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Special Needs
macchiatto
member
ADOS question
macchiatto
member
How subjective would you say scoring the ADOS is? Have any of you had a child who scored really low on the ADOS with one evaluation team but got really different scores from another team?
My son's EI suggested yesterday that I might want to consider getting another eval for him--basically a second opinion--from a local autism team. She thinks the devel pedi team that evaluated him this past fall may have had an inflated view of his social skills, especially since he does so well one on one with therapist-type adults, and may have scored him generously. She's still concerned about his eye contact, interactions, etc. If I understood her correctly, going ahead and getting a "second opinion" now might be helpful since when he turns 5 in January, he'll no longer have access to EI/service coordination or other things he's eligible for right now through DDSN and it also might help in getting things in place to help when he starts Kindergarten.
Thoughts? Is it worth it or is it unlikely he'd really score that differently on the ADOS with different clinicians?
fraternal twin boys born january 2009
This discussion has been closed.
Re: ADOS question
He qualified through DDSN as an "at-risk child" to keep his EI until he turns 5. (We contacted EI when he was 2.5 so by the time things got set up, he'd only had 3 months of services and 6 weeks of OT and PT before he turned 3.) He was getting services through the school system as well starting at age 3 (along with continuing his EI, private PT, OT and feeding therapist he'd been set up with through EI) but we actually discontinued the school district services about a month ago b/c we really felt like he wasn't getting much out of them. He had an itinerant teacher for an hour a week and PT for 30 mins 3x/mo. (Last year he also had an OT.) His PT was pretty useless so we d/c'ed to free up the time for things like My Gym classes, which he gets a lot more out of.
They did a bunch of other evals (at the initial 5-hr meeting, then asked us to come back for the ADOS) but none of the ones you listed. The school system did do the Vineland when he was turning 3 though so I know they had access to those results at least. (The devel clinic did the WPPSI-III, the VMI, ... and the last 3 pgs of the report are missing. Oops.
)
I can ask about a neuropsyc eval. The school system really didn't seem concerned about his social skills, the SPD, perseverations, anxiety, the very inconsistent eye contact, etc.; they never really addressed all that. We are house-hunting now and looking to move into the better school district by January.
The evaluators she was suggesting is a local Autism Resource and Evaluation Center rather than a different devel pedi. I think she may be suggesting a second opinion now while she knows she's in a position to get us well-connected with resources, but it's good to know you think his scores may not change that much till he's a bit older. We weren't able to get much helpful feedback out of the boys' preschool teacher this year (she contradicted herself a lot and just didn't seem to have a great grasp of child development) but they'll be at a much better preschool next year and I'll look forward to getting feedback from those more experienced teachers.
Thank you so much for your input! Always much appreciated.
Thanks for the reply! For more info, when he was first evaluated through EI at 2y9m, he qualified for PT, OT, feeding therapy and EI family training. His biggest delay was gross motor skills; when the PT evaluated him he was 34m and scored at 17m for gross motor. DDSN covered just keeping his Early Interventionist's services (and I found out that b/c he has DDSN eligibility, he can also get in-home PT and OT now. He's been on a waiting list for that since January. I don't think DDSN actually covers it; just makes him eligible to get it in-home and then we'd bill our insurance). After he turned 3 we covered continuing his PT, OT, and feeding therapy through our insurance and also were able to get him on Medicaid to supplement that (qualified by income). We were hoping to phase out the private therapies after a couple months since he started getting school system services as well (since he had just started and we were already seeing good progress, we didn't want to just drop the individual therapists when he turned 3 and Early Intervention stopped covering it) but after a few months of both we realized the private therapies were just way more valuable for him. His issues were all mild to moderate but we felt like we wanted to do everything possible up front in hopes that any delays or issues could be minimized by the time he started K.
In terms of Dx, the devel clinic this fall diagnosed him with developmental coordination disorder, hypotonia, SPD, anxiety, and she also noted mild perseverations on his list of Dx. I don't know if it's unusual to list perseverations separately like that; I know that's not an actual diagnosis.
I don't know much about the autism team but those are good questions. I'll find out more. It's this: https://uscm.med.sc.edu/cdrhome/care.htm
OK, one *more* note.
Because the devel clinic had his preschool teacher fill out a form and I knew her feedback might be misleading, a friend of ours who's a child psychologist offered to also go observe his class for an hour and fill out the same form that we could also turn in. She gave me the disclaimer that she hasn't worked directly with kids in years professionally (she's been working at a university) so she felt rusty, but she goes to church with us, has babysat for us several times, and has seen DS in various social settings. We were treading lightly b/c of the dual roles but she did provide some helpful feedback. She was glad we were getting him evaluated b/c she said she had noticed his anxiety in social settings, his perseverations and that he can be somewhat rigid.
Once she visited his preschool though, she was surprised that he actually did better there socially than in any of the other settings she's seen him in. She thinks he struggles a lot more in a setting that's unpredictable but thrives in the structured predictability of the preschool setting. She said the two things that jumped out to her most when observing him with his peers was his gross motor delay (she said he was obviously slower and less coordinated than his peers) and his tendency to stare off into space (which pedi really thinks is behavioral, not absence seizures). She also said he did interact some with his classmates (which is big progress compared to a year ago) and that she noticed a difference in the quality of his interactions, but it was subtle. Like he was sort of "distant" in interacting with them. [Also at play dates, he'll often try to cling to me though he's made progress in recent months with trying to interact more with the other kids. He'll sometimes run around with them now, which is great, but definitely still tends to do his own thing/be on the fringes most of the time.]
When child psyc friend filled out the form, she noted these things briefly and said to feel free to contact her for more info. They didn't contact her and I'm not sure how much they factored in her report. (I know it was unsolicited, but she offered since she lives right by their preschool and knew that they didn't have plans to observe him with peers and they seemed appreciative that we brought that as well.)
Sorry; I know that was a LOT of info and not the clearest summary.
Which line of reasoning? Mine? The child psyc's? The devel pedi's?
Heading out now but when I get back I can consolidate into a clearer, more concise summary.
Going back to your original question. My son had the ADOS twice, a few months apart by 2 separate teams - a school eval, and a dev pedi eval. The results were different by a couple of points, not drastically different.
Ah, OK.
Yeah, that theory somewhat made sense when he was first evaluated (right before he turned 3) b/c at that point, he wasn't interacting with peers at all and I think that was partly because of his problems with spatial awareness, weakness, lack of coordination and lack of confidence. I think initially it did contribute to him holding back with peers and increased his anxiety, especially in crowds or in a setting where he's got active peers running all around him and he would feel overwhelmed. But overall, I think I agree with you that his anxiety is its own issue and I don't think the devel pedi was all that helpful with how to address the anxiety or the social issues. (The school psyc who participated in the eval was not at the feedback meeting or I would've liked to ask her more about treating those two.)
At any rate, it's good to know the ADOS probably wouldn't change that much if done again this soon by different evaluators. I might wait till he's a few months into pre-K next year and if the anxiety and social issues don't improve, maybe see a child psyc or counselor who specializes in children to address those.