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Where is the line between personality and disorder?

LoveEeyoreLoveEeyore member
in Special Needs

DS went through EI from 21 months (evaluated with a 14 month delay in language) and received speech 2x/week, OT 1/week and PT 2x/month.  He was dismissed at 3 as being age appropriate in language, mildly delayed with fine and gross motor skills.  I declined being referred to the school system.

Fast forward 7 months.  He is chatty and bright at home but will not speak to anyone but me when we are in public.  His OT came by last week to pick up a carseat and stroller I offered EI for needy families they service.  He wouldn't make eye contact or speak to her, though he loved her. At home, he is SO moody and sensitive, but bright and chatty.  He interacts with his sisters in play completely age-appropriately.  At school he engages in parallel play but does not speak.  He comes home and relays every detail of who was naughty, who was funny, etc.

 But I worry about the "selective mutism" aspect.  I am considering some kind of group social skills group, DH thinks we should give him more time and thinks it's a 3.5 year old thing.  I KNOW all 3 year olds go through phases, but I want him to be confident enough to show himself by the time he is in Kindergarten.  He has one more year of pre-K and I know there is time for growth.  Would you look for a social skills group for a child who is fine at home with siblings but not functioning at the same social level at school?

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Re: Where is the line between personality and disorder?

  • LoveEeyoreLoveEeyore member
    image-auntie-:

    Only a professional can make the call between what's a quirky personality trait and what is a clinicially diagnosable condition. Sometimes there is a continuum between what is neurotypical to a full blown diagnosable disorder. In atism, for instance, there's NT on one end and Austism on the other with broader autistic phenotype, and previously PDD-Nos and Aspergers, in between. It can be hard to place a person on their spot in line and that spot may shift has skills are acquired or expectations are raised.

    Is there some reason you declined the referal? I have a hard time understanding that, even if he probably wouldn't have qualified for services at the time, it's great to have people at the next level take a second look at where he was at the time in terms of skills.

    The selective mutism is something I'd want to explore. There's nearly always an anxiety piece to this. It's often comorbid with other stuff. I'd want to address anxiety because anxiety is such an awful thing with which to live. And because untreated anxiety has a way of multiplying.

    I wouldn't do the social skills class without first exploring why he's struggling. A good school stories group is designed to meet the needs of a very specific kind of delay. A group for kids with AS or PDD-Nos would have to include rote instruction on very basic concepts like that friends are fun and that people sometimes people know and like different stuff than us and it's OK. A class for kids with ADHD might work on self regulation so a child could access the behaviors in the moment that they already know in an academic sense. One for kids with anxiety would focus on strategies to get outside one's comfort zone with others. Since you describe your son's play and social skills as typical within the safety of his home, an ASD social skills group might be a waste of your time.

    Auntie- thanks for the thoughtful response- so much I hadn't considered.

    About the referral- frankly at that point we really hadn't noticed the social deficits because he was always with me and I hadn't seen him (co-op preschool) having difficulty yet (he was dismissed 3 months before starting).  Neither the PT or OT were concerned about his lingering physical issues because they were not impeding him in any self-help, play or day-to-day activities.  We built a gym in the basement to work on those slightly off issues, and continue to work on those daily. As a former autism therapist, turned autism teacher, turned consultant and advocate, I felt confident with his past progress and the equipment we installed, and my experience, that we could overcome those delays. He has, with work and natural development as far as I can tell, at this point. He was, at that point evaluated a few months ahead for social-emotional development at the time of dismissal.

    ANxiety.  It's a label I hadn't considered.  Shy, yes.  A little stubborn, yes.  Anxious- no.  But it is often an "omniscient" 3rd party to see this type of thing.  Thank you- tough to swallow (mama guilt obscures that as an option) but I definitely need to look into it.

    I won't waste time with the pedi on it- after nearly a year of expressing concern about something not clicking, I finally self-referred to EI... What type of specialist would you suggest at this point?

    Thanks, so much! 

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  • LoveEeyoreLoveEeyore member
    Thanks so much.  The hardest part is starting, especially after going through EI and thinking we "were done.".  Helps a lot to  have a hand/nudge in a direction to get started.
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