Sorting, lining things up, fascination with letters

[rbk mama]

These all seem very normal to me. I have a 4 yo foster child who attends Head Start four days a week. Since he's been with us for the past 5 months, he gets read to a lot, and has lots of preschool activities at home that involve letters and numbers. He loves letters and was quick to learn to identify upper and lower case and associate them with sounds. He's on the cusp of being able to read CVC words, though he has already started spelling CVC words. He has a weak grasp when using writing utensils, but still likes to write letters and words. At a recent meeting with his head start teachers, they said they were concerned that he often likes to line up toys or sort them (by color or size or type). They played an activity where the kids had to draw out a letter from a bag and if they knew what it was they had to say it out loud and put it in a jar. This kid took each one out, said it, and lined it up in alphabetical order. They thought that was very strange and concerning. I explained that he only just learned the whole order a few weeks ago and was kind of excited about that.

He was a preemie and does have some issues with eating and fine motor, and sometimes I think developmentally he is a bit delayed - but not sure how much is due to emotional trauma bcz of his situation and the fact that in his previous home he was treated like an infant (dependent 90% on liquids for nutrition, not used to dressing himself or really doing anything for himself). He is now potty trained, dressing himself, and eating normally (though from a very short list of foods he will eat). My bio kids all liked to line up toys and sort them, though they did so at a younger age. And at home I see this child do that sometimes, but not often. He likes playing with cars, blocks, paw patrol characters, all in normal 4yo ways. He does sometimes seem more like a 3 yo in his inability to see things from another person's perspective, but he was a preemie, and he just turned 4.

When I asked the teachers (who are both very experienced) why they were concerned, they said "well, it could be something." I asked them what it could be, and they just said, "well it could be lots of things." Am I missing something? He is very social, makes great eye contact, loves meeting and interacting with people - very much an extrovert. Does anyone know what these teachers might be concerned about? Thanks for your thoughts.

[Lecka]

They mean autism.

They said what they said.  They gave you the opportunity to say “in fact, I see him do x, y, z and I have some vague concerns but hadn’t mentioned them to anyone yet.”

You didn’t say that and I think it’s fair to drop it.  
 

Edit:  what I mean is, it’s fine for them to ask in order for them to do their due diligence, the due diligence is done, it sounds like it’s not a big deal.  

Edited March 31, 2022 by Lecka

[Lawyer&Mom]

I would just keep Autism in the back of your mind and keep observing.  As an example, my Autistic daughter loved letters, and had them all memorized by 2 years old.  She was also very socially motivated.  Liked interacting with people, very chatty.  What she wasn’t good at was social awareness.  When she arrived at preschool at age 4 she couldn’t quietly observe what the other kids were already engaged in and find a way to slip right into their existing play, which would be developmentally appropriate at that age.  She just barreled in with “Hey, I’m here! What’s going on? Let’s play together!”  So don’t mistake social interest with social skill.  Contrary to the stereotypes, Autistic people can have social interest and be extroverted.  What we lack is social aptitude.

Also, by age 4 her special interests were already apparent.  At age 2 she was obsessed with the color purple.  By age 4 it was princesses.   (She played princess, drew pictures of princesses, wanted stories about princesses…)  Special interests aren’t always “weird” they are just intense areas of sustained focus.

[Lecka]

If they bring it up again I think that would be a different situation, I think Lawyer&Mom makes good points, too.

But I don’t think it sounds like a big deal right now, at the same time.  
 

You might get a different impression as time goes on.  Or, maybe the child will adjust more to the Head Start program over time.  
 

I am definitely in favor of teachers keeping their eye out, though!  Early intervention is so important.  If they are keeping their eyes out for kids where it turns out to be nothing, they are also keeping their eyes out for kids who will really benefit from early intervention.  

[rbk mama]

2 hours ago, Lecka said:

They mean autism.

They said what they said.  They gave you the opportunity to say “in fact, I see him do x, y, z and I have some vague concerns but hadn’t mentioned them to anyone yet.”

You didn’t say that and I think it’s fair to drop it.  
 

Edit:  what I mean is, it’s fine for them to ask in order for them to do their due diligence, the due diligence is done, it sounds like it’s not a big deal.  

 

1 hour ago, Lawyer&Mom said:

I would just keep Autism in the back of your mind and keep observing.  As an example, my Autistic daughter loved letters, and had them all memorized by 2 years old.  She was also very socially motivated.  Liked interacting with people, very chatty.  What she wasn’t good at was social awareness.  When she arrived at preschool at age 4 she couldn’t quietly observe what the other kids were already engaged in and find a way to slip right into their existing play, which would be developmentally appropriate at that age.  She just barreled in with “Hey, I’m here! What’s going on? Let’s play together!”  So don’t mistake social interest with social skill.  Contrary to the stereotypes, Autistic people can have social interest and be extroverted.  What we lack is social aptitude.

Also, by age 4 her special interests were already apparent.  At age 2 she was obsessed with the color purple.  By age 4 it was princesses.   (She played princess, drew pictures of princesses, wanted stories about princesses…)  Special interests aren’t always “weird” they are just intense areas of sustained focus.

Thank you!! I was wondering if they were hinting at autism, but he seems so normal socially, and actually better at social interactions than a few of my NT bio kids in terms of his motivation and interest. I do see him "barreling in," though and didn't realize it could indicate a lack of awareness! I don't get that many opportunities to watch him with other kids as mine are much older than him. The other day he played well with a kid at the library, and it seemed like they did well together, but now I am realizing that I wasn't paying super close attention.

The special interest thing doesn't seem strange at all to me, as all my kids have been that way. And this kid has lots of interests - not just letters and numbers. 

If you don't mind my asking, did you notice the lack of social aptitude inside your house, or just with other less familiar people? Like, this kid seems to do a good job communicating with us about what he's thinking about, what he wants, and asks questions about others, notices if someone is upset and comments on it. But I'm not sure if he is that way with others. Also, did you notice a difference in eye contact with your daughter? I'm realizing that I don't have a great understanding of the range of autism. Thanks again.

 

[Lawyer&Mom]

My daughter’s differences were relatively subtle in preschool.  I focused on them early on because I had just become aware of my own Autism, but my husband didn’t think there was anything different about her, and she actually “passed” the preschool ADOS.  But an experienced pre-K teacher agreed with me, and when she was six she was diagnosed using the elementary school ADOS.  Sometimes they need to get older for the differences between them and their peers to be more apparent. (It helped that she has a younger sister, and I could compare the two of them entering the preschool classroom.) Now at age 8 my husband totally sees it.

Other clues we had at age four:  1) Difficulty with potty training.  She wasn’t great about awareness of her own body.  We got there eventually, but there were bumps along the way.

2) Memorizing and reciting whole picture books.  Non-autistic kids can do this too, but it’s a very Autistic endeavor. 

3) Verbal stims.  She was constantly humming and singing to herself.  You could always tell when she was near you in the house.

4) Different eye contact:  She could make eye contact, but wouldn’t necessarily sustain it.  Her eyes could dart around your face.  She wasn’t aware of it, and I only recognized it from my own behavior.

5) Subtle literalness.  It isn’t that she can’t understand figures of speech, but sometimes they trip her up, if only momentarily.  She has to stop and think about the literal meaning, and maybe even make a joke about it.

Her social differences are still more apparent with her peers.  She’s pretty good with adults, we adults instinctively compensate more for kids, than kids will do for other kids.   

 

[rbk mama]

11 minutes ago, Lawyer&Mom said:

My daughter’s differences were relatively subtle in preschool.  I focused on them early on because I had just become aware of my own Autism, but my husband didn’t think there was anything different about her, and she actually “passed” the preschool ADOS.  But an experienced pre-K teacher agreed with me, and when she was six she was diagnosed using the elementary school ADOS.  Sometimes they need to get older for the differences between them and their peers to be more apparent. (It helped that she has a younger sister, and I could compare the two of them entering the preschool classroom.) Now at age 8 my husband totally sees it.

Other clues we had at age four:  1) Difficulty with potty training.  She wasn’t great about awareness of her own body.  We got there eventually, but there were bumps along the way.

2) Memorizing and reciting whole picture books.  Non-autistic kids can do this too, but it’s a very Autistic endeavor. 

3) Verbal stims.  She was constantly humming and singing to herself.  You could always tell when she was near you in the house.

4) Different eye contact:  She could make eye contact, but wouldn’t necessarily sustain it.  Her eyes could dart around your face.  She wasn’t aware of it, and I only recognized it from my own behavior.

5) Subtle literalness.  It isn’t that she can’t understand figures of speech, but sometimes they trip her up, if only momentarily.  She has to stop and think about the literal meaning, and maybe even make a joke about it.

Her social differences are still more apparent with her peers.  She’s pretty good with adults, we adults instinctively compensate more for kids, than kids will do for other kids.   

 

Thank you so much for these details. I have a good friend who diagnosed herself as having Aspergers only years after her son was diagnosed. Your daughter is so lucky to have you. How has early awareness of your daughter's diagnosis helped her? In what ways has the school helped, or do you seek help outside of the school system? 

[Lawyer&Mom]

My daughter gets speech therapy at school.  It isn’t for articulation, her deficits fall under “pragmatic” speech or  how we actually use speech in conversations.  Taking turns, narration, making sure the other person has enough context to understand your story etc.  She is also on the waiting list for occupational therapy.  (Retained reflexes etc.)  She is in a mainstream classroom.  Her teachers know about her diagnosis, but it hasn’t really been an issue yet.  I had a rocky elementary school experience myself, so I’m always expecting something to go wrong, but fingers crossed so far so good. 

[PeterPan]

5 hours ago, rbk mama said:

Thank you!! I was wondering if they were hinting at autism, but he seems so normal socially, and actually better at social interactions than a few of my NT bio kids in terms of his motivation and interest.

It doesn't seem very fair to decide someone else's diagnosed based on how he compares to your kids. There are many people who have shades of autism who go a LONG TIME without being diagnosed. And while it's true that "all autism behaviors are human behaviors" it's also true that you have a whole bunch of markers there.

So yes they are trying to walk you up to the idea that he has autism. No they can't outright say it because it's not their place. But yes that's what your list says. And you're saying it too when you list out the rest of those things (feeding issues, sensory/texture/food issues, developmental delay issues, difficulties with perspective taking, etc.).

8 hours ago, rbk mama said:

He is very social, makes great eye contact, loves meeting and interacting with people - very much an extrovert.

That's because there are extrovert, socially motivated people with autism. 

It might make you feel better to wait, but it's not to his advantage. They're seeing it and they're telling you they're seeing it. There are SO many paths into autism and developmental issues that whatever is going on he deserves the intervention that comes with early diagnosis.

Edited March 31, 2022 by PeterPan

[PeterPan]

You could look into Play Project. It's not so much that it's a terrible thing to line up toys. I mean, mercy, millions of people play Solitaire, which is lining things up. The issue is when it reflects difficulty with the narrative language and social skill and perspective taking development that would drive more typical play. That's why you want to do something, because you'll be able to connect him with resources to go those developmental steps going

And yes, trauma affects interoception and narrative language development. Could be any combination of things going on. I'm suggesting you look for the root skill issues underlying lining up. You can say it's a stim (sure, it can be), but it can also reflect those skills aren't developing properly to play other ways.

[rbk mama]

11 minutes ago, PeterPan said:

It doesn't seem very fair to decide someone else's diagnosed based on how he compares to your kids. There are many people who have shades of autism who go a LONG TIME without being diagnosed. And while it's true that "all autism behaviors are human behaviors" it's also true that you have a whole bunch of markers there.

So yes they are trying to walk you up to the idea that he has autism. No they can't outright say it because it's not their place. But yes that's what your list says. And you're saying it too when you list out the rest of those things (feeding issues, sensory/texture/food issues, developmental delay issues, etc.).

That's because there are extrovert, socially motivated people with autism. 

It might make you feel better to wait, but it's not to his advantage. They're seeing it and they're telling you they're seeing it. There are SO many paths into autism and developmental issues that whatever is going on he deserves the intervention that comes with early diagnosis.

 

7 minutes ago, PeterPan said:

You could look into Play Project. It's not so much that it's a terrible thing to line up toys. I mean, mercy, millions of people play Solitaire, which is lining things up. The issue is when it reflects difficulty with the narrative language and social skill and perspective taking development that would drive more typical play. That's why you want to do something, because you'll be able to connect him with resources to go those developmental steps going

And yes, trauma affects interoception and narrative language development. Could be any combination of things going on. I'm suggesting you look for the root skill issues underlying lining up. You can say it's a stim (sure, it can be), but it can also reflect those skills aren't developing properly to play other ways.

Wow. OK, I have a lot of research to do. I am obviously clueless about autism. Are there books or other resources you would recommend?

Yes, he has a complicated story overall - has had it rough from the very beginning of his existence. Almost wonder if I need to start a new thread asking for book recommendations for myself. I will if I need to. Thank you for your feedback!!

[Lecka]

So, this doesn’t come across to me as any smoking gun, huge red flags kind of thing.  It’s hard to tell — but it doesn’t come across that way.

You have options like asking at Head Start are they concerned?  
 

You have options like looking into a screening by Early Intervention (the Head Start people would probably know about this).

 

You have options like talking to the doctor, bringing it up, seeing what the doctor thinks, possibly asking for a referral for an evaluation.  
 

 

[Lecka]

This is a newer book but I like the author, I have her older book.  She does a lot with young kids with autism.  My understanding is it’s all the kind of thing that would be good to do with any kids.  
 

https://www.amazon.com/Turn-Autism-Around-Parents-Children/dp/1401961479

 

(Turn Autism Around by Mary Barbera)

 

[Lecka]

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

 

 

(An Early Start for your child with Autism by Sally Rogers.)

[rbk mama]

2 hours ago, Lecka said:

So, this doesn’t come across to me as any smoking gun, huge red flags kind of thing.  It’s hard to tell — but it doesn’t come across that way.

You have options like asking at Head Start are they concerned?  
 

You have options like looking into a screening by Early Intervention (the Head Start people would probably know about this).

 

You have options like talking to the doctor, bringing it up, seeing what the doctor thinks, possibly asking for a referral for an evaluation.  
 

 

 

1 hour ago, Lecka said:

 

https://www.amazon.com/Turn-Autism-Around-Parents-Children/dp/1401961479

 

 

1 hour ago, Lecka said:

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

 

Thank you for the book recommendations! I have requested both from our library. Also, I will definitely ask about Early Intervention with his Head Start school. I can speak with his pediatrician as well. Thanks again!!

[kbutton]

I would keep autism in mind as well. My DS was not diagnosed until he was almost 9 and in many ways has a very mild presentation. Earlier help would’ve been appreciated. He kind of grew into it in some ways, though he had language issues that were missed early on because they were really narrow, and he had an excellent vocabulary. 

I don’t have current book recommendations. 

[PeterPan]

13 hours ago, rbk mama said:

Yes, he has a complicated story overall - has had it rough from the very beginning of his existence. Almost wonder if I need to start a new thread asking for book recommendations for myself.

Just hit your library and see what they have as it will likely be the normal books. 

Are you following up on any recommendations they make and discussing these things with the dc's doctor? If you're seeing food issues, restricted eating, and developmental delays, is he getting therapies or referrals for more evals? 

Fwiw my ds is 13 and doing therapy for eating, lol, so I'm all over that. However his issues were less sensory (partly) and more that he had myofunctional issues affecting his ability to move his tongue around and chew properly. He's been doing therapy for that and a lot of the strange food refusals (which stemmed in his case from FATIGUE with chewing) have reversed. He's finally gaining weight nicely and has gone from 50th percentile height all those years to 95th. So getting help with eating and evals to figure out what is going on is always good. 

Has he had *private* OT, SLP, etc. evals or only the services through Head Start? That would be an interesting question, whether it's time to be making some evals happen. My hindsight with my two kids is that calling developmental differences personality or whatever just didn't get us anywhere. Once we got them eval'ed, got the right words, got the right approach, then we made progress. So getting evals at the right time can be very helpful. 

He's 4? Around 5 they'll start to get concerned if any primitive/neonatal reflexes are not integrated. It's something to watch for and something some OTs will check. Maybe not just yet, but file it on your list, kwim? Retained reflexes will affect speech acquisition, motor planning, vision development, all sorts of things, so they're good to catch early and 5 is about the time.

11 hours ago, rbk mama said:

I can speak with his pediatrician as well.

Perfect. You're not trying to make a big deal or say what it is. Just say the things you're seeing and advocate to get things checked. If professionals who work with kids all day long are saying something, it's definitely a bring it up with the ped. We had a swim teacher do that. She wasn't trained in anything besides swimming, but she saw enough kids to know he was reacting *differently* from the norm. Later we got words for it, things like "joint attention"... 

[PeterPan]

https://www.kelly-mahler.com/resources/blog/interoception-trauma-the-latest-science-on-healing-2/

 

https://mindwingconcepts.com/blogs/maryellen-moreau-s-musings/nobody-made-the-connection

 

Two articles to get you going. These are two big areas (interoception and narrative language development) that are affected by trauma and that may need some work. They have a cascade of effects on academics, behavioral regulation, etc.

There's a TNL (test of narrative language) normed down to age 4, so if you find an SLP who does a lot with expressive language they can run tools like this. Language will also been in some of the autism developmental tools. 

Fwiw, it does not matter if the trauma was pre-declarative memory. I've met people who errantly think that you can (merely) talk through trauma with a christian counselor or pastor and they do not understand the physical and developmental effects of trauma.

https://www.amazon.com/Body-Keeps-Score-Healing-Trauma/dp/0143127748/ref=sr_1_1?crid=1G9BFGL1OUF9A&keywords=the+body+keeps+the+score&qid=1648820571&sprefix=the+body+keeps+the+score%2Caps%2C147&sr=8-1

Edited April 1, 2022 by PeterPan

[PeterPan]

15 hours ago, Lawyer&Mom said:

She is also on the waiting list for occupational therapy.  (Retained reflexes etc.)

We were successful with the exercises from Pyramid of Potential. https://www.pyramidofpotential.com/primitive-reflexes/  We were taught them by a PT after multiple incomplete experiences with other systems and other OTs, but I think they sell an inexpensive dvd you can order to do it yourself. Really, they need to be done daily at home anyway, meaning there's no benefit to waiting for the OT. 

Edited April 1, 2022 by PeterPan

[Lecka]

Two of my kids had daily “something the OT wanted to be daily” without having daily OT, at school.  One was exercises for retained reflexes.  The OT made a note card with the exercise and an aide or the resource teacher would do it.  For one of my sons he was going to pull-out anyway and that teacher had a mat in the corner of her room.  
 

I don’t think that is common, in fact even qualifying for OT was not common at all there.  
 

But just to say — things like that can work out in a school setting.

 

But I agree if it’s private OT and you go once or twice a week, there are likely to be daily exercises.
 

Its not the kind of thing I would be able to figure out on my own, but I think other people can go pretty far with a book or DVD. 
 

For my son that did it at school, I signed a form for the school and private OT to be able to communicate and the private OT didn’t address it since it was being addressed at school.  

[rbk mama]

6 hours ago, PeterPan said:

Just hit your library and see what they have as it will likely be the normal books. 

Are you following up on any recommendations they make and discussing these things with the dc's doctor? If you're seeing food issues, restricted eating, and developmental delays, is he getting therapies or referrals for more evals? 

Fwiw my ds is 13 and doing therapy for eating, lol, so I'm all over that. However his issues were less sensory (partly) and more that he had myofunctional issues affecting his ability to move his tongue around and chew properly. He's been doing therapy for that and a lot of the strange food refusals (which stemmed in his case from FATIGUE with chewing) have reversed. He's finally gaining weight nicely and has gone from 50th percentile height all those years to 95th. So getting help with eating and evals to figure out what is going on is always good. 

Has he had *private* OT, SLP, etc. evals or only the services through Head Start? That would be an interesting question, whether it's time to be making some evals happen. My hindsight with my two kids is that calling developmental differences personality or whatever just didn't get us anywhere. Once we got them eval'ed, got the right words, got the right approach, then we made progress. So getting evals at the right time can be very helpful. 

He's 4? Around 5 they'll start to get concerned if any primitive/neonatal reflexes are not integrated. It's something to watch for and something some OTs will check. Maybe not just yet, but file it on your list, kwim? Retained reflexes will affect speech acquisition, motor planning, vision development, all sorts of things, so they're good to catch early and 5 is about the time.

Perfect. You're not trying to make a big deal or say what it is. Just say the things you're seeing and advocate to get things checked. If professionals who work with kids all day long are saying something, it's definitely a bring it up with the ped. We had a swim teacher do that. She wasn't trained in anything besides swimming, but she saw enough kids to know he was reacting *differently* from the norm. Later we got words for it, things like "joint attention"... 

So this child came to us about 5 months ago, having been in foster care in another home since he was an infant (removed from bio parent due to neglect). When he came he was receiving OT for eating issues as well as speech therapy. After both scripts were ending, both practitioners felt it made sense to take a break from therapy. The OT felt his aversion to different foods was mostly a control issue, and the speech therapist said he was mostly at age level in every area of speech so didn't need more therapy. The OT had made significant progress with him since he started with her - she got him to tolerate strange foods being on his plate, to touching them, smelling them, licking them, and taking a tiny bite. Now is able to do that with most new foods. But she did mention that he has some trouble moving his tongue around, and she was doing exercises with him for that. What kinds of foods was your son preferring to eat? This child likes hard texture foods mostly - beef jerky, crackers, apples, cereal, but also loves cheese -just not soft cheese. I was thinking that's because its hard for him to get soft sticky foods off his teeth. It sounds like he needs a new OT eval to focus more on his tongue issues and any other muscular problems.

Both prior therapists were "private" - not through Head Start. I requested a speech eval with Head Start last December (after the private one was ending and before he actually started attending Head Start), and they did what seemed to be a fairly comprehensive eval overall of him (all of this is new to me, so I'm not sure what all was missing - he had like 5 people in the room with him for hours), and they came back saying he didn't require any services. His speech was apparently close enough to age appropriate. Their only concerns were with his lack of self-care skills (like dressing himself), which we just hadn't been focusing on yet since he was so new and in fresh trauma from leaving his prior home. Once we showed him how to dress himself, he was fine doing it on his own. When he came to us he was in diapers (not pullups) and did literally nothing for himself. 90% of his nutrition was from Pediasure in a sippy cup. He is now nearly off it altogether and has gained weight. This all seemed bizarre to us, but we attributed it to his prior foster parent since he was relatively easy to potty train and teach to dress himself and eat solid foods.

Since his Head Start teachers have conveyed their concerns to me (that previous eval was done before he even joined Head Start), I have contacted the special ed person at his school and am waiting to hear back. His pediatrician is great, though, and I will also speak with her. If the Head Start people are not ready to do any other evals, I know that I can get the scripts necessary from his pediatrician.

I SO appreciate all of you who are sharing your experiences and thoughts on this with me! THANK YOU!!

[rbk mama]

7 hours ago, PeterPan said:

https://www.kelly-mahler.com/resources/blog/interoception-trauma-the-latest-science-on-healing-2/

 

https://mindwingconcepts.com/blogs/maryellen-moreau-s-musings/nobody-made-the-connection

 

Two articles to get you going. These are two big areas (interoception and narrative language development) that are affected by trauma and that may need some work. They have a cascade of effects on academics, behavioral regulation, etc.

There's a TNL (test of narrative language) normed down to age 4, so if you find an SLP who does a lot with expressive language they can run tools like this. Language will also been in some of the autism developmental tools. 

Fwiw, it does not matter if the trauma was pre-declarative memory. I've met people who errantly think that you can (merely) talk through trauma with a christian counselor or pastor and they do not understand the physical and developmental effects of trauma.

https://www.amazon.com/Body-Keeps-Score-Healing-Trauma/dp/0143127748/ref=sr_1_1?crid=1G9BFGL1OUF9A&keywords=the+body+keeps+the+score&qid=1648820571&sprefix=the+body+keeps+the+score%2Caps%2C147&sr=8-1

Thank you for posting these. Trauma is a big part of his history - in utero and immediately after birth when he was in the NICU for two months. Then removed from birth mom due to neglect, and then removed from the foster home he was in for 3 years. The articles you posted are interesting, as is the book on the body and trauma (which correlates with another book I am reading right now (https://www.amazon.com/My-Grandmothers-Hands-Racialized-Pathway-ebook/dp/B0727L1NGJ/ref=sr_1_1?crid=8Z3TPCJZ3TEA&keywords=grandmothers+hands&qid=1648848814&sprefix=grandmothers+han%2Caps%2C122&sr=8-1).

How do you find therapists who can interact with him at this level? 

[PeterPan]

2 hours ago, rbk mama said:

she did mention that he has some trouble moving his tongue around, and she was doing exercises with him for that.

It sounds like he's making amazing progress!!! In our experience, yes they will dismiss when there is more going on. If you are still seeing feeding issues, sure push it further. Was this SLP trained in myofunctional therapy? That's the word for it. They have testing they can do to track progress, so that's an objective way to assess whether he's age appropriate or not. You could write her and flat out *ask* if she did exit testing and whether he'd benefit from more time. If you think his eating is now age-appropriate, then you could pivot and work on other areas.

 

[kbutton]

10 minutes ago, PeterPan said:

It sounds like he's making amazing progress!!! In our experience, yes they will dismiss when there is more going on. If you are still seeing feeding issues, sure push it further. 

Yes, though as PeterPan said, it might be later while you work on something else.

Feeding issues can also be related to hypermobility in the jaw due to a connective tissue disorder. The most common one, Ehlers-Danlos, is thought to have an overlap with autism.