Expert: Trey McGowan - 10/31/2007

Question
My 3 year old has had problems ever since he was an infant. I noticed when he was just a few months old that he rarely looked me in the eyes. As he got older he was meeting his milestone's. (crawling, walking, grasping, self feeding). When he was 19 months old he entered a toddler room of head start and I discussed with the teachers that he did not talk. We were lucky if he said mama, dada, and baba. He had a hearing test and it came out fine, no hearing problems at all. We had early intervention work with him until he was three and he speaks now, can hold a basic conversation, but it is difficult to understand some of his words. It's like he has an accent. After he turned three early intervention stopped saying that his speech was fine. He is now in preschool and his new teacher has concerns along with me about his behavior. He rage's at times when he doesn't get his way or if you don't pay attention to him the second he wants you to. He does not interact with the children in class. He plays by himself. If someone bothers him he starts crying and hides in the corner behind a chair. At home he hits his older and younger brothers. He doesn't play games with them unless it involves running around and even then he's not playing a specific game like tag he's just running.  It's hard to say about the eye contact now. If I am trying to talk to him about something he will not look me in the eyes. He is seeing a clinician now. We've only met with her once. I was just wondering if anyone has input on what I should ask her or what I should be concerned about.

Answer
Hi there, Diane!

I'm going to answer the question put in your title as well as the one you ask a little later on: one of the main ways that they will test for Asperger's and other PDDs is just what you are doing here: answering questions about the milestones and about the important cues that they need to look for. They will also be using their observation on the child as well as possibly asking them questions of their own, depending on the child's age and speech difficulties. At 3, it is likely that most of their information would come from the main lists of questions they will have you answering.

Now, for the question that you asked in the actual meat of the letter, remember that your clinician has been through the same sort of thing with a multitude of patients. He or she is experienced in dealing with parents who are shocked, scared, disbelieving, angry, and any host of possibly negative reactions to what they believe is a very negative situation. The best thing you can do is to be straightforward, be courteous, and treat them the way you would another doctor in answering what questions they present to you. If all goes well, you should feel comfortable with asking any questions that you feel like asking.

However, being as this is your first time there (or rather, second), one of the better things you can do is *before* the meeting, take a moment to think about what questions you want to ask. Write them down whenever you think of them and find them, if you feel that it's important to ask. Even if you think that it's one you wouldn't forget. That way, you have them there and on-hand. And I can assure you that the doctor, if he's worth his salt at all, will understand if you forget what you wanted to ask and pull out the paper to be able to double-check. Stress and worry make it easy for even the best minds to forget things, and this is a stressful time for both you *and* your child.

Some suggestions for questions that I would probably ask:
Are there any significant delays that we should be working on?
How should I handle the problem behaviours (tantrums, hitting, self-isolation, whatever else)?
What can I do to help him without making him *too* dependent?
If it is not autism/Asperger's, what do you think it might be and where would I go to treat it?
Is there a support group in the area that I can speak with or join?
If there are developmental issues to be treated, who would you suggest I deal with to handle them?

I'm not including 'What is the diagnosis, Doctor?', since that would likely be a part of the answers he would give as soon as he's done with observing and checking the M-CHAT. Don't feel too concerned if it takes more than one meeting to be sure, though; he may very well want/need to give the child time to relax and be certain the observations weren't skewed.

As for what to be concerned about, something that might help you get a feel for it is the M-CHAT. Here is a link to the PDFs of the test and scoring.
http://depts.washington.edu/uwautism/resources/chat.html
Now, please don't use this as your only exam, or try to score it yourself. It may be simple to score if one follows a key, but there's more (or hopefully more) to diagnosis than just that. So make sure that even if you do decide to fill it out, rather than read it, you take the sheet in with you to let the doctor look at it. However, M-CHAT gives a good idea of key points that are being looked for, either for their presence or their lack.

If there's anything else I can help with, don't hesitate to ask! Good luck with your trip to the clinician, and I hope that everything goes well for you.

Trey