DS13- Do we need an evaluation? What kind?

[SweetandSimple]

I would appreciate any advice that anyone could provide in regards to my 13-year-old son.  I really don’t  know much about what steps to take with a teenager. It seems like I should’ve sought some help earlier, but I thought that he just needed more time and maturity.

 

I think that he may have some sensory issues,or perhaps ADHD? Maybe dyslexia? Dysgraphia? I just don’t know where to start! Is he too old for occupational therapy?

 

Or perhaps it is just that he isn’t very motivated, and we need to help him learn to work harder? Our parenting style has probably been more permissive than it should’ve been.

 

Biggest Concerns:

 

-DS is an extremely picky eater.  He hates “weird†textures (Jello, whipped cream, rice) and thinks that most foods are too spicy—even the red sauce on pizza is too much for him.

 

-He has an extremely low pain tolerance.  As a child, he always screamed and bawled over small injuries. He is getting better at not doing that now, but seems to be constantly complaining about stomachaches or sore legs or headaches.  He also cannot stand any kind of exercise—any bit of exertion seems painful to him and reduces him to tears very quickly.  He is quite overweight, which is part of the problem… or a symptom of it?

 

-He generally refuses to wear jeans or other uncomfortable clothing… prefers sweatpants as much as possible.

 

-He has always had an obsessive interest in insects/fish/birds. He really hyperfocuses on these things, and tends to want to talk about them ALL THE TIME. He is better at controlling this when he is around his peers, but when adults show any interest at all, he will talk excessively about his own interests.  (However, he very much wants to hear about others’ experiences with fish/insects/birds.) He will also stop in the middle of a math problem to talk about fish or birds.  It is like he has a hard time switching his brain away from his obsessive interests to other things.

 

-Schoolwork seems to take him a very long time. He is distracted all the time, either by external stimuli or by his own thoughts. Even when he is focusing fairly well, he is really slow.  He seems to understand most math, but works slowly and makes lots of mistakes. He gets frustrated (to the point of tears) really easily if he doesn’t understand a problem.  

 

-His handwriting and spelling are very poor. He sometimes forgets to put periods at the end of his sentences and capital letters at the beginning. A lot of times he will write the sentence, then catch himself and go back to the beginning to fix the initial capital letter. Shouldn’t capitalizing the beginning of a sentence be routine by now?  It just seems like he has to think really hard about everything… how to form the letters, how to spell the words, etc.   He will quite often switch two letters in his writing… for example, spelling “perfect†like “prefect† or “morning†like “monring.â€

 

When he dictates and I type, his writing skills are not bad at all—the organization and word choice are fine.  He went to public school for K-2^nd grade, and struggled to learn to read, then finally learned to read suddenly--without a strong phonics base.  Last year, I finally backed him up to AAS level 1, and that has seemed to help, although we are only on level 4 now, so we still have a ways to go.

 

 Other Background:

 

-At 3 years old, DS tested in the 2nd percentile for speech articulation, and had several years of speech therapy until he was 9. None of the speech therapists ever noticed any red flags for any other issues.

 

-Socially, he interacts well with others. He gets along well with kids his age. He is friendly and mild-mannered, fairly empathetic, and is a good listener.

 

-He is fairly relaxed and easygoing about schedules/routines, etc. 

 

-He is generally compliant and happy, but not very motivated.   

 

--As a child, we had one episode where we had to leave a restaurant because he was crying that the music was too loud. Other than that, he has never seemed to have much of a problem with being overstimulated in public.

 

-I would never consider him to be hyper—he spends a lot of time sitting and reading, examining insects, etc.  However, whenever we are at church or doing school, he can’t hold his hands and legs still at all. He is always playing with a pencil, or jiggling his legs, or drumming on the table, etc.

 

 

We have a wonderful pediatrician, but I am not quite sure what to tell her about all of this. Is there something specific that I should ask of her?

 

We also homeschool through a public charter and could go that route for evaluation, although I have heard that our district moves very slowly concerning evaluations... someone told me they are running a a year behind!

 

Thank you so much for your time and any advice!

[kbutton]

I think OT is a great place to start. It's not too late. I HIGHLY recommend urging the OT to check for retained reflexes on top of the sensory stuff. If they don't want to, ask them for a solid place to have it checked. OTs who are SIPT-certified are good at sensory, but your son is too old for a SIPT evaluation. It's just a way to find a good sensory-based OT.

 

The obsessive interest will pique some speculation about ASD here, but if his social is good, I would be looking at a passion, not obsession (maybe?). To be sure, I would want an honest accounting of his social skills from a variety of people. My son has better social skills at home with us (in some ways) than with others. It's a function of familiarity, relationship, etc. It can be less obvious than you would like to think. This survey is a decent place to start: http://www.ocali.org/up_doc/Autism_Social_Skills_Profile.pdf

 

If he's a good reader and writer and did not use phonics, I would consider something more like Sequential Spelling for his spelling issues. I have my son type his lists. The curriculum is pattern-based, and typing the lists reinforces good typing habits. It's also tons faster! 

 

An overall evaluation would not hurt at all, but it's okay to start with something like OT and go from there. Some places have waiting lists, so you might want to get on a list for a general evaluation by a psychologist (there are various preferences, but I no long put a ton of stock in neuropsychs--we have done just as well with regular educational psychologists)., 

 

Don't leave out vision and hearing (COVD optometrist for vision if you can and an actual audiologist for the hearing--the screenings at the doctor's office/school are not nearly sensitive enough). The auditory sensitivity can be sensory, but it can also be a sign of auditory processing problems. You might look at a list of symptoms to see if any ring  a bell--there are many facets of auditory processing, so this is an area where it's especially true that you don't have to have all the symptoms to think it might be reasonable to have a screening. The screening is called SCAN 3, and if that' suspicious, they'll run more tests. Most of the hearing, vision, etc. stuff is not expensive--you might pay slightly more than a "regular" screening, and it's often covered at least partly by insurance.

[PeterPan]

Yes, it's time for evals.  Yes there's still help OT can give him.  

 

It's a little odd that you're saying he's fine socially but then in conversations he's running over everyone with his bug passion.   ;)

 

No he's not going to outgrow it.  The real question is how much his issues will affect his employability without intervention.  I would get a clinic that specializes in ASD.  They'll usually have SLP, OT, and psych all under one roof, which means one place, all the evals.  You need all of them.  The reason is because an up to date SLP eval may turn up pragmatics, language processing issues, or a flag with an APD screening, all of which the SLP can do.  So you need ALL the evals, and you need a place that specializes in ASD so they can discriminate confidently between ASD and ADHD with social delay.  Ok, truth is that's a lotta crap, but that's what they're going to do.  So they're going to feed you some line about how he has social issues because he's impulsive and ADHD (and needs meds) or they're going to tell you it's because he has ASD, doesn't understand, and needs meds.  Either way, same therapies and probably meds.  

 

And the sooner you get it done, the sooner you get on track.  It's not just going away.  And if dad or a beloved relative was like this and wants to say they turned out fine... well everyone is unique.  Some people's mixes don't turn out fine.  Now we have better tools.  He's GOING TO BE FINE, but he'll benefit from the extra tools and information you'll get with thorough evals.   :)

 

PS.  Welcome to LC.  :)

Edited January 13, 2016 by OhElizabeth

[Dmmetler]

That sounds a lot like my DD11-lots of sensory issues, passionate interests about a few things (mostly animal related), and fairly good social skills when she needs them, but is also a major introvert and fatigues quickly around people. She has been evaluated twice and both times come up as not being clinically ASD, borderline SPD, and just a hair over being considered to have gross motor delays, but can hike for hours straight if she's looking for snakes.

 

One of DD's mentors calls it "typical bio nerd"-that generally, field biologists are sensory-sensitive folks who tire easily around people and the stuff they make and bring, adore animals and nature, and realize that not everyone shares that, but honestly can't understand why.

 

I'm not saying an eval isn't useful-both of DD's have been. But there is a place in the world for this kind of kid, and a lot of the adults I've met who are the grown up version are pretty awesome people.

Edited January 13, 2016 by dmmetler

[PeterPan]

Fwiw (which is obviously not much, lol), I agree that it's not likely to push over to ASD.  But we're only seeing what you're saying here.  And an ASD clinical will usually see those borderline cases and it gives you all the evals under one roof.  Even kids with lots of language can have some funky holes that are causing problems.  My ds has apraxia, and where he has this 99th percentile vocabulary, his single sentence comprehension was nasty low.  That really underlay some of the funky issues we were having, kwim?  So I was just piecing all that together as sort of a one stop shop thing.

 

Technically the ps could get this done.  Might not be as cathartic an experience as private (or even as accurate), but they can get it done.  Pricepoint is certainly right.  If you go private, you could look for a psych from the Hoagies Gifted list.  Then, I'd still go get those OT and SLP evals to cover the bases.  The SLP can run an APD screening, or you can get that done privately.  Our local university does a good job at a great price for that.  You *can* do psych evals with a university, but those are students.  Board track record seems to be mixed.  

Edited January 13, 2016 by OhElizabeth

[Tiramisu]

My 13 yo is scheduled to start OT this week. So it does happen. No one acted strangely about it during the eval. We'll be doing Interactive Metronome but since finding visual processing weaknesses in an np eval, the OT will work in that, too.

[PeterPan]

Even adults can go back and do brushing protocols, etc.  It's definitely not too late.  :)

[MisH]

Alot of this sounds like my ds1 (age 9.5)! He was formally eval'd at age 6 by a psychologist - diagnosis for him: Very, very high IQ with profound dyslexia and mild dysgraphia.

 

Now. For what it's worth.....SweetandSimple (OP) you mentioned that your son had Speech therapy for awhile, but that "None of the speech therapists ever noticed any red flags for any other issues."

I can tell you that, unless any of the SLPs had specific training/classes, they did not have any concern for dyslexia because they did not really know to look for it/what to look for! I have my MA as an SLP....I had one paragraph in one book in grad school that pretty much said "yep, dyslexia is a thing - it exists" - nothing more....nothing! (Now, this was 15ish years ago....I HOPE the grad school curricula for SLPs has begun to include dyslexia....but I don't think it has - not in a broad way at least! (well....based on the fact that I can only find 1, maybe 2, SLP continuing ed classes about dyslexia!)).

So, unless YOU as the parent brought up / bring up your specific concerns AND make sure the person/people evaluating/treating know about the concerns you have AND have proper experience to eval and treat those concerns, then your concerns will likely not be addressed! (Now, a good therapist *should* still notice red flags and/or refer as needed when asked about areas for which he/she has no training/experience.... but, not all will notice anything except that which they have been asked to treat!!!).

 

I do agree with others that 1. it's not "too late" but that 2. it is time for an eval! :)

 

Good luck with it all!!

[ElizabethB]

I would have him watch through my spelling lessons so he can have a quick overview of all the phonics needed to sound everything out and spell well. You might need to follow on with my phonics lessons, but the quick overview of everything should help. They are 2 hours total and include all the phonics and spelling rules from my phonics lessons. The phonics lessons are 10 hours total.

 

http://www.thephonicspage.org/On%20Spelling/spellinglessonsl.html

[SweetandSimple]

Thank you all so much for the advice! You have given me a lot to think about. I've been googling a lot and trying to make sense of things.

 

I called the pediatrician's office-- they want me to pick up some "ADHD paperwork" and then fill it out and schedule an appointment. So I guess that should be my next step.

 

I also found a local OT that specializes in sensory issues and is highly-regarded-- I'd really like to call her right away, but I should probably work with the pediatrician first to see if there is the possibility that insurance will cover it.

 

I'm also very interested in the auditory and vision screenings-- I'd like to do those for sure. Again, I'll see what the pediatrician says.

 

After that, I guess that I'll have to decide whether or not to involve the school district. 

 

Again, than you so much! It is nice to know that I am not imagining that these quirks deserve some attention-- I think my husband thinks that DS13 is just lazy, but I think there is more to it than that.

 

ElizabethB-- we'll definitely spend some time with your lessons to see if that will help.

 

DMMetler-- my son would have so much fun with your daughter! One of the only times when he seems really sad is when he is telling me that he can't ever find friends who love nature the way that he does. 

[PeterPan]

The ped diagnosis of the ADHD won't tell you as much as a psych eval will.  With the psych eval you'll get all the breakdowns (processing speed, IQ, working memory, blah blah), and you might find there are more areas you can work on.  You could even skip the ped diagnosis if you don't need it for a referral.

[SweetandSimple]

The ped diagnosis of the ADHD won't tell you as much as a psych eval will. With the psych eval you'll get all the breakdowns (processing speed, IQ, working memory, blah blah), and you might find there are more areas you can work on. You could even skip the ped diagnosis if you don't need it for a referral.

I was hoping that the ped might give me a referral for a psych evaluation... Is that the way it is usually done, or is it unlikely that she'll do that? We have an HMO, so everything has to come from her for any of it to be covered by insurance...

[Tanaqui]

It seems to me that it's less important to be concerned over the right label and more important that the label gets him what he needs. If nothing else, just looking at the list of sensory issues seems exhausting, and I'm sure it's not too late to get help for that.