Developmental Delays vs. SPD vs. ASD ??

oandmplus1

I had written a post yesterday that DD's school district team is questioning her ASD diagnosis at 21 months, I just keep going over it in my mind and would love some others opinions and feedback. The school district said that the psychologist that did the ADOS did not take her cognitive delay into account, they recognize that she she SPD, but are questioning ASD because, they said, that with ASD, typically there is a spike in one area of development, and with DD, she is consistently delayed to the 12month age in all areas.

When I look at typical development of a12 month old, DD still struggles with a lot of it, and to me it can't all be related to SPD or developmental delays. For instance, lack of eye contact (they blame her vision, but I don't buy that), she avoids peers except for 1 little girl that she is co-treated with at ABA, no pretend play at all except what she practices at ABA. She does not use objects appropriately such as brushing her hair or holding a phone to her head, She doesn't respond to her name often (despite this being something that we have spent significant time on in ABA). She is very difficult to engage or keep engaged, and shows very little expression on her face a majority of the time, and she often just stares into space, like she is in a trance and spaced out.

Am I just not understanding developmental delays and SPD?  Are these things typical with those diagnoses?  To me, they seem to fit a picture of ASD (at least what I thought ASD was I guess). All of these things were mentioned in her evals. Just looking for the experience of others as I find myself so confused by all this.

typeset

"... they said, that with ASD, typically there is a spike in one area of development ..."

Based on what? The federal definition of autism for educational purposes is 

1. Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in paragraph (b)(4) of this section.
   

oandmplus1

typeset said:

"... they said, that with ASD, typically there is a spike in one area of development ..."

Based on what? The federal definition of autism for educational purposes is 

1. Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in paragraph (b)(4) of this section.
   

In my opinion, the only thing about my daughter that does not fit the definition above is "resistance to environmental change". She is so laid back about that stuff. Everything else is her for sure. Of course on top of that she has other delays as well.

Junebug060609

kballou said:

typeset said:

"... they said, that with ASD, typically there is a spike in one area of development ..."

Based on what? The federal definition of autism for educational purposes is 

1. Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in paragraph (b)(4) of this section.
   

In my opinion, the only thing about my daughter that does not fit the definition above is "resistance to environmental change". She is so laid back about that stuff. Everything else is her for sure. Of course on top of that she has other delays as well.

My DS is a 'go with the flow' guy. He got an ASD dx in Jan.

oandmplus1

Thanks Auntie for your response. The clinician who did the ADOS I do trust, and I agreed with everything he wrote in his report. We got the diagnosis right at the time that my state passed a law that insurance had to cover treatment for ASD, so that may have played a role in the early diagnosis, but I truly felt it fit.

That being said, I agree that they are offering amazing services, and I don't want to rock the boat over this. From what they said, the diagnosis they gave isn't going to change what they would offer her, and they said this teacher has a lot of experience with Autism and would let the Autism specialist know if she sees specific red flags. I guess it was really for my own benefit that I wanted to understand it better since DD is well taken care of at this point.

oandmplus1

Also to answer a few of your questions. We have asked about absence seizures but the developmental neurologist was not concerned.
I assume they mean ID when they say developmentally delayed, she is delayed in all areas of development, including cognitively, and physically, but all the specialists here always just say developmental delays. That part always confuses me, I am never sure how to phrase it.

kcisthebombdotcom

kballou said:

I had written a post yesterday that DD's school district team is questioning her ASD diagnosis at 21 months, I just keep going over it in my mind and would love some others opinions and feedback. The school district said that the psychologist that did the ADOS did not take her cognitive delay into account, they recognize that she she SPD, but are questioning ASD because, they said, that with ASD, typically there is a spike in one area of development, and with DD, she is consistently delayed to the 12month age in all areas.

When I look at typical development of a12 month old, DD still struggles with a lot of it, and to me it can't all be related to SPD or developmental delays. For instance, lack of eye contact (they blame her vision, but I don't buy that), she avoids peers except for 1 little girl that she is co-treated with at ABA, no pretend play at all except what she practices at ABA. She does not use objects appropriately such as brushing her hair or holding a phone to her head, She doesn't respond to her name often (despite this being something that we have spent significant time on in ABA). She is very difficult to engage or keep engaged, and shows very little expression on her face a majority of the time, and she often just stares into space, like she is in a trance and spaced out.

Am I just not understanding developmental delays and SPD?  Are these things typical with those diagnoses?  To me, they seem to fit a picture of ASD (at least what I thought ASD was I guess). All of these things were mentioned in her evals. Just looking for the experience of others as I find myself so confused by all this.

Per my autism society in my area kiddos with splinter skills on the spectrum are the exception, not the rule. Your school department is off base in using that criteria to rule out autism. You're also right on that what you describe about your dd isn't just developmental delays. Kids who are chronologically and/or developmentally 12 months old respond to their name, express emotions, and are easily engaged. I would take the schools info with a healthy dose of skepticism.

Assembly_Reqd

Can I ask what her vision dx is? Before having my son, I thought that you see with your eyeballs and hear with your ears. No. You see and hear with your brain. Nate has 20/60 acuity and gaze directed nystagmus. (You can't see the eye wiggles unless he's looking in a certain direction.) He also has mild-moderate hearing loss. His eyes and ears are structurally perfect. It's his brain that is the problem.

I also thought absence seizures. Since you are seeing a developmental neurologist, I can't see a reason to question it. Is it possible that the school district wants you to dig further? Have you had an MRI?

oandmplus1

Assembly_Reqd said:

Can I ask what her vision dx is? Before having my son, I thought that you see with your eyeballs and hear with your ears. No. You see and hear with your brain. Nate has 20/60 acuity and gaze directed nystagmus. (You can't see the eye wiggles unless he's looking in a certain direction.) He also has mild-moderate hearing loss. His eyes and ears are structurally perfect. It's his brain that is the problem.

I also thought absence seizures. Since you are seeing a developmental neurologist, I can't see a reason to question it. Is it possible that the school district wants you to dig further? Have you had an MRI?

She was born with a congenital cataract and wears a contact and also has something called optic nerve hypoplasia, which means under-developed optic nerves. So you are right, her vision difficulty is not just her eyes, but also her optic nerve and brain. She had an MRI which was normal, other than her optic nerves. She also appears to have auditory processing difficulty too, though she passed all her hearing tests including a BAER. Basically her case seems to be very complicated and we hear over and over again from different specialists that she doesn't seem to fit into any one particular dx. It seems as though she just has a difficult mixture of things going on that all complicate each other.

oandmplus1

Assembly_Reqd said:

Can I ask what her vision dx is? Before having my son, I thought that you see with your eyeballs and hear with your ears. No. You see and hear with your brain. Nate has 20/60 acuity and gaze directed nystagmus. (You can't see the eye wiggles unless he's looking in a certain direction.) He also has mild-moderate hearing loss. His eyes and ears are structurally perfect. It's his brain that is the problem.

I also thought absence seizures. Since you are seeing a developmental neurologist, I can't see a reason to question it. Is it possible that the school district wants you to dig further? Have you had an MRI?

She was born with a congenital cataract and wears a contact and also has something called optic nerve hypoplasia, which means under-developed optic nerves. So you are right, her vision difficulty is not just her eyes, but also her optic nerve and brain. She had an MRI which was normal, other than her optic nerves. She also appears to have auditory processing difficulty too, though she passed all her hearing tests including a BAER. Basically her case seems to be very complicated and we hear over and over again from different specialists that she doesn't seem to fit into any one particular dx. It seems as though she just has a difficult mixture of things going on that all complicate each other.