Gifted Issues Discussion homepage Forums Age or Ability Specific Forums Pre-school DS's Pedi doubts us.

From our last two appointments, I've gotten the feeling that my "concerns" or questions about DS(18mos)'s eccentricities to his Pedi have been largely brushed off. I asked her when we'd start to notice OCD or ASD and told her I was a little concerned about DS showing signs. Such as: He does NOT like things out-of-place or dirty. He picks up wrappers in the park, throws them away, he recycles & throws away garbage at home. He puts his plates, bottles, cups in the sink. He turns off lights and closes doors when he leaves a room (or he'll go back and do it), puts his toys back, picks up dirty laundry(none of this has been taught). He will throw a fit if he can't accomplish his tasks. Anyways, when I asked, she said I shouldn't worry about it - everything sounded normal for his age.
Normal? Seriously? Is it normal for a baby to demand to practice walking with assistance from 6 months and only crawl for like a week? Is it normal for this same baby to reliably sign multiple baby signs at 5 months with just one or two contextual exposures? Is it normal to be signing well and understanding almost all adult conversation in English and Spanish at 18 months? Is it normal that we've had to change baby safety locks on our cabinets three times (and finally gave up)? This kid, at 14 months, said "want down please" clear as day. He somehow knows the alphabet and numbers to 6. He plays jokes and tries to fool us. He actually plays the piano by sound. Anyways, you get the gist.
When talking to his doctor at a follow-up just over a month ago, she was saying we needed to schedule his 18 month appointment to check his milestones. I told her I wasn't worried about any milestones and we could just do it that day and my DH followed-up saying "we can, he's already surpassed what most 24 month olds can do." He wasn't bragging, just being practical and honest. She looked at us like we were crazy and replied with something like she'd like to wait until he was a full 18 months to assess since we'd expressed concerns for OCD/ASD in June. He will be 19 months and I feel like she's still going to be writing us off as THOSE parents - who think their kid is golden. She said not to even worry about potty training him until he's 3. I wanted to tell her, he's already started showing signs (literally and figuratively) but I didn't say anything. He'll be potty trained before he's two if I had to guess. He's already been evaluated by Cognitive and Developmental Psychologists, had an fMRI, PET scan, and EEG (for infant/toddler cognition research). We know he's precocious, but I don't know how to get her to take us seriously. We really want him to be referred to a child psychologist for speculation of OCD/ASD and ways to help him cope or work with him. I'm not wanting her to tell me that he's too young or I don't know what I'm talking about. Tips from those that have been there? Does this warrant switching Pediatricians?

I think whenever you feel like your concerns are not being addressed it's time to switch pediatricians. She should at least give you reasons why she's not concerned. I think it's fine for a doctor to disagree with a parent about parent concerns, but they need to give you reasons. It irks me when I feel brushed off with no explanations given, or dumbed down explanations, as if I'm too stupid to understand.

Also, make sure you give HER reasons why you think it could be ASD or OCD, for instance a checklist, and name the characteristics where you have concerns. Otherwise there is no way for the doctors to determine which parents are fruitcakes and which have done actual research.

If you can go to specialists without a referral, go ahead. I know some folks find pediatricians and family practice doctors and love them, but I have yet to find one that thinks for himself/herself. I do not know one person from my HS or college who went on to become a GP or ped who was considered a top student in HS/college. Above average intelligence - yes - but just grinds who could memorize a bunch of stuff.

I found that the pediatricians could not deal with the physical ailments, which were rather routine, so there is no way I would even ask about something that is not a physical problem. Switching doctors is a pain, so I would just go to the specialist if possible.

My youngest had a fairly routine condition, but an "extreme" case, and we eventually had to travel to CA from PA for treatment (surgery). I always ignored those flyers with recommendations on TV viewing and the such that the doctor hands you - they need to address physical conditions before they venture into other areas.

Sorry for the rant. One of these doctors also noted something they considered advanced cognitive skills during a visit at 16 months, but I brushed it off (since my eldest had achieved that at an earlier age than middle kid). Doctor did not suggest that we do anything special though - just noted that "they aren't supposed to be able to do that yet" or something along those lines.

Even if you go to a specialist without a referral, which many health plans allow (ours do), I would still suggest changing pediatrician.

There are good ones out there - we love ours a lot, who always take the time to discuss issues and his reasoning and he has never dismissed our concerns (in fact, he flagged a few things that were critical when we had not realized it was serious). He was the one who caught a co-worker's daughter's diabetic condition early enough that the children's hospital were impressed he detected it. So there really are good pediatricians out there.

I know my parents regret listening to their doctor when even a family friend who was also a doctor told them that I should be checked out - their concerns were also brushed away as "she is fine, she will outgrow that" and by the time I was checked out, I was almost 4. It took years of remediation and work to make up for the gaps I had developed in those early years.

Seconding blackcat's advice.

FWIW, I also have some questions - these aren't meant to pick apart your concerns, but might help you look at this from the ped's perspective. The ped, also, has actually seen your child - which is something none of us here have had an opportunity to do. Anyway, I'm not clear from your post if you're concerned that OCD/ASD might be present, or if you want to rule it out. Also not entirely clear if you're wanting confirmation of giftedness and are concerned that you need to be addressing the potential gifted abilities. One thing that is confusing to me is - how is your 18-month old able to put his dishes in the sink and turn off lights? Please note, I'm not questioning that he's doing this, but my limited experience with 18-month olds, light switches and sinks makes me question it because of height. Is it possible your ped is hearing things that just don't make sense to the ped from the normal realm of childhood and therefore discounted not only those things, but other things you brought up? Also think about how you presented what you were talking about - if you're seeking a referral make it up front, clear, direct, and have reasons to support it.

We've had issues with a ped and early childhood drs in our family in one specific instance with a child who had medical issues that didn't fit the norm of what the drs were used to seeing. Two big roadblocks that were difficult were: 1) dr's ego - drs who felt they were being questioned when we weren't able to report back what they expected to hear, and 2) limited time during an office visit - our dd's drs were heavily booked and didn't expect to have to spend more than a few minutes with each patient, and became annoyed when we had more than a few minutes worth of questions that weren't easily answered.

Another issue we ran into (same dd) were drs who made assumptions based on behaviors/etc they saw within the limited timeframe of an office visit - which is an environment that the child isn't usually living in, hence isn't exactly the best illustration of "typical" behavior for the child. It sounds like there's a possibility that in your situation the dr is seeing a child with no behavior issues partly because they are observing in a limited window... a work-around for refocusing on true issues is to have a list with you that you've put together before the appointment, listing what you see as concerning behaviors.

My advice is to take a step back, clearly define in your own mind what it is you're seeking, find supporting evidence, and try again with a new dr. Think through the roadblocks you might encounter at that dr visit and be prepared with a plan if they pop up - for instance, if the dr seems to be short on time, let them know you have more questions and ask if you can leave a list and have them call back or schedule a follow-up visit, or ask what you can do to get your questions answered. etc.

The other thing to do: filter your list to only include pieces of data/info that fit with what you are concerned about or make sense in the story you are trying to convey. For instance, in your OP you mention toilet training, the dr said don't worry about it until your ds is 3, you're noticing signs of readiness. In reading the post, it's not clear to me how this relates to what your concerns are - I hear the dr saying that not being ready to toilet train isn't an issue until 3 (which mirrors everything I heard as a parent of young toddlers), and I also hear you saying you see signs of readiness so you're frustrated that the dr is mentioning don't worry about it yet... but I don't understand how any of this applies to your concerns you're trying to follow up on with the dr re ASD/OCD - which is, I think, your priority concern. I realize this sounds like I'm picking your OP to pieces, and really I'm not - just trying to make a point, when you have very limited time with a dr, you'll want to be as clear as possible and not get off-focus with extra questions/etc.

Hope this makes sense!

Best wishes,

polarbear

ps - this is just a total guess, but I'm wondering if part of the reluctance to finish off the 18-month check at the 17-month visit was vaccine schedules - there are several boosters/vax required in our state at 18 months which can't be given sooner.

As always, pb has excellent advice. I also agree with blackcat's pedi suggestion.

It also sounds like there might be some confusion about which behaviors are suggestive of high intelligence, and which of ASD. Many of the behaviors you describe could be perfectly normal--in a GT toddler.

So in the context of concerns, it would be reasonable to consider the motor skills, orderliness, language, toilet training, etc., to be "normal", because they are not delayed.

If you are looking for clarity about ASD/OCD, the target category of behaviors would be restricted/repetitive behaviors, or rigidity. For ASD, you would add social communication and interaction skills. TBH, your posts to date don't suggest deficits or delays in SCI, nor do the RRBs appear to fall substantially out of the range for toddlers. It's just that the range of his awareness is wider than that of many other 18-month-olds, which usually means that the gap between the world of which he is aware, and the world over which he has control, is even wider than that usually experienced by toddlers, which naturally would be expected to raise his anxiety--which contributes to his need for order and predictability. Having raised a number of toddlers, and worked with many, many others, I can say that it actually is common for 18-month-olds to pitch fits about not being able to finish little tasks they've set for themselves. HIs tasks are just a little more sophisticated than those of some other toddlers.

Of course, we know only the tiny slice you've shared about your son's development, so it may be that you actually are seeing RRB and SCI symptoms. If that is the case, I would suggest focusing your symptom reporting on those two categories, when you are listing your concerns for the pedi.

With respect to acknowledgment from your pedi that your child is above the norm, I would agree that, if this is an important part of your relationship with the pedi (and it may become more important if you will need this person's role as a resource for addressing GT needs in the future), then you should consider a new provider.

And small note to NSG:

I just have to mention that one of my EG sibs is a family practitioner, as was one of my parents (not tested, but contributed one set of chromosomes to each of multiple children, all EG/PG, so can't be too low IQ!). And our pedi graduated from an elite post-secondary institution in a STEM field, prior to medical school.

So obviously, not all pedis, FPs, and GPs are just high average grinds!

Polarbear, your post was SO helpful! Thank you! To explain, we have a couple low light switches and if we are carrying him, he signs and reaches for the switch. For the dishes, there is a step stool in the kitchen that he moves around and climbs onto and puts dishes into the sink. He asks for help a lot, but he is very tall for his age (just shy of 3'), so he can easily reach door handles and such. I think I'm unhappy with her dismissal because she seems to think that because I was concerned about DS having ASD/OCD that he couldn't be as advanced as I was letting on. When we fill out those questionnaires about milestones, DH and I would discuss out loud what he was able to do/not do and she kept giving us weird looks when we said he could do something out of the norm for his age...like we were lying. Like you'd imagine,the kid I have at home is different than the one I bring to the dr.
Regarding the potty training, I'm just wondering how I can trust her to give me accurate advice for MY son, not just the norm. I had already explained to her that he was telling us when he peed in his diaper and when he wants changed. He prefers taking off his own pants each night after we unbutton and unzip them. Those to me are signs and while I'm in no hurry and don't mind the diaper phase (he's already growing up too fast), I don't want to miss opportunities or give him the wrong message.
I'm not so concerned about being labeled as gifted because it doesn't change anything, but the OCD/ASD would require further action on our part and I'd rather intervene early than late. DH's uncle is ASD/OCD (also HG) and we see A LOT of the same behaviors in DS and they don't spend any time together.
I appreciate your critique of how I can maximize my time with his pedi and how to best get what I'm after. I'm terrible at being concise and concrete. I will definitely be making a short list of my questions/concerns and ask for a referral. If we still get the brush off, then I know it'll be time for a new pedi for sure.

aeh, I know the good GPs and peds are out there somewhere, but unfortunately I have not found them. At this point, with only one under age 18, I am just waiting to be done with pediatricians. I laugh at some stuff - such as CHOP inviting middle kid to be in a study of children who will end up as adults of short stature based upon her height as an 11 year old (she is now 5'-5", which is hardly tall, but considerably more than 4'-10" to be considered short stature). I am still angry and want my youngest to pursue legal action against the one pediatrician (since she has until the age of 20 to do so) for refusing treatment/referral, with the result of permanent facial disfigurement.

As far as the OP, I learned from experience with my youngest that if you think you need to see a specialist, do it. If you think a certain test/evaluation might be needed, insist that the ped or GP orders it. If they won't, try the Urgent Care (but might not work as well with ASD as with ordering blood tests).

As for potty training, whenever the kid is ready is fine, whether it is prior to age 2 or closer to age 4. I don't think the age of potty training has much to do with IQ. I thought middle kid would be going to college in diapers, and she is the brightest of my three kids.

I'm an inpatient Pediatric nurse and know a lot of PNP's and one of my best friends will have her PNP license next year and I've decided to switch DS to her practice when she's accepting patients. I don't really want to switch now, just to switch again in a year.
NotSoGifted: I was always told boys take longer to potty train and I thought 3 was the norm for most kiddos to start. I hadn't thought anything of it until he came to work with me and I had 3 different colleagues (veteran parents) tell me he was showing signs of readiness. They had to explain to me what I was missing; It just wasn't on my radar yet. I've seen several patients potty trained anywhere from 1.5-5, but never gave much thought to it other than I had never noticed a correlation to intelligence.