Questioning original evaluation for my son

[Ells1982]

Hello,

My son was diagnosed in July of 2021. He was just shy of 2 years old. At the time, he wasn't waving, talking, pointing so I got him evaluated. Because of the pandemic, they were still following strict precautions, so his evaluation was 12 minutes long as they didn't want to keep anyone in the office that long. They had me sit in a room with him while they watched us through a two-way mirror and I had to conduct these 2 minute play sessions and then move onto the next task. I didn't know what I was doing. So he was diagnosed and they recommended 20 hours of ABA but I decided to put him in speech and floortime, which he did well with but then graduated once he turned 3. He did start daycare soon after the diagnosis came and did learn those gestures he wasn't doing soon after. He was a late talker, but now is talking like any other 3.5 year old. He does have some trouble regulating his emotions when he's upset but I can't tell if that's just regular toddler behavior or if services are needed. I don't want this to come across as I'm in denial if he has autism, I simply wonder if having a 12 minute evaluation is sufficient enough to really assess him. I'm thinking of getting him evaluated again, as the only big thing he struggles with now is regulating his emotions, but I'm not sure if that is just regular 3 year old behavior.

I'm just confused on what to do as I don't want to abuse the system and sign him up services, which could take away services from another child in need but I also don't know if I should question the doctors. Any feedback is appreciated. Thank you

 

[Forest Cat]

Hello, 12 minutes sounds a little short. I'm not a doctor but 12 minutes watching behind a two-way mirror? I would like to hear what other people here think about it. We do actually have a doctor here, maybe he will let us know what he thinks.

 

[1ForAll]

An Autistic evaluation should be about two to three hours long for those under age five from what I remember, which includes the Parental Interview/questionnaire and the clinician observation. Testing may be given as well, like the ADOS or other, but it is not required if the evaluator was trained in Autism or had much knowledge there what to look for.

If the 12-minutes was just on observation and there was not much extensive additional time devoted to asking the caregiver comprehensive questions about the child's development from birth to the time of the evaluation, including probing questions if core components and issues often involving one with Autism had occurred or were seen developing, through asking about the child behaviors, limitations and actions in various environments, too, I would highly be suspicious of the quick diagnosis.

I mean two year olds can be late talkers and have temper issues obviously. This is not enough to warrant an Autism label. In order to thus diagnose Autism in a child as young as that, just based on 12 minutes of observation, there would have had to be much prior information received from the caregiver leading in that direction, like some questionnaire or formal interview given or other testing. Even the ADOS test alone is supposed to be on average 45 minutes in length.

Both of our children were diagnosed between two and four, with the first child being diagnosed by the school system closer to age two after a team of three professional experts: a psychologist, the mental health director, and the speech therapist evaluated that child over two ninety-minute meetings. Detailed questionnaires were given to the parents before that too, which were quite comprehensive and exhausting to fill out.

The second child who was diagnosed closer to age four had to be seen by an Autism specialist that we found on our own, to evaluate for that diagnosis as the many other pediatricians and general doctors were refusing to see what we saw, probe or screen further for some neurodevelopmental condition, give such referrals to a specialist, etc. They wanted to be patient or seemed to have difficulty analyzing, if not were receiving pressure from insurance companies or other to wait until the child was older, which would seem better for your type of case, not ours where more symptoms and delays occurred.

The Autism specialist for that second child too gave us extensive questionnaires too for us to fill out to give at the evaluation meeting. That meeting lasted three hours, as the doctor reviewed about sixty minutes of video we voluntarily gave too showing this son spinning, hand flapping, hyperactivity wandering, poor eye contact, tip-toe running, lining up toys, other routines, incoherent sounds, sound and texture sensitivities, refusal to engage, meltdowns at seeing new people and environments etc.

So for that evaluation meeting, it was about an hour of reviewing the questionnaires, an hour of observing our son and his actions, reactions, behaviors and inactions, and an hour of reviewing our video. During the observation of our youngest, the doctor saw the child would not engage when he and we attempted to engage him, and he refused to budge from his IPad and stroller, wanting to repetitively click on the same program over and over again, without finishing it to the end.

He then was diagnosed with Autism and ADHD after taking everything into consideration and putting everything into perspective.

The fact you do not mention any sensory issues, fine or gross motor skills, rigid routines, atypical fascinations, hyperfocuses of interest, other delays now, and you do not mention any difficulties adapting, other oddities and any other typical core components of Autism, other than the speech delay and meltdown/emotional regulation issues, with the speech being caught up now, of course then you have a right to question things, if a diagnosis was based just on the 12 minutes and nothing else.

This does not mean the child could not have Autism, but just that based on the information you revealed so far to the forum, in absence of knowing more that the doctor saw to justify that diagnosis, I would not assume anything they said. As a parent I would want to ask them how they came up with that diagnosis. How did your child satisfy the DSM or other Autism criteria. It is never a bad idea to get a second opinion if you as a parent are not convinced, as wrong diagnoses are given all the time, usually though the opposite is true though, where some unnecessary diagnostic delay occurs or one really has the Autism but nobody will diagnose it.