"delays"

[mamashark]

We're finally getting the first steps in getting help for my son. We have filled out a sensory processing disorder checklist, had a physical, and a basic developmental screening as part of the physical. We are making dietary changes and a few other small things to start. We are waiting for word on the next steps to take. 

 

One thing the Dr. mentioned was that there "are some delays". This was after he failed to adequately draw a stick figure. (he drew a head, 3 randomly placed shapes for eyes and nose, and an arm was sticking out where an ear should have been) I know the delays cannot be in gross motor skills based on the conversation.

 

I had a LOT to process during the appointment and never remembered to ask specifically what delays she saw. What do you think the drawing of a stick figure indicates regarding development? Can someone point me in the right direction as I research some of this on my own?

 

Thanks!!

[OneStepAtATime]

I can't recall.  What is the age of your child?

[mamashark]

I can't recall.  What is the age of your child?

 

He turned 4 in January

[OneStepAtATime]

Hmmmm...then I'm not sure.  My kids were not big on drawing when they were that age, or even for a few years after that age, so I don't have a frame of reference.  Hopefully someone else can chime in on what that might indicate.  I was terrible at drawing so goodness knows what I would have drawn.  :)  Can you call and ask?

 

On a side note DD had little tolerance for coloring or drawing of any kind up through about the age of 7.  (Which is kind of ironic since she is an excellent artist).  I remember her being at church and all the little kids had been given coloring books to keep them occupied.  The other little children in our pew were coloring away.  DD stared at the page, grabbed a crayon and rapidly scribbled across the whole thing (she has excellent fine motor skills by the way).  The little boy next to her watched her for a bit then smiled sympathetically.  He told her he remembered when he used to color poorly too and tried to reassure her it would get better.  She looked highly offended and promptly told him something like "I'm not coloring poorly, I'm coloring efficiently!".

[Arcadia]

One thing the Dr. mentioned was that there "are some delays". This was after he failed to adequately draw a stick figure. (he drew a head, 3 randomly placed shapes for eyes and nose, and an arm was sticking out where an ear should have been)

My kids have that "test" so many times at the doctor and in school at the start of kindergarten that I am just amused by it. It is probably the "Draw-A-Person" test. I don't see any correlation with intelligence with regards to my kids, my kid who likes drawing "test" drew the sign outside the guys restroom and my other kid who hates drawing "test" drew a hangman game style stick figure just to be done with it. When the doctor prompted him to improve his drawing, he drew 5 ovals (body, arms and legs) and a circle (face).

 

Below quoted explains it and has 4 year old examples on the link

"Imagine a world where intelligence is measured like this:

 

A child sits down at a desk. She is given a piece of paper and a crayon. Then, she is asked to draw a picture of a boy or girl. “Do the best that you can,†she is told. “Make sure that you draw all of him or her.†If the child hesitates, or asks for help, she is gently encouraged: “You draw it all on your own, and I’ll watch you. Draw the picture any way you like, just do the best picture you can.â€

 

When the child is done drawing, the picture is scored. It’s a simple process, with little ambiguity. One point is awarded for the “presence and correct quantity†of various body parts, such as head, eyes, mouth, ears, arms and feet. (Clothing gets another point.) The prettiness of the picture is irrelevant. " http://www.jonahlehrer.com/blog/2014/8/27/the-draw-a-person-test

 

ETA:

My oldest had gross motor skills delays going by the usual milestones chart at the pediatricians clinic since newborn. He nearly ended up needing a PT evaluation.

Edited April 7, 2017 by Arcadia

[Lecka]

I would not assume it is based on the actual drawing, or that alone.

 

It could be some behavior that was observed at the same time as the drawing.

 

Because that just doesn't seem like it is a delay for a 4-year-old!

 

But there could have been something about following directions or using words or things like that, that were observed in the process.

 

They are looking for stuff like that, too, sometimes, and not just the exact thing they are asking the child to do.

 

Just because my son has autism -- I know he would have shown a delay in language and social interaction in the process of doing a drawing like that, which would have been noticed as a delay by a tester.

 

So it could really be anything if the tester was noticing some associated behavior.

[Crimson Wife]

Delays in ability to draw a person could reflect any number of underlying issues- fine motor control, visual processing, cognitive, attention, etc. By itself it tells the evaluator little information.

 

The general pediatrician was doing a basic screening and you need a full assessment by a developmental pediatrician and possibly one or more of the following: Occupational Therapist, Physical Therapist, Speech & Language Pathologist, Developmental Optometrist.

[Lecka]

Honestly I would imagine the delay is related to whatever the reason is you are seeking testing.

 

Because then it means the tester sees what you are seeing.

 

/optimism

Edited April 7, 2017 by Lecka

[Lecka]

Oh, I think Crimson Wife is right.... maybe this translates into doctor-speak for "I will approve the referrals you are asking for."

 

Some things require a physician referral and then just recently I heard of one where they have separate waiting lists for physician-referred and parent-referred, if I understood that correctly -- it was new to me.

[mamashark]

Delays in ability to draw a person could reflect any number of underlying issues- fine motor control, visual processing, cognitive, attention, etc. By itself it tells the evaluator little information.

 

The general pediatrician was doing a basic screening and you need a full assessment by a developmental pediatrician and possibly one or more of the following: Occupational Therapist, Physical Therapist, Speech & Language Pathologist, Developmental Optometrist.

 

Yes I realize that I need more evaluations, this was a first step. we've already had a speech and language assessment too, actually, which was normal. (or average? on target? however they say that he is not delayed in speech/communication)

 

I'm pretty sure the Occupational therapist is next up.

[Arcadia]

Some things require a physician referral and then just recently I heard of one where they have separate waiting lists for physician-referred and parent-referred, if I understood that correctly -- it was new to me.

Our insurance only allows physician-referred for in-network testing but would allow parent-referred for out-of-network testing. Ironically the parent-referred was faster for us because we pay full and then file an out of network claim.

[Crimson Wife]

 Some things require a physician referral and then just recently I heard of one where they have separate waiting lists for physician-referred and parent-referred, if I understood that correctly -- it was new to me.

 

Yes, the local pediatric rehab clinic prioritizes physician-referred patients over parent-referred ones. I had been told a 6 month wait list for OT originally but when the neurologist sent over the referral a month later, that bumped her to the top of the waiting list and she got in a few weeks later.

[Guest]

This:

Delays in ability to draw a person could reflect any number of underlying issues- fine motor control, visual processing, cognitive, attention, etc. By itself it tells the evaluator little information.

 

The general pediatrician was doing a basic screening and you need a full assessment by a developmental pediatrician and possibly one or more of the following: Occupational Therapist, Physical Therapist, Speech & Language Pathologist, Developmental Optometrist.

Lots of :grouphug: while you are going through the process.

[geodob]

Though that's an interesting question about 4 year old's drawing Stick Figures ?

 

What is particularly interesting, is that these 'shapes' that they draw?

Could be looked at in terms of their ability to create 'Symbols' to represent different things?

 

When they draw an eye, they are not trying draw real representation.

Rather they have to concieve of shape, to represent an eye. Basically a symbol.

Though they also have to concieve of these different symbols for eyes, nose, arms, legs in relation to each other?

 

While the accuracy isn't important. What is more important, is that they develop 'abstract thinking'.

To understand how 'things' can be represented by symbols.

Which directly relates to representing sounds by symbols/ letters.

That can take on a new meaning, when combined together.

[Jennifer-72]

My understanding of that test was part of how it is assessed is really how the child approaches it and carries it out not so much the resulting picture. Can alert to troubles with ideation, organization and also auditory processing, but like crimson mom said it is just a quick screen to help decide if it is necessary to follow on withore assessments.

[Clemsondana]

I vaguely remember them doing a basic version of this at my kid's preschool. When they explained what they were looking for, it seemed to e something about perspective or relationships between parts (did you put the head at one end of the torso and the legs at the other, with arms in the middle? did you show 2 things that can't be seen at the same time, like did the head have 2 eyes, a nose, a mouth, and ALSO the back of the head?). There was also maybe something about the act of drawing it - grip on the crayon, ability to cross the midline, etc. This was just a teacher-based assessment looking for major delays. I seem to remember them doing it at the start and again at the end of the year and looking to see what had changed - there are some developmental targets that they could see. Most of the drawings changed a lot over the 9 months of the school year. They talked to the kids so that they'd have explanations if it was strange (I drew it upside down because she was doing a cartwheel!).

[mamashark]

Here is a picture he drew for me last night of a person. he worked painstakingly at it.

 

 

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[nature girl]

:grouphug:

 

Can he trace lines? At this age, most kids can do mazes and simple dot to dots, and trace the shape of letters. If he has a hard time tracing, does he realize when he's gone off the line?

 

Can he do easy (10 piece) puzzles? Does he recognize letters? Were there any other delays you've seen that led you to seek evaluation?

[mamashark]

:grouphug:

 

Can he trace lines? At this age, most kids can do mazes and simple dot to dots, and trace the shape of letters. If he has a hard time tracing, does he realize when he's gone off the line?

 

Can he do easy (10 piece) puzzles? Does he recognize letters? Were there any other delays you've seen that led you to seek evaluation?

He can connect dot to dots but not always in a straight line. I've not tried tracing lines. He is working through lolipop logic with me and doing well. he can do easy puzzles.

 

The thing that's caused most of my concern was behavior... He'll throw big fits and shut down and be non-communicative. He's got serious attachment issues and thew a big fit last night when he had to go home with dad because I was going to swing through the store. He didn't really calm down before I got home and I had to finish getting him ready for bed. He often won't go to his church class and it took a minor miracle to get a weight and height on him at the dr.

 

 

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Edited April 20, 2017 by mamashark

[PeterPan]

You might see what was actually done at the SLP eval, whether they were looking at articulation or language or vocabulary or what. There are certain patterns to things, like maybe having advanced language but not actually using it or having high vocabulary but low paragraph level comprehension, etc. 

 

If you get complete evals, they'll have forms like the Vineland that can look at all kinds of aspects of development.

 

Fwiw, the stick figure thing is sometimes a reflection of OT issues. The theory is that they draw the parts they sense in their own body. So the drawing and lack of clear placement of any body parts, is showing  you that he's having trouble making connections in his body, that he has OT issues. It's something we saw with my ds. So you would want a SIPT-certified OT or someone who is really good with sensory, retained reflexes, etc.

 

It can show other things. Main thing is just start getting evals and keep getting evals and don't let anybody blow you off. Sometimes these $100 an hour people are too idiot to know what they're seeing.

[Crimson Wife]

:grouphug: :grouphug: :grouphug: :grouphug:

 

FWIW, tantrumming beyond what would be normal for her age is what prompted me to seek an evaluation through EI. I chalked the behavior up to frustrations caused by the expressive and receptive language delay, but even though I did not recognize it as autism, I did know that it was atypical and a reason to have her evaluated.

[mamashark]

You might see what was actually done at the SLP eval, whether they were looking at articulation or language or vocabulary or what. There are certain patterns to things, like maybe having advanced language but not actually using it or having high vocabulary but low paragraph level comprehension, etc. 

 

If you get complete evals, they'll have forms like the Vineland that can look at all kinds of aspects of development.

 

Fwiw, the stick figure thing is sometimes a reflection of OT issues. The theory is that they draw the parts they sense in their own body. So the drawing and lack of clear placement of any body parts, is showing  you that he's having trouble making connections in his body, that he has OT issues. It's something we saw with my ds. So you would want a SIPT-certified OT or someone who is really good with sensory, retained reflexes, etc.

 

It can show other things. Main thing is just start getting evals and keep getting evals and don't let anybody blow you off. Sometimes these $100 an hour people are too idiot to know what they're seeing.

The SLP eval was articulation and comprehension based on age-appropriate norms. He was receiving services for a while, then it was consult only, then a final eval and she determined that he was within age-appropriate norms. (this was a PROMPT certified SLP whom I trust with my life). 

 

The Sensory processing checklist we filled out indicated that he has some sensory avoiding issues and the Dr. made some suggestions to work on regarding that and we are supposed to go back for a followup after a 6 week food trial to ensure that it is not food allergies causing difficulties. One of the suggestions was to get an electronic toothbrush and that was magic! We've gone from fighting him tooth and nail to brush his teeth once a day to him voluntarily brushing them twice a day! I know as a toddler he used to crawl on the floor pushing and rubbing the top of his head along the floor as he went. We spoke to our DD's OT about it and she said it was likely related to reflexes, but I can't remember exactly what she said - she indicated it was fine at the time. The sensory things we're changing in his day right now are also showing an increase in his willingness to give/receive hugs and kisses and I've discovered that he likes deep pressure - I almost can't push hard enough when doing a "hotdog rollup" in a blanket for his liking.

 

I expect that a full OT evaluation will be next after the follow up. It is very interesting about him not being able to draw the parts of the body he's having trouble connecting to, I'm going to ponder that some more. The thing I am thankful for is that I finally have a dr. who is taking me seriously. She did not even want to give the vaccines that he's due for because she wants to figure this out first. 

 

 

:grouphug: :grouphug: :grouphug: :grouphug:

 

FWIW, tantrumming beyond what would be normal for her age is what prompted me to seek an evaluation through EI. I chalked the behavior up to frustrations caused by the expressive and receptive language delay, but even though I did not recognize it as autism, I did know that it was atypical and a reason to have her evaluated.

Yes, I've gone back and forth with DH about the possibility of autism. I'm going to follow this thing through one step of the time. I know enough to know that his behavior is not typical for his age, and that I need help.

[PeterPan]

Ok, here's the problem with the "follow through one step at a time" thing. The waiting list for autism evals at a good autism clinic is sometimes a year. Even at a $$$$$$ hospital it can be a 6 month wait. 

 

You would be EXCEPTIONALLY WISE to go ahead and get on the waiting list. Because I guarantee you by the time you've waited for SLP, waited for OT, waited for this food allergy theory, blah blah, and you really WANT the evals for the autism, you're going to be heartbroken at the wait.

 

[mamashark]

Ok, here's the problem with the "follow through one step at a time" thing. The waiting list for autism evals at a good autism clinic is sometimes a year. Even at a $$$$$$ hospital it can be a 6 month wait.

 

You would be EXCEPTIONALLY WISE to go ahead and get on the waiting list. Because I guarantee you by the time you've waited for SLP, waited for OT, waited for this food allergy theory, blah blah, and you really WANT the evals for the autism, you're going to be heartbroken at the wait.

I understand what you are saying. I'll see if I can get on that waiting list the same time I go for the ot eval. It's a pretty big deal that I've found a dr. who agrees with me, our last ped. Blew me off and said his behavior was normal. So at least I feel like I'm making progress.

 

Maybe I'll contact the dr. This week instead of waiting the 3 weeks we have left until his next apt.

 

 

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[kbutton]

We did piecemeal, but it was with someone familiar with autism, and there weren't a whole bunch of guesses about things. For instance, there was no guess that sensory was a piece of it, but we had no overlap between sensory and a lot of the behaviors suggestive of autism. It was really more like both/and than "Is sensory causing all of this?" The one maybe was the ADHD--we thought it might be sensory, not ADHD. It was both, and he "grew into" his ADHD symptoms more fully.

 

*ETA: The autism was a surprise to us, not the evaluator. We did not know the full range of expression, and we also had been told things about eye contact and such that were just not true. 

 

I think that if you can get a Vineland early on, that might give you some piecemeal data that is helpful in the long run. But you're really going to want full evals, and the wait can be shocking. We were exceptionally lucky to get things examined correctly the first time, especially since we were a bit clueless. Different evaluator, and we'd have been really at a disadvantage.

Edited April 20, 2017 by kbutton