Saturday, May 9, 2009

Early Childhood Development, School, and Alarmism

DS1 started 3 year old preschool (PreK3) last August. We enrolled him at a small, church affiliated PreK3 about 2 miles down the road and he has been going every Tuesday and Thursday for 2.5 hours per day. Given that DS1 has never been in a day care setting before and we live out in the country (i.e., no neighbors within his age range to play with), we thought it would be a good idea to get him into some kind of preschool setting as early as possible, primarily for social skills training and to make a few friends.

The first couple of weeks were rough because DS1 was in the afternoon class, which was during his nap time (though, he honestly only actually naps about 50% of the time though I do make him lay down for quiet time regardless). I had tried to get him into the morning class when we enrolled and was told it was full. Anyway, after seeing the sleepiness issues, the school agreed to switch him over to the morning class - big improvement.

Then, in November, one of his teachers mentioned that DS1 seemed to have what she viewed as Autistic or Aspergian type behaviors that she wanted us to be aware of. Now DH and I had noticed these same behaviors at home and they constitute things like hand flapping particularly when upset, answering questions by repeating back the last 3 words he heard, trouble focusing on tasks, and getting very upset when things don't work right the very first time. Since I have no idea what is considered "normal" behavior for a 3 year old, I responded as I always do - I did research, lots of research. Within about a week, I had eliminated autism as problem; however, there are a whole host of autistic spectrum behaviors and disorders including OCD, ADHD, and Asperger's Syndrome. I suffer from some OCD type behaviors (inherited from my father's side of the family) and, yes, I seem to have passed some of these on to DS1 and perhaps to DS2, but these are known quantities for me and are not related to the issues the teacher brought up. Asperger's was the only thing that seemed to fit some, not all, of DS1's behavior patterns; however, depending on which test method you use, he either had it or he didn't. These tests are fairly subjective as well (at least in my opinion they are) and, again, I could find no clear definitions for what was considered "normal" behaviors for a 3 year old.

So I called the pediatrician (who did not seem overly worried on this issue) and, at his suggestion, then I called the Grant Wood Area Education Agency and arranged to have DS1 observed by someone more educated on the subject of autism and Asperger's than I. We were assigned to Denese in the early childhood development group. Now, I thought Denese was a child psychologist and I was hoping that she would be able to answer my questions on Asperger's and what constituted "normal" 3-year-old behavior. My initial conversations with Denese left me feeling that she was refraining from giving direct answers until she had observed him and formed on opinion. Come to find out that she is not a child psychologist but a social worker instead. I am always a little nervous around social workers in the context of assessments, but she is nice enough and genuinely seems to want to help us out. I am, however, disappointed that we did not get a doctor's opinion.

After almost 8 weeks of periodic phone calls and rescheduling of the observation, Denese called out of the blue on a Monday in January saying she would be at his school in the morning if that was alright. Uh...OK. After this initial and rather short observation at school and a second, longer observation, Denese finally had an opinion - DS1 is a 3 year old and she did not really see anything that qualified as autism or Asperger's. However, she did note that she thought he had some language delays and made an appointment for us with a Grant Wood speech pathologist, Kelly. Note that no observations were made of DS1 in any other environment other than school at this point.

We met with Kelly in early March and she put DS1 through a standard language skills test for PreK kids. The testing took place in her office which had a couple of shelves of interesting toys which DS2 got to play with while DS1, much to his dismay, had to sit at a table and answer a stranger's questions about some picture in a book. Needless to say, DS1 was not into the testing. He was more concerned with when he could get up and play. If I had thought he would remain calm in that strange environment with me out of the room, I would have taken DS2 and gone for a walk while the test was administered. As it was, I don't think it was a good environment to get a descent set of scores. But what do I know.

Anyway, a week goes by and no results are communicated, so I prompt Kelly with an email and she gives me an informal rundown on what she observed and her opinion via email response. She said she was putting together a formal report and would get a copy of that to me later. To date, I still have not seen this formal report even though I have asked for it twice more. Anyway, in Kelly's opinion, Hank is normal for a 3 year old but his scores show that he "could be at risk for delays later on" and she identified a few areas that we need to work on.

Now keep in mind that at this point, I have gone from being told that my son exhibits autistic or Aspergian behavior to "he has some language skills deficits" to "he is at the low end of average which might put him at risk later on". It seems to me that everyone in this entire set of events, not matter how well intentioned they are, has been more than a little alarmist with me. They succeeded in worrying the heck out of me only to tell me in the end that “well he is 3”.

Quite frankly, in my humble and perhaps uneducated opinion, DS1 is just developing at his own pace following his own interests. Who cares if that pace and those interests don't happen to be “average”. I still don't have a clear definition of what is "normal" behavior for a 3 year old beyond what described in my American Academy of Pediatrics Handbook. Noone has been able to answer that question even though I have kept asking it. I don’t want to be one of those parents that says “not my child” to a teacher and turns a blind eye to potential trouble; but, geeezz, I can certainly understand now why a lot of parents do.

So where are we now? Well, Denese found another Grant Wood speech pathologist, Sue, who gives half hour early childhood language skills classes on Friday mornings at a nearby elementary school and suggested that DS1 would get some benefit from attending. I emailed Sue and DS1, DS2, and I have attended the last couple of classes. Sue is nice and good with kids and the classes are centered around a story and a game to incorporates the skill we're working on that day. However, near as I can tell, she seems to focus mostly on pronunciation, which is what the other kids in the class need help with. This is not DS1's issue at all. His identified skill deficits are based more on social uses of language and some cognitive understanding of some words. We have been working with him at home on these issues and Denese did talk with his teachers at school about how to incorporate some of this training into the daily class routine. I am already seeing improvement on these identified issues. We will continue with the Friday classes, which end with the school year in a couple of weeks, mainly because it doesn't hurt anything to attend and I am loathe to set aside social worker's suggestion for fear of being labeled a bad mother. (An unfounded fear, I know, but one that goes to the heart of my nightmares. However, my fears, unfounded or otherwise, are a topic for a different post.)

For those interested, I did a ton of research on Asperger's Syndrome during the course of this ordeal and its really a fascinating subject. I have all kinds of info on dietary changes and social skills training that are supposed to benefit Aspergians and kids suffering from autism. I can also suggest website and further reading if you want to learn more. Just send me an email or leave a comment.

1 comment:

  1. Yes.

    I would like to know much more about the dietary concerns for such development issues.