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Should I get a psychological evaluation to rule out ASD? (Part 1)

Questions like this one are very common in my circle. The main driver of this question is the underlying fear:

Is it possible to misdiagnose autism or ASD during early childhood?

The answer is: Yes, absolutely! To understand the how and why autism may be misdiagnosed, I think it is best to understand the process and the issues associated with it, so that we can better understand how to move forward.

Let’s look at the whole process, shall we?

What happens first?

One of the most difficult questions for parents to answer is whether they would like to receive a psychological evaluation for their young child. Even though this is a simple yes or no answer, the majority of parents that I’ve worked with are baffled or just simply confused by this question.  This is a question that parents may be asked at different times during the early intervention years.  Sometimes it occurs as early as during the initial meeting, before any services are even provided.  Other times, it is a questions posed by different member of the therapeutic team.  Sometimes, this question gets asked at multiple times by different people. 

But what does this mean?

A psychological evaluation done within the context of early intervention serves one main purpose:  to either diagnose, or rule out the diagnosis of ASD. Perhaps an evaluator suspected that this may be the case, and the questions gets asked at the initial meeting, or perhaps a therapist feels that a diagnosis is the best course of action, hence the question to the parents.

For the most part, when parents hear the words “psychological evaluation,” they become anxious. This happens sometimes because there isn’t enough time spent on explaining exactly what this means. Sometimes, parents themselves are too shocked to even ask any questions. And some other times, parents feel “pushed” to make a decision, shut down, and no longer ask questions.

In my almost 20 years as an early interventionist, I have seen the gamut:  I have seen parents whose children would benefit from an evaluation, but the parents did not consent to one, and I have also seen parents whose children were clearly not on the spectrum, but were pushed to get one.  The result?  Children with autism that do not get what they need right from the start, but also quite a few children without autism who receive diagnoses (or misdiagnosis) of ASD out of pressure and get therapies that are less than ideal for them.

What happens after the diagnosis?

What happens next typically depends on decisions made at family planning meetings after evaluations are completed.  In general, Applied Behavior Analysis is offered as a method, often, but not always, at the direction of a special instructor (a teacher trained in special methods and strategies).

Parents normally ask me about this type of methodology, wanting to know my personal opinion of this method. I often respond that the methodology need to fit the need. I often remark that even though a cold and the flu may look alike, only the flu gets an antiviral prescription, not the cold. Similar ailments do get different courses of treatment. The same is true of ASD and other conditions.

I’m not sure, what should I do?

If you are not sure, sometimes it pays to wait just a few months (2, 3 or 4, but no more than 6), and observe your child. Consult with your team. Read up on the subject. Talk to family. Let the current intervention work. Do all the carry over homework that your team suggests you do.

But most importantly, listen to yourself. Listen to your heart. I always listen to the moms and dads I work with. They are my BEST RESOURCE!

Stay tuned for more information. And as always, leave me a note with any questions.

Boy sitting holding a pink toy

Cheers!

Dr. Klimek

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Should I pursue a diagnosis for my young child?

When it comes to getting a firm diagnosis for their children, I often get two types of reactions:  1)  Absolutely yes!  This way, we can get all services as soon as possible, 2) No way!  I don’t want to put a label on my child unless it is absolutely necessary.  What happens when children are younger than 3 years old and this question becomes central?  Let’s explore some possibilities.

  1. What is the right thing to do?  The right answer depends not only on the child but also on the timing.  Typically, for very young children, when the parent is undecisive I advise to wait a little while (somewhere between 3 to 6 months), and make sure that we get solid intervention on the part of the intervening team (special instructors, occupational therapists, speech therapists, physical therapists, etc.) and the parent/s.  Of course, sometimes even waiting as little as 3 months to let intervention produce results seems like a very long time.  This is when it becomes evident that even with the strongest intervention, without the proper intervention, will not suffice.  I have had situations where I clinically know, after meeting the child and working with the child for a short time, that he/she will have difficulty responding to treatment.  In these cases, I suggest we move forward and pursue a diagnosis.
  2. My child was just diagnosed, now what?  Now is the time to look at all the options available to you through that diagnostic lens.  If your child was diagnosed with ASD (Autism Spectrum Disorder), then you may have access to certain school programs and to the specialized expertise of ABA (Applied Behavior Analysis) teachers, who will tailor programs specifically for your child.  If your child was diagnosed with Cerebral Palsy, for example, you may be able to access equipment that may become central to any gross or fine motor work later on in your child’s life.  Whatever the diagnosis is, the specialized treatment will follow.  I like to compare treating children with treating the flu vs. treating a cold.  Even though some of the symptoms look the same, we treat the flu differently from what we would treat a cold.  The flu is much more severe, and it requires a specific intervention!
  3. I’ve decided I want to wait, or not pursue a diagnosis at all, now what?  Remember that the intervening team will still continue with provision of services, as the needs of each particular child is what drives this service provision, not the diagnosis itself.  In many cases, it is not necessary to pursue a diagnosis.  The child’s needs are self-evident and sufficient.  They are enough to carry out an intervention.  In the flip side of the above example, we wouldn’t treat a cold with the same medication that we use for the flu.  It is simply unnecessary and would not work!

Of course, as with anything else that requires careful consideration, it is important to do a lot of learning, consulting, and above all, soul-searching, before embarking on this route.  One thing to keep in mind is that nothing is written in stone, and a decision that you make today, you can take back tomorrow.  (We will have a course on parental rights.  More on this coming soon!). 

This is an important topic and we will continue exploring all the ramifications of each decision.  If you have any questions or comments, please drop me a note!

Sometimes, no diagnosis is needed to design a quality intervention.
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The Ultimate Goal of Education: Learning how to learn!

In my work with young children, I often get asked by caring parents about what goal/s I’m working on with their children.  For the most part, goals are varied and they depend a great deal on 1) the functioning level of the child, 2) the needs of the family.  When working with very young children (0-3 years old), the family is the principal stakeholder. 

But no matter the individual goals and objectives for each child, the main goal of education is to help children become independent so that they can learn for themselves.  College students, for example, will have forgotten over seventy five percent of what they learned in college a few years after graduation (my observation), but they would have learned HOW TO LEARN.  They would have become smart consumers and will know how to keep themselves abreast of the latest developments in their field.  We don’t want physicians that only remember what they learned in medical school!  We want them to keep themselves up on the latest medical news!

Similarly, children (even young children) need to learn how to learn.  How do they do this?  With some individual variables, we can say that most children learn by 1) being shown how to do tasks (commands or play), 2) being given the opportunity to repeat those tasks, even if they make mistakes, 3) and providing them with free play time.  This last point is important, as it will be used to reveal how much a child can do by him/herself.

Children need modeling, and strategies and techniques in order to learn from those around them, but they also need space to be able to practice on their own.  Two -year old children have a difficult time sitting for any period of time as it is, and it is not natural to have them sit and pay attention for a long period of time.  This would set an unrealistic expectation for the parent and it would only hurt the chances that the child will be able to learn how to learn.   We need to build in time for children to express themselves.

Next time you wonder what’s the best legacy you can leave for your child, think of yourself as the nest, and of your children as birds who are slowly spreading their wings so that they can fly.  What can you do for them to become more independent?  What does your child like?  What is your child good at?  Does he like to do what he/she is good at or does he/she struggle?  Make sure that when you teach your child about “learning,” you make it look more like play. 

Of course, there will be times when you will feel like you need help, and you should ask for help!  If you have a young child, and need help determining whether your child would qualify for the early intervention program, click here.  If your child is 3 to 21 years old, and you need help determining whether you should request help, and want to know more about help in school systems, contact your child’s school psychologist, or drop me a note at ourspecialvillage@gmail.com.  I will get back to you.

All The Best!

Dr. Klimek.

Two young smiling women in graduation caps and gowns.
Ready to engage with the World!
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Help! My child was just diagnosed with a disability!

Your child has just been diagnosed with a disability and you are upset, confused, and angry.  You still can’t believe it and you are already getting the “fight or flee” feeling in your stomach.  What do you do?

First, take a deep breath.  I know, this sounds beyond difficult, impossible, but it is necessary right now.  Take a step back, and take a deep breath.  You will have time to revise the words later.  You will have time to look at reports, and you will have time to consult on them.  For right now, you will need to breathe.

Second, take a look at your child.  Your child needs you and will be there after the first shock of the news go away.  Enjoy being with your child.  Enjoy this moment.  At the risk of sounding cliché I will tell you that moments are precious and will not come back.  Your child will give you moments that will try your patience but will also give you moments of extreme joy.  Be with your child, right now.

Last, do something for yourself.  You will need to take care of yourself so that you can take care of your child.  You will need the energy to be there and to fight.  You will need the energy to withdraw whenever necessary.  You will need the fortitude to be your child’s voice and your child’s advocate.

Above all, keep in mind that no ride through life is never without bumps.  Some rides may be bumpier than others, but it is your very own bumpy ride anyway!