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Autism and cognitive delay

Hiccup15Hiccup15 member
in Special Needs
DS1 had his first psychologist appointment yesterday. After going through my concerns, the psychologist said he doesn't have autism because there must be a cognitive delay. He ended up repeating it again saying all autistic kids have a cognitive delay. From my limited experience this is wrong, correct? 

He said from what I told him and what he sees, he thinks it could be PDD-NOS (I thought this isn't a diagnosis anymore) or he just has severe anxiety on top of his sensory issues which is causing all his difficulties and quirks. 

The session went pretty well. DS1 is great with adults, especially one and one, so he was great. He could not sit still at all and his psychologist kept commenting on it so we will see what he says about that. 

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Re: Autism and cognitive delay

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    Hiccup15Hiccup15 member
    -auntie- said:
    Color me confused.

    Generally speaking,  the term "cognitive delay" is very broad and can encompass a lot of glitches. Sometimes clinicians, in the spirit of being "gentle" , will use it in leiu of "intellectually disabled" or "low IQ". This is especially true in younger kids and if they haven't done the necessary testing to determine an accurate IQ. 

    Cognition is more about "thinking processes" a person could be delayed or disabled because of an LD issues, a processing disorder, low IQ, a stroke, TBI or dementia. I often think of some of DS's educational glitches- like his inability to process math at the usual age and then do very well a few years later to be a cognitive glitch. Some executive function deficits have their antecendent in poor cognition.

    So, if this person is truly suggesting your child can't be on spectrum because he doesn't have an IQ under 70, then you should probably move on. The "high" in high functioning is IQ. Autists with average and higher IQs exist. Temple Grandin, John Elder Robison, Daniel Tammet. Hell, I have one sleeping upstairs as I write this.

     I also seriously side-eye a clinician who is suggesting a dx that your school district and insurance company will ignore since it doesn't exist.  I makes me think this person isn't as familiar with ASD and the realities of advocating for such a child once you leave the office. That said PDD-Nos used to be a kind of "close but no cigar" dx that was sometimes used to convey the idea that a person's development was "off" enough to cause impairment but not enough to meet the diagnostic criterai for autism or Aspergers. Like the kid who seems to have Aspergers but has a speech delay or doesn't have a "fixed interest".

    It's interesting you mention anxiety, sensory and "out of seat behavior" in a 1:1 setting. Years ago we car pooled with a boy who had a great IQ, but who had wicked ADHD, the worst sensory issues I've personally witnessed and moderate anxiety. His mom, a sped teacher really felt he probably had Aspergers but he never met the criteria. This was a huge frustration for her because she felt the lack of dx was preventing her from putting a comprehensive plan together. Once she met DS, who had those same issues subsumed by Aspergers, she could see the difference in what @light-brite calls "with-it-ness". Her son was more tuned into what was going on even if his reactions were at times less appropriate than DS's. In the end, it was determined that her Occam's Razor did not apply- there was no one condition to explain all his differences, he was a kid with a laundry list of behavioral health issues. 

    Turns out, his anxiety and behavior were exacerbated by the old line stimulant meds, once Concerta came out, the sun came out for the kid. He left the special school in 6th and excelled in the mainstrea. Last I heard he was headed to law school.

    Just curious, how long did you wait for this appointment. IME, the best clinicians have considerable wait lists. DS's psychologist is scheduling about 18 months out for an eval and he doesn't take insurance.  I'd be suspicious of anyone who could see you fairly quickly.
    Good to know. It was only a couple weeks to get in. Which made me cautious going in. He was recommended by our Pedi and then when I asked around at the clinic the boys go to, everyone recommended him as well. 

    We will be seeing a developmental pediatrician. We won't be able to get into the highly rated one until July of next year. However, I've had some parents recommend another center. It is the only one in the area that has a 3 month waiting list instead of 12. Would you just go to both, using the 12 month out appointment as a second opinion? So far I have an appointment for both. 

    A question regarding eye contact. I've never noticed any issues with eye contact before, however, when DS1 was playing blocks with the psychologist he barely stopped looking at the blocks. He would answer questions and play games while keeping his focus on the blocks and not looking up to the psychologist while talking to him. This lasted about 15 minutes. The rest of the visit he was looking off at different areas of the room. Although, I'm sure it's hard to have eye contact when you can't sit still haha. I'm going to watch and see if this happens again in different environments. Would this be something to look for or does it seem pretty normal taking into consideration that it was a new place and person.

    I feel like it's so hard to tell what's normal and what might not be. It has been much easier to tell with DS2 because it's pretty obvious. 
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    Hiccup15Hiccup15 member
    McRib said:
    Yeah I don't think cognitive delay and ASD go hand in hand. They can but they also often do not. My son sounds similar to yours- great social skills with adults but lacking the peer to peer with other children. PDD NOS will get you nowhere right now because it doesn't exist. We were grandfathered in on it. I would push for a second opinion from a dev pedi or a neuro that diagnoses ASD. The ability to attend was really helped through ABA for my son
    We have appointments for two different developmental pediatricians, one had a 12 month wait. So I'm hoping to get some answers when we go. 
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    KeeptruckinKeeptruckin member
    I am a newbie here lol but had to respond. My DD is going through assessments right now. She had an the WPPSI -IV the other day. The testers report states she has clear strengths and weaknesses within her cognitive profile. Her academic skill area scored significantly higher than her average across all skill areas. Basically what the tester told me was the discrepancy in the scores shows the a typicality of autism. Her performance on the certain subtests was crazy high in relation to average scores in others. She had no scores below average. But what was different was she scored in the highest range of very superior in things like fluid reasoning but only average in working memory. Her visual spatial reasoning skills are in the gifted range. Yet she doesn't realize she can't run in front of a swing without getting hit. Obviously there is something going on and we still have more testing to do. But the gist of it I got was the very high and then lower scores is the a typicality. Most people are on a. Curve or stay pretty consistent. DD's results were peaks and valleys.
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    Hiccup15Hiccup15 member
    Keeptruckin said:
    I am a newbie here lol but had to respond. My DD is going through assessments right now. She had an the WPPSI -IV the other day. The testers report states she has clear strengths and weaknesses within her cognitive profile. Her academic skill area scored significantly higher than her average across all skill areas. Basically what the tester told me was the discrepancy in the scores shows the a typicality of autism. Her performance on the certain subtests was crazy high in relation to average scores in others. She had no scores below average. But what was different was she scored in the highest range of very superior in things like fluid reasoning but only average in working memory. Her visual spatial reasoning skills are in the gifted range. Yet she doesn't realize she can't run in front of a swing without getting hit. Obviously there is something going on and we still have more testing to do. But the gist of it I got was the very high and then lower scores is the a typicality. Most people are on a. Curve or stay pretty consistent. DD's results were peaks and valleys.
    Thanks for explaining it like that. We haven't done any testing yet so I'm anxious to see how those go. 
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