Pediatician Pooh-Poohed Me

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After finally voicing my concern that DS may have autism at his parent-teacher conference, and being emphatically agreed with by his teacher (who has worked with autistic children in the past), today I called his pediatrician. I explained that his teacher and I feel he may have autism, and that I would like to have him evaluated.
He said, "Does he have problems with social interactions?" (Yes, very much so)
"Does he speak?" (Yes)
"Is he smart?" (Yes) - a very strange question I think.
Then he says that Asperger's is not a serious problem and a lot of people have it and don't need to be diagnosed. He says I can bring DS in to his office "if I want to" and we'll "talk about" a referral.
So now I guess I get to plead for an evaluation. I'm pretty annoyed at having my concern trivialized in this way, especially after agonizing about whether DS should be evaluated for literally YEARS.
Is this a typical attitude among pediatricians?

Also, sorry for the typo in the title.

Tell this doctor that your child's teacher had very serious concerns about him, and that if you do not get a referral, you will be finding a new pediatrician.

Pediatricians can be surprisingly uninformed. Our first pediatrician knew something was "off" but was certain it was not autism because he loved to snuggle. He was referred to the county and he passed the phone screen because he was *smart.*

Guess what, my son is labeled autistic and not Asperger's. Why? Because of the severity of his social deficits and issues with developmental skills.

There are certain stereotypes that even doctors and others who should know better follow. That is why girls have trouble getting diagnosed, too. Even if it is Asperger's and not autism, that diagnosis will be subsumed under autism as of the next publication of the DSM (V). So the point really is, what are your child deficits and how severe are they.

I don't know where you are, and what your options are if you do not get a pediatrician referral, but I would try to get one if you need it.

That doctors sounds like he doesn't even know what AS is. Lot of people do not have it. It may seem like it just like it seems like tons of people have learning disabilities but I know that isn't the case.

I think your pediatrician is drawing conclusions outside of their realm of expertise. Before my daughter was diagnosed, I had a very good pediatrician and here is what he said to me when I asked if he thought she had autism "I am not remotely qualified to comment on that as it is outside my area of expertise. Let's get you in to see someone who is qualified to give an opinion on it." Then he went on and on to talk about how pediatricians make comments on such things all the time, but that they really should just be referring kids out unless they had significant experience with autism because most of them are not really prepared to diagnose something of this complexity.

I totally agree with him.

I agree with pp. I would tell your pedi that either you get a referral, or you will find a new pedi.

Sorry this happened. It must have been monumentally frustrating.

I went to our pediatrician when DS was five, and said (with obvious, serious concern) "my son is hitting me and I don't know what to do." My pediatrician (otherwise a very good one) responded "Don't get angry." That was it.

It takes a set of specific skills to diagnose the high-functioning end of the spectrum. Does your pediatrician act as a gatekeeper for other specialists, or can you go to another doctor yourself? If so, you want to find a developmental pediatrician, or a pediatric neurologist - preferably one that specializes in autism. Check with your health insurance to find one that they will cover. The tests you want to ask for (and try asking your pediatrician for these specific screeners if he is indeed your gatekeeper) are listed here: http://www.cdc.gov/ncbddd/autism/hcp-screening.html

Here are a few, recommended by the CDC, you can fill out in advance of your pediatrician visit and bring with you:
http://www.aspergersyndrome.org/Article ... drome.aspx (see if you can get the sympathetic teacher to fill it out, too.)
(these are for toddlers, so you'd have to do them from what you remember) http://firstwords.fsu.edu/pdf/checklist.pdf
http://www2.gsu.edu/~psydlr/Diana_L._Ro ... AT_new.pdf

Can you find a 'more qualified' person to see him? A developmental paediatrician or child psychologist?

I am so thankful that our experience with the pdoc was like Inthistogether's. She didn't bat an eye when I told her the school suspected autism, she just told me that she would figure out who to refer us to and would get back to me asap. It really stinks that our experiences can be so vastly different based on what appears to be how open minded our kids' docs are. I concur with others about finding another doc!

Don't need to be diagnosed? That doctor obviously does not have a child or a close relative with AS. But now that you mention it, my daughter's pediatrician reacted about the same way when we told her our daughter was dx with AS. He acted like it was not a big deal. Are they trying to trivialize it to make us feel better? Because if that is what they intend, it is not working. Actually, I felt he was a moron or just didnt care.

I think what you have to remember is that a paediatrician is just a child doctor and likely knows next to nothing about neurology or mental health. I'm in the UK, and as an adult to get a referral for AS you have to go to a GP, my GP knew nothing whatsoever about AS and the paediatrician who has initially seen my youngest daughter doesn't know any more as far as I can tell. She's waiting for a stage 2 assessment at the ASC clinic. I provided a 20 odd page report on my daughter's life to the paediatrician via the GP, and all he would commit to saying on an interim letter he sent me is that she has "some features that are seen in children with autistic spectrum condition". If you saw what a huge volume of behaviours and traits she has listed in the report I provided, you would say that this was underplaying it in the extreme. She has been referred in the meantime for help with her anxiety, almost as if that's something he recognises more easily so has done something practical about, but he feels unable to comment in-depth about her AS status because he simply doesn't know enough.

What angers me, is your paediatrician's comment that AS isn't a serious problem, despite being told that your son's social issues are problematic. If there is anything that can have huge adverse effect on a person's mental health and emotional wellbeing, and in turn their life prospects it's socialising problems. Humans are supposed to be social animals who have got where we are by co-operation and grouping, inter-tribal trading etc. So if someone is missing those skills or is hindered in them, their life could be a poor shadow of what it should have been without help.

We initially had a similar response when we brought up the idea of AS, but from a neurologist, rather than our pediatrician. Our ped had referred us to a neurologist because of DS's tics (both verbal and motor), and by the time we got an appointment, I had some reading on other things and suspected AS. The neurologist brushed that off, said 'Yes, he has tics, so that's Tourette's Syndrome, but there's nothing else going on."
It wasn't until almost a year later, with the backing of the autism specialist at DS's school (who was working with him under a separate special ed classification) that we were able to push for an evaluation, where the psychologist confirmed our suspicions.

I agree with others who say that if you can't get a referral from your current ped, find one who will give you a referral. I wish we had pushed a bit more a bit sooner, as it would have made DS's first few months of school much easier, I believe.

And once you have a dx in hand, the ped may be pretty useless, too. I scheduled a visit with our son's ped to discuss his diagnosis, and her only comment about it was, "What do you want from me?" She had no insight into what providers I should look into or what therapies to pursue. It was pretty frustrating at the time, since the clinic that provided the diagnosis basically handed me a book from the local autism society that listed all 300+ providers of every service under the sun in our area, with very little guidance as to what therapies our son actually needed.

I have had a lot of "I don't see it" convos with doctors. Our first pediatrician did a lot of "wait and see" then our new pediatricians office (we moved), the NP made comments more than once about how she "didn't see it." All of our assessments have been done through the school system, where there is no disagreement that he is on the Spectrum..... he's had a full assessment, including the psychologist evaluation and they all point to ASD. Oh, a neurologist we saw also said he didn't see it. None of them used a tool to assess him. They were basing it on short little visits in the office.

If you are wanting a diagnosis outside of a school assessment, I recommend finding a developmental pediatrician or child psychologist. They are the ones who see it regularly and have the tools for a diagnosis.

Luckily, our regular pediatrician we see just assumes the school is right. He's never questioned their diagnosis... it's only the NP in his office who says anything to us.

I'm so frustrated. We went to the pediatrician today, who unsuprisingly doesn't see anything wrong. He also told us that high-functioning autistics are "geniuses" and low-functioning means "not smart".
He says no autistic can be outgoing. "They sit like this," he said and slumped with his head down and looked sad.
So finally he agreed to refer us. Great. He asked if we wanted a referral in town A or town B. Guess what? When the receptionist called later, the appointment wasn't in either of those towns. Okay, that's okay. But when I looked the place up online, it's a Christian Counseling Center!! ! There are no child psychologists there, and there is no mention of autism! I called them and asked if they administer the ADOS, and they have to check and get back to me!
Arrrgggghhhhhhhhhhhhh. I just want to pull my hair out.

Sadly, that's how things go. Don't settle for counseling: we were also sent to counseling with DS in the very beginning. Talk therapy doesn't do any good if you have a child with a social communication disorder (duh.)

Here's what I would do: hop on the internet and google your local Autism society. See if they have recommendations for the resources you need (especially check for ones covered by your insurance; if your insurance has a "list" it will be available on their website or you can call and verify.) Ask the teacher who agrees with you to write a recommendation that you see one of the people on the list you create. Take that to your pediatrician and tell him your son's teacher told you to get a referral to someone on the list.

Sometimes you just have to do an end-run around things to get them to work. Good luck!