Doctor and OT give contradictory advice....

Post Reply New Topic

I am more inclined to do what the OT says, but my son's pediatrician and the occupational therapist disagree on a couple things-
1. My son is 'into' trains and train tracks and Thomas the Tank stuff... the OT recommends that I use them to help with counting, learning colours etc. The doc says I should take them away from him!
2. Baby J likes to watch certain shows and he repeats certain sections (echolalia). The doc says I should stop him from watching ALL tv. The OT says I should watch shows with him and talk with him about it.

Does anyone else face this contradictory advice?
My instincts tell me to stick with what the OT advises, but my sessions with her are almost up but I know I probably won't be asking my son's doc for advice since I disagree with his approach.

I definitely side with the OT, especially on the trains. Getting rid of a special interest or "inappropriate play" smacks of trying to normalize the child.
He's young, but I think some shows on tv are okay. A better idea is to get the shows on tape or dvd. That shows that you are doing an activity for a specific time. Or maybe putting something over the tv when it's not being used.
We used the Baby Mozart series (before it was bought by Disney), which was wonderful. Then we moved on to the Teletubbies. He learned to ask 2 word questions and how to hug/request hugs. The people behind Teletubbies stated they received anectdotal stories about autistic kids being helped by them. BTW, my son did the movements too, so he was exercising and overall learned to use shows/music for movement/exercise.
If your son is watching Thomas the Train, try introducing the books too. There are the picture books and the Step Into Reading. I have used the latter for my son. The train interest is very common and I don't see anything wrong with it. ( I bought some of the toys but never the actual train set)

Definitely stick with the OT.

How old is the doctor?

Sometimes you get an older doctor who isn't up to date on what to do with autistic children. The OT has to be more up to date because an OT works more regularly with autistic children than a GP.

I don't believe that the obsessive interests should be taken away, but I do think they need to be limited -- or better yet -- develop an array of obsessive interests, and, as the OT described, use them as ways to socialize. I think your OT is definitely on the right track.

We have a dr. who would probably have suggested the same things your doctor did, but the irony is I think our dr. is an undiagnosed Aspie! But he does go on and on about limiting TV and video games.

Kris

Thanks Kim!
We do have the Thomas the Tank DVDs, train sets, and read along story books. Those were the only books we could initially get him to even glance at. We limit the amount of time that he watches DVDs and we do a lot of interactive play with him. We have lots of other toys and books- and we actually have a little schedule of different types of activities we're going to do during the day.

Schleppenheimer, Baby J's doctor is in his 40's. And he's a teaching doctor at that! I wonder what his students think when they hear the advice that he gives to parents of autistic children. The OT spends all her time with autistic kids and the doc only has a couple patients with it. Other than his views on tvs, computers and that sort of thing, he's an excellent doctor. I just question why he'd want to take away something that my son can learn so much from.

Well, taking the trains away is born out of prejudice and outdated thinking.
The tv is another story. A couple of years ago, the Pediatrician's Something or Other (something like the AMA) decided that children under 2 should have no tv whatsoever. And very limited (like 30 minutes/day) tv between the ages of 2-4. This isn't about the content of tv but the act of setting a child in front of a tv that shows two-dimensional images and sounds they may not comprehend in a meaningful way. In other words, for toddlers and infants, the tv is a box with flashes and pointless sounds. They downplay educational tv, even for 5 year olds because of the unlikeliness (sp?) it will help.
There is some truth to that but there's evidence that infants as young as 6 months old can decipher meaningful information from screen images. I think the key is limiting, augmenting with 3D objects/experience and interaction during the tv time.
My son modelled after the Teletubbies and no one else, even when other "real world" examples were given to him. (around 2 1/2-4 years old) On the other hand, more sophisticated PBS shows (Sesame Street) and plain entertainment were much less meaningful for him until he hit 5. I think parents should really decide on an individual basis what helps their child and where he is developmentally.

Sounds like your pediatrician is clueless. That's pretty blunt, but that's the impression you've given of them. Have you brought up the OT's advice with the pediatrician? The responses to that could be interesting. It would also likely give more insight to the quality of the doctor. If the pediatrician acts like anyone else's advice is flawed, or flat-out wrong, get a new one. Sure, they may simply not be well trained in the psychological side of treating children, but if that's the case, who is to say that the doc doesn't have other shortcomings? Again, responses from the doc could be interesting and insightful.

The pediatrician says that I should remove anything that my son becomes obsessed with. So, no trains and nothing with wheels. I should try to divert his interests to other things. He said I should 'nip it in the bud'.
With regard to the computer he said that since my son is repeating things that they say in the shows I should also 'nip it in the bud'.

Did you bring up the OT's ideas though, and get a response to those? I've got a feeling the pediatrician wouldn't even consider them as valid. Which is unfortunate, but, eh. The pediatrician seems to be looking only at the face value of the obsessions, that they are obsessions. Would he say the same thing if the obsession was on, say, history, or math? I hope not.

If it isn't a problem, don't treat it like one. If it can be beneficial, then let it be a benefit.

I didn't talk about the OT's ideas. I'm pretty sure that he would have advised against them though.

Can you get a second opinion from some other pediatrician, is there anyone round you who specialises in autism spectrum disorders? This one sounds totally ignorant!

Unless the pediatrician/family doctor is directly involved in dealing with the autistic traits, I don't see the need to change. Once my son was referred to a neurologist at age 2 1/2, I never had the family doctor address his special needs. He's never been on meds and because he's off the meter with developmental milestones anyways, no need to discuss it with Dr.
He may be a bigot when it comes to autism but a competent doc when it comes to illness, allergies, or nutrition.
But it's important to decide what he's good for and what he is not, so that appointments are meaningful. If he's pushy and demanding about his ridiculous opinions, then that's another story.

He's really good at referrals and getting the right people to help at the right time....I've never had to wait long for a referral and that is a major accomplishment!
Thankfully, he only wants to monitor Baby J's progress and he's not really involved in the therapies that we're doing.

He still should be interested in autism, and willing to educate himself. Otherwise he shouldn't be offering advice, but realise it isn't his field.

listen to the OT!
as far as tv goes, i'd limit the amount of viewing he does~
i know a good doc is hard to find, but IMO I'd be looking for one who knows a bit more about ASDs. You've got a long road ahead of you, and you don't need to be put back a few steps by a doc who thinks your child should be treated exactly like an NT child .....
i think it's good to use Thomas toys as learning tools, but not to the exclusion of other toys.