Has my son been properly diagnosed?

[Alicia4]

My son, Aidan, is 5 and half years old and preparing to enter Kindergarten in apublic school on the fall. He started having behavioral issues when he was 2 1/2 everything from bouncing off the falls to repetitive behaviors like flipping light switches to figuring out how to break out of the house. When he was 3 and a 1/2 his dad left for a year long deployment to Iraq followed by 6 months of him living in Las Vegas to finish his enlistment and me and my two kids living in LA where we had relocated when he deployed. Just before his dad left his behavior started to worsen and once my husband was gone it went from bad to worse. A couple months after Aidan turned 4 his pediatrician and his preschool teacher suggested he be evaluated by a psychologist. So we took him for regularly for a few months and had him evaluated and we also to took him to a second doc for a second opnion and they both agreed he had ADHD and OCD. We hestitated on putting him on medication, but over the summer while he was being evaluated his behavior turned dangerous. He was only sleeping about 6-7 hours a night so he would wake up before the son got up and he'd go outside and wander around in front of our house, he was constantly repeating himself, you could hardly hold a conversation with him because any time you asked him a question he would be totally engulfed in his own world and it was very difficult to ever get an answer, he was hoarding food under his bed and eating boxes of cookies and fruit snacks in single sittings, he was hyper and couldnt focus on anything, even getting dressed, I would have to say something a dozen times before he actually did it and even then he wouldn't always complete the task and while it was hard at home, my biggest concern was school. He wasn't able to complete anything he started, he didnt have any friends and he almost always played by himself. He wouldnt participate during chapel time or circle time, he was always off in the clouds at home and at school. He had this awful fear of the cat and if he had to walk past the cat while he was close, Aidan would fall on the ground and start crying and panicing. This is just a sample of some of the things he was doing, and so they started him on 20 mg of Prozac and his fears, anxiety, and repetitive behaviors seemed to get better, but he was still out in the clouds  and when it came to the cat he went the opposite direction. Aidan became obsessed with the cat and actually took a screw driver and disassembled the two way dead bolt locks we put on the doors to keep him in the house all so he could pet the cat. So they put him 18mg of Concerta, and he seemed to be slightly less in the clouds and it was a little easier to hold a conversation with him. Then they put him on 27mg of Concerta and he got really grumpy and agressive, so they dropped him back to 18 and over the past 7 months have gradually brought him to 18mg of concerta and 60 of the Prozac. In February his father returned home for good and we hoped his behvaior would improve a great deal and it seemed to only get better as they gave him more prozac. In June, he was doing ok, except he was still in the clouds half of the time and still very impulsive, he would get upset easily but them would be quick to apologize. So in the beginning of July they kept him at 60mg of Prozac and moved him back up to 27mg of Concerta and he has gotten really aggressive and he's angry all the time, you can hardly be around him because he is so grumpy. If you ask him to do something more then once because he isnt responding to you the first time, he gets mad and repeats I hear you mom a dozen times. It's as though he is hearing me, but his brain isnt telling his mouth to reply and say ok mom and his brain isnt telling his body to move and do what mom said. He is frustrated with one thing or another all the time. At school he is fighting with everyone and his teacher said his ability to focus is worse then it's ever been before. Which brings me to my question, his teacher (who has a grown son with ADHD and OCD and 20 years experience working with pre-schoolers) disagrees with his diagnosis. She is concerned that he has a mild form of autism, which is why he is having a negative response to the Concerta and is so socially awkward. I have told his doctor what Aidan's teacher thinks and he disagrees. His doctor has just given me the ok to put him back on 18mg of Concerta since the 27mg has just made things worse for the last 10 days. My concern is that we have spent a year plus getting him diagnosed and trying different dosages of medications and I have a great deal of respect for his teacher and his doctor, at what point will the diagnosis become more clear? And also does my son sound like he has a mild form of Autism or is his teacher way off? Do you have any suggestions for his treatment and what our next move should be? I would greatly appreciate any feedback or suggestions.

[Sally44]

I will comment on the things you mentioned in your post to me that I recognise as being similar to how my son is, who is 7.5 years old with a diagnosis of an autistic spectrum disorder.  He also has some impulsive behaviour, but has been given a dual diagnosis.
Firstly you have to understand that it is quite possible for children to have a mixture of diagnosis in the same way that you can have many types of fruit salad eg. banana, strawberry, peaches etc or you can have a mixed fruit salad.  So you may be dealing with two things.
My son also has alot of sensory issues, infact that was some of the main behaviours I saw.  Google the name Olga Bogdashina and read an article by her in Autism Today.  If that sounds relevant to your situation then her book Sensory and Perceptual Differences in Autism and Aspergers might be useful to you.  It also has a caregivers questionnaire at the back that you can complete to get a sensory profile of how your child is affected.  Olga is a reputable professional who has been invited to our city on a number of occasions to give seminars to both professionals and parents and her questionnaire is used by our autism department.  Olga also has a daughter with Aspergers and a son with Autism.
Another thing I recognise is your talking about his attention and focus and that he has lots of it for things he is interested in and very little for engaging in what you, or others, want him to be interested in.  That is typical of and ASD (autistic spectrum disorder).  It also fulfills the criteria that says 'restricted/limited areas of interest'.  
What I would suggest is engaging him in what he is interested in and trying to 'teach' things through his interests, simply because if you don't then he just will either tell you to go away, or get up and walk out the room.  My son is the same.  He easily loses interest or has none at all for what I consider is important or what he should be doing.  If someone comes over to play with him he will lose interest and tell the child to go and play with his sister or with me.  If I get them both doing something he is interested in then he stays engaged.  But his play can be re-enactments of things he has seen on DVD or TV and he sticks to the 'script' and cannot deviate from the storyline, which causes both him to get frustrated (because the other child doesn't know what he should be saying or doing), or my son gets frustrated because the child is trying to introduce a imaginative storyline and my son just wants to renact something.  This meets the criteria for problems with social interaction, not being able to have peer relationships, rigid behaviours/routines and lack of imagination. (although I must emphasis that my son does have imagination in his areas of interest).
You say your son doesn't know how to get other childrens' attention, so he might shout at them and finds it difficult to hold a conversation.  This again is how my son is.  But my son doesn't know how to initiate contact or a conversation.  For example he might go up to a child and say 'my scooter has got two wheels'.  We would expect him to ask their names or tell them his name, or ask them if they want to play, or ask if he can join in etc.  But these are social rules that other children pick up, but children on the spectrum do not learn these things automatically, they have to be taught them.  It also demonstrates a difficulty in understanding other people (called Theory of Mind - you can google that too).
Your son might also have language processing problems and semantic pragmatic disorders around speech, which will make communication difficult for him.  You can see examples of this at http://www.hyperlexia.org/sp1. html (take out the spaces).

[Alicia4]

I re-read your first post and forgot to mention that my husband and I have discussed taking him off all medication and re-evaluating Aidan ourselves along with professionals, to determine what the biggest behavioral issues are, get him diagnosed again, and re-assess what our goals need to be in terms of treatment....but I hestitate because Aidan was in a very scary place a year ago, I couldn't keep him safe. I had every sharp object hidden in the house, I couldn't leave him alone with his sister, he was breaking out of the house in the early morning hours, even after we put two way dead bolt locks on the doors. The biggest issue a year ago was that he was incredibly smart, but had zero impulse control, which made it impossible to kee him safe and i fear that if we take him off the prozac that something is going to happen to him.

[Alicia4]

Can you tell me what exaclty is the difference between a Child psychologist, child psychiatrist, and developemental pediatrician? I am unclear as to who is the most qualified to observe and diagnose behavioral disorders.

[Alicia4]

My son is always in his own world and I treasure the moments he allows me in, or comes out for a bit to visit.The difficulty is finding a way to educate him and socialize him without taking his world away from him...because I don't want to do that, he is a happy child and that's important to me, but it's also important to me that he learns to socialize and make friends and get an education, all of which he is struggling so much with. If you don't mind me asking what difficulties have you encountered socially and academically and how have you dealt with them? As far as art goes my son had no interest in crayons til he was almost 4 and still takes little interest in being creative. My husband is a wonderful artist, so I thought maybe he would be more inclined to draw, but he would rather watch movies or play his Leapster or put together his puzzles. My daughter is just now 2 and she loves to draw, so I encourage both of them and who knows he might come around. I think it requires him to be still and that's why he doesnt do it, he doesnt have the attention span. He doesnt sit still to play his Leapster or watch his movies. The only thing he ever sits still to do is put together his puzzles, he is incredibly focused when it comes to his puzzles.

[Alicia4]

I clicked on the heath page, then Autism, and then I clicked on the medical definition of Autism. I believe that is where you were directing me, if not please let me know if there is somewhere else you wanted me to click. Forgive me I am not too familiar with forums. I read the criteria and there are only certain criteria he meets. He is overly sensitive to sight, things that sound average to me are often too loud to him and he'll cover his ears or look for the quickest exit. Although if it's something he's interested in like a movie or his Leapster game, a little loud is ok. He doesnt adapt to change that well, he gets frustrated and upset if you change certain things. He is extremely socially awkward, it's as though he doesn't quite know how to behave around other children. If he wants their attention, he might shout at them instead of speak in a normal tone, because he wants to say something, but isn't sure how to go about get their attention. He has 2 friends and they are both girls. Also the majority of the time he plays alone, at home and at school. He is difficult to connect with and hold a conversation with, although he is very loving and empathetic, not at all aggressive. He can be very affectionate, but mostly just with me (mom) and somewhat affectionate with his dad, sister, cousin, gramma, and auntie. Once you do connect with him, it's difficult to keep him engaged for an extended period of time (more then 10 minutes or so) unless you are helping him put together a puzzle. When you do play with him, it's by his rules, and if you go off the beating path he will lose interest in playing with you and actually ask you to go away. He speaks well and the only real delays he seems to have are that he isnt able to do much on his own, you sort of have to hover and remind him a dozen times to get him to complete a minor task, like getting dressed, putting his clothes in the dirty laundry, etc. Most of the time he cant handle more then one task at a time and if you ask him to do it and you walk away count on it not being done when you return. He is capable of alot you just have to stay with him, be patient and give him direction and keep him focused otherwise he becomes overwhelmed and gives up or melts down. He is very jumpy and easily frightened. He repeats things over and over dozens of times, like a scene from a movie, or a phrase from one of his Leapster games. It's like he's a broken record saying the same thing over and over. He refers to play by himself, and if I let him, he would do nothing but watch movies and play his leapster. He always wants to know where we are going and what we are doing and how soon will we be going home, because home is where he wants to be. He gets overwhelmed at family functions and we have sort of accepted that it is just too much going on and when there is a birthday party, once he says hello to most of the family we let me retreat to wherever he wants to play. Before he started medication he had lots of rituals, especially at bed time and he would completely loose it if you tried to change anything. He's better now that he has been on prozac and also his fears have improved, he use to be terrified of the cat and now he is obcessed with the cat and wants to be with him all the time (Just a note: all of these behvaiors were full force up until they started him on medication almost a year ago and alot of them have gotten better, some more then others.) He does get stuck on tasks all the time, he's hyper and has a short attention span, even on medication. Although he isn't nearly as impulsive as he use to be, which has made it possible to keep him safe. He does have narrow interests, which include puzzles (dozens and difficult ones beyond his age range), movies, Leapstar, and action figures. He will play with other things some of the time, but he would rather watch movies and play his Leapster and it's when I make him take a break from either of those things then he plays with his puzzles and action figures. So theres Aidan up against the criteria....there are certain criteria he seems to meet, but then other criteria, like difficulty with imaginative play, rubbing or licking things, flapping hands, lack of eye contact, speech developement, and so on....he has no problems with. So I guess what I am wondering is how much of this criteria has to be meet in order to consider a child as having Autism?

[MJIthewriter]

I think either way, autistic or not, having the father away will cause emotional upset. That can manifest itself in many ways. One thing with autism, is the tendency to not always share emotions. Heck, just understanding emotion can be difficult, especially in the younger years. I know with me as a kid I seemed to believe I had to cope with them by myself and that people could just stop feeling.... It doesn't work that way.

Not only that but emotions tend to snowball when not coped with... A minor thing that didn't get addressed may stay in my mind. Something else happens, then I feel worse...and it eventually builds up to a point that it explodes. I don't believe this is specific to autism, but because autism presents a communication berrier, this happens a lot easier, expecially for those who are nonverbal.

I don't remember really talking about my emotions to my parents under age 11. Maybe I did, but I can't pull up a specific memory. If I did, perhaps one of my parents can remind me... I know my mom lurks my posts here. I did complain if someone bullied me.  That I did, but as far as saying I'm upset, I don't know... There was a time my dad had to work several hours from where we lived. He was gone for the week and visited on weekends.  I don't remember a whole lot if I behaved worse when he was gone or not. I know I was really happy to see him on the weekends. I'd wander around the bus stop, catching bugs, and otherwise looking like I wasn't paying attention to the world. But once I saw the bus come and my dad come out, I ran right up to him to give a big hug.