Aaron - assessment & diagnostic appointment

At Aaron's 4 year check up Rich and I were concerned about his difficult behavior and wondered if he's on track developmentally. The pediatrician referred us to Square One with Dr. Axelrod, a pediatrician who speciallizes in developmental and psychological assessments for children. She did several rating scales with us and Aaron's teacher, a physical and neurological exam, an hour long observation and screening with Aaron and the child psychologist, and a clinical interview with us. She also referred us for an additional speech assessment.

We met with Dr. Axelrod and Dr. Causey (child psych) last week. Aaron meets criteria for ADD, in attention and emotional regulation. They said that they did debate over this as a diagnosis and said that as he matures and we have more information, the diagnosis may change somewhat. They are concerned about a mood disorder. His IQ is normal and his speech is typical for a 4 year old - both causes for celebration because we've worried about a cognitive delay and he had an expressive speech delay as a toddler. He still has low motor tone in his upper body and sensory integration concerns.

We have some direction now. They are recommending one-on-one work with a child psychologist (checking Humana for out-of-network expenses for the one we'd like to use) to work on his frustration tolerance, self-help, and social skills, plus work with Rich and I on how we parent him. We are also going to continue with the occupational therapist at Green Hill for sensory integration, so Aaron will get to continue riding horses and she also does a lot of work on fine motor skills and self-help, such as buttons, zippers, etc.

Medication is an option. Dr. Axelrod suggested re-evaluating medication after about three months of therapy to see where he is on mood and frequency of tantrums at home. Her concern is his developing self image and typical mood, that it's not healthy for him to be consistently frustrated and out-of-control.

I was surprised by ADD as the initial diagnosis - my fear was that he would be on the Autism spectrum with either Asbergers or PDD. Dr. Axelrod said that his early speech delay probably has slowed down his development socially with his peers.