Hi, Eco!
These are mostly in reference to ASD, which seems to be a really complicated diagnosis, sometimes.
Can be. There is no biological test for autism-- lots of people have disagreements about what the boundaries of the condition are, and what the defining traits are (vs. what are traits often seen but not essential to the dx).
My answers/thoughts here are not clinical but come from my experience with DS12 and his providers, and other people with ASD.
School counselor suggested a potential motor-planning issue bc DS was irritating his teacher by being slow and clumsy with his (big) binder. This is not the same as a fine-motor issue, correct? School OT administered VIM (I think?) and he was above average. Is motor-planning something we should look at, and is it part of ASD (I don't see it anywhere in DSM).
Lots of people with ASD have comorbid (co-occurring) issues. Poor motor planning is often in that mix.
Our DS was awful at this stuff until we really worked on it. He will never be an athletic type, but he does OK now.
On the binder: my whole family's relationship to objects and their organization is a bit hinky. It always seems easier to put things down and walk away from them than to put them away. We all struggle with binders and drawers and clutter. No idea if this is "broader autism phenotype" or just "us."
He does struggle a lot with simple things like dressing himself. It takes forever, even when he is motivated.
That's an EF issue. We have that too. Standing around in underwear thinking is par for the course.
2) Constipation/encopresis issues, severely delayed full toilet training, nighttime enuresis (improved but not resolved). Not in DSM. ASD symptom?
Many people with ASD have this issue, which often relates to anxiety (holding/control). Once a person has encopresis, it can take a long time to resolve because the bowel stretches and loses sensation.
This makes me feel that you should have a developmental pediatrician or other expert medical provider managing the whole picture.
3) Pragmatic speech issues mostly related to inability to monitor himself appropriately and anticipate others' reactions. EFD or ASD? This one seems to be the most obvious ASD thing...but could be discrete disorder?
Could be a discrete disorder, ASD, or some of each. Some evals for ASD include assessment of pragmatic language by a specialist SLP. I recommend this.
Nearly all people with ASD I have encountered have significant EF issues; certainly true at my house. Some doctors will not diagnose ASD and ADHD together because there is so much overlap. Some will; it often depends on insurance coding needs rather than actual diagnostic bright lines.
At age 5, I'd say that autism drove the bus for DS. At age 9, autism and EF. Now at age 12, the EF is the more obvious issue (though social skills glitches remain); most of his IEP deals with EF.
4) ADHD (inattentive/impulsive) which never seemed to fully account for behavioral issues. Not hyperactive. Does well one-on-one with or without medication. Extraordinarily distracted by externals.
See above. Some clinicians think autism and ADHD are related. Some do not. ADHD can have serious social impacts, which means there is no bright line between the two.
5) Remarkable ability to learn all there is to know about subject of interest. For instance--baseball. Knows all current info, as well as complete baseball history. It is next to impossible to ask him even very obscure question without his knowing the answer. However--he has not had serial obsessions, really. Unless creative endeavors count.
That is typical of the gifted/ASD child. They are often information gatherers with absolutely stunning capacity.
6) Huge spread between GAI and PSI on the only FSIQ he has ever taken, age 7. However, his IQ has been all over the place, even just the GAI. High at age 5, borderline gifted at 7 (but he was very stressed), high again last year when re-tested for this program (but not as high as it was at 5, by a long shot).
IQ tests can be inconsistent for people with ASD or other social skills impairments, in part because they can rely on skills that don't function "typically" for an ASD person. An ASD person may process images differently-- rather than looking at faces, they notice details of the scene that most people wouldn't, which may lead to "wrong" answers. Being literal can get you points off, as can missing social information in a question.
7) Thought of one more: dx'd anxiety disorder. When younger, had what I thought were OCD symptoms (phobias) that lasted a really long time. Terrified of tornadoes, had to process every single "what if?" every night for months, then moved on to childhood cancer. Terrified of alarms (this is getting better) but not clear if it's the sensory overload or anxious thoughts that accompany them. He is still somewhat hypochondriacal and scared of tornadoes but can process this using (homespun) CBT methods and calm himself, now. Deep breathing, guided meditation helped when he was younger.
DS12 has always been like this. Serious weather obsessions related to anxiety about possible disasters.
Homespun or formal CBT is great; we have also chosen to medicate for anxiety, which was life-changing for DS.
It's hard for me to conceptualize it because I have mostly just adapted to him and vice versa.
Most parents do adapt to their children, and yes, it's hard to see all these patterns unless you are really looking, even if they are noticeably different compared to others. (You don't live in other families, you live in yours.)
I don't really struggle with him, with a few exceptions, mostly when I try to force him to do something (he requires a very conscious approach, which drains my energy). I've largely just stopped doing that because it was futile and caused a lot of negativity in the family. And that was probably a mistake.
I would say, rather, that you've gotten to a phase where you see that it might be strategic to manage it differently than you have in the past.
You are doing a great job of thinking through all these issues.
I hope you enjoy the field trip!
DeeDee
