Normal or Red Flags for 1st grader?

[Anliena]

I've requested additional testing for my son to see if there any possible LD that we don't know of.  He already has an IEP for speech (articulation).  I'd love to know if I'm just overeacting or if you think there might be something there.

 I know a lot of this can still be normal for his age, but I'm not sure it is when all of it is combined.  I waited a long time to request a speech assessment because I kept hearing how he was still young and it would fix itself (it didn't..) and I keep hearing how kids with speech problems should be watched closely for reading problems as well.  I don't want to wait if there is something, but I also don't want to be that mom who is looking for something that isn't even there.  I'm just frustrated and I'm not sure if it's the way I'm teaching him, the curriculum we're using, or if there is a bigger issue at play.   

 

 

Background:

 

My son just turned 7 (1st grade, but schooling started at TK for letter sounds and basic math/counting).

We've been in speech (articulation) since he was 3 years old.

We have an IEP through a homeschool charter school for speech 2x a week.  Nothing else has been tested for yet. (I've requested it though so it's coming.)

 

Reading is hard for him and he JUST figured out blending this summer.

He's missing a lot of phonemic awareness skills (like rhyming), but is great at others (first/last sound, counting syllables).  We went through AAR Pre-level but a lot of it was just too hard for him in Kinder.  We worked on it over the summer and started AAR 1 when he figured out how to blend. Comprehension tests really high (if it's read to him since he's still not reading fluently), but he has problems remembering letter names, some sounds, reverses numbers / letters.

 

I thought he was doing awesome at math but at beginning of the year assessment he scored really low, and high.

He understands math concepts and tests well for algebraic thinking.  But he can't count to 20 and doesn't always remember what the numbers look like.  We're using Singapore and are just finishing 1b.  I'm not going to move into 2A because of the issues and thinking about switching to RightStart in January although I have no idea if I should do A or B...

 

He also can't remember the names of his friends, family members he doesn't see regularly.  He didn't even know my husband or I's real names, just Mom and Dad, as little as a few weeks ago until we went over it

Handwriting is hated and I only make him write a few words here and there, maybe a short sentence (3-4 words), or one page of a math worksheet. 

 

Other, non-school related issues.  

He's a VERY picky eater and it seems to only be getting worse.  Foods he would eat just a year ago he won't touch now.  I don't know why.

He bites his nails a lot and at one point even started chewing on his shirt.  I got him a chewy necklace and it helped break him of the shirt.. but not the nails.

When he gets really excited, he bounces a lot and does some arm flapping.  I have no idea if this is normal but my other kids don't do this.  It's only when he's excited. 

He will talk forever about video games.. especially minecraft.  Ask him about anything else and he's pretty quiet.

He loves hanging out with other kids but I've noticed he doesn't always notice when he's being picked on or kids are being mean to him unless it turns physical (hit, push, etc). 

He has never done a lot of pretend play.  He hated dressing up when he was younger.  Although he will play 'house' with his little sister now that she's older and takes charge.  She's really taught him how to pretend play I think, it never came naturally to him.

He's not sporty at all.  He's kind of clumsy and has never done well in, or really enjoyed, team sports much. 

He has a VERY hard time sitting still, even when he's playing video games.  He tips back in chairs, moves all around, always fiddling with things.  We've worked around this for school stuff and made adjustments, but there are days it's a lot worse and hard to do anything, even with the adjustments.

 

If you read all of this, thank you!  It's been weighing on my heart since the start of the school year and I honestly don't know if it's really just all normal high energy boy type stuff with just a later start because of his speech, or if there's something more to look at. 

 

If there is something more, are there any particular tests or things I should request from the school? 

 

 

 

 

[PeterPan]

You're going to want to talk with your ped about getting a referral to a clinic for a full eval.  What you're actually giving are things that point to ASD.  There's no need to wait, because they're easily distinguished from normal development variations *and* because you're past the wait and see time anyway.

 

Personally, given how long you've been getting speech, I would suggest you get a fresh eval with a PROMPT therapist to look at the question of whether there's praxis involved.  Also, make sure somebody (psych or SLP) runs the CELF and other detailed language testing.

 

Sometimes peds will refer to a developmental ped, but in your case, since you already know you have serious sensory and speech issues, you should be headed to a full clinic to get a multi-factored team eval.  The school will do an eval because they must, but in reality the real leg work is done in private evals when it's a complex situation like this.

 

You're not being "that mom".  You're being a proper advocate.  Meantime, go give the pretest for Barton and see how he does.  https://bartonreading.com/students/#ss

 

Adding: You *can* call an autism clinic and schedule the eval yourself.  The reason you go through your ped is for insurance purposes and getting that lined up by whoever pays for it.  If you're self-pay, you can just call and get it done.  And no, there's no need to wait.  It's time.

Edited December 20, 2015 by OhElizabeth

[Tanaqui]

I concur with OhElizabeth. This sounds like almost certainly ASD with possibly some sensory issues to me.

[PeterPan]

http://www.promptinstitute.com

 

Here's the link for PROMPT.  Don't ask if they do PROMPT.  Look on the provider map.  If you *ask* someone if they do PROMPT, they'll say "Oh yeah, I "prompt"!'  Not the same, not at all.  

[Guest]

Print out this list and take it to your ped to ask for evaluations.  If you don't have a pediatrician who trusts parents to know their own children, then find a different one.

DS had several of these behaviors, some of which he grew out of...but putting them all together does sound off.

[PeterPan]

Btw, this will sound a little nuts, but my new favorite person for ASD is the behaviorist.  We've been to three psychs so far (because, like I said, the ps CANNOT get this done themselves, it WILL require private most likely), but the behaviorist, who in our case works under another psych, is SO intuitive about behaviors.  I mean, it sounds almost obvious when you say it that way, lol.  But seriously, crazy intuitive, able to see patterns, predict, understand.  And you can get into them sooner.  The big autism clinic in our state capital has a 6 month wait.  Frankly, I get on that list but also be looking around for some of these other people who can get you in sooner.  They'll be out there, and they can still do you a good job.  Our state has an extensive disability program, so it means there are a lot of services.  If you contact your state autism org (google to figure out what it's called), you can talk with them and get connected with resources.  I talked with ours and they hooked me up this week with MORE places I didn't even know about!  They're connecting me with a paid parent mentor, so I don't have to go into IEP meetings scared.  Everything was fine when we were talking SLDs and speech (my ds has verbal apraxia), but once we started talking ASD, everything got ugly.  Now I'll have a parent mentor with me.  And they have another office where a man who had been in the system spent an HOUR explaining to me how to advocate and make things happen.  I had more things to get done.  When you're saying ASD and you homeschool, it's really hard to get those things into the IEP because the ps can't SEE them.  So I've had to go back and make VIDEOS, lots more videos, this time candid.  

 

Please, please call these people and get hooked up with resources.  When my ds was newly 6, we sort of wondered and we were living with it but surviving.  I mean, it was weird and pesky, but we were surviving.  He turned 7, and things have gotten much worse.  The expectations are higher, the gap larger, the problems greater.  We're at the point where we're no longer confused about what we're seeing, but that's because it has gotten to be so much and so hard.  So don't wait till that point.  Get the help now.  That's my two cents.  :)

[Mom28GreatKids]

I would go to you ped and tell them everything you just told us and he/ she will likely wrote every referral you need for evals. There are many unusual behaviors you have described- definitely beyond "normal boy stuff." Sounds like some social, sensory stuff and combined with the speech, memory and attention/ activity level, you definitely need help.

[PeterPan]

Also, and sorry to keep replying here, lol, but my ds basically has your whole list.  And his diagnoses indeed are verbal apraxia (the speech problem), SLD reading, SLD writing, SLD math, ASD, ADHD combined, SPD.  All in one boy!  It can happen.  And he's gifted, which really amps everything and makes it even more frustrating.  

Edited December 20, 2015 by OhElizabeth

[Mom28GreatKids]

I would go to you ped and tell them everything you just told us and he/ she will likely write every referral you need for evals. There are many unusual behaviors you have described- definitely beyond "normal boy stuff." Sounds like some social, sensory stuff and combined with the speech, memory and attention/ activity level, you definitely need help. There are lots of resources out there for you. Take heart and be an advocate for your boy.

[Anliena]

You're going to want to talk with your ped about getting a referral to a clinic for a full eval.  What you're actually giving are things that point to ASD.  There's no need to wait, because they're easily distinguished from normal development variations *and* because you're past the wait and see time anyway.

 

Personally, given how long you've been getting speech, I would suggest you get a fresh eval with a PROMPT therapist to look at the question of whether there's praxis involved.  Also, make sure somebody (psych or SLP) runs the CELF and other detailed language testing.

 

We actually had a lot of changes with SLP's so I think that was a large part of the problem.  We started off with a good place but through our insurance and it only covered part of it and got too expensive.  By the time we got him an IEP he started TK and we started with a different SLP after a few month break.  His SLP had no idea how to work with him and there was NO progress made for a year and a half.  I requested a new SLP last year and he's been there a year and half now and is actually finally making progress and starting to use the sounds in normal conversation.. but it's still not consistent.  When we switched they did the tests over and I think they only found articulation problems.  His understanding of language, vocabulary, and story retelling was very high.

 

Sometimes peds will refer to a developmental ped, but in your case, since you already know you have serious sensory and speech issues, you should be headed to a full clinic to get a multi-factored team eval.  The school will do an eval because they must, but in reality the real leg work is done in private evals when it's a complex situation like this.

 

Is something like that covered by insurance? He has his 7 year old check up in a few days.  Do I just ask for a team eval?

 

You're not being "that mom".  You're being a proper advocate.  Meantime, go give the pretest for Barton and see how he does.  https://bartonreading.com/students/#ss

 

Adding: You *can* call an autism clinic and schedule the eval yourself.  The reason you go through your ped is for insurance purposes and getting that lined up by whoever pays for it.  If you're self-pay, you can just call and get it done.  And no, there's no need to wait.  It's time.

 

Thank you for responding so fast!

[Mom28GreatKids]

Sorry to hijack, bolut OhE does your DS have fine motor delay?

[Mom28GreatKids]

Sorry to hijack, but OhE does your DS have fine motor delay?

[PeterPan]

I would still look into PROMPT.  *If* it's apraxia (which it could be, given its non-responsiveness to other techniques), then getting the best technique can improve progress.  It's also something they can teach you to do at home.  

 

Yes, if you're going in for his 7 year check-up, you're going to ask him to give you a referral for an autism eval.  The ped will probably have places he likes to refer to, but you can also do word on the street and ask around too.  You need full evals at this point.  And frankly, if this ped has been seeing this kid every year, I guess I'd give him a thwack and not even show up.  But I'm really nasty like that.  I mean, missing it one time based on one screening tool, sure, but if this guy has seen your dc a lot of years, that's pretty whack to have missed it.

[PeterPan]

Sorry to hijack, but OhE does your DS have fine motor delay?

You want one of my convoluted, long answers, right?   :lol:  Technically, he has SLD writing but has, at this point, appropriate fine motor skills per the OT.  When he was little, he had OUTRAGEOUS fine motor skills, which reflected the channeling of the energy that *should* have been going into speech into fine motor instead!  So, when he was 9 months old he would sit on my lap while I sewed and pull the pins out as we got to them.  I kid you not!  I would pause, he would pull the pin out, and he would place the pin in a small styrofoam bowl.  Later, by maybe 1 1/2, he had recognizable handwriting and was seeking pens daily.  I had marks constantly on my furniture.  It was crazy!  And literally, within just a short time of starting PROMPT speech therapy, it all STOPPED, just totally stopped.  Like frozen, bam, done, no more.  No more asking for pens, no more writing, NOTHING.

 

That continued until 6, when I decided we really needed to break it into small chunks and TRY to get some breakthrough.  He can now color small amounts if you break it in chunks and stay with him.  He can do a dot to dot.  He's a little crunchy on some of the alphabet.  He can write his first name and most numbers.  He enjoys trying to write words and needs assistance.  To write a sentence takes him 40 minutes with constant help.  

 

So to me, what I'm seeing is still brain diversion plus disability.  But, for right now, his fine motor skills are considered ballparking appropriate enough that nobody is putting that into his IEP.  He gets OT, but for right now fine motor is not in his IEP.  That *could change* in the future, and definitely I make efforts at home to sneak fine motor in every single day.  Dot to dots, coloring, this thing I got at the ed store with a zillion colored screws that you use to make pictures, things you lace, I put this kind of stuff in his independent work bins and weave them into his day.  K'nex, we do astonishing amounts of K'nex.  He LOVES K'nex and it's SUPER for the fingers.  Like today we were breaking down *2* big coasters.  That's thousands of pieces and it's just snap, snap, snapping those things apart!  

 

So yes, there's definitely a method to my madness, but no, fine motor is not current in his IEP.   :D

Edited December 20, 2015 by OhElizabeth

[Mom28GreatKids]

Gotcha. My dude got his eval Thursday. 2 hrs with a dev ped and a neuro psych. He was diagnosed with a fine motor delay in add to his severe lang delay. Looks like that goes along with Apraxia. One more thing to add to the list. OT has only been working sensory so she will get a new job come Monday. Ha ha. Very interesting about your son's over the top fm skills. The brain is weird.

[kbutton]

OP, I would urge you to seek evals also. I think a PROMPT therapist would be very helpful. I have heard of other therapists that use kinesthetic methods to prompt for apraxia (with good results), but it's no guarantee that you'd get someone to do that outside of PROMPT. My DS8's motor issues (both speech and oral motor for eating) were totally missed by a local guru two years ago, but the PROMPT person pointed out stuff that's been a problem his entire life. It's worth a closer look. My son developed a lot of oral sensory seeking in the last couple of years, and some other sensory seeking. It seems strongly related to his proprioceptive and motor deficits. It seems like the areas where he struggles to make his brain and body work are the places where he seeks sensory input, like chewing on shirts and such. It's totally different from my older son with ASD, though they share some motor issues as well.

 

My older son with ASD has both crazy high motor skills (knitting at four) and some lower skills (anything to do with balls moving in the air). All of his skills improved with vision therapy. VT was amazing. We followed up with OT, and now he's able to do a lot of things he wasn't able to do before. Some of it was vision, but we think a lot of it was retained primitive reflexes (worked on in VT).

 

I would ask your pediatrician who he recommends but then also ask around. Ask the board of developmental disabilities. Ask other parents. Ask autism groups. See what you hear and then decide. 

[PeterPan]

Gotcha. My dude got his eval Thursday. 2 hrs with a dev ped and a neuro psych. He was diagnosed with a fine motor delay in add to his severe lang delay. Looks like that goes along with Apraxia. One more thing to add to the list. OT has only been working sensory so she will get a new job come Monday. Ha ha. Very interesting about your son's over the top fm skills. The brain is weird.

I'm sorry, this is with your 3 yo?  And they told you the results or that's like the low-hanging fruit while they tally the rest? 

[Guest]

Adding another vote for testing for ASD. Yes, there are enough red flags there to at least have him tested.

Edited December 20, 2015 by Guest