Another dev pedi question

[akafred]

I think it's obvious already that the clinic we have been seen by is not the right clinic for us for many reasons. But one thing that always bothered me is that they have never once done any kind of screening test. They asked for OT eval for SPD, but they never did M-CHAT or any other test. I don't believe DD has ASD (and they did say it was not a concern), but I am just so surprised they never did any kind of screening or testing. When I asked about testing they said she was too young (she was new 5 at the time) to test for ID. (Which was/is not on my radar and shows how out of touch they are). They have asked a lot of questions about development. They have barely interacted with DD at all (and the psych did not interact with her at all except to scold DD for showing interest in her name badge).

Concerns I do have include ADHD, SLD, IQ/giftedness possibly, working memory, and BPD. And IDK what I don't know, so there could be more concerns. Is it unusual that they have done nothing except try to sell their parent training and say "we'll look into your concerns when she's older" (basically)?

I don't believe there are other options in our insurance in the area for dev pedi so I am stuck. My regular pedi is a wealth of knowledge but is on maternity leave, and we're switching schools next year and all that so we're sort of in a holding pattern which is ok. This is more from curiosity than a place of action, I guess.

[mrsbuttinski]

Feb 23, 2015 14:56:39 GMT -5 akafred said:

I think it's obvious already that the clinic we have been seen by is not the right clinic for us for many reasons. But one thing that always bothered me is that they have never once done any kind of screening test. They asked for OT eval for SPD, but they never did M-CHAT or any other test.


I wouldn't expect M-CHAT, it's a screening tool meant for PCPs and parents. The appropriate age for M-CHAT is 16 to 30 months. Char's PCP should have a copy or two of the results in her records assuming it was done at the usual time. 


You're at Vandie, no? Are there other option in your community?


I don't believe DD has ASD (and they did say it was not a concern), but I am just so surprised they never did any kind of screening or testing. When I asked about testing they said she was too young (she was new 5 at the time) to test for ID. (Which was/is not on my radar and shows how out of touch they are).


I wouldn't expect ID to be on their radar assuming they're looking at the child in front of them. Did her birthmom have a hx of drug or alcohol use during pregnancy?

She'd be old enough to do WPPSI-IV at 2 1/2 which would yield an IQ. Maybe not as reliable as one done closer to 7, but it's valid. Do you feel like you aren't being taken seriously- as if you are the worried well? Could it be that they see you as a run of the mill anxious mom? Getting a pat on the head and shown the door?


They have asked a lot of questions about development. They have barely interacted with DD at all (and the psych did not interact with her at all except to scold DD for showing interest in her name badge).


Why do people like this work with children? DS once spit on his dev pedi; the man acted like it was all in a day's work. 

Concerns I do have include ADHD, SLD, IQ/giftedness possibly, working memory, and BPD. And IDK what I don't know, so there could be more concerns. Is it unusual that they have done nothing except try to sell their parent training and say "we'll look into your concerns when she's older" (basically)?


These aren't typically concerns taken proactively at this age. TBH, these are all conditions where one would expect her to "fail" or demonstrate some unusual behavior before evals would be done. ADHD is generally something dxd in 1st or 2nd grade when children are expected to follow the rules of a traditionally structured classroom. Being in an experiential classroom, such as a Montessori program could mask that as it allows more movement breaks and self-direction.

BPD can't be dxd until there are symptoms; onset of symptoms is generally no earlier than puberty and usually a few years older than that.

Giftedness, Learning differences, processing and memory issues are also something that would come to the fore in first grade or beyond. Again, she would have to "fail" at the traditional curriculum. She'd either not do as well as expected or would demonstrate a need for accelerated instruction in one or more subjects.

I don't believe there are other options in our insurance in the area for dev pedi so I am stuck.


I'm sure there are other options. You could attempt to access an eval through your school district, but it might be more challenging since you aren't in the system at this time. They are going to need her to demonstrate behaviors that could be educational in nature. Districts are mandated to serve private school students, but they tend not to go as deep if the child is in a private or parochial school since they won't be completing an IEP. Private schools don't typically accept students with IEPs since they don't have funding for the resources to service the IEPs.


You could also pay out of pocket or out of network. DS's dev pedi took insurance when he was affiliated with CHOP, since setting up an independent office he doesn't take insurance. He will provide receipts to file OON or deduct from your federal taxes. DS's psychologist never took insurance; his psychiatrist doesn't take our carrier. We write a lot of checks. The irony is that the developmental neurologist DS saw to tease out his SPD did take insurance albeit OON. I don't know of any top notch people where I live who take most insurance. Most take none.


My regular pedi is a wealth of knowledge but is on maternity leave, and we're switching schools next year and all that so we're sort of in a holding pattern which is ok. This is more from curiosity than a place of action, I guess.

Is this the same pedi who you don't think ever did M-CHAT?

What school will she be attending next year? A traditional district elementary? A charter? Magnet? Or private?

[akafred]

I think it's obvious already that the clinic we have been seen by is not the right clinic for us for many reasons. But one thing that always bothered me is that they have never once done any kind of screening test. They asked for OT eval for SPD, but they never did M-CHAT or any other test.


I wouldn't expect M-CHAT, it's a screening tool meant for PCPs and parents. The appropriate age for M-CHAT is 16 to 30 months. Char's PCP should have a copy or two of the results in her records assuming it was done at the usual time.

My point is they have done NO testing or screening of any kind whatsoever. All they have done is take verbal history, say "You are doing all the right things. You can refer to parenting education or take our parenting intervention program." So, you know, we're doing all the right things but need parenting training? Weird.


You're at Vandie, no? Are there other option in your community? Yes, but none take her insurance. I believe there are psych options but not dev ped.


I don't believe DD has ASD (and they did say it was not a concern), but I am just so surprised they never did any kind of screening or testing. When I asked about testing they said she was too young (she was new 5 at the time) to test for ID. (Which was/is not on my radar and shows how out of touch they are).


I wouldn't expect ID to be on their radar assuming they're looking at the child in front of them. Did her birthmom have a hx of drug or alcohol use during pregnancy? There was a hx of drug use, not alcohol. I specifically asked about IQ or cognition testing and she said they wouldn't look to test for ID until later (which was a surprise because I assumed they would look at her and see her as bright, but apparently her mind went the other direction apparently).

She'd be old enough to do WPPSI-IV at 2 1/2 which would yield an IQ. Maybe not as reliable as one done closer to 7, but it's valid. Do you feel like you aren't being taken seriously- as if you are the worried well? Could it be that they see you as a run of the mill anxious mom? Getting a pat on the head and shown the door?

Pretty much. I have an autoimmune disease much like Lupus and I spent my 20's being "6 month"ed to death before I found a dr who would listen. My labs were borderline so dx wasn't easy or simple.


They have asked a lot of questions about development. They have barely interacted with DD at all (and the psych did not interact with her at all except to scold DD for showing interest in her name badge).


Why do people like this work with children? DS once spit on his dev pedi; the man acted like it was all in a day's work.

Concerns I do have include ADHD, SLD, IQ/giftedness possibly, working memory, and BPD. And IDK what I don't know, so there could be more concerns. Is it unusual that they have done nothing except try to sell their parent training and say "we'll look into your concerns when she's older" (basically)?


These aren't typically concerns taken proactively at this age. TBH, these are all conditions where one would expect her to "fail" or demonstrate some unusual behavior before evals would be done. ADHD is generally something dxd in 1st or 2nd grade when children are expected to follow the rules of a traditionally structured classroom. Being in an experiential classroom, such as a Montessori program could mask that as it allows more movement breaks and self-direction.

That's pretty much exactly what they said. Specifically the psych, who said very first part of the only appt we had, "I already told dev pedi we will not consider ADHD until your child goes to public school and fails." I just don't accept this. Every decision I make (and agonize over lol) is designed to help prevent her from failing. I have what I consider to be legit safety concerns, especially after what happened last summer. She has problems in school; the fact that I found a private school that doesn't kick kids out when they have behavior problems doesn't mean there aren't any problems.

BPD can't be dxd until there are symptoms; onset of symptoms is generally no earlier than puberty and usually a few years older than that.

I've been reading a lot about how BPD needs to be ruled out before ADHD is dx, so I assumed it was something that could be identified, maybe not at 5, but before puberty.

Giftedness, Learning differences, processing and memory issues are also something that would come to the fore in first grade or beyond. Again, she would have to "fail" at the traditional curriculum. She'd either not do as well as expected or would demonstrate a need for accelerated instruction in one or more subjects.

I don't believe there are other options in our insurance in the area for dev pedi so I am stuck.


I'm sure there are other options. You could attempt to access an eval through your school district, but it might be more challenging since you aren't in the system at this time. They are going to need her to demonstrate behaviors that could be educational in nature. Districts are mandated to serve private school students, but they tend not to go as deep if the child is in a private or parochial school since they won't be completing an IEP. Private schools don't typically accept students with IEPs since they don't have funding for the resources to service the IEPs.

Exactly, which is why we haven't yet pushed for school eval. The only thing they could serve her with is OT and they don't touch sensory.


You could also pay out of pocket or out of network. DS's dev pedi took insurance when he was affiliated with CHOP, since setting up an independent office he doesn't take insurance. He will provide receipts to file OON or deduct from your federal taxes. DS's psychologist never took insurance; his psychiatrist doesn't take our carrier. We write a lot of checks. The irony is that the developmental neurologist DS saw to tease out his SPD did take insurance albeit OON. I don't know of any top notch people where I live who take most insurance. Most take none.

I can't do OOP. Just can't afford it, especially if we can't find a good dr the first shot. Maybe down the road, but not now.


My regular pedi is a wealth of knowledge but is on maternity leave, and we're switching schools next year and all that so we're sort of in a holding pattern which is ok. This is more from curiosity than a place of action, I guess.

Is this the same pedi who you don't think ever did M-CHAT?

I don't know if M-CHAT was officially done. They do have developmental questionnaires at every appt that are thorough. And we have had many conversations with her. She's the type to call you at 8:00 on a Friday night because she wants to make plenty of time to talk things over with you.

Next year she will most likely go to a private Montessori for elementary. They are the ones she shadowed last month. They don't kick kids out for behavior issues, and the elementary teacher is a perfect example of "kind and firm." I really think Char will respond well to her. Potentially she can stay there through 6th grade. I would hope for at least 3 years.

I just still cannot imagine Char in a traditional classroom. In our district they do 15 minute recess. They are "proud" to be increasing to 20 whole minute recess next year. And they don't go out if the temp is under 38 or over 90 or raining, so at some times of the year that is almost every day. And they take recess away for behavior. Etc etc etc. I know some of that can be addressed in an IEP but some won't. Maybe when she's a few years older...but not yet. She is high on the wait list for a public Montessori, which is possibly the best of both worlds. She is 7th; I know when she was 3 she was third on the wait list and didn't get in, so my hopes are low even though I do know another kid in her grade who is moving and freeing up a spot so she's effectively 6th. There is some hope but not much. She is also 17th on the list for another public Montessori and 28th for a design center (best school in district). But yeah I fully expect those not to happen, so we will most likely do to private Montessori route. And I think it will work out at least pretty well.

Like I said though, I'm not really asking for advice so much as curious why the dev pedi didn't do *anything* in the way of testing or screening. I always read questions like "Did they do Connors/WISC-2/M-CHAT/etc etc etc. Well they didn't do anything so my question is "Is that normal?" It's so frustrating to know that something is wrong but have "professionals" who don't seem to care. We're in a holding pattern ATM and that's probably for the best until we see what comes up next year.

[mrsbuttinski]

Feb 23, 2015 19:59:46 GMT -5 akafred said:

My point is they have done NO testing or screening of any kind whatsoever. All they have done is take verbal history, say "You are doing all the right things. You can refer to parenting education or take our parenting intervention program." So, you know, we're doing all the right things but need parenting training? Weird.

It could be the verbal history portion of the exam was part diagnostic tool. Sometimes clinicians are so adept at doing scales like BASC or Vineland that you don't realize you're doing them. When we first contacted DS's psych, he and I had a phone conversation in which he embedded the Sohn Grayson Scale for Aspergers. At the end of the conversation, he gave me an appointment later in the week during which he interviewed DH and myself- based on that he gave a tentative dx and scheduled DS. 

Are there other option in your community? Yes, but none take her insurance. I believe there are psych options but not dev ped.

TBH, the sorts of things that concern you are well within the expertise of a clinical psychologist or neuropsych. But you may have to pay out of pocket. Unless you end up with BPD at some point or choose to medicate for ADHD, this wouldn't be an ongoing expense. 

Do you feel like you aren't being taken seriously- as if you are the worried well? Could it be that they see you as a run of the mill anxious mom? Getting a pat on the head and shown the door?

Pretty much. I have an autoimmune disease much like Lupus and I spent my 20's being "6 month"ed to death before I found a dr who would listen. My labs were borderline so dx wasn't easy or simple.

That can be frustrating. But this isn't necessarily the same thing. All in all, Char is doing pretty well. Yes, she has some sensory issues/immature sensory integration and probable ADHD. But on the whole, she's accessing the curriculum at her school and learning. Like they said at the clinic- you're are doing the right things.

These aren't typically concerns taken proactively at this age. TBH, these are all conditions where one would expect her to "fail" or demonstrate some unusual behavior before evals would be done. ADHD is generally something dxd in 1st or 2nd grade when children are expected to follow the rules of a traditionally structured classroom. Being in an experiential classroom, such as a Montessori program could mask that as it allows more movement breaks and self-direction.

That's pretty much exactly what they said. Specifically the psych, who said very first part of the only appt we had, "I already told dev pedi we will not consider ADHD until your child goes to public school and fails."

Sounds like some serious bias. That would turn me off. Both DS's dev pedi and psychologist had very strong opinions about schools and often disagreed with our school choices as parents. It made for some uncomfortable cognitive dissonance. The dev pedi was all about accommodation and protection- find a private school with a small class of mostly NT kids for safety's sake. The school psych was of the mind that DS had a chance to be part of society at large and that public schools were the learning lab for what was ahead. 

That said, ADHD is a set of behaviors, if you have been lucky enough to find a school setting that is ideal to accommodate her ADHD it may not be fully diagnosable at this age. I've heard experts claim that in the days we hunted, trapped and farmed as occupations, there wasn't ADHD. Sounds like my niece who just last year got an ADHD dx. In retrospect, it was always there and her family and at least 3 psychs missed it. Including a Rutgers professor who has seen her weekly since 2006. The point is, niece is really smart and has generally made educational and work choices that worked for her ADHD skill set- she quickly gravitated to jobs in college and grad school that included novelty and multitasking. She was a much adored nanny and highly compensated waiter- on her feet doing a dozen things at once her ADHD didn't need meds- even in grad school where she kicked ass academically. But when she got her big girl job that includes acres of spreadsheets, unending teleconferences and staying socially appropriate in the context of a conservative workplace- she is happier with meds. 


I just don't accept this. Every decision I make (and agonize over lol) is designed to help prevent her from failing.


You might want to rethink this. Kids learn from failure. Don't protect her her from the growth that comes from the consequences of her actions. Granted you have to balance the magnitude of consequence against her age and her availability for learning. Going forward, a little failure could be a good thing. So could dealing with a couple of teachers who don't like her based on behaviors or because she rubs them the wrong way.


This book explains this better than I can-


www.amazon.com/The-Blessing-Skinned-Knee-Self-Reliant/dp/1416593063 


I have what I consider to be legit safety concerns, especially after what happened last summer. She has problems in school; the fact that I found a private school that doesn't kick kids out when they have behavior problems doesn't mean there aren't any problems.

The incident last year was a one off, wasn't it? Just some impulsive nonsense. 

What sort of problems are you hearing about now? I thought she had shown some real growth around participating in school and following directions.

BPD can't be dxd until there are symptoms; onset of symptoms is generally no earlier than puberty and usually a few years older than that.

I've been reading a lot about how BPD needs to be ruled out before ADHD is dx, so I assumed it was something that could be identified, maybe not at 5, but before puberty.

Not sure I agree. It's true that BPD would be a primary presenting dx if comorbid with ADHD, and it's true that you might see red flags for BPD in retrospect when the dx is made in adolescence or early adulthood. Most specialist I know think of BPD as something that "develops" or "reveals" rather than something that was always there as ADHD and ASD are even though a kid like mine wasn't "official" until he was almost 7.

I'd be careful, too, because there is some thought that BPD is over-dxd in children which means powerful meds that come with scary side effects. 


www.nimh.nih.gov/news/science-news/2007/rates-of-bipolar-diagnosis-in-youth-rapidly-climbing-treatment-patterns-similar-to-adults.shtml


psychcentral.com/blog/archives/2009/12/13/medicaid-children-get-4x-more-antipsychotics/

Exactly, which is why we haven't yet pushed for school eval. The only thing they could serve her with is OT and they don't touch sensory.

I can't do OOP. Just can't afford it, especially if we can't find a good dr the first shot. Maybe down the road, but not now.

There are ways around it. You could travel to a center that has someone who takes you insurance.

You could look into whether you have out-of-network coverage or even talk with you insurance company to see if you can get an exception to see someone. 

How much is a neuropsych eval where you live? Is there a discount offered for those paying OOP? Can you prioritize your concerns and have those portions of the workup done? 

Next year she will most likely go to a private Montessori for elementary. They are the ones she shadowed last month. They don't kick kids out for behavior issues, and the elementary teacher is a perfect example of "kind and firm." I really think Char will respond well to her. Potentially she can stay there through 6th grade. I would hope for at least 3 years.

I hope she has a good year. When picking schools for DS, DS's psych's mantra for such things always rings in my brain- figure out where he'll be in 5 years and what he'll need to be able to do to be successful there that he's not doing and work on that. YMMV, but sometimes that means more practice at what doesn't come easily.

For years DS was one of the most fidgety kids in scouts. Standing still while listening is a courtesy observed in scouting- and it's hard. So hard. And DS had a scoutmaster in middle school who could go on and on and on. The man called me last week to thank me for some PR I did for him and kept me on the phone so long (93 minutes to be exact- DS calls this death by PowerPoint))  I had 3 beers and got completely buzzed. At the end of 9th grade DS marched with the band in the Memorial Day Parade and stood stock still during the playing of Taps and the endless speeches. Scoutmaster commented to me about how maturity and scouting grew DS to the point where he could stand at attention for 20 minutes in a black wool suit after marching 5 miles on a 90F afternoon. IMHO, which I didn't share with him, the credit goes to the band teacher who brooks no nonsense- the sight of DS running a lap around the practice field with his trombone over his head for talking is one I will never forget. I could have made that consequence go away in his IEP, but I thought he was ready to have the consequence like every other kid. It's the skinned knee. 

I just still cannot imagine Char in a traditional classroom. In our district they do 15 minute recess. They are "proud" to be increasing to 20 whole minute recess next year. And they don't go out if the temp is under 38 or over 90 or raining, so at some times of the year that is almost every day. And they take recess away for behavior. Etc etc etc. I know some of that can be addressed in an IEP but some won't.


Ugh. She'll get there. Maybe middle school with changing classes, science labs and specials will suit her better.


Maybe when she's a few years older...but not yet. She is high on the wait list for a public Montessori, which is possibly the best of both worlds. She is 7th; I know when she was 3 she was third on the wait list and didn't get in, so my hopes are low even though I do know another kid in her grade who is moving and freeing up a spot so she's effectively 6th. There is some hope but not much. She is also 17th on the list for another public Montessori and 28th for a design center (best school in district). But yeah I fully expect those not to happen, so we will most likely do to private Montessori route. And I think it will work out at least pretty well.


That's unfortunate. Waitlists are crazy here, too. There is a great Quaker School here I would have loved to send DS to. But they didn't have a single opening over the 5 years he would have been able to attend. People just didn't leave his grade. In other grades, older siblings got priority based on their young sibs being enrolled. I have a friend who went there who couldn't get her DD in because of this situation.

The money spent on tuition would likely buy a top notch eval- and would be something you could deduct as a medical expense.

Like I said though, I'm not really asking for advice so much as curious why the dev pedi didn't do *anything* in the way of testing or screening.

They probably didn't see it as necessary. Most dev peds turf out the psychological testing- it's time consuming and writing the reports is mind-numbingly dull, I'm told. Plus, his psychologist shared that they didn't see a need. In the world of special needs kids, yours is really on the cusp and doing comparatively well.


I always read questions like "Did they do Connors/WISC-2/M-CHAT/etc etc etc. Well they didn't do anything so my question is "Is that normal?"

Maybe they don't have your sense of urgency- Char's a bright little girl who is mostly doing well. Given what you've shared about your pedi, they probably did M-CHAT at a well visit- probably at 18 or 24 months.

She's too young for WISC-2 or -3; and it's an expensive one to do. DS's WISC took about 2 hours, plus time to score and create a written report. DS's psych gave us the F&F discount and charged us hourly rather than the usual set price- so close to $600 at the time. TBH, WISC is generally only done if there's a concern about ID. DS had it done as part of the application process to private school; the private LD schools want proof that your child have an average or higher IQ for enrollment. Sometimes WISC is used for GATE placement in public school if the child didn't quite make the cut on CogAT or STAR and the parent wants to challenge the result.

Conners is the more common ADHD scale; there's an awful lot of overlap with Vanderbilt Scales. Given where you live; I would expect the local scales are more common. 


It's so frustrating to know that something is wrong but have "professionals" who don't seem to care. We're in a holding pattern ATM and that's probably for the best until we see what comes up next year.

That's the hardest part. Short of either going ahead with a private OOP eval that probably won't give you any information you can use for school purposes or plunging into public school and seeing how she does, it's where you're going to be for a time.

[akafred]

Just to clarify a couple of things:

When I say the decisions I make are intended to prevent failure, I mean large scale. I ABSOLUTELY believe in skinned knees and natural consequences. I am the opposite of a "helicopter mom."

However I'm not going to choose a school environment that I believe she will truly struggle with, be labeled negatively due to bad behaviors brought about in part by the very environment, not be challenged academically and not be able to learn new things when I have the option of a school environment that while maybe not IDEAL for her is at least supportive, nurturing, and allows her to learn and grow as a whole child just so she can have the chance to "fail" and be given supports to help her not *succeed* as they should do but rather simply "not fail." The psych said it was absolutely fine if she didn't learn a single thing this year, did nothing but run and crawl around the classroom, and we would wait until she is in public school to even discuss ADHD. She seemed not to listen at all when I pointed out she may never go to public school.

Was last summer a "one off"? IDK. Hasn't repeated, but the same impulsiveness around the same topic is still present. There are safety concerns, like climbing the 25' baseball chain link backstop, jumping from 8' in the air, etc etc etc. It just isn't typical behavior. And keep in mind this appt was just after and precipitated by the incident this summer.

We do give Char practice doing things that are hard for her, trust me. She takes TKD at school and has to stand still and listen reapectfully. It's "tiger cub" TKD but that (standing still and listening) is a huge part of their class and what they work on. I work with her on seat work at home and her teacher really works with her this year. I read to her every night and am more strict about sitting still and listening before I allow her to lie down and cuddle; I may even be too much of a hard ass here. To "practice" and make it easier at school. If I thought that putting her in Montessori for the next 3-6 years was making it harder for her to succeed later vs letting her struggle through public school now, I wouldn't make this decision. Again, this is what I mean by "the decisions I make are designed to prevent her from failure", not in the moment but long term. I believe she'll mature a lot in this area in the next year or two and get there in a few years, even with the increased expectations down the road. If I'm wrong, we'll make a change. I don't take that lightly; I would prefer not to make a change of course, but I'm not too stubborn to do it if it is the right thing to do. I honestly believe (and I don't mean this in a self-congratulatory way) that the reason she doesn't "fail" is because of all this work we do. I give her plenty of room to learn from mistakes, but not to "fail" in that sense.

[spooko]

I'm really sorry you've had such a struggle with this. I've been there and I can definitely commiserate. I do wonder if you'd be better off with a child psych at this point over a dev pedi. I didn't know about our clinic (because it's an hour away) until we applied to be seen at our Children's hospital and were turfed elsewhere. We weren't even permitted an appointment at the dev pedi clinic based on the years of documentation of DS' difficulties, but it ended up being for the best. We found a whole clinic of children's mental health professionals and when I called to set up the preliminary appointment, I was able to speak with a nurse or director or someone who was able to listen to everything I had to say about DS and find me the appropriate provider. I feel like that was the first time I was really taken seriously and we've made a lot of strides there.

TBH, I don't know that even then you'd get a ton to work with, though. You're already an excellent parent who really is in tune with and on top of Char, and I'm not sure they'd have much to offer you that you either have already researched and rejected as strategy or already tried. I do hope you find something that works for her, though. Whether that's the new school with the new teacher, or a medical professional down the road. I'm confident you'll figure something out for her, though, because you are so proactive and attentive to her.

[spooko]

FWIW, I do believe you can have an "off" summer. DS had one 2 summers ago. Last year was markedly better. Maybe it's that age or something, but it was ROUGH. I would have sold him mid-way through given the chance. I really only had smaller incidents in the whole summer last year--it was a huge difference. I hope this year goes smoother for her.

Also, we still have safety issues at nearly 8 yo here. Either my kid just doesn't have self preservation instincts or he's THAT impulsive that their deep in there and being overridden constantly. Cognitively he "gets it" but nothing ever changes. You know how with some kids you can say, oh, if they fall off the couch they won't do that again? Yeah, not my kid. He's had countless bruises, trips to the ER, and even killed one of his teeth over the years and he still does the same crap. GAH!

[akafred]

Right, but your kid has ADHD. That's kind of my point. The dev pedi/psych at dev pedi office ignore those safety (and other) concerns. I think it deserves more than a pat on the head.

Anyone know what the book symbol by this post means?

[spooko]

I wasn't saying they should down play it, just that I know what it's like to have these concerns and not get anywhere with it. We sit right on that cusp, too, where it took 2 school evals (one that I filled out as a worst-case scenario of his day) before the IEP was granted, 4 or 5 psychologists, a rejection of being seen at Children's, and hitting 6.5 yo before we were finally in a better place with this. And we still don't have it all figured out, even with a label and moving on to meds. I relate, that's all.

[akafred]

I wasn't mad at you ,

[Captain Serious]

Fred, our developmental pediatrician sounds a lot like yours, except they aren't pushing any kind of parenting style on us. I look to him as a kind of coordinator; he reviews all the kids background and records, and discusses their current situation with us, our concerns, and helps us make an action plan for the year. He makes recommendations for school setting and IEP implementation, further testing/specialist visits, and social welfare services.

Our nueropsychologists were the ones who did all the evaluations to help us determine what, specifically, was impacting the boys' educational and social development. They were the ones who administered all the evaluations and gave us huge reports and debriefings discussing everything they believed could be impacting their development and what steps we could take to alleviate some of those issues.

I think we could have been fine with just the nueropsychologists, but since we already had the developmental ped in place, it's nice to have him as a resource and advisor, of sorts. Also, he was the one who was able to diagnose M's FASD (based on social history, records review, current development, and interviews), so we needed him for that.

[mrsbuttinski]

Feb 24, 2015 22:02:25 GMT -5 Captain Serious said:

Our nueropsychologists were the ones who did all the evaluations to help us determine what, specifically, was impacting the boys' educational and social development. They were the ones who administered all the evaluations and gave us huge reports and debriefings discussing everything they believed could be impacting their development and what steps we could take to alleviate some of those issues.

I think we could have been fine with just the nueropsychologists, but since we already had the developmental ped in place, it's nice to have him as a resource and advisor, of sorts. Also, he was the one who was able to diagnose M's FASD (based on social history, records review, current development, and interviews), so we needed him for that.

I kind of hinted at this in my last post. You are so much more articulate. 

Since Charlotte's potential issues are strictly behavioral/mental health, rather than developmental delays, a good psychologist/psychiatrist should be able to sort this out. Good is key. We're lucky to have more options where we live. 

[akafred]

I think there are a lot of options here, but Vandy sort of holds the monopoly. At least where Medicaid is concerned. I think a psych is where we need to go next. We'll wait until pedi returns from maternity and address then though.

ETA that we have had a fair bit of problems with Vandy for Char. I go to a Vandy internist and my gynecological surgeon was Vandy (and incredible), but Char has been extremely hit or miss. The GI was pretty good when she was an infant (and the diagnosticians were great), but her ENT was seriously awful. She was only going there because she had some fluid in her ear after an infection and her records indicated she hadn't had a newborn hearing test. She went to the ENT twice. The first time DH took her and waited 3 hours to be seen. 3 hours! The second time was to see the audiologist for a test and to follow up on the fluid. Saw the audiologist who couldn't remember her name and just called, "Over here, baby. Baby" during the test and then told us they gave her a test she wasn't quite old enough for. After audiologist, we waited 2 1/2 more hours before walking out. In the parking lot the nurse called and said she had talked to the doctor who wanted to know if we wanted to go ahead with tubes. What the f? They hadn't even looked in her ears to see if she still had fluid, had not determined if her hearing was good or not, had not even said good morning to us, and wanted US to tell THEM if we should do tubes (which had never been discussed before) for a baby who had had one ear infection following the flu?

My husband never wants to hear the word Vanderbilt again, to be honest. I can't blame him!

At any rate, it's clear the dev pedi office is not going to be a good "general contractor" for us. Thank goodness our pedi is so wonderful.

[princesslily]

Fred, I'm so sorry you were dealing with a dev pedi who is giving you a business scheme rather than what you deserve, an answer. I can't imagine putting your eggs into a basket, to only find out you may have just wasted a year or so to come out of there with nothing.

You have every right to be disappointed and angry. I would just walk away at this point though - and figure another plan of action. Have you considered a child psychologist who specializes in special needs?

DS's psychologist asked us what in specific we were looking to test for - he specialized in ASD, LDs, ADHD - the whole gammut. I said we are looking at anything and everything to test. The more we knew, the better prepared we will be for DS' future. I know its not a dev pedi, but a psych who specializes in children, IMO is just as good.