Find" and it is for those children that are too old for early intervention yet too young for kindergarten.

Here are some general language milestones for your child's age:

http://www.asha.org/public/speech/development/45.htm

[sbgrace]

I think there is likely more than one thing going on though they all may be related. I'm not saying any of these are it--just starting points to investigate; she is behind.
1. Has she had a hearing screen? Definitely in order here...that could explain her speech issues both ways in my mind.
2. Look into apraxia of speech. This would affect her articulation.
3. Look into auditory processing.
4. Look into this being a spectrum issue. I say that because of the lack of ability to follow a point (does she point) and her conversation, understanding, and personal space issues you describe along with your mention of sensory issues. http://www.childbrain.com/pddassess.html This is a little thing to let a person know whether an evaluation might be in order. Not saying this is her issue at all..just that some of what you mention reminds me of my son.

[LowFlyingAnimals]

Wow. She sounds exactly like my 5 yo dd! And, yes, she is considered to have a severe language disorder, receptive and expressive.

Has she always had language issues, late talking, not interested? Or is it new? My dd has always had communication and language issues. I noticed when she was 9 months old.

Start with a hearing test to rule out something obvious and physical.

Next, I'd definitely have her evaluated. If I were you having not had her evaluated yet, I'd seek out a developmental pediatrician first or maybe a very qualified speech language pathologist.

If you suspect sensory (and we're just getting there with my dd) you can get sensory screenings with an OT, but I'd start with something more general. A good dev pedi or SLP can tell you if they think there are sensory problems.

Auditory Processing Disorder cannot be accurately tested for before age 7, according to everyone we have been in contact with. It's a likely culprit for my dd. But, the evaluations will give you directions as to why things might be happening.

Let me tell you that with my dd, we have no formal diagnosis yet. She isn't considered on the autism spectrum, but could be. (This is the conclusion of the latest dev pedi visit, helpful as that is ). She does get speech, ot, and lots of extra help at school.

For my own curiousity, does your dd also have trouble drawing, writing letters, coloring? My dd has tremendous problems here, and it all seems connected in my opinion.

Let me know if you want to know more.

[hippymomma69]

fwiw, she sounds *exactly* like my DD - and we have a working DX of Auditory Processing Disorder. It can be "treated" and improved with an intensive language program. We have a good prognosis and we are hoping (and expecting) that in a few years she will not seem much different than a NT child language-wise (although there may be lingering learning issues when we get to the reading stage).

A good book to read to find out more is "When the Brain Can't Hear". APD is like dyslexia of the ear - sounds go in but they get mixed up in the brain which makes it hard to "decode" for the child. Also, many APD kids have trouble distinguishing the "important" auditory information from the extraneous (foreground/background confusion).

Anyway, I would ask for a referral to a developmental pediatrician or to your school district (free services!) to see if they think that is what is going on.

It may be that your DD will eventually normalize on her own - but I found that the langauge delay was really starting to hinder my DD socially (other kids would say "how come she won't answer me?") so I wanted to get treatment. Now she is in a SN language intensive preschool and things have improved drastically.

good luck and I hope you find your answers!
peace,
robyn

Edited to add: my DD also has trouble following a point or distinguishing an item if looking for it - I think it has something to do with the way her brain parses out relevant information....hth

[Nature]

Originally Posted by sbgrace

I think there is likely more than one thing going on though they all may be related. I'm not saying any of these are it--just starting points to investigate; she is behind.
1. Has she had a hearing screen? Definitely in order here...that could explain her speech issues both ways in my mind.
2. Look into apraxia of speech. This would affect her articulation.
3. Look into auditory processing.
4. Look into this being a spectrum issue. I say that because of the lack of ability to follow a point (does she point) and her conversation, understanding, and personal space issues you describe along with your mention of sensory issues. http://www.childbrain.com/pddassess.html This is a little thing to let a person know whether an evaluation might be in order. Not saying this is her issue at all..just that some of what you mention reminds me of my son.

She has not had any screening since birth. And no, she doesn't point at all. She does show me things she does herself like drawings, and can look me in the eye though she prefers not to. She seems to prefer talking to me while looking to the side, sometimes making this kinda funny scrunched up face, and turning her words into questions when they aren't. (if that makes sense. Her voice inflection goes up at the end like a question even though it isn't one.) Most of the time when she talks its quickly, with some purpose, and never just to chat with me.

Sometimes she stops talking and holds up her cup, or turns my head to look, or pulls my arm to where she needs me and its like a charade game.

I did the questioneer and though she does not do some of the typical things that I see autism being. (flapping, toe walking, non social, non verbal, obvious stimming with fingers, etc..) she scored a 106 "moderate PDD" on that link.

Originally Posted by LowFlyingAnimals

Wow. She sounds exactly like my 5 yo dd! And, yes, she is considered to have a severe language disorder, receptive and expressive.

Has she always had language issues, late talking, not interested? Or is it new? My dd has always had communication and language issues. I noticed when she was 9 months old.

Start with a hearing test to rule out something obvious and physical.

Next, I'd definitely have her evaluated. If I were you having not had her evaluated yet, I'd seek out a developmental pediatrician first or maybe a very qualified speech language pathologist.

If you suspect sensory (and we're just getting there with my dd) you can get sensory screenings with an OT, but I'd start with something more general. A good dev pedi or SLP can tell you if they think there are sensory problems.

Auditory Processing Disorder cannot be accurately tested for before age 7, according to everyone we have been in contact with. It's a likely culprit for my dd. But, the evaluations will give you directions as to why things might be happening.

Let me tell you that with my dd, we have no formal diagnosis yet. She isn't considered on the autism spectrum, but could be. (This is the conclusion of the latest dev pedi visit, helpful as that is ). She does get speech, ot, and lots of extra help at school.

For my own curiousity, does your dd also have trouble drawing, writing letters, coloring? My dd has tremendous problems here, and it all seems connected in my opinion.

Let me know if you want to know more.

Her language always seemed normal to me. Its only been the past few months that I took notice that others were often confused by her. Mostly her rambling, trailing off, and out of context thoughts. She blurts out things in the middle of conversations, or other people talking that have nothing to do with what people are talking about in any way. And she says it like she is contributing to it, yet there is no back and forth conversation.

For example, I asked her what we did today in playgroup.
She said, "I did a good girl?"
I said, "Yes you were, but what did we play?"

"What did we play. trains? an da kids run an I fall.. it hurt..I cried.. booohoooo *she demonstrates crying* (fire engine quite far away sounds its siren) I hear someting. What dat? *looks around everywhere, tips head* I hear it. I hear.. where.. Mama? I wanna snack. *I glance at her* Dun look at me ok? *we pass a church we usually do every day* Oh look! We been here last mornin. Last mornin we were."

She tries to keep a conversation going, attempts to answer it, but then suddenly she is off in left field talking about something else, looking at something else, and her sentences are so close together that she loses me every time. Conversations turn into, "Oh really?! Wow!" when I have no idea what she's talking about. Its not that she talks FAST, its more like it all rambles together. Almost like she has so much in her head and to her it comes out fine.. she gets very angry if you ask her to repeat herself and often doesn't even repeat.. she just changes the subject yet again. She doesn't require that I participate, and it seems she doesn't want me to. She just wants me to repeat back to her what she says. Or say, "Okay." and nod. If I try to engage her, ask questions.. etc.. I often don't get anywhere except around the mullberry bush. I should note, she also doesn't ask me any what, where, when, why questions either. with the exception of "What you say?" that she repeats all the time.

She forces me to look at her and then retells me Spongebob episodes daily.. and I can hardly understand a word say says. She just drops off sentences... laughs.. jumps around acting something out.. and then runs off. She does this with movies and shows.

She just recently started drawing more than scribbles. She seems to hold the pencil correctly, though she lays on the table or floor and puts her head on the ground while she does it. She also lays down when playing with toys, or watching tv. If she's not laying sprawled out, she's upside down playing or watching. Its never sitting still watching tv either, though she seems engaged in it... and goddess help me if I turn it off on her. (!!!) She does not name all her colors yet, and confuses them. She can draw only a few letters. She just mastered the ones in her name, IVY. She writes the "I" then the "Y" and either puts the "V" at the end, or adds it to the middle. She says however that its her ENTIRE name. I try to explain its her first name and she won't have any of that. DD colors, but.. everything is one color and she can't stay in the lines. ... that is when she's even looking at the paper. Sometimes I watch her and she colors while looking ahead of her staring off into space.

I thought it was age appropriate.. but after watching other kids.. I'm guessing its not. All the other 3 & 4 year olds at playgroup today were cutting things out with scissors and my dd was trying so hard but couldn't do anything but a straight cut that was very crooked and cut off half her picture. (so, not even able to cut on a straight line.) She has had plenty of oppurtunity to do these things.. we've been cutting, gluing, coloring etc at home for well over a year. I'm sure I started right around 15 months with coloring and added the other ones as she grew.

I'm starting to feel like I did something wrong here.. I had no idea she was so far behind typical 4 year olds.

[sbgrace]

If you hang around here long enough you'll see that much of what autism looks like in our minds isn't reality...in other words my son does none of what you mention as typical autism and has an autism diagnosis. Given what you've written and the score on that test I think autism is a strong possibility.
I'd also check into apraxia and have her hearing tested.
The thing is the lack of pointing is big, not following your point big, the social stuff, etc...none of those would be due to a hearing or auditory processing problem in my experience. Those are spectrum. And spectrum is ok (I hope the idea doesn't freak you out...my son is doing really well).

[Nature]

Originally Posted by sbgrace

If you hang around here long enough you'll see that much of what autism looks like in our minds isn't reality...in other words my son does none of what you mention as typical autism and has an autism diagnosis. Given what you've written and the score on that test I think autism is a strong possibility.
I'd also check into apraxia and have her hearing tested.
The thing is the lack of pointing is big, not following your point big, the social stuff, etc...none of those would be due to a hearing or auditory processing problem in my experience. Those are spectrum. And spectrum is ok (I hope the idea doesn't freak you out...my son is doing really well).

It doesn't freak me out at all, I just never considered the possibility. Everyone I have known personally with autism had at least one of those obvious behaviors I listed. I never knew you could have an autism diagnosis without them.

I'm attempting to get a video of dd, but its kind of hard to catch a moment when my camera phone only records 30 seconds.

[hippymomma69]

Originally Posted by Nature

I'm starting to feel like I did something wrong here.. I had no idea she was so far behind typical 4 year olds.

Please don't feel like you did something wrong! She sounds very similar to my DD (poor fine motor, expressive/receptive language delay, etc) and she is just now turning 4. She's had intervention for only 6 months or so - but the changes have been huge. I think your DD is still going to do FINE with help! And I think you have plenty of time. So don't feel like you did something wrong!

Also, my DD wasn't so far off her peers when younger - it's just as she's gotten older that it has been more obvious....so I think it's probably normally around 4 that most people really start to notice these things. So I think you're probably right in the range you should be to start seeking services!

good luck mamma!
peace,
robyn

[orangecanoe]

Don't have time to fully read the other replies, but wanted to chime in w/ the dyspraxia connection again. My oldest also has trouble finding something right in front of her. Very poor visual tracking/locating/etc. Ditto the following multi-step directions. Your observations will be very helpful to a therapist if/when you do an eval!

[cchrissyy]

she sounds more delayed in langauge, articulation and comprehension than my autistic 4.5 year old.

that said, his articulaiton was that bad at 3, but with ST he got much cleaer. and like others said, don't feel bad for whatever you missed, these things look so much more like normal variation at 2 or 3, it's at 4 and 5 that you realize how far off the curve they are. in fact, at 2.5 I took my son for an autism eval and they didn't diagnose him, only speech and sensory... but right at 4, he had Autism and Auditory processing disorder.

I'd recomend imediate audiology exam, speech assessment and therapy, and skip right past her regular ped to get scheduled for a developmental pediatrician.

you have a right ot all the above through the school for free, but if it were me I'd not wait on them. do your own while you wait for theirs. her life will get so much happier when her speech is understandable and she can start understanding more of the language around her. you've described her quite a lot and it just screams autism to me. like SBGrace says, the sterotyped behaviors or only 1 optional! criteria for autism diagnosis. everything else you show her doing is so classic! and yes, that's OK, you can both be Ok but think how much easier it will be once you understand what's up and she gets help with her speech!

[AuntLavender]

My 4 years 3 mos ds has apraxia and dysarthria

that's a motor planning disorder and coordination problem. He also has hypotonia and it affects his tongue (low muscle tone in his tongue - he can't move it side to side very well or stick it out of his mouth or point his tongue or touch his nose with his tongue).

If you can understand a little bit then hopefully speech therapy will help her become able to be understood. My son has been in speech therapy for almost 2 years now and he's still extremely difficult to understand.

Your daughter may be developmentally delayed. My son was diagnosed with PDD-NOS, HFA, and with autistic tendencies depending on who we saw! He learned to point and he has learned to make eye contact. He's affectionate so my in-laws think it can't be autism. It's a spectrum. Everyone is different.

Best wishes. A speech language evaluation can't hurt and is fun for the child as it involves play.

Sincerely,
Debra

[Nature]

I just read this and its exactly what I was trying to describe that she does...

One reason children with autism are prone to such outbursts of frustration, says pediatrician Myriam Peralta-Carcelen, M.D., is that they apparently lack what scientists call “theory of mind,” or the ability to imagine what other people may be feeling or thinking in a given situation. Indeed, people with autism may not even grasp the basic fact that other people’s consciousness is separate from their own—as demonstrated by their interjecting of disconnected words or phrases with no transition or explanation, as though they assume everyone is sharing their thoughts as they occur.
“In normal development, we learn to recognize a wide range of facial expressions and body language,” Peralta-Carcelen says. “People with autism have a problem with those social cues. It’s possible to reconfigure the brain to some extent by teaching them specific skills that other children learn automatically, such as the fact that it’s not appropriate to stand too close when you talk to someone.

http://main.uab.edu/show.asp?durki=87709

[MyTwoAs]

Both of my kids do that to an extent but most notably my son. He's 6 and has Asperger's Syndrome. My daughter (4 next month) isn't at the point with her language development that she does that but I'm sure as she gets older and gets a better grasp on language that it will likely occur.

My son often-times has a partial conversation in his head and then starts up vocally with me mid-thought and then gets quite upset when I have *no* clue what he is talking about. Frustrating for both of us.

[my3peanuts]

I didn't read any of the responses but my dd is 4 and her language sounds vastly behind IMO.

[LowFlyingAnimals]

Originally Posted by sbgrace

The thing is the lack of pointing is big, not following your point big, the social stuff, etc...none of those would be due to a hearing or auditory processing problem in my experience. Those are spectrum. And spectrum is ok (I hope the idea doesn't freak you out...my son is doing really well).

This isn't true according to the specialists dd has seen (developmental pedi, pediatric neurologist, speech language pathologists, psychologists...).
Dd didn't point, follow a point, all of that. Socially, she's still got problems. However, autism was all but ruled out last year, and this year they felt they needed to test specifically for autism because of strong echolalia and obsessive behavior. She does have the symptoms of autism, but no one will diagnose her with it because the symptoms don't seem to stem from the same place, plus she does do things that would rule out autism. IMO, a lot of autistic behaviors are a result of the inability to use language like typical children do. My dd's problems with language are very similar to many children with autism. Most likely diagnosis right now for my dd is auditory processing disorder, maybe with some other stuff, although her case is also more severe than most cases of auditory processing disorder I've heard of.

Sorry to go off track, but I do encourage an open mind with diagnosis. There are less common conditions that respond better to different treatments that at first glance do look a lot like autism.

Nature, about doing something wrong, please don't think that! You noticed something that may not have even been evident before, and you have plenty of time to correct it!

[sbgrace]

Originally Posted by LowFlyingAnimals

She does have the symptoms of autism, but no one will diagnose her with it because the symptoms don't seem to stem from the same place, plus she does do things that would rule out autism.

Sorry to go off track, but I do encourage an open mind with diagnosis. There are less common conditions that respond better to different treatments that at first glance do look a lot like autism.

No doubt true low flying and I appreciate your perspective. I guess I phrased that wrong. Those are strong indicators of autism. I agree they aren't diagnostic. As an aside, I didn't know that auditory processing issues would affect pointing though I am sure language delay could so it makes sense.
Out of personal curiousity--what symptoms does your daughter have that rule out autism? I was told the opposite with my son...that nothing rules it out. And this from a mom whose son points, has good joint attention, is social, and has a great imagination. He also meets the criteria for a pdd-nos diagnosis. And we've had 4 assessments all that reached the same conclusion--pdd-nos (mild).
If a child meets the criteria for autism don't they have autism? I mean it is a diagnosis based soley on symptoms. So if a child meets the diagnostic criteria...
I don't know what I'm trying to say or why I'm saying anything. My son has autism because he meets the criteria. As I said above, he does a lot of atypical things well (and has some very strong weaknesses in certain areas as well). But still he meets the criteria for a pdd-nos diagnosis. Thing is we know the cause for him is probably actually metabolic. So he's got something else that is causing those symptoms...but he still has autism because he meets the criteria. And more to the point he benefits from autism therapies because that is where his weak areas are.
I'm not speaking about your particular daughter--sounds like she's been assessed completely--I'm just confused personally I think by the different perspectives we as parents seem to encounter.

[Nature]

I'm confused too.

:

DO certain behaviors rule out autism?

If the core things are not there, the ones everyone associates with autism (flapping or other obvious hand stim, toe walking, non verbal, not interested in others, not social ) can a child still have autism?

[LowFlyingAnimals]

Originally Posted by sbgrace

No doubt true low flying and I appreciate your perspective. I guess I phrased that wrong. Those are strong indicators of autism. I agree they aren't diagnostic. As an aside, I didn't know that auditory processing issues would affect pointing though I am sure language delay could so it makes sense.
Out of personal curiousity--what symptoms does your daughter have that rule out autism? I was told the opposite with my son...that nothing rules it out. And this from a mom whose son points, has good joint attention, is social, and has a great imagination. He also meets the criteria for a pdd-nos diagnosis. And we've had 4 assessments all that reached the same conclusion--pdd-nos (mild).
If a child meets the criteria for autism don't they have autism? I mean it is a diagnosis based soley on symptoms. So if a child meets the diagnostic criteria...
I don't know what I'm trying to say or why I'm saying anything. My son has autism because he meets the criteria. As I said above, he does a lot of atypical things well (and has some very strong weaknesses in certain areas as well). But still he meets the criteria for a pdd-nos diagnosis. Thing is we know the cause for him is probably actually metabolic. So he's got something else that is causing those symptoms...but he still has autism because he meets the criteria. And more to the point he benefits from autism therapies because that is where his weak areas are.
I'm not speaking about your particular daughter--sounds like she's been assessed completely--I'm just confused personally I think by the different perspectives we as parents seem to encounter.

I think we're hijacking her thread. I'm still a little confused too. I think our doctors look at autism spectrum as specific conditions, not ones that can be caused by other things. In dd's case, first she would be high functioning if she were to get the diagnosis. Getting an autism diagnosis wouldn't even be necessarily inaccurate any more, since she does meet the criteria. But, when they did the assessment of her (I'm blanking on the name of the test, and I don't have her report yet, since it was just last week), they said that among other things she did show creative imagination not just scripting, "warmed up" after a while, showed joint attention, has a precocious sense of humor, reacted quickly and reliably to her name, wanted to interact with the people in the room. The doctor stressed that a lot was her experience and observation that she didn't see the same kinds of reactions that she would characterize as autistic. She described some of it as that the symptoms were coming from different places than they would in a child truly on the spectrum. She does specialize in autism and pdd. We also had a conversation about the kinds of services and therapies that would benefit my particular dd. She would not benefit from the services they give kids with autism in our school system (based on ABA). She does better with different kinds of therapies right now. Until she is 7, she will remain without a diagnosis. In our experience this makes her IEP committee sit down and say "what will work for her?" Not she has x, so she gets the prescribed y and z therapies. The pedi also mentioned, even at last year's appt where she "all but ruled out autism" that there are a lot of different "interpretations" if you will, to the autism diagnoses right now. Different doctors do consider different conditions onto the spectrum than others. In dd's situation, none of the specialists (all independent and non affiliated with the school system) have thought autism really "fit." We'll see what happens.