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What Type of Specialist Do I Need?

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Developmental Pedi or Neuro-Psych for 5-year-old?

April 2001

I am having a very hard time at home with my 5-yr old son. He is very sensitive and emotional, and has terrible temper tantrums, becoming hysterical for very irrational reasons. He is also very aggressive toward his 3 yr old brother. He suffers from low self confidence and poor self esteem, due, I think to several borderline developmental delays/disorders(?). He "scored" below his age for kindergarten testing for fine and gross motor skills, visual and auditory perception, and language. He has trouble integrating himself into large groups of kids. He behavior is excellent at school, although his teacher is a bit concerned about his development. I should note that he is bordeline in all of the categories, not noticeably different from any other kindergartner to the average observor. To me, it seems as though it takes him a bit longer to process things than for some of his peers. And, it has taken him longer to learn his letters, numbers, etc and his is still grappling with time. There are, apparently, no public school tests available to him at this age, so we are trying to decide whether a pediatric developmental specialist or a neuro-psych specialist would be more appropriate. He seems unhappy with himself, and I just don't know how to help him. His tantrums make our household very volatile, which is very hard on all of us. Anyone have any suggestions as to which direction we should take? K


>> There are, apparently,
>> no public school tests available to him at this age,
I'm not sure what you mean by this last statement. The school district is required to test him if you request it. Do so *in writing.* If you want to contact me, I can send you a sample letter. The fact that his teacher is concerned just strengthens your argument that he needs a full evaluation by the school district. I don't know what you mean that he is borderline in all categories --- according to whom? I assume that you don't mean he has been formally tested for developmental delays. At his age being "borderline" can be a red flag that he is really having trouble. Lots of people will tell you not to worry, and while you might choose that approach, you also should consider that you have the opportunity to understand what's happening with him and begin getting him the help he might need at this young age, when he hasn't had the time to fall behind significantly.
>> so we are trying
>> to decide whether a pediatric developmental specialist
>> or a neuro-psych specialist would be more appropriate.  
>> He seems unhappy with himself, and I just don't know how 
>> to help him.  His tantrums make our household very volatile, 
>> which is very hard on all of us.  Anyone have any
>> suggestions as to which direction we should take?
It does sound like you and he need help. A neuro-psych and a ped. developmental specialist are different. A neuro-psych will do cognitive and developmental testing, and also an emotional/behavioral eval if you request it. A Behavioral or Developmental Pediatrician will take a thorough history, perhaps do some initial, exploratory testing, meet and talk with your child, talk with his teacher and is qualified to diagnose and treat conditions like Aspergers and ADHD. She/he can provide ongoing care, and coordinate your child's care. The neuro-psych is usually a one-shot sort of evaluation, but it will be a thorough test of your son's cognitive abilities.

One road you might consider is seeing a Developmental Ped. and having the cognitive testing done bythe school district. Some people prefer to pay for a private evaluation, rather than have the school district do the eval, for various reasons, but you can't beat the price of a school district eval! I could go on and on. Feel free to contact me if you want. Good luck, Lindsay


I am currently a Mommy of two small children, but before the children, I was a kindergarten and 1st grade teacher. The thing that made me think I should respond to your email were these two sentences that you wrote: "He 'scored' below his age for kindergarten testing for fine and gross motor skills, visual and auditory perception, and language. To me, it seems as though it takes him a bit longer to process things than for some of his peers." I had a 1st grader a few years ago that had been dubbed by her kindergarten teacher as "ADD," but I didn't buy it because I have seen ADD, but she wasn't classic. I sensed she was more frustrated about something than she was just not able to keep her attention on something. I won't write the whole experience in here because it's quite lengthy, but please write me if you want specifics. To make a long story short, I told her mom to have her tested for "Auditory Processing Disorder." APD is basically a disorder where the child can not PROCESS the information given him in life. It's not that he wouldn't understand it (once it's finally processed) or that he is distracted too easily (because it takes so long for the child to process one three-word sentence, that two or three-sentence instructions from a teacher or parent is so hard that after 15 or 20 minutes, he finally gets so frustrated he stops trying and begins to do his own thing -- thus some think these children are ADD). Anyway, this mom had her child tested and she was severe APD and she was able to see an APD specialist and she began getting A's on her spelling tests (where-as she was getting F's on EVERY SINGLE spelling test during the first few months of school). It is definitely something you can have looked into. You may have to have him tested at a special place as most schools don't yet test for this disorder. But if this is what your son has, it will make life SO MUCH easier for him once you know for sure and can begin to deal with that specific problem. Good luck! April
I have had a similar experience with my son, and would be happy to review the various tests and consults we used. (Too lengthy to write.) The "magic" answer for my son was ocupational therapy for sensory integration disorder and fine motor delays; your son sounds very similar, and I urge you to get and O.T. eval. Call if you'd like to discuss. Valerie
A developmental and behavioral pediatrician recommended a sensory integration evaluation (among other things) for my 8 year old son; he's now receiving occupational therapy (OT) services from his school under an independent education plan (IEP). A good book explains the array of sensory integration issues and how sensory processing challenges can affect fine and gross motor skills, as well as social skills: Out of Sync - Sensory Integration Disfunction, by Carol Stock Kranowitz. It was valuable to see the developmental/behavioral pediatrician first, since sensory integration is just a piece of the puzzle for us; there seems to be quite a bit of overlap in how these challenges present themselves, and kids can have more than one set of challenges going on. PS, we had seen a pediatric neurologist at Children's Hospital before taking the steps above. Meredith
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