Reassessment and ADHD/ADD/Autism/Asperger’s (and any other A-conditions you can think of!)

So, here’s a topic that seemed to warrant its own blog post, as it’s rather long and involved: Our decision to have Theo reassessed by a developmental pediatrician.

For any of you who don’t know Theo’s history, when he was a little over three, we started him in a small Montessori preschool. He loved it, and they loved him. However, they were pretty honest with me about the fact that it worked because of modifications to their program that they made for him—ways they could make the environment work for him and vice versa. When I pressed the head teacher to understand more, she finally said, “Theo functions beautifully in his own way, but I’m not sure a standard classroom is ever going to be a good fit for him.” She acknowledged that he was far too young to say anything for sure, but it was at that point that we realized we might need to get creative with education for him.

Shortly thereafter, we relocated and enrolled him in another Montessori preschool. That crashed and burned badly. Weeks after Sam was born (and just four months after Theo started at the school), the preschool called it quits with him. (Yes, yes, I’m the mother of the kid who was kicked out of preschool!) To be fair to them, they had some good safety-related reasons. He was exhibiting behaviors that could’ve been harmful to him—it was on a large farm, and he was eating plants and other non-food items out in the yard, and they were worried that he would ingest a poisonous plant or something. And they really had tried to work with him. They weren’t nearly as flexible as his first Montessori preschool, but they did make efforts. And it just wasn’t going to work.

Before they kicked him out, they suggested that we have him assessed—meaning, assessed for autism-spectrum disorders, among other things. Not knowing where one goes for such things, we went through our medical group. They met with him for three straight hours one morning and then delivered their assessment: no autism, but possibly ADHD. He was 3-1/2 years old, so too young for an ADHD diagnosis. And frankly, I think assessing a 3-1/2 year old boy in one long session is ridiculous—even the calmest of preschoolers can’t focus for 3-1/2 full hours! So we took their comments with a very large grain of salt.

After Theo was kicked out of that preschool, we had to have him assessed by the school district so they could determine a placement for him. So we did. And their assessment process seemed a lot better: They met with him six different times for 30 to 60 minutes at a time, at different times of the day so they weren’t seeing him at the exact same time window every time. They administered a battery of tests, but in small doses, and they spent a lot of time just talking to him. He actually enjoyed the testing, in fact—it was like play for him. And then they delivered their assessment: high-functioning autism, mild sensory-processing disorder, a fine-motor delay, and a possible nonverbal learning disability. However, they came right out and said, “We’re not sure about the autism piece. By the numbers on the test, he falls on the autism spectrum. But he’s far more verbal than most kids on the autism spectrum, so we’re uncertain. But for now, we’re going to classify it as autism to get him a placement in a mild/moderate special-day class, where they can work on the areas where he struggles and prepare him for a mainstream classroom.” They also told us that he was too young for them to know for sure about the nonverbal learning disability, but that they suspected it because there was a huge disparity between his verbal IQ (superior) and nonverbal IQ (simply average) scores. I believe there were something like 60 points between the two, and they told me that only a small fraction of the population has that significant of a gap and that it usually indicates a nonverbal learning disability.

Huh. Okay. So we decided to focus on the sensory-processing disorder piece, since that was the part we could all agree was likely. I had that as a kid (probably still do, really), and Theo definitely showed the signs of it. We hit that piece hard, with a lot of sensory-focused occupational therapy. We also hit the fine-motor delay hard, since we could all agree that was likely, too. The rest we filed under “who the heck really knows? And does it matter?”

So here we are 2-1/2 years later, and Theo has just entered first grade. He did fantastic in his special-day class for preschool. He went into mainstream kindergarten with an IEP and a continued focus on OT for his fine-motor delay. And he managed. Kindergarten wasn’t necessarily easy (for any of us!), but he managed. Some times were good, some times were awful. We took the good with the bad and muddled through.

Summer was good for Theo. It was a break from school—from trying to work in a classroom environment, from struggling to be able to produce legible handwriting, etc. And he matured a lot in the social sense, which is great. In some ways he’s very much like an old man—with old-man interests and old-man verbal skills—but in other ways he’s a very naïve, young six-year-old. So the maturity did him good. But some new challenges have also cropped up, and Chris and I finally decided that we ought to have him reassessed. When he was 3-1/2 and had the assessments done, everyone told us they’re more accurate when kids are six or seven. So now he’s 6-1/2 and having some struggles, and we decided it would be good to get an updated picture of what’s going on.

In some ways, we still wonder, “Does it matter? Do we need to know if we’re looking at autism or Asperger’s or ADHD or ADD or something else?” But in other ways, we feel like if we better understood what poses the challenges for him, we could better help him. And getting a new diagnosis doesn’t necessarily mean throwing medication at him; it means understanding more about what seems to present difficulty for him and then making a decision for how to handle it.

A good friend recently posted an article about the rise in ADHD diagnoses, positing that the real problem is that kids don’t physically move enough these days—we expect them to sit for long periods of time, and developmentally they aren’t ready for that at such a young age. I do think there is a lot of truth in that—especially for boys. Say what you want about gender neutrality; I truly believe that boys and girls develop and mature differently, and there is certainly a lot of evidence to support that. Boys are movers and shakers—they’re not ready to sit down and buckle down to schoolwork as early as girls. I definitely get that, and I think one major bonus of Theo’s school switch is that we can walk to school (and it includes a hike up a pretty steep hill), and he has a chance to get out and move and exercise before he has to sit down at a desk.

But there’s more to it with Theo. It’s not just that he’s a wiggly kid who doesn’t sit still well. It’s much more a focus issue. Sometimes he is so locked in his own brain that we literally can’t break through to him. And I’ve been working with him on reading and writing and have noticed that he seems unable to track across a line from left to right, as you need to do to read and write. He’s jumping all over the page, switching words, reading words that aren’t there, writing words out of sequence, etc.

Theo’s OT had mentioned to us a few months ago that she noticed Theo’s eyes aren’t tracking together (as they should), and she gave us the name of a behavioral optometrist if we wanted to follow up and get him vision therapy. I have another friend who has done that with her daughter and has seen major improvements in reading and writing, so we will likely follow up on that. But in the meantime, we’re also pursuing the reassessment through the developmental pediatrician, because I honestly don’t know if his difficulty in processing a line of text (whether reading or writing) is due to a visual tracking problem, some sort of cognitive-focus issue, or simply a little boy with a brain that races so fast that he can’t/won’t concentrate long enough to process the line.

So there’s the latest on Theo’s diagnosis. We never were sure it was correct; I’m not certain we’ll be sure this time, either. But it seems like it’s time to revisit the old topic and see what progress we can make. Because the school year is going to be a long one if the poor guy is struggling….

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