Expert: Dr. Judy Horrocks - 1/13/2012

Question
My son will be 7 this May and is currently in first grade.  He has always been the type of kid that needs a little push and then he's fine.  He was in a private Kindergarten program and showed signs of struggling academically mid year.  He was given an evaluation through the public school system (OT, Speech, IQ tests, Math etc.) and basically at that time all involved recommended not to be held back out of first grade because he would be bored.  He scored 100 on their math test and much lower on reading.  He did have a tutor over the summer.  

So, he moved to the public first grade this year.  He has always been one not to express his feelings or talk about things.  This year in first grade he started out good.  Spelling tests are nearly all 100's, his reading is below average, and his math is good.  But, what I see at home is not being reflected at school.  They have weekly assessments and he's either right on with S+ or he gets 'N'=Needs Improvement.  He's gotten in trouble several times due to behavior issues i.e. pushing another boy in mud, touching kids back during reading circle time.  Most recently, he hit another kid in the eye because the kid tagged him back right away in a game of "It" and didn't give him a chance to run away.

 So, they re-opened the evaluation from last Spring to re-evaluate him.  Since he had passed the age requirement of six, they were now able to do more testing.  Basically, he was up and down with scoring.  Reading fluency and story recall very low, but spelling, basic reading skills, word attack in the mid average range.  It seemed as if his scores hovered either right below or right above their earmark.  The Conners 3 rating scale was administered to me (and my husband) and his main teacher.  It concluded with an educational diagnosis of ADHD.  Lastly, a Cars-2 Questionnaire was administered to his teacher,speech teacher and myself where they concluded that his behavioral and social emotional difficulties are related to a form of High Functioning Autism.  Also, would like to note that lately he is getting into hitting/kicking me or his sister and sometimes he thinks it's funny.  A lot of times this centers around him being mad about something, then he doesn't talk about it when asked and then will lash out usually at me or my daughter not usually my husband.  Sometimes he'll tell me he hates me or his sister or call us stupid etc. He does have lots of good times and fun moments.  I just want to eliminate this path that we're going down.

Concluding all of this, he did qualify for a bunch of services more social/emotional from speech, social worker time and the instructional reading and math programs (slightly different program but with only 5 students for better focus) for certain time slots.  He has just started this week.  

So many questions to ask you....when someone throws that word out there-autism.  I know this is from an educational standpoint, but who or where do I go to validate the ADHD and high-functioning autism diagnosis'from a medical standpoint?  How can they put that diagnosis on the table when it's solely based on his teacher, speech teacher and our responses to a questionnaire?  With the behavioral issues I'm currently seeing what type of therapy/doctor/psychiatrist do I start with?  Sometimes I think the diagnosis could be right on and then sometimes I think he doesn't fit it completely, but then again I'm the Mom and want to believe certain things.  I want to do what is best for my son and try to keep my feelings out of it...what type of game plan should I have?

Answer
You are asking some very good questions!  First there is both an educational definition of autism and a medical one.  The educational diagnosis is fairly easy to get if your child scores from a questionnaire indicate social, communication, and behavior issues.  A school psychologist can give this diagnosis which is based on the educational definition as included in educational law.  (the first IDEA law had autism included) This is not the same as the medical diagnosis which is much more involved, but assists the school district to find the appropriate educational placement.  The placement should be determined by the IEP team, based on your child's needs not their diagnosis.  

The best doctor to get the medical diagnosis is a developmental pediatrician.  Most major hospitals have one or two on staff.  This is the specialist for children's developmental problems such as autism.  You can also get the diagnosis from a child psychiatrist or neurologist as well as some pediatricians with experience with autism.  Pediatricians are now getting more training to make accurate diagnosis!  

There is both Asperger's Syndrome and Autism on the autism spectrum.  Asperger's Syndrome is closely related to autism ( in fact they are talking about combining them in the future as they were in the past).  Children with Asperger's Syndrome do not have the language delays that children with autism have, however, they may still have difficulty with communication as it relates to social aspects and figurative speech.  In other words, they tend to not understand the rules of conversation and take everything literally.  The diagnosis of Asperger's in other aspects is the same as autism.

For a medical diagnosis of autism, the child has to demonstrate a total of six characteristics in three areas.  The has to be at least one characteristic in communication, at least two characteristics in social skills, and at least one characteristic in behavior.  Some children have more than the required six characteristics.

It sounds like your child may qualify for Asperger's Syndrome if the school said high functioning autism.  Asperger's Syndrome is sometimes referred to in this way.  

I would recommend your getting an appointment with a developmental pediatrician for an evaluation.  However, the diagnosis is not the most important thing for your child's education....the educational services and placement are more important and not decided by diagnosis!  You want to look at your child's needs.  It sounds like he needs more assistance in academics as well as some social skills.  Have the speech therapist look at his understanding of figurative language and auditory processing.  If he is having trouble with communication, it may be adding to his social skills and behavioral issues.  The small class may be very helpful to him!

I have a blog that has more information on autism and social skills.  www.drjudyautismblog.com.  You may find some articles of interest.

I hope your son blossoms in the new class!
Dr. Judy Horrocks