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What type of evaluation would you pursue next?


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I don't want to seem cranky here, but what is your experience with autism? I recognize things in other kids because my kid does them. People who are trained to see autism by being in the room with a kid for an hour do the ADOS. They train for that, get a certificate.

The two most harmful things to that child right now are 1) to miss an possible autism diagnosis, and 2) to receive less than top quality speech intervention. So you want to be exceptionally cautious about encouraging someone NOT to pursue an eval for autism unless you have some solid, clinical background that enables you to say CONFIDENTLY it should not be on the table. And as for the speech, well I'm sorry but odds are the private SLPs will be dramatically better than what the county EI services provide. They could do BOTH, sure. Call out EI *and* use private services.

Yes get the ASD evals and yes get private therapy. In fact, I'd go so far as to say it's possible even the private therapy they're getting isn't good enough. The best intervention for apraxia is PROMPT, and 60% of kids with speech issues plus ASD have apraxia. So we can go in circles and say Kauffman, flashcards, all this other stuff is good. I really hope it works. But once you're talking a kid's speech, something that affects him the rest of his life, and a diagnosis of SEVERE DELAY, you really want to be asking what the BEST intervention is, the best they can afford, the best they can make happen.

Disclaimer. I didn't call in EI, and they would have easily caught my ds' autism. I let an SLP who had no training in identification of ASD dissuade me on the question, and it delayed our diagnosis by YEARS. I'm RABID on the point that early diagnosis and early intervention is where it's at. And my ds has what is currently considered severe apraxia. We've been in speech therapy, driving 2- 2 1/2 hours each way for 7 1/2 years. I drive by a lot of private therapists because I go to the only place certified in the best technique for a long way.

May this little boy not have autism. May he not have apraxia. May he respond very well to the services he gets locally. But once you put autism and severe speech delays on the table, you want more services, not less, and you want the best, most experienced, most committed people you can get. The EI SLPs are often newbies wanting some experience so they can go into private practice. No matter what's going on, this little boy has a long road.

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1 hour ago, PeterPan said:

I don't want to seem cranky here, but what is your experience with autism? I recognize things in other kids because my kid does them. People who are trained to see autism by being in the room with a kid for an hour do the ADOS. They train for that, get a certificate.

The two most harmful things to that child right now are 1) to miss an possible autism diagnosis, and 2) to receive less than top quality speech intervention. So you want to be exceptionally cautious about encouraging someone NOT to pursue an eval for autism unless you have some solid, clinical background that enables you to say CONFIDENTLY it should not be on the table. And as for the speech, well I'm sorry but odds are the private SLPs will be dramatically better than what the county EI services provide. They could do BOTH, sure. Call out EI *and* use private services.

 

Disclaimer. I didn't call in EI, and they would have easily caught my ds' autism. I let an SLP who had no training in identification of ASD dissuade me on the question, and it delayed our diagnosis by YEARS. I'm RABID on the point that early diagnosis and early intervention is where it's at. And my ds has what is currently considered severe apraxia. We've been in speech therapy, driving 2- 2 1/2 hours each way for 7 1/2 years. I drive by a lot of private therapists because I go to the only place certified in the best technique for a long way.

May this little boy not have autism. May he not have apraxia. May he respond very well to the services he gets locally. But once you put autism and severe speech delays on the table, you want more services, not less, and you want the best, most experienced, most committed people you can get. The EI SLPs are often newbies wanting some experience so they can go into private practice. No matter what's going on, this little boy has a long road.

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I thought I made it quite clear that they are definitely pursuing further evaluations and that they are open to various dx. The potential concern is where to go, and what type of evaluation is best. Is it best to go to someone who is only looking at an autism dx or not, and stands to make money on that specific dx? I mean, didn't you just post the other day about clinics and practitioners having a vested interest in getting your money? Would a different type or more complete evaluation be better? 

What is my experience with ASD? As I clearly stated in my OP, "I'm no expert but have seen ASD in the family and in classes I have taught." I am not presenting myself as an expert to you or to them.  

You said, "I didn't call in EI, and they would have easily caught my ds' autism." Well, that's exactly one of the things I suggested, to call in EI, what is the objection there? While I'm sure some of the SLPs are new, because everyone is new at some point, my personal experience and observation is that the majority are quite experienced, obviously they have the required education, and many of them also provide private services.  Yes, I have personal experience with them. I don't think you can make a blanket statement that private clinics are always going to be better than public services. And our EI is an entire team of various experts, it would not be a second s/l only evaluation, and an SLP would not dx autism or rule it out on their own. 

I did not say or imply that I would discourage them from seeking an autism eval. They want advice, and I figured this would be a great place to get it. The question is not "are evals on the table?" because they are most definitely doing evals. The question is, what type of evaluation is best? If you think that's an autism eval, great, I am happy to have your opinion. But please do not act as if I'm being dismissive of the importance of evals. The secondary question is, do any of his behaviors possibly indicate something else that an autism eval might miss?  

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I would start with the free option.  

I would spend money on a book about early signs of autism, at this point.  For one thing you can start some parent interventions as soon as the book comes!  Also it will be informative.

https://www.amazon.com/Early-Start-Your-Child-Autism/dp/160918470X

https://www.amazon.com/gp/aw/d/146252091X/ref=pd_aw_sim_14_of_4?ie=UTF8&psc=1&refRID=RN3ZNR9B9QSEKQBKFH4C

I think if you get books like this then you can feel like you are making an informed decision.  

I do think early intervention is important but what they said as their reason for the referral seems light to me.  Could they possibly have said anything more detailed about his speech delay, that would also more specifically be making them think of autism?  

I will post another early autism link in a minute.  There are a lot of different-looking early signs.  

 

 

 

 

 

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As for what they would actually do for an “autism eval” at the clinic, it would depend.  I think you would ask that or look at their website.

It can depend a lot on referral paperwork or what kind of information is provided by parents before the appointment.  

And it could depend on their purpose as a clinic or office, just what it is they would provide and what their goals would be.  

I do think if you look at some solid info about early signs then that makes sure you aren’t going by some things that could be individual characteristics.

Also if there are genetically related family members I think that is worth looking more closely.

But if you account for that and don’t see anything — I would not do that appointment.  But maybe I would be open to doing it in 6 months or a year depending on what happened in that time.

If there was any waiting list I would get on it and then just cancel later if it seemed unnecessary.  I would get on a waiting list though in case things didn’t improve and then not having to wait a long time to get an appointment later.  

Long waits where I live!  And it’s hard to get in and hard to get a referral.  

I don’t have personal experience of places where it seems pushy, but I have heard of it on the internet.  

I think educate yourself about early signs and high quality information you don’t have to wonder about (as far as them trying to get some billable hours).

Edit:  maybe call or email the office if there is no website.  You can ask what they would do and what kind of information they would provide.  

 

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Also, autism at 26 months may not look like autism with older kids, even just a year older.  So ———— I think it’s worth it to look at early signs for toddlers.  

If you have seen more kids pre-school and older in teaching, and fewer kids as young toddlers, it can look different.  Early signs can be a lot less obvious and become more obvious at different ages (like between age 1-3) for different kids.  It depends.  But then when they are in pre-school the kids could have more obvious signs.  

It’s just one of those things, and also part of the reason they are trying to screen more kids for autism at younger ages.  Because early intervention is good but a lot of kids are missed because they don’t have really stand-out signs until they are a little older.  

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Oh, things that look similar to autism can include hearing problems (including silent ear infections with fluids in ears) and a kind of seizure.  I am vague on this kind of seizure but it can look like autism but then kids need to take seizure medicine.  

Those are the ones that come to mind and I think both can really look like autism at these young ages.  

Edit: but that is in general, nothing you said makes me think of either of those.

However with a speech delay it is good to check on hearing and ear infections anyway!  

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4 hours ago, katilac said:

This is for a family member's 2-yr-old. Their ped referred them to a speech clinic after his well visit, and they said his speech was severely delayed and he would need therapy, and they also brought up getting him checked for autism. I'm fully in favor of early evaluations and early intervention, but I have a couple of concerns in this case. 

One, the ped referred them to a private speech clinic when we have excellent early intervention services that will evaluate and treat at no cost or on a sliding scale (two different organizations). This clinic wants to refer them to another private clinic.

...With my lengthy description in mind, would you be comfortable starting with an early interventions evaluation?

 

Are you asking whether EI actually diagnoses ASD? They qualify people for services, which is not technically the same. Check. I don't think in our area EI actually diagnoses. I was saying that if I had had them in, they would have connected dots for me, and we would have gotten further evals. The private SLP clinic is referring the dc for private evals because that's how you get a diagnosis. You can be qualified for services with the ps, with the county, etc., without a diagnosis, but having the diagnosis opens more doors for coverage. 

If you are concerned about the connections, then you would go to a different clinic. I've seen that happen with tutors, where they have a buddy they went to school with and they just kick everyone over to that other doctor, optometrist, whatever, assuming they're good. Sure there's that type of system. But really, the better question is whether the dc needs private evals. There with be a significant wait to get private evals, meaning this 2 yo will be almost 3 before he's seen. It's far better to be on the list for a high quality, private clinic and cancel than to wait on getting on the list and WISH you were on it later. That wait can be really long when you really want the answers.

So the answer is do both EI intake evals to qualify for services AND the private, though getting the private through a different place if you don't feel confident in the referral.

Also, the intake window for EI is pretty narrow. This dc is 2? He can begin intake with EI *now* and get something going *now*. In our area, the wait for an autism clinic eval, and this is in a really big city with multiple options, is 6-9 months. That means the dc will be almost 3 and aging out of EI. So it's not really about one or the other. Do they intend to hs or ps? Going through EI smooths the transition to ps and getting an IEP. 

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I have also heard that some places, private places contract EI services?  I wonder if that is a factor?  If so it might end up being free.  

I haven’t lived somewhere that does that so I don’t know how obvious it would be.

Where I have lived a “medical” diagnosis is different from an “educational” diagnosis and a medical diagnosis is needed for some services. It depends locally I think.  

Edit:  ime EI would only say “developmental delay” or something like that for such a young child and wouldn’t say autism until an older age unless parents bring in a medical diagnosis.  

Some parents just have a school diagnosis and don’t have any services needing a medical diagnosis (or wouldn’t have access to anything even if they did have a medical diagnosis).  

Other parents get a medical diagnosis but can’t qualify for autism as the disabling condition on an IEP.

So it just depends!  

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If there are any services other than EI, like something provided by personal insurance or a state waiver program or other program for “autism” ———— then a medical diagnosis is probably needed to access those services.  (Though it will depend on where you live!)

Sometimes they let you start with those while on a waiting list for an official diagnosis.

Those are reasons I can think of to pursue a medical diagnosis — it can make a big difference for some kids if that is how they get into autism-specific EI (which may have a different name) instead of more generic EI (which is good but not targeting autism as much).  

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5 hours ago, PeterPan said:

 But really, the better question is whether the dc needs private evals. There with be a significant wait to get private evals, meaning this 2 yo will be almost 3 before he's seen. It's far better to be on the list for a high quality, private clinic and cancel than to wait on getting on the list and WISH you were on it later. That wait can be really long when you really want the answers.

So the answer is do both EI intake evals to qualify for services AND the private, though getting the private through a different place if you don't feel confident in the referral.

Also, the intake window for EI is pretty narrow. This dc is 2? He can begin intake with EI *now* and get something going *now*. In our area, the wait for an autism clinic eval, and this is in a really big city with multiple options, is 6-9 months. That means the dc will be almost 3 and aging out of EI. So it's not really about one or the other. Do they intend to hs or ps? Going through EI smooths the transition to ps and getting an IEP. 

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Definitely public school. The EI recs carry over from under 3 to over 3 here, he won't age out in the middle of a year, so that's a help.

Good point about getting in wherever he can first, with another appointment as a backup. I just hope they don't all  have a long waiting list. 

Ignore weird quote box below. I tried to edit a question that I now see is answered in another post, but forum is being weird. 

4 hours ago, Lecka said:

 

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5 hours ago, Lecka said:

 https://www.amazon.com/Early-Start-Your-Child-Autism/dp/160918470X

https://www.amazon.com/gp/aw/d/146252091X/ref=pd_aw_sim_14_of_4?ie=UTF8&psc=1&refRID=RN3ZNR9B9QSEKQBKFH4C

I think if you get books like this then you can feel like you are making an informed decision.  

I do think early intervention is important but what they said as their reason for the referral seems light to me.  Could they possibly have said anything more detailed about his speech delay, that would also more specifically be making them think of autism?  

 

 

 

I will check out those books, thanks! The parents did not mention anything more detailed about the speech delay, but I can ask them next time we talk.

5 hours ago, Lecka said:

http://www.autismnavigator.com/  video glossary showing young kids.  

 

Oh, excellent, thank you! 

 

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