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


Dr. Klimek

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!

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!