Expert: James Michael Roan - 4/24/2009

Question
QUESTION: Hi there, I need to get an outside opinion, please. I have no insurance for my daughter who is 22 months - and I firmly believe she is being slighted because of this fact. (Why order tests when they refuse to take payment plans and I obviously can't pay for it all at once?) The doctor however has plainly told me I'm paranoid.

During the pregnancy I took Zoloft, per doctor recommendation for my own needs. I am aware Zoloft studies show delays in learning for the child. So when milestones began to bloom late, I wasn't overly worried, believing she'd catch up.

Except milestones came later, longer and worse in her development. She persistently would make a droning/humming sound for hours, non-stop. She did it to alert us to her needs and wants as well as a form of comfort. (She has truly only cried out of anger/distress of not liking how something is going or if she's become overwhelmed.) It has cut down tremendously but still surfaces intermittently. She did not crawl until she was 12 months, she did not walk until she was 18 months and still at 22 months she walks with the "high guard" position. She began at 19 months to finally "knock" on your leg/arm to gain your attention, she very seldom points and would rather use something the wrong way - or not at all than to engage an adult for help.

Through out her growth, I've been working with sign language, as a means to communicate since verbalizing was not forthcoming. I utilize home-schooling techniques and talk and interact with her to make everything I can a learning experience; to encourage both repetitive and incidental learning.

Still at 22 months she can say roughly 15-20 words but only with prompting. Extreme prompting. She can string more than one word together, but again with much prompting - it is not of her own volition; nor can she say two-syllable words. She will not respond persistently to her name. She is very into her "own world," and she often holds her ears when she is upset, wants to tune you out or becomes overwhelmed. She has a "hard blink" as I call it, reminiscent of a tic-like movement. It has begun a month ago and is quite transient, but when she starts - it just doesn't stop.

She does not like the texture of certain foods and hates to touch certain textures. If she gets something on her hand, she will not remove it, but hold it up and refuse to utilize the hand. She freaks out with water if it is on her head or her chest in a bath, but loves to try to "catch" the water from a running faucet.

She also persistently takes off her diaper, to play in her feces and often times ingests it. She does not cry to alert us that she is dirty or indicate she needs to use the potty chair. She simply strips herself and performs the actions of flinging it, playing with it, and/or eating it.

She also has strabismus of the right eye which the doctor said would need surgery to correct, until he asked what my insurance was and now - "she's looking okay and a little turn out of a lazy eye isn't so bad."

I enrolled my daughter into Early Childhood Development, (which she's been participating in for four months) and the pt and speech therapist don't "see autism," though they do see a very "aggressive and stubborn child with extreme outbursts." I personally think they are missing the ball.

Also her brother(12 years-old) has been diagnosed with ADHD and Tourettes - he does the same blinking of the eyes; rolling them and clearing his throat persistently. They claim Tourettes was invoked by too high a dose of Ritalin and not genetics - but my daughter is exhibiting the same eye blinking.

I do NOT want there to be anything wrong with my daughter -but every bone in my body is telling me - no insurance, is equating to my daughter being passed over.

Am I paranoid as they claim - or am I on the money that something is not right? If so, where do I go for help? I feel like I'm losing a battle against time here.


ANSWER: Hi Sheynn;

Firstly, do you live in the United states?

Secondly, download the links below to the M-CHAT and score it sending me the answers. The M-CHAT is just a screening tool and not an assessment tool, however, it is well respected by most health care professionals and they would be considered to be unprofessional by not referring you for an autism evaluation should she fail the M-CHAT. It's data, and as such, a way for you to appeal to health care "higher powers."

M-CHAT: http://www.firstsigns.org/downloads/Downloads_archive/m-chat.PDF
Scoring: http://psychlops.psy.uconn.edu/ED/downloads/M-CHATscoring.pdf

Kind regards,
James


Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting assessment professional responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.






---------- FOLLOW-UP ----------

QUESTION: Hi and thank you greatly for such a timely response.

1. I do live in the United States.

2. I have actually been given this chart previously and is
what granted us to be referred to Early Childhood
Development. Though I never saw the scoring aspect of the
chart - which I admit, makes me nervous. Scoring her today,
as she responds, reacts and interacts she has failed two
critical areas and 15 overall areas; the two "critical" are
inclusive.

3. On a side note, one other thing which is being taken
with a grain of salt is her head measurement. It is 17 3/4
inches in diameter. Each time we go for a visit, they
measure two or three times, then say; it's no big deal. Yet
they sure act like it's a big deal. I do understand this is
the opposite concern related to autism - but thought it
might be something which could be of importance.

ANSWER: Hi Sheynn;

Is the head circumference big? What is the percentile compared to others? A head circumference at the 97 percentile or greater taken 6 months after birth is highly correlated with autism. The fact she failed the M-CHAT with the scores you have indicate she must evaluated as soon as possible. Do not allow them to talk you into a "wait and see" position.


Your school district is responsible for the assessment and Early Intervention if she qualifies. If you disagree with their assessment or if they are unable to do it themselves then you may request an Independent Evaluation from your school district. Look for a university or Children's Hospital autism unit. There are variations from state to state, so contact the superintendent of public instruction in your state for specifics.

Kind regards,
James



Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting assessment professional responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.


---------- FOLLOW-UP ----------

QUESTION: No her head circumference is actually smaller than average;
like I said - I know a larger head is related to autism,
but she does not fit that criteria.

Answer
Hi Sheynn;

That is good news then.

Kind regards,
James


Disclaimer:

While James Michael Roan has attempted to make the information on this web site as accurate as possible, the information is provided in good faith without any express or implied warranty. The purpose of this web site is to provide information to families with children, teens, and adults with an autism spectrum disorder or other developmental delay. James Michael Roan does not prefer any one organization to another, and it is not responsible for the information listed on an organization's web site, or any disseminated information either verbal or written. Please be advised we are not giving medical advice and that circumstances can dictate different treatments. If these issues affect you or your loved ones you should seek professional advice. This site is operated for informational purposes only. At no time will James Michael Roan attempt to diagnose or dismiss a potential diagnosis over the Internet. We hope that you find our resources useful.


Bio

James Roan is a certified school psychologist who has been consulting in the areas of autism, Asperger’s Syndrome, and learning difficulties in the United States and in Ireland for over ten years (http://www.jamesroan.com). James earned his M.Ed. in School Psychology and M. Ed. in Adult Education and receives ongoing post graduate training in autism at the University of Washington’s Autism Center. James Roan has traveled to Galway, Limerick, Mayo, Clare, Dublin, Cork, Waterford, and other cities and counties across Ireland assessing children and adults, and consulting with solicitors (lawyers) in defense of children with disabilities. James Roan was the consulting assessment professional responsible for many of the autism and AD/HD screening tools and other content for Access Special Needs.Com. James Roan consulted with the graduate department of the Waterford Institute of Technology in Waterford Ireland in the development of their graduate program for the certification of private autism tutors. James has conducted formal assessments of students in the Autism Unit in the Claddagh National School in County Galway Ireland.