Autistic like behavior

[gotkids]

I have a child in my preschool class who just turned 3 and has been with me for about 2 weeks.  After the first few days of school, I noticed that he was really behind all of the other children and acted more like a 2 year old.  Everything from his speech (repetitive echo speech) to the way he moved around so clumsily, to circle time reminded me of a much younger child.  There are obviously some issues.  I spoke to mom about how he was at home and did he have patience to do any kind of activity with her.  Her response was that he did not have playmates, they rarely went to the park, never attended story time or any kind of structured activity and that was why he was having such a hard time at school.  (Why did she have this child???)  My question is, is mom in denial?  What can I say or do to suggest this child needs extra attention without totally offending her and having her pull him out of my class?  To top it off, she had her pediatrician evaluate him and he said he was fine.  I know in my heart that he is not fine.  He can't figure out how to get out of a sandbox or climb onto a trike.  His fine motor and gross motor are very poor.  The other children are not interested in him, nor is he interested in them.  I guess I would like some advice as to what to do next?  Thanks

[888mom]

I'll forewarn you I don't do well answering concisely and am a little jumbled in responding... but wanted to share my thoughts and opinions with you.

I can understand your frustration about not knowing what to do.  Parents don't like to hear that their child has issue(s) either.  

Can you suggest to the parents to have the child evaluated through the public school system?  Okay, so they don't think their child has autism or any other type of thing like that, but if he has delays, the delays should be addressed whether or not they are part of something else.  If you're in the U.S., then starting at age 3, the public school assesses children to see if they qualify for developmental preschool.  Developmental preschool is for kids who have all sorts of delays or disorders.  Autism/PDD, verbal apraxia, speech delay, social communication delays, etc.  The parents contact the public school system, they meet with someone to discuss options and they have to do an evaluation later with the child, and then I think you have to have another meeting to discuss if the child qualified and then to talk about getting services or preschool for your child.  I also know there are private developmental preschools, but I'm not sure if they do assessments or not.  But they are at least better set up to help children with special needs, such as delayed speech and motor skills.  Developmental preschool is freely provided by the public school system, provided the child qualifies.  I'm starting to go through this process for my daughter who will be turning 3 soon.  I am hoping to get her started the week she turns 3, so she can transition from the Birth to 3 program straight into Developmental Preschool where they will offer a speech therapist.  From what her therapist says right now, she will probably qualify for somewhere between 3 to 5 days per week for about 2 1/2 hours each day, and I can choose to have her go less often per week, if I want.  I am not sure what she will qualify for, though.

Also wanted to say that although you sound frustrated with the parent(s), you can't start pointing fingers about why the parents had a child... she may have reasons for not taking her child to the park or attending story time.  Does the family only have one car?  Or did they just get a second car but before only had one?  Or maybe she can't afford the gas prices to even go out to do those things.  Does the mom have health issues that prevent her from getting out?  Or is she a single parent struggling?  Anyways, I know your intent is well meant, but you can't start second guessing the parents who may have things going on in their lives.

Another thing you may not want to tell the parents is that you don't think their child is fine.  My daughter may have her issues, and we have been working with therapists and doing everything we can, reading up on books... but I say my daughter is fine the way she is.  She is who she is, and she always will be different, and I love her for who she is.  I know you don't mean it in that way, you mean saying that he's not fine in that he should get speech therapy to help with the echolalia issues and that he might need an occupational therapist to help him with his gross and fine motor skills.  Just wanting to warn you that how you phrase something may come across differently to the parents than how you intended it to be.  

Another thing is that many children progress in their own speeds and the child may not have autism.  My brother was pretty antisocial when he was a child.  He was a late talker but then started speaking in complete sentences.  He couldn't bounce a ball or tie a shoe lace in kindergarden, but he was reading at age 3.  He was moved on to first grade because the teacher decided that if she kept him behind because of his social and motor skills, he would get depressed because his mental skills were that of someone probably a few years older, and he had to go to first grade so he didn't get bored which he already was since at age 5, he was reading at a 3rd grade level and doing math (he was doing computer programming in Basic on his Commodore Vic 20 in 4th grade, which back in the early 80s was pretty impressive and new).  My mom decided to put him in a private school for first grade that had smaller class sizes and where the kids would not pick on him for not being able to bounce a ball.  I remember my mom working with him a lot on his motor skills.  Though she never thought anything was wrong ever, when the teachers thought everything was.   My brother is now social and he can bounce a ball.  He was also late to ride a bike.  My mom was frustrated because I was 1 year younger than my brother yet I could climb a tree at age 2 and my brother couldn't climb a tree even when he was age 7.  

My sister also had delayed speech and motor skills, though her speech was so behind and she had a language processing disorder that she needed to have speech therapy, which was offered through the public school system.  She was 3 1/2, going on 4 when she started.  My parents thought she was a little behind but didn't realize how far until she was that age.  That was my youngest sister who was the 4th, so they knew compared to the other 3 of us, by age 3 1/2 going on 4, she should be pronouncing things better and not repeating everything back.  She was also really bright, but she was very social unlike my brother.  Regardless, my sister got a lot of help.  My brother did not get any help with social issues, and those seemed to resolve themselves on their own.  He didn't have the speech issues my sister had though.

I wish you luck in trying to get help for the child.  You're doing a lot trying to find out what's available out there!  :)  So kudos to you for doing that.  I'd love to have my daughter in a preschool where the teachers cared that much about the children.  

[888mom]

Oh, another thing I wanted to mention, was that we took our daughter to see a developmental pediatrician.  He's a specialist who deals with developmental delays, behavioral issues, etc.  They can diagnose autism, ADHD, OCD, anxiety disorders, apraxia, and a whole lot of other stuff.  They can also recommend things to do with your children or a speech therapist, etc., if necessary.  

Anyways, the school system might be a better place to start with the parents since they seem pretty adverse to any sort of diagnosis.  

But, when my daughter was seen (it was a 4 month wait list to get her in to one of the top in the area we were living in at the time)... the office had a team of 3 therapists (2 speech and 1 occupational) do an assessment which included speech, cognitive abilities, and motor skills.  It took 90 minutes.  Then the doctor saw her and us for probably about 30 to 45 minutes for the first visit, asking lots of questions and making lots of observations.  The second and third visits were much shorter, probably about 20 to 30 minutes in duration.  Although our daughter's pediatrician is excellent, she was not experienced in diagnosing PDD.  She did make the referral for us, and the Birth to 3 Program also highly recommended this doctor.  If the doctor doesn't think the child has issues, the parents can tell the pediatrician that they think there are issues and ask for recommendations.  If it's a good pediatrician, he will give them options and not dismiss the issue.  

Though their insurance may not cover a specialist like that, and it can get quite pricey, so they may not be able to take advantage of doing something like that if their financial situation does not allow for it. Our insurance paid for the doctor but did not pay for the 3 therapists doing their 90 minute assessment and we also had to pay a deductible for the blood work to rule out some other things.  

[gotkids]

Thanks so much for your thoughts.  You really did a great job of giving me insight on the other side of things.  Mom and Dad of this child are actually quite affluent.  They drive 2 very nice cars and I am stumped why there has been no effort to try to socialize this child at all.  At least they put him in preschool so that is good.  He is a sweet boy and what I meant by "not fine" was that he was having so many struggles and so much frustration that I had to say something to mom.  The whole day is bumpy for this child from sitting down for snack, to using the potty, to painting a picture.  I am trying to be patient but he is very high maintenance and disruptive to the rest of the class.  I invited mom to come and to class today and she said she would stay for part of the time.  Last night, she called me and said that she was pulling him out of my class.  I am sad that this has happened because it was not my intent.  I had talked about the county office of education coming in and doing an assessment and I think that totally freaked her out.  Anyways, thanks again for your valuable insight.  I am sorry if some of my description seemed insensitive.

[888mom]

To me you didn't sound insenstive, but I thought to the parents it might be if they sensed you felt a certain way on things.  Sorry the child was pulled out of your class.  You at least did your part mentioning the county office of education coming out and asking the mom to sit and observe.  And even for just saying something to begin with.  Maybe they didn't socialize their child because he had some bad experiences that they were afraid to bring him places?  I don't know.  Both of us could make lots of guesses as to why.  The mom might have a phobia of some sort or depression that she is not addressing.  Or maybe she has social communication problems of her own.  Or maybe she doesn't want to deal with the issues of parenting.  Which she'll wake up soon because you can't avoid being a parent when you have a child.

I had an experience with my father-in-law this past year.  He is pretty affluent, and when he heard our daughter might have autism, he made some comment about how he would stop putting money in to her college fund until we got a diagnosis.  He also panicked and stopped emailing me for updates on her for awhile, I guess thinking no news was good news.  I think some people see the bad in a diagnosis, not the good.  We told him our daughter has PDD-NOS and not autism.  (actually the doctor said it was one or the other, and he felt it was PDDNOS, but it might be typical autism and we'd have to wait several years to find out).  Yeah, we're probably lying to him telling him they're not the same thing.  There is a difference, otherwise they wouldn't make them separate diagnosis, but they are both in the autism spectrum.  He hasn't asked about therapy or any of it and I think he's just pretending none of it exists.  Personally, I would rather not see the jerk (he walked out on my motherinlaw after having an affair, and without so much as talking it out first), but I know our daughter should have a relationship with all her grandparents even if they are jerks.  I guess part of me wants to get the money for her college fund as well.  I have no doubt in my mind she will go to college, and it would be nice to have money from her grandfather since he seems to have a bit of it to go around.  Yeah, that makes me pretty cynical I suppose.  

[Sally44]

I just wanted to address your observation that she hadn't taken her son to the park, social times etc and you queried 'why did she have this child'.  It maybe that the mother recognises that her child struggles in these environments and is not at all interested and that is why she is not taking him.  The difficulty is then moving that on to recognise that there maybe a problem as opposed to a personality perferance.
The fact that she has now withdrawn him may not be a totally negative thing.  She may have come in and seen that he was 'out of his depth' and for that reason has removed him.  I too struggled with whether I should hold my son back a year because I too could see that he was very immature in all the areas needed to begin nursery/school.  In the end he went to nursery and then to school and went on to get a diagnosis of an autistic spectrum disorder.
Is it possible for you to contact her to just enquire if all is okay and to offer your support if she needs it.  She maybe struggling with what to do next.  She may feel that you invited her into school to show her how her son was failing compared to other kids.  But whatever contact you have be open with them in the fact that you don't know what his diffficulties are, just that he is finding it hard compared to other children his age.  But that assessments maybe able to find out what his strengths and weakness are and that will help them decide what additional help/supports their child needs.

Children on the spectrum tend to have language/communication problems.  If that fits this child then maybe your intial conversation with parents would be about referring the child to a Speech and Language Therapist.  A good SALT should be able to identify if the difficulties are those associated with an autistic spectrum disorder.  Repetitive echo speech maybe echolalia.
Have a look on the Health Page.  You can access this by clicking on the health page icon on the top right hand side of this forum page.  Have a look at the behavioural characteristics behind the clinical diagnosis of autism.  I have posted the DSM IV criteria for autistic spectrum disorders and parents have posted examples of their own childrens behaviour.
I think the best way to approach the parents is to say that you think he is behind his peers and that it would be useful for him to be assessed to see where his difficulties are so that they know what the appropriate supports would be.  As they are 'affluent' they may want to undertake private assessments etc.

The childs physical clumsiness maybe dyspraxia (which can be physical or mental), or it could be sensory integration issues.  Many times it is not a