I'm sorry this is so long...I could use some guidance.

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Blueskygirl
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25 Oct 2010, 8:23 am

I posted this is the wrong forum...so I thought I'd post here...

I'm a 34 yr old woman whose daughter had a full neuropsych eval done at 3 yrs, 9 months of age. She turned 4yrs old in Sept. Her ped sent her for this eval due to hand-flapping. He believed it to be a motor tic, but wanted to make sure...so he referred her for an eval to rule out PDD. It was ruled out (apparently) Her test results were as follows (using the WPPSI - III)

Verbal IQ - 139 99.5 percentile
Performance - 125 95th percentile
Full scale - 137 99th percentile
General language - 99.8th percentile

Receptive vocab - scaled 17 very superior
block design - 14 high average
information 17 very superior
object assembly 15 superior
picture naming 18 superior

OWLS oral written language scales-listening comprehension
standard score 110 75th percentile
Expressive one word picture vocab test - 145
receptive 124 95th

Motor and visual perceptual
visual-motor drawing 111 standard
visual-spatial matching 98
fine motor pegboard 114

NEPSY-II a Developmental neuropsych assessment
Visuomotor precision time scaled - 11
visuomotor percision combined - 17

Attention/executive functioning - scaled score 12 Average

Memory
memory for designs - scaled 11
Narrative memory - 13

Behavior
affect recognition - 13 scaled
Theory of mind - 11 scaled

The neuropsych wrote "She maintained good eye contact, engaged in imaginative play, and displayed social and communicative reciprocity. Charlotte displayed understanding of other's emotions in a story, demonstrated empathy, and consistently instigated and sustained interaction. Charlotte specidically said "Let's play with this!" while maintaining eye contact and smiling. She grabbed toys from the eaminer when she wanted them, but was also able to request verbally while integrating eye contact (I need some help with this). She engaged in joint attention, displayed enjoyment in interaction, initiated and maintained functional play, used nonverbal modes of communication, and reciprocated smiles. Her interaction style is not consistent with a diagnosis on the autism spectrum."

Okay, so the neuropsych said that she does have some sensory issues, and OT would help with that. I have her in OT now, and she loves it. She goes M, W, and Friday. The recommended twice a week, but I added a day at another place because she loved going there too. I got the eval from one of the OT's and it says (under physical examination) Cooperative, Alert, and she checked "Other" and put, "Fair-eye contact throughout evaluation. Hand flapping demonstrated with excitement one time. Charlotte talking throughout evaluation, however speech not consistenly directed toward therapist." I have noticed this with my daughter as well...but it's so confusing to me because one day...everything the neuropsych saw, is what I see as well...and then the very next day, she can exhibit poor eye contact, not answer questions...etc, etc. The OT said the same thing...and that she had the neuropsych drop in on one of their sessions to observe and the neuropsych said..."I did not see any of this in my evaluation with her." I guess she wasn't making very good eye contact and she was off-topic. The OT told me the neuropsych said they would keep an eye on it and maybe we'd need to re-evaluate her in a year. The thing is, if she had aspergers or autism, would it just come and go like that? I'm wondering if she needs to have an MRI to see if there is anything else going on (something that could be medically wrong).

BTW, I've wondered about aspergers in regards to myself. I had a horrible time growing up in regards to social situations and would do things like pace back and forth in my room, hum in the movie theatre (in order to finish my "sequence" of hums, which of course never happened), eat lunch in the bathroom because the cafeteria was too loud... I wonder if it was just a straight sensory thing with me as well...or if it's something more? Or if I just kind of lingered right outside the spectrum. Everything changed my last couple years of high school...and once I got to college, things just kind of clicked for me.



mgran
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25 Oct 2010, 8:45 am

Girls do present AS differently from boys, and are often underdiagnosed because they can maintain better eye contact etc.

I just wondered, when she's seeing the OT is she the only child in the room, or are there others? If there are other children, that might be a factor. Of course, another possibility is simply that she felt safer with the psych, and liked them better, which would lead to better communication.

When I was a kid I was better with adults who didn't wear glasses, since neither of my parents wore glasses. I also felt happier around men with beards, since my father was bearded. Anything like this might play into the situation.

I wouldn't necessarily worry about whether your daughter gets a formal diagnoses by the way... she sounds like a very bright and able kid. Sometimes children who are exceptionally bright can appear to be on the spectrum when they're not.



Callista
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25 Oct 2010, 9:20 am

Yeah, the scores you posted look pretty unremarkable. I don't see anything about them that really stands out to me.

Autism/Asperger's doesn't go away and come back sporadically. It can worsen in times of stress, though.

Young kids do flap their hands occasionally; so that's not a hard-and-fast sign. I don't see why your pediatrician was so worried. Typical kids will make that same gesture, especially when they're excited.

If she's having trouble with sensory processing, her unresponsiveness to having her name called may be related to her processing the sound of your calling her name. If she has sensory processing disorder, reducing overwhelming sensory input may be all she needs.


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Blueskygirl
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25 Oct 2010, 9:58 am

Thank you both for your input.

The thing about her hand-flapping is that is looks completely different in different situations. We were never worried about it when she was excited because she still looked engaged (and smiling about whatever it was she was excited about)...but then there are other times when it seems to come from nowhere and she will move her head side to side and look up in the air like she is watching a tennis match. At those times, she looks like she's in her own little world. So when I first told the ped about her hand-flapping, he was the least bit concerned (because he saw her do it when she was excited). Then, she went through a period where she seemed to do it more (after dad left for Afghanistan) and I took her into the doc, and said, "Well, now THAT is significant." He was sure it was a motor tic though...but neuropsych said not a motor tic, but instead, sensory related.

So can the lack of eye contact and talking off-topic be simply a combination of both sensory and just her little creative/smart mind?

She says the cutest/smartest things like...

When she was 2 yrs old she would quiz me and ask...

"What lights up the porch at night?" I'd say, "The porch light?" and she said, "Yes, the porch light...but also....the moon."
"What floats in the air?" My answer: A balloon. Her answer: An astronaut.
The other day she was pouring some water in another cup. I asked her what she was doing and she said, "I'm doing some math." Then we were in the car and I let her roll the window down. She likes to feel the wind on her. We were listening to some music and she said, "Mommy, my hair is moving to the rhythm of the music!"



Blueskygirl
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25 Oct 2010, 10:07 am

mgran wrote:
Girls do present AS differently from boys, and are often underdiagnosed because they can maintain better eye contact etc.

I just wondered, when she's seeing the OT is she the only child in the room, or are there others? If there are other children, that might be a factor. Of course, another possibility is simply that she felt safer with the psych, and liked them better, which would lead to better communication.

When I was a kid I was better with adults who didn't wear glasses, since neither of my parents wore glasses. I also felt happier around men with beards, since my father was bearded. Anything like this might play into the situation.

I wouldn't necessarily worry about whether your daughter gets a formal diagnoses by the way... she sounds like a very bright and able kid. Sometimes children who are exceptionally bright can appear to be on the spectrum when they're not.


These are all really interesting points that I never thought of. She really did love the psych a lot. I'm pretty sure she is the only one in the room...at least she was the last session, because I got to peek in on her. She goes to another place that's a lot bigger (and has a lot more sensory stuff) and there are a lot of other kids in there. I asked her OT there about it, and she said, "Oh my goodness, no, she exhibits great eye contact and social reciprocity." This is why it's so confusing to me. It depends on who she's with and what day you catch her on, I suppose. Her other OT said she had her go through a cloth tunnel (which was dark inside) and that when she came out of it, she was showing great eye contact and was more focused. So, can that be Aspergers? Or just sensory? Or both?



jenstate
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25 Oct 2010, 2:55 pm

My daughter is six and has severe SPD with Asperger's tendencies. She is too high functioning (and has great handwriting) to be considered on the spectrum. OT, berard ait, and neuronet have helped tremendously - google for more info! I just wrote a post about her here if you want to read more specifics about her:
go to Babyminding dot com and click on Special Needs Corner.

Also, Brain Balance has some interesting perspectives on neuro disorders as well. There are so many therapies now that really help children communicate and feel less anxiety from SPD. Good luck choosing the right ones!



Blueskygirl
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03 Nov 2010, 11:15 pm

Thank you, I will definitely go check out that site.



buryuntime
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04 Nov 2010, 12:23 am

mgran wrote:
Girls do present AS differently from boys, and are often underdiagnosed because they can maintain better eye contact etc.

I don't understand why there are so many misconceptions with autism in girls. I had a late diagnosis but can't mimic to blend in, make eye contact, etc. Sure, they might present differently than a boy because we aren't boys.

Girls seem to be often stereotyped here-- as not having any problems, that their Asperger's doesn't matter, of that they have better social skills. In the professional world autism isn't even looked for, but may be increasingly so now as the OP demonstrated with their daugher handflapping and them worrying over it. I feel like an outsider even here increasingly.

Anyway, hand flapping is normal in children. Your daughter is young and it sounds like her behaviour is being overly-analyzed. Kids are just kids. By your post it doesn't sound like autism, but social demands increase as one is older and so things might change later on.

Don't focus on a label right now unless it is needed.



Blueskygirl
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04 Nov 2010, 10:24 am

buryuntime wrote:
mgran wrote:
Girls do present AS differently from boys, and are often underdiagnosed because they can maintain better eye contact etc.

I don't understand why there are so many misconceptions with autism in girls. I had a late diagnosis but can't mimic to blend in, make eye contact, etc. Sure, they might present differently than a boy because we aren't boys.

Girls seem to be often stereotyped here-- as not having any problems, that their Asperger's doesn't matter, of that they have better social skills. In the professional world autism isn't even looked for, but may be increasingly so now as the OP demonstrated with their daugher handflapping and them worrying over it. I feel like an outsider even here increasingly.

Anyway, hand flapping is normal in children. Your daughter is young and it sounds like her behaviour is being overly-analyzed. Kids are just kids. By your post it doesn't sound like autism, but social demands increase as one is older and so things might change later on.

Don't focus on a label right now unless it is needed.


Okay. What the OT and neuropsych are concerned with is the "getting off topic" and the lack of eye contact. I go back and forth...and do feel like her behavior is being over-analyzed sometimes. For instance, yesterday my mom was telling her about how someday she'll teach her how to play chess. The conversation went like this:

Grandma: I'll teach you how to play chess someday.

My daughter: Daddy teached me how to play when he was home.

Grandma: Oh, I didn't know that! Well, you'll have to play with me sometime.

My daughter: Yah... We didn't find the balloons in the living room closet. We looked and looked, but couldn't find them.

To the observer, my daughter got off topic by bringing up balloons when they were talking about chess...but she was thinking of the last time my husband was looking for balloons. He couldn't find them in the living room closet, so he took out the chess board and decided they would play with that. I think this happens frequently when she's in OT. She starts talking about something, but sometimes it seems to them that she's not talking to them, just herself...or the OT will ask her about whatever it is she's talking about, and she'll change the subject. I don't know. I notice it a little, but she's my daughter, and I just always thought it was a 4yr old thing. But then normally, there is back and forth reciprocity. She can hold a conversation.

Another example of the off-topic thing...one time, my husband and I were with her in the front yard, all sitting together and talking and then she got up and starting walking around and talking about the "rules of the game". She started explaining something elaborate, but she wasn't looking at us. She was just kind of talking out loud to herself. She was making up a game in her head.

When I took her to school today, we were waiting outside the classroom and she sat down. Another boy from her class walked up and she asked him if he wanted to sit down with her. She's fairly sociable, but sometimes when she's playing, and other kids come over to play with her, she's okay with them joining in, but as long as they do exactly what she wants them to do...but it also depends on what she's playing with. She plays with one little girl a lot and my daughter likes to pretend to be a cat, and the other girl is the owner. She loves that girl and asked if she could come to our house to play, so she's going to come over sometime next week. The pediatric neurologist asked her what her favorite thing to do at school was and she said play. He asked her what she likes to play with and she said the dinosaurs. He asked her if she likes to play with the other kids or alone, and she said alone. He asked her why and she said it's because the other kids take the toys. Then he said, "So you don't like to share?" and she said "no". But I've seen her share just fine with other kids. But maybe what she's not sharing is herself?

I was like that when I was little. My favorite thing to do was to run off and go in the cedar trees, plop myself down on the ground and look for butterfly cacoons. I loved daydreaming and doing my own thing.

This morning, she asked me if today was a school day. When I said yes, she replied, "I don't want to go to school". When I asked her why, she said "because all of my friends think I'm snoopy." I asked her what that meant and she said "That I'm not a good friend. Cole doesn't let me play with him." I asked her if she plays with her friend Adrian, and she said yes. I asked her if she plays with Sarah, and she said yes, that the three of them like to play in "Housekeeping"....which is kind of funny, because normally she prefers playing with boys...but maybe the boys aren't letting her anymore. I know that her teacher also encourages her to play with others sometimes when she's just kind of doing her own thing. I don't think it's a problem if she's doing her own thing, personally..if that's what she wants. But the thing is...she does really want to play with the other kids and craves it actually. I just hope that the reason why she goes off by herself is because she wants to, not because she feels like the whole socializing thing isn't working in her favor.
I don't know. I just need to calm down, I guess. She's only 4 yrs old. The neuropsych recommended that I get her into a social skills group though...but the problem is finding one that suits her. And the whole thing with the eye contact is so hit or miss. One day in OT, she may not make eye contact at all...and then the next time, she does just fine. It almost seems like when there is MORE activity, she does better at making eye contact vs. when she's not in motion or when there's not a whole lot going on. I take her to one therapy place on Mondays, and the OT's there say that her eye contact is great...there gym is HUGE, with climbing walls, swings, all kind of stuff. The other place is more hospital-like, white walls...very quiet. So maybe this is a sensory issue.