March 19, 2015
“Our four year old son is having problems at school and with friends. He will have an emotional meltdown at the slightest change to routine or anything unexpected. At his teacher’s suggestion, we had him evaluated for both autism and attention deficit/hyperactivity disorder. We found the assessment process very confusing. Worse, the results were inconclusive.
Now what? We so want to help him.”
Today’s “Got Question?” answer is from pediatrician Dr. Patricia Manning. Manning specializes in developmental and behavioral issues and directs Cincinnati’s Kelly O’ Leary Center for Autism Spectrum Disorders. It is one of 14 sites in the Autism Speaks Autism Treatment Network.
Thank you for reaching out.
You describe a challenging and common situation. Many of the children whose evaluation results are inconclusive are clearly struggling socially and behaviorally. But their symptoms don’t clearly fit that of a child with autism, ADHD or another identifiable developmental disability. Social and behavioral struggles can occur in children who don’t have autism or ADHD.
For example, we see these issues in children struggling with anxiety, sensory issues, obsessive tendencies, language delay or challenging temperaments.
While a specific diagnosis is helpful for guiding treatment, it’s not necessary in order to start using behavioral intervention and related strategies at school and home. While many of these approaches have been developed for children with autism, we know that they can help a wider range of children.
For instance, your son may greatly benefit from a visual schedule. It can help him both follow his usual schedule and prepare him for changes to that schedule.
Your son may likewise benefit from a social skills group or one-on-one social-skills counseling with a qualified therapist. Talk with his doctor and/or preschool teachers about how to access these services through the development of an Early Intervention Program. These programs are legally mandated nationwide.
Even without a clear diagnosis, your son may qualify for specialized preschool programming for children with delays or disabilities. Children who demonstrate delays in one or more aspects of development can benefit tremendously from this type of programming, which provides more support in the classroom.
Through your school district, you can request that your son be evaluated and considered for one of these programs. The evaluations he has already completed may help speed this process.
If your son does not qualify for specialized preschool programming, he still needs behavioral support. I suggest working with your pediatrician or family doctor to identify options for behavioral counseling to address your son’s needs.
Behavioral therapists can be psychologists, social workers or family counselors. They can work with you and your son on challenging behaviors, regardless of a diagnosis or lack of it. Your involvement in this process is crucial. Behavior counselors can guide your entire family through behavior management strategies such as effective use of time out, positive reinforcement, planned ignoring (ignoring the behavior, not the child), etc.
Working with Teachers to Identify Triggers
If your son’s problems exist primarily in school, I suggest taking a closer look at that setting. Specifically, work with his teachers and the school director to look for triggers to his meltdowns. I likewise suggest discussing how the staff is responding to his meltdowns.
You may all benefit from working with a behavior management counselor to develop and implement more helpful and consistent behavioral strategies. (More on this below).
Re-Evaluate As Your Son Matures
In some cases, young children need to be followed over time to understand their developmental issues. An autism or ADHD diagnosis that isn’t clear at age 4, may clarify as your son matures. The wonder of childhood is that nothing stays the same. In some children, developmental and behavioral issues become more pronounced. For other children, early challenges fade as they develop and mature.
It’s good that your son had a baseline evaluation, albeit an inconclusive one. This will help you, his teachers and his healthcare providers follow his development over time.
If his difficulties continue or worsen, I recommend that you have your son re-evaluated in 18 to 24 months.