A special case

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Wednesday, September 25, 2013


A READER wrote to me. He is an educator in a regular school and has a special case of a first grader who exhibits unruly behaviour repetitively since he was enrolled in the school. The teacher observes that the child has poor eye contact and has difficulty following instructions. He is unable to control repetitive actions despite gentle reminders. Constant efforts are being exerted by the teacher to guide him but no significant changes happen. According to the teacher, the parents seem to be in denial and simply dismiss the situation as child's play. The parents admitted that their child underwent evaluation about two years ago but the result was a normal diagnosis. Could there be a misdiagnosis? What is the right age of a child to really know he may have special needs?

Here is my advice. As an educator, it is best if you can request for a copy of the diagnosis because you might find some answers to your questions regarding the child. In some cases, developmental pediatricians indicate a summary of the child's performance in terms of gross motor skills, fine motor, speech, behavior, etc. Some developmental pediatricians would go further by indicating the mental age vis-a-vis the chronological age of the child, thereby helping the educators know where to start. And again, some developmental pediatricians would also recommend several options for the child, e.g. mainstream education, special education, one-on-one tutorials, speech therapy, occupational therapy, etc.

Since the child's evaluation was done by the developmental pediatrician two years ago, it would be advisable for the parents to have a follow-up evaluation to rule out autism or other developmental disorders or maybe some psychological problems. In autism, for example, repetitive behavior and other characteristics do change in intensity or form from one year to another, depending on many factors. The spectrum is so wide. Ideally, a yearly evaluation is recommended.

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It would be very difficult to say if there is a misdiagnosis. Developmental pediatricians usually base their evaluation on a standard criteria called Diagnostic and Statistical Manual of Mental Disorders (DSM), among other testing tools they use, coupled by clinical observations of the child, including an interview of the parents and caregivers and if lucky, some notes from their teachers or tutors. It is interesting to note that in the DSM 4, there are three categories for autism: Autism Spectrum Disorder, Asperger's syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). What I am trying to say is that even in the DSM 4, individuals who cannot be diagnosed as ASD or Asperger's syndrome but exhibit some developmental delays or disorders are then categorized under the PDD-NOS.

I sometimes come across some articles saying that diagnosis can be done as early as one year old. My eldest son was diagnosed at 3 years old, but as early as 1 year old, we have already noticed signs of autism in him.

Some children with special needs would go unnoticed by their parents until they reach pre-school and sometimes, it is the teacher who is able to easily observe the child's behavior as compared to his peers. And indeed, it is very difficult for a teacher to suggest or give unsolicited advice to the parents to have the child assessed or be re-evaluated because parents have different levels of openness and acceptance. If this is the case, my suggestion is for the school to invite a development pediatrician to talk before a group of parents and give an overview about developmental disorders such as autism, Down syndrome and other developmental delays. They usually give emphasis on what the parents and teachers can do if they detect some behavior problems caused by developmental disorders. This might open the eyes of the concerned parents and will make it easier for the teacher to propose to the parents the possibility of having a re-evaluation of their child.

I think that the results of the re-evaluation would be beneficial to both the parents and the teacher. If indeed the results would rule out any developmental or psychological disorder, this would give the teacher an opportunity to review his strategies on the student. But if the re-evaluation would indicate a specific diagnosis, this would pave the way for the parents to plan for the appropriate educational placement of the child. Let us just hope that the parents are willing to provide you a copy of the diagnosis or the doctor addresses his/her recommendations to your school/teacher.

Thank you, my dear reader. I admire your dedication in helping your student by giving an extra mile in studying his case. May we have more educators like you.

(Jane Ann S. Gonzales is a mother of a youth with autism. She is an advocate/core member of the Autism Society Philippines and Directress of the Independent Living Learning Centre (ILLC) Davao, a centre for teenagers and adults with special needs. For comments or questions, please email janeanngonzales@yahoo.com)

Published in the Sun.Star Davao newspaper on September 25, 2013.

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