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

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!

3 Basic Skills Every Toddler Should Learn

One of the most common questions that parents ask when I start working with their children is “When is my child going to talk?”  Of course, the answer varies.  This concern is one of the most often cited reasons for referrals to the Early Intervention Program and it is understandably a huge concern for families.  It is also quite curious to me that overall, when I first meet children and their families, there is little emphasis placed by teams or other professionals regarding basic skills.  Basic skills are like the building blocks of cognitive development, and toddlers need these in order to be able to grasp everything else, including (but not limited to) the concept of language. Therefore, as a parent or family member, it is important to understand what this entails.

Language is not only a skill, but also a cognitive concept, whereas one person relies on a set of symbols (the language itself) to relay meaning to another person.  You may have observed that when children first learn to speak, they will not speak while another person is talking.  They are grasping the give-and-take of a conversation and understanding the turn-taking that is needed to have a dialogue.

However, this does not happen overnight.  There are certain skills that must be emphasized before children can learn those more complex skills, that include language.  Knowing what skills to work on and emphasize, and how to get toddlers and children to learn them, is a very important first step.

There are 3 skills that I consider essential and I teach every toddler in order to cement an understanding of more complex skills sets.  They are:

  1. Focusing: Focusing is very similar to “paying attention” and refers to a child’s ability to keep attention on the task that he or she has in front of him.  He or she is concentrated and does not want to explore other toys or tasks.  For example, if a child is engaged in putting together a ring stacker, this should be the ONLY activity they are performing. They are not simultaneously building a block tower or completing a puzzle.  Those toys may come next, but for right now, they are only engaged in this one toy.  How do we build on this skill?  Make sure that your child has only a few toys at hand.  Keep toys away if necessary and reduce your child’s need to explore.  Less is more in this case.
  2. Following Directions:  Following directions does not necessarily mean that toddlers should blindly do what they are told.  This is rather a learning tool, a way to get your child to do a simple task, from beginning to end, on request.  It is important that your child be involved in simple, one step tasks such as “close the door,’ “bring your cup,” “throw this in the garbage.”  This is a precursor to language as it reinforces the symbolism of words, and promotes understanding, among other skills.  We already discussed this in part in this prior post.
  3. Completing Tasks:  A task should be performed from beginning to end.  This skill is a reinforcement of the previous two.  Once a child is engaged in a task, it should be carried out to completion.  Otherwise, it is the same as letting your child explore.  Exploring does have a place in learning, but it should be used in moderation and as a precursor to focusing and completing the task at hand.  Promote task completion by re-directing to the task when focusing is lost and by giving your child something he/she likes after a job well done.

Continue practicing these skills and higher, more complex cognitive skills will make their appearance, including talking!

Child laughing.
Learning in a happy environment!

3 Foolproof Ways to Teach Your Toddler at Home

As we wrap up our Fourth of July celebrations this weekend, I am always reminded of how important independence is in all aspects of our lives.  I remember back in my days as a classroom teacher, when most of my students had severe disabilities that precluded them from a regular curriculum, testing, etc.  Then, it was very clear that our number one objective was to build independence in each student so that they could always fend for themselves. But although this was such an important outcome of everything we did back then, it was not and it is not exclusive to the special education sphere. In my work as an educator and consultant, I constantly get asked about ways to teach toddlers or children so that they can learn more at home, to maximize carry over. The answer is simple. Build independence.

We all envision and want children that can make good decisions, think independently, and eventually grow to need us less and less, but this objective has been somehow diluted in this day and age with such an emphasis on “getting good grades” to “get into a good school.”  We forgot how and why this all began.   Independence is one of the unspoken benefits of education, and one that in the age of over-testing has quietly been forgotten.  Creating independence is one of the hallmarks of learning.

Parents can implement strategies at home so that their child can learn. It is all about building blocks to becoming independent later in life.  It is never too early to get your child started on this path.  What can you do at home to facilitate learning?  Here are three ways to do it:

  1.  Let your child be creative with toys.  Sometimes we get caught up in the way things must be done (big to small, matching by shape or color, etc.) that we forget our creative capacity.  We all need space to be creative and children are no exception.  I am not suggesting that we should not teach toddlers to abide by rules. What I am suggesting is that each child needs his/her own space to experiment and create what they find valuable.  So what if they want to group triangles with squares?  Perhaps they realize that two triangles can make one square, and what if they want to build a train with blocks, instead of a house?  Perhaps they see more value in what moves rather than what is static.
  2. Let your child problem solve.  Many parents experience the parental pull to solve problems for their children.  I have seen parents tell their toddlers “not this one, that one,” effectively telling their children how to resolve a puzzle, stacker, and so on.  Problem solving is like a workout for the mind, and once we solve something on our own, we are less likely to forget it.  Have you ever noticed that if you are mindlessly driving, following GPS directions, you are less likely to remember how to get to a place?  Have you noticed how not using a GPS makes you more likely to remember the roads and how to get there?  It is the same principle.  Force the mind to stretch its boundaries, build some cognitive discomfort, and you have a mind workout.  Does your child get frustrated?  Offer help, and teach them to ask for help, but be mindful of not doing the task for them.
  3. Let them do things on their own.  Have you ever asked your toddler to do something and you ended up doing it yourself?  Young children need time and space to be able to do things on their own.  They may make mistakes or not do things exactly as you requested.  This is why we guide them and we model behavior, but what we don’t need to do, is to do things for them.  Try asking your toddler to bring you an item, or to perform an action (“please bring your shoe,” or “please close the door”).  Create a sense of self-efficacy by allowing your child to complete simple tasks.

Of course, it is also important to remember that just as we all need some type of reinforcement for a job well done, so do children and toddlers.  They will be waiting for you to praise them, hug them, kiss them, clap for them as they become more creative, problem solve, and do things on their own.  Show them how you are there at every turn to back them up and catch them if they fall. Be their biggest fan.

Child playing with blocks.
Let your child be creative, problem solve, work problems out on their own!

Do you need help or guidance implementing these strategies yourself? Drop me a note.

Looking forward to hearing from you!