Do we need to do more for DS2?

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08-03-2017
AngB

Do we need to do more for DS2?

DS2 is 4.5 and has an IEP for speech, OT, academic delays (I don't remember what it is qualified as exactly but it was a generic "early childhood delay" label he qualified under.)

He goes to half day preschool through the school district and has an inclusion preschool class and receives his speech and OT there. We are relatively happy with it all and he has made tremendous progress (literally went from spending the fall semester hiding in the corner and refusing to participate at all at his regular ed preschool to interacting, making friends, riding the bus to preschool without getting upset, etc. He can go to a busy playground and make a friend now vs. a year ago he'd be crying on a bench begging to leave and refusing to play if there were more then a couple kids at the playground.)

He has never been formally diagnosed with anything but I am pretty sure he has sensory processing disorder (I have an education background and my mom is a retired special ed teacher), and my mom feels like there is probably either some OCD/anxiety at play as well but it's really hard to eek out right now. (Does he only wear the same 3 shirts and 3 pairs of shorts every day over and over bc it's a sensory thing and he knows they are comfortable, or is it an OCD thing, or just a 4yo who loves Batman shirts thing?) We would not medicate him for anything at this point as we can talk him through a lot of his anxieties most of the time with a lot of time and patience (ie. last year he refused to swim/do water play/do Ferris wheels, etc., this year he has been fine with everything except doesn't like getting his face under water.)

Anyway, we have his well visit at the ped coming up and I am not sure if I should ask about a developmental ped/work toward getting a formal diagnosis or just keep going as we are since he is already receiving services and making really great progress and I'm not sure that there's a point in pursuing a label further at this point when he's already receiving services and it is going well. I don't want to shortchange him by not getting more information though if it could be helpful. Thoughts?!
08-04-2017
annex

Reasons you might want to pursue a medical diagnosis would be wanting it in the medical record e.g. to ease referrals if you want insurance to cover outside therapies. Also for school, I think in most (all?) states they can't continue the ECDD eligibility beyond a certain age (6?) so they will be looking at eligibility soon-ish and your outside eval might smooth that process. Having the "label" will also help you find support groups or info online or locally to connect into with any questions. Also it will give your child language to use to explain why their brain/body works differently if the issue persists to help them self-advocate and not be confused about why some things are hard for them compared to their peers. Wait lists can also be long, so even if you get on a list now, you still may not see the specialist for 6 months, or a year, from when you call.

Reasons you might want to skip it - not wanting insurance coverage for outside therapies, so why have it in the medical record as a pre-existing condition when/if health insurance might go back to that model of excluding those with pre-existing conditions. Also, the school psych can do some diagnostics when they revisit IEP eligibility - those might be sufficient (and free!) to help you continue to maintain IEP services and make progress at school.
08-04-2017
niccig

Do we need to do more for DS2?

I work as a SLP in my school district. It sounds like your son's eligibility for school services is Developmental Delay. In my state, a child can no longer have that eligibility for K, so all the preschoolers get re-evaluated before K. The eligibilities we can use for school aged include Speech and Language Impairment, Specific Learning Disability, Autism, Other Health Impairment, Emotionally Disturbed and Intellectually Disability. The issue we have is that many children that qualified under DD, don't qualify under other eligibilities, except maybe for speech, but that only gives speech therapy not OT or academic support. SLD requires proof of academic delay, and preschoolers aren't doing academic school work, so that's often not given until late K or 1st grade. OHI is used for a range of Other Health Impairments, including ADHD, or medical conditions. If you child had a diagnosis, it may be considered under OHI eligibility. I had one student who was Speech only that needed academic support, but we couldn't give that to her. She wasn't going to qualify as SLD as beginning of Kindergarten, but as she had a medical condition, we could reclassify her as OHI, and she got academic support.

Sometimes you need the label to get the services. I had one parent that wanted to dispute the Autism eligibility as outside provider said child had Social Language Disorder. We don't have that option as an eligibility for Special Education services. It was either Speech or Language Impairment with no academic support or Autism eligibility with Speech and academic support - keep in mind that the school criteria for Autism eligibility is not the same as DSM criteria for Autism diagnosis, and the child did meet schools criteria for that eligibility. Parent agreed and child got services they needed.

I would find out how long the Developmental Delay eligibility continues in your state, and ask about the process of transitioning to K. If he will keep DD eligibility for a few years, you may not have to worry about reclassification and gave time to see how he does in K.

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08-06-2017
AngB

Thanks for the information as far as kindergarten/transition. That's a really good point I haven't considered. I am not so concerned with him having a "label" or not as much as I wasn't sure there was a point since he is already receiving services we are happy with. I know these appointments can take awhile so I will definitely talk to our ped about getting a referral to get his issues formally assessed. I don't think there is much doubt he will still qualify for speech into kindergarten unless he progresses this year more then we expect, but we do definitely want him to get the academic and emotional/sensory support he may need for kindergarten so it definitely sounds like it's worth starting the process now.
08-07-2017
hillview

I'd get a neuropsych eval. As a parent I've found it helpful to know exactly what I'm working with.
08-11-2017
niccig

Quote:

Originally Posted by AngB

Thanks for the information as far as kindergarten/transition. That's a really good point I haven't considered. I am not so concerned with him having a "label" or not as much as I wasn't sure there was a point since he is already receiving services we are happy with. I know these appointments can take awhile so I will definitely talk to our ped about getting a referral to get his issues formally assessed. I don't think there is much doubt he will still qualify for speech into kindergarten unless he progresses this year more then we expect, but we do definitely want him to get the academic and emotional/sensory support he may need for kindergarten so it definitely sounds like it's worth starting the process now.

It may be easier to qualify for academic support in elementary school if he has a diagnosis from a medical provider. I'm not saying it definitely will, but it can be a difficult process when we transition a child from Developmental Delay to one of the other eligibilities. Often, they only qualify for speech only and NO academic support. We know they'll probably need more, but the school psychologist doesn't have any evidence to prove the need, and we have to wait to see if they're struggling academically. A medical diagnosis may open up the Other Health Impairment eligibility that will provide speech and academic support.