Autism & Asperger's Syndrome Expert Forum
Pre School Related Question
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Pre School Related Question

We have a son who is 34 months old who has some autism symptoms, but doesn't display all of its common symptoms.  For example, he loves going out to crowded places, has no issues with loud noises, is very coordinated, points at objects, no food issues, has good awareness to danger, and doesn't make unusual sounds or gestures.  His issues are a delay in speech (it just began to emerge several months ago), very bad temper (but not violent), an inability to happily accept his younger sister (8 months old; he seems to imiate her to deflect attention from her back to him, such as by crying) somewhat avoids eye contact, a tendency to carry objects around like cups, doesn't always respond when called (seems to ignore us unless he's interested in a topic), and tends to play by himself when around other kids.

We have had our area's Early Intervention working with him at our home and are pleased with the insights they have provided us.  We also took him to a class for kids with autism and autistic learning styles, but were concerned about this experience.  What concerned us was that the other kids were more obviously autistic (making strange noises and flapping) and he started copying their behaviors, which he has never engaged in before.  

So here are my questions:

1) For kids with milder autism (or possibly just autistic symtpoms), is it sometimes preferrable to have in home treatment for children and send them to a regular pre-school?  Is it common to send mild autistic kids to a mainstream pre-school?

2) If we really wanted to know if our son was autistic, is it better to have the diagnosis done by the Early Intervention Specialist or by a Pediatrician that Specializes in Childhood Development?

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To answer your second question first: I would suggest that you go  identify a hospital in an urban area where they specialize in diagnosis of children with autism spectrum disorders. A comprehensive evaluation by a team of specialists will result in diagnostic information as well as treatment recommendations. You can then take these recommendations to your local early intervention program or public school.

In answer to your second question: The most effective treatment for children with autism regardless of level of functioning is early intensive behavioral intervention. This means that your son should receive 20 hours of direct teaching in language, social skills and self-help skills. This can include a portion of integration time with a specialized teacher who can make sure your child takes advantage of all the learning opportunities in that setting, such a social initiations, play, conversations and participation with peers. Services can be provided by early intervention or the public schools in your area. You may want to look for behaviorally trained professionals to supervise a treatment program by checking for a person in your area.
I am not an expert, I am a mum of an 8 year old boy on the autistic spectrum.
A multi disciplinary team assessment carried out by health professionals is usually the best way of getting a diagnosis because it is more indepth than through education for example.  There are lots of different characteristics of autism and a child only has to have enough of them to get a diagnosis.  No two children are the same.  My son also doesn't flap or spin (although he did spin sometimes as a toddler - but even then not so much that I thought it was an issue).
Your son is just at that age when he should be beginning to develop his social side.  If he is on the spectrum he will start to have difficulties with social interaction which may look like he is simply delayed because his peers will be developing these skills and he won't be, or he won't have the same level of skills.
Once you have a diagnosis you start to think about what educational setting will be appropriate.  In my experience I resulted to getting private reports done because I couldn't get anyone to test my son so that I knew what his strengths and weaknesses were.  I was repeatedly told that "children on the spectrum typically have difficulties with x y and z".  But, for example, if a child has difficulties with social interaction is that because of (a) language difficulties  (ai) problems with receptive language; (aii) problems with auditory processing; (aiii) problems with comprehension or inference, (b) sensory or environmental difficulties, (c) executive function difficulties etc.  And depending on what is the 'root' problem the approach, strategy or therapy will be different.  Does that make sense??
So typically a private report by a Speech and Language Therapist and Educational Psychologist should give you a very clear idea of what his difficulties are.  The Ed Psych should also be able to tell you what kind of educational environment is going to best suit him as they assess for cognitive ability.  If you do go for private reports make sure that they are independent professionals ie. not employed by the health or educational service and that they have experience of being expert witnesses at educational tribunals.  The reason for this is that they will be impartial and will give a true reflection of his needs.  Someone employed by the health or education system will assess knowing what their department is able to provide - and that will be at a much lower level.  
In the UK if you have evidence of need (through professionals reports), the school has to provide that support regardless of whether they have the staffing level to do so.  If they don't the educational authority has to provide additional funding to meet that level of support.  That is why independent professionals are needed.
At the state you are at, I would have thought a paediatrician who specialises in childhood development and who has experience of diagnosing autistic spectrum disorders.  Or if they don't have that experience that they can refer you to a multi disciplinary team that does have.
Once you have the diagnosis, you need to find out how your educational system works and what you will need to access certain schools.  Everyone country is different, and I don't know where you are.  If you feel you are hitting your head against a brick wall and getting no answers you can always find a legal advocate who specialises in special educational needs law and get some advice from them.  If you are in the UK you can contact the National Autistic Society as they have alot of helplines and educational advisors as well as a educational tribunal service.
If you do along the private report route this does cost money.  Therefore it is wise to do it at the most beneficial stage.  That is why seeing how the educational system work.  For example you may get access to a nursery you are happy with without a diagnosis.  Or you may need a diagnosis to get access to the nursery that can meet your child's needs.  The same will apply for primary school.  Find out what schools have experience and expertise in teaching children with autistic spectrum disorders.  An Ed Psych should be able to tell you whether your child needs to be mainstream or whether an autism only environment is better suited.  And remember that there are high functioning autism only schools (not many but they are out there).  
Usually the biggest problems start at secondary school, because even if your child has been mainstream up until then, at secondary level 11+ inclusion doens't ususally work because the other children aren't interested in special needs kids, and your child cannot interact with them socially and being in that environment is very stressful for them.  Also at this age they need alot more input on things like life skills etc that a mainstream school just won't provide.
You are right at the beginning as he isn't 3 yet, and you don't know how he is going to develop, but you do need to know what his areas of difficulty are and what are the optimum levels of therapy and by whom at this stage.  
But I just wanted to add that spending the money at the right time is the most wise.
Wherever you are, it is also worth finding out if you are entitled to any benefits post diagnosis as it all helps you to achieve your goals as the money can be used for advice or therapy.
A further thing I noticed from your post is that he doens't always respond to his name ie. appears deaf.  He isn't noise sensitive.  He might be auditory hypo sensitive (ie. under sensitive to auditory noise).  It might be worth googling Sensory Integration Disorder.  Also google Olga Bogdashina and read an article by her printed in Autism Today.  If that sounds relelvant you can find her book called Sensory and Perceptual Differences in Autism and Aspergers.  There is a caregivers questionnaire at the back of this book that can give you a sensory profile of your child.  Our Autism Outreach Department uses this questionnaire so I know it is reputable.  
Sensory Integration Disorder means that there is differences in sensory perception which can be over or under sensitive and can fluctuate between the two.  So you will get a different response to the same sensory stimuli.  It can affect any or all of the senses or the ability to co-ordinate the senses or multi talk from a sensory point of view.  So it is very typical for a child to be engrossed 'doing' something and to appear deaf or unaware of its environment or others close by or even calling their name.  The senses are vision, sound, touch, smell, taste, balance and co-ordination.  There can be any combination of difficulties eg. a child might appear deaf on occasions, be sensitive to smell and tastes of food, brilliant balance and co-ordination - or they could be the complete opposte, or a different combination.
Thanks for the reply.  To answer a couple questions, we are in the U.S.  In regards to not responding to his name, we are 100% sure he has no hearing issues, as he obeys multi step commands and is quite good in carrying out tasks that we request (e.g. turn off the light, close the door, put something on a table, etc).
Yes, the hearing tests have to be done to make sure there is no hearing loss.  But my son is the same.  I can call his name many times and he just ignores it if his attention is elsewhere.  On other occasions he responds to his name straight away.  It is a sensory and focus/attention issue.  Those on the spectrum tend to be able to do one thing at a time.  So we can watch TV whilst being aware of other people in the same room, and evesdrop on a conversation someone is having and also be aware that mum is in the kitchen making dinner etc.  Someone with autism, when watching TV is ONLY watching TV and can be totally unaware of anyone or anything else in the environment.  Their attention is 100% on the TV.  And whenever their attention is on something, either TV, or a puzzle or lego etc and you interrupt their concentration, they can become very upset.
My son is now 8, and he was eventually diagnosed when he was 6, although I had been raising my concerns about certain things since he was 3.  And along the way I have learnt alot about my son, and have made professionals assess and explain to me why he has difficulties with certain things, and when they have refused I have had private assessments.  This has shown me that my son has an autistic spectrum disorder, he also has disordered speech and Semantic Pragmatic Speech Disorder.  He has Sensory Integration Disorder, Irlen Syndrome and Auditory Processing Disorder.  He also has auditory processing delays and difficulties with auditory memory.  Knowing all those disorders etc makes me very clear about what his needs are and who should be going into his school (eg. Speech Therapist, Occupational Therapist, Educational Psychologist etc) and how much time they should be dedicating to him.  It has meant I have the evidence of his needs, and have been able to go to an Educational Tribunal and win every single thing I had proved he needed.  This is way over and above what would normally be provided in a state school, and is way above what those in the autism unit receive.  My son is mainstream and the school has experience and expertise in autism.  I was refused a place for my son at that school, but through finding out about the educational system and my sons legal rights, I managed to get him in anyway.  
As you are in the USA, it will be much easier to navigate your way through the education system than some other countries, and get the help you need either through the health system or getting your own reports done.  Never take no for an answer.  Always check any information you are given (especially if it is denying your child access to something).  You are the advocate for your child and you are the only person who will make sure that they get the provision they need.  Have the attitude of the long distance runner and just take everything a step at a time and work through it, because it will be a lifelong thing - as any child is always a lifelong project to their parents - but children need us to be more focused about what they are being provided with because we are aiming for them to be independent as adults.  If we don't have that goal in mind it won't happen.
As he is just coming up to three, you really don't know how he will progress, and these children do not come with a manual.  Typical children are measured on typical percentiles and they stay on those percentiles.  Our children don't.  They can be at the same stage for a long time, then suddenly come on and make incredible progress.  
So at this stage, I think you need to work towards a diagnosis, and find out what different kinds of nursery there are in your area and what the entry criteria is.  
Most parents start by wanting and hoping that their child can remain mainstream - and some, with high functioning aspergers do.  Those on the autistic spectrum (which by definition means they have the language difficulties as well) tend to struggle much more in a mainstream school.  Then parents try to move their child to a school that will have the supports their child needs only to find that there are no places left.  Then you end up fighting to get a school place that you initially hoped you would never need.  And the diagnosis you dreaded getting is suddenly the ticket to the therapies your child needs and then you worry about ever having that diagnosis removed and therefore the supports and therapies removed.  It is a strange merry-go-round.  
That is why I advise you to find out about the education system in you county, and the legal rights your child has through educational law.  If you are refused access to certain nurseries or schools you think your child needs, don't take no for an answer.  By law the state has to provide the educational needs of a child.
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The New England Center for Children
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New England Center for Children
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