January 16, 2010,
A.D. asks from Sammamish, WA on January 14, 2010
Autism Evaluation Vs. OCD and Tic Evaluation.
My son is on a 4-6 month waiting list to be evaluated for autism. But my concerns are more than just that. He also displays some OCD and tics. Which is more important to get diagnosed? One is neurodevelopment while the other is mental heath so two different categories they told me. Since my insurance isn't great, I have to pick one. Is some of the tics and OCD related to autism? If you have had your child diagnosed, any advice would be appreciated. Thank you!
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M.S. answers from Seattle on January 15, 2010
I just saw an advertisement that on February 1 and 2 there is an autism clinic sponsored by Safeway and University of Washington Autism Center. I believe that is it being held at the UW Tacoma campus. It is supposed to be an evaluation and consultation. You could probably contact the UW campus in Tacoma and find out more.
M.L. answers from Seattle on January 15, 2010
I'd do the autism evaluation first. The OCD and tic may be part of the autism. While treatment is helpful for OCD, early intervention for autism is much more important.
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I.G. answers from Seattle on January 14, 2010
Ideally an evaluation is done outcome neutral, meaning the evaluator does NOT look to confirm a suspected diagnosis, but rather will collect all information about all the symptoms that your son exhibits and form a diagnosis based on those observations. Unfortunately due to insurance limitations that is not always the practice and many children are misdiagnosed and receive the wrong treatment.
While we as parents and patients love to hear a clear cut result, any medical professional must explore possible differential diagnoses before coming to a result. Autism Spectrum Disorders are very widely defined and have a lot of overlap in symptoms with other developmental and mental health issues.
A developmental psychiatrist should be able to diagnose either one or both. That said, children with ASD do often exhibit traits that can be associated (and sometimes confused) with OCD or "tics". When have your appointment make sure to address all of the concerns that you have about your son. It is a good practice to make a written list of issues you would like to address.
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J.K. answers from Bellingham on January 15, 2010
Both will be important in the long run because they will both impact the treatment of the other and your life quite a bit. So, I'd like to make a suggestion. There are agencies that can help kids with special needs that will provide funds for needed medical tests/therapies when the insurance won't and the parents can't pay. You have to apply. Here are two that I know of:
http://www.sisuchildrensfund.org under the tab "application". They paid for our daughters to get equipment for the "tomatis program", a therapy that is not covered by insurance. I know they've also helped a friend's child get vision therapy.
http://www.blueskiesforchildren.org/ I've heard they will pay for a one-time need for lower income children.
The ARC might be able to help or direct you to resources:
The Arc of King County
Sylvia Fuerstenberg, Executive Director
233 Sixth Ave N
Seattle, WA 98109
###-###-#### - fax
AND, one of the biggest helps is community support. With my two special needs girls, the best help has been from learning the stories of other parents and what resources are out there. Get involved with a local parenttoparent group.
http://www.arcwa.org/parent_to_parent.htm to find resources
and http://www.arcwa.org/p2p_contacts.htm to find out when/where they meet..
I know this is a hard time. Take one step at a time and know that it will eventually get easier for you and your child!!
In the meantime, about which to do first.. which do you see as causing the greatest problems right now? I'd normally say work on the autism first, but if the OCD symptoms are causing greater agony, start there (unless your pedatrician says different).
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G.R. answers from Spokane on January 14, 2010
Hi A. - I know that dealing with the waiting game is a tough road. The big thing is to remember that even just us moms are making a guess at what is "different" or "special" about our kids. Right now you have some general ideas/categories of where your son might fall into. Only use those ideas as a spring board but dont get stuck on them.
Side note: I also know that dealing with private insurance is hard too, dont stress that they will drop your coverage, the only way they are permitted to do so is if you miss payments, etc so if you keep everything up to date you should be just fine. It is always a good thing to read the fine print on your contract to refresh your memory about your policy.
Back to your questions...Regardless of who you have evaluate your son (sometimes it will take several different specialist to get a proper full diagnosis) is to put everything in order - every symptom, observation, history from birth, etc (you will have lots of forms & paperwork to fill out and this will save lots of time). You need every doctor/specialist to have the same information & be on the same page. The doctor then is to review the information you give and then order additional tests/evaluations to help rule out some things and confirm others (these can be blood work, MRIs, observation, Q&A, etc). We as parents & specialist need to be open minded as to the possibilities and many possible overlaying disabilities that one person may have. It is entirely possible that a child with autism may also have OCD as well as other concerns or disability.
So my suggestion is to take the specialist who has the most experience with a variety of disabilities not just a specific one. I also recommend that the specialist you end up working with primarily deals with pediatrics. For us personally we have worked with a variety of specialist including: SLP, OT, peditrician, ENT and also a pediatric neurologist - as they work with all disabilities and can do official diagnosis as other "professionals" can only give an educated guess, this again depends on their education & certification.
It is usually through a team of experts that you will be able to get a better picture of your son. One of the things that I do caution you is that some evaluations (usually if they are fine tuning evaluations) they may not be able to do until he is older but do not let that stop stop you from starting the process. Remember to also take any evaluations that his school does to the specialist (this will save you time & money) as you want to make sure the specialist has as much information as possible to help give you the answers you need. God Bless
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M.P. answers from Portland on January 14, 2010
A quick response for now. You can have him evaluated thru the Intermediate Education Service District in connection with the school district. Evaluation is free and mandated by law. They will look at him as a whole child and be seen by more than one specialist.
The school district is then mandated by law to provide any assistance that he may need in order to be successful in school.
You can still have an evaluation with a private specialist at a later date. But by connecting with the school district he will be seen within a week or two and you'll have an idea of what is going on. And the office and you will formulate and IEP (Individual Education Plan) which will help his needs to be addressed sooner rather than later.
My daughter, who has ADHD, has an IEP which provides for a writing coach during school hours. Otherwise she's in a regular classroom. There is no stigma involved as there was whenever a child was different when I was young, 40 some years ago.
My daughter has been working with the Intermediate Education Service District with her son since he was 2 1/2 and has been happy with the evaluation and services provided. I think that using private services may provide a more intense evaluation and treatment but as you said it's expensive.
My grandson has received some services thru his insurance, Kaiser Permanente, and was seen immediately once the school district finished their evaluation.
You can find the phone number for your county's Intermediate Education Service District under your county's phone listings at the front of the phone book. Or you can get the number from your school district office. Your son's school may also have the number and be able to discuss it's services with you. Or his pediatrician can give you the number. My grandson got started when his pediatrician gave his mother their phone number.
I highly recommend that you get started as soon as possible. Start with The County Education Service District. They will consider all of your concerns. It's quite possible that the all 3 are related. If there is any concern that they cannot address they will tell you and recommend a place for you to go to get help. You can also get involved privately once your son gets an appointment off the waiting list.
N.M. answers from Seattle on January 15, 2010
Don't know how old your son is, but mental health professionals are technically not supposed to diagnose children (if I remember, even until they are in their teens) with having any kind of disorder because a lot of the behaviors that define the various disorders are NORMAL behaviors for children and so it is very difficult to say that a child displaying these behaviors is behaving so far out of the range of normal as to have a disorder. Whereas, autism is a disease that definitely needs to be identified, understood, addressed, and treated appropriately sooner rather than later. Further, a diagnosis of autism would likely explain some of the behaviors that concern you about OCD/tics and treatment of the autism may moderate those behaviors. Best to have him tested for autism.
M.D. answers from Seattle on January 15, 2010
I'm new in this too - but I think that the neurodevelopment evaluation is more important. You need to rule out the more serious disorder and if he does fall in the Autism spectrum then he will receive therapy for all of his issues. A child with Autism can have related OCD and tics but just because he has the OCD and tics doesn't mean he has Autism. That being said, my 3 yr old son was on that 4-6 month waiting list at the Childrens Autism clinic after I went to the pediatrician with concerns about his OCD and social behaviors (he was seen after only 2 months by the way)and when he was evaluated they said he wasn't even close to being autistic and they said nothing about the Sensory Integration Disorder that he was diagnosed with at MOSAIC a week later. I personally think that his OCD is a result of the sensory issues because it is his way of having control over things when he doesn't have control over himself. So I'm hoping that it will improve with his therapy for Sensory Integration Disfunction. If not we were told that he would need to be seen for mental therapy. So first do neurodevelopmental and then mental if necessary.
J.C. answers from Spokane on January 15, 2010
It is not uncommon for a autistic child to have ocd and tics... my 9yr old is PDD-NOS and had some ocd traits as well as ticks. my advice is focus on the autism and then go from there.
good luck =]
J.L. answers from Portland on January 15, 2010
In my experience with our 4 1/2 yr old (autism spectrum/aspergers, sensory integration disorder) OCD is definitely a symptom of Autism. I don't know about the ticks since mine hasn't been diagnosed with ticks but he tends to repeat things that he's heard or fixate on a piece of dialog from a book or movie (it's called echolalia). Are you getting an evaluation from Early Childhood education or one through a hospital clinic? We got both eventually (both before he wast 3). We found the ECE to be more thorough with regard to educational needs. He now goes to ECE preschool and gets Occupational Therapy & Speech Therapy at a clinic. They focus on different areas and both have been valuable. Since ECE is free, I recommend getting them involved. We wish you much success with your son.