After talking to my DS4 preK teacher, I called his Pedi. After a 10 min phone chat, he wants me to come in for an evaluation. Bringing examples of DS4 writing and drawing. Any "contraptions" he has created or build. Examples of his math skills, etc.
DS also has some social/ sensory issues. Getting overwhelmed (screaming and or shutting down), not socializing at school, and frustration with circle time (really anything he has to stop and be still, or is just not challenging).
To us, it's just the way he is. I am aware of the issues, but he's only 4 and it's something we can work on as he gets older. Pedi mentioned a occupational therapist, but I am not sure if it's needed and I don't want him to be labeled.

Hubs wants to wait until the end of PreK and reevaluate. If he is still having issues, then have an appointment. I am also fine with this but wanted some advice.

I might also add, I don't have examples of his skills/ abilities. Not actual proof. He is behind in writing and drawing. He gets really upset. He is reading but there isn't much comprehension. He loves science and math, but nothing to show on paper. He creates engines and fans with legos, but disassembles them constantly. He is a perfectionist! I'm not sure what I could bring to an appointment, if we have one.

Do you trust your pediatrician? Do you have confidence in the doctor's abilities?

Some folks seem to have great pediatricians. If this is the case, I would discuss with him/her. If they are like the incompetent doctors we have encountered, I would not. My rule is that the doctor must first address any physical medical issues before they tackle any social/behavioral/intellectual issues. (Ten year old has a facial deformity that can be attributed to area pediatricians being completely useless - and it would have been even worse if we had followed their advice.)

I can't imagine a four year old being "behind" in writing and drawing. Sure, some kids may really shine at these skills, but I think many aren't doing a whole lot.

Personally, I would wait. Middle kid had sensory issues and more or less outgrew them (or learned when she should hide them to have social acceptance). Others here may have a different take on this, and may have found early intervention to be best. The "wait and see" approach worked just fine for middle kid, but that is a study of one.

I should add that middle kid's drawing skills were pretty advanced at that age (not so much anymore at 16). Don't know if that might be important.

It is possible that the entire explanation is that he is 4, and some adults have unreasonable behavioral expectations.

We homeschool so our children can develop in their own way and not have to conform to the convenience of others.

Personally, I don't see why an evaluation would be so bad. No one says you have to do what they recommend, or that you have to do it right away.

I also think that many children may enjoy and benefit from OT. OT for kids is play based. There are sensory things that may help his general well-being at school and at home that you can be taught.

In my area, many people would use the the Intermediate Unit (IU) or Early Intervention program to do such assessments when the child is not yet school aged. Sometimes, if the child qualifies, some or all of the treatments are free.

If there is a disability or signficant delay, therapy can help a great deal. I don't necessarily subscribe to the "wait and see" approach. DS has been in and out of physical and occupational since around his 4th birthday. His motor skills were in the average range until he was around 3 1/2 but the percentile kept dropping down, til finally he qualified for services. When he was 4 a pediatric neurologist told me he probably has dyspraxia, and he was diagnosed formally by a neuropscyh when he was 6. At age 4, he was able to draw pictures...for the neurologist he drew pictures of cats with various body parts and was able to write his name. But the problem was we just weren't seeing much progress. 4 year olds aren't expected to be able to do that much in terms of writing, but they should be able to hold a pencil (with it not being in their fist) and copy simple shapes. An OT can do a standardized eval and see where things stand. Many medical insurance policies cover OT and PT if the child tests low in one or more areas. They can also give parent assessments for the child's functioning in the home, for instance self-care skills--can the child wash their hands, put on clothes, zip their pants and button their shirt, walk up and down stairs with a reciprocal foot pattern, etc. They can also watch for sensory issues and give you an inventory to fill out. You don't even necessarily have to tell the school system if he is getting private therapies so having a "label" shouldn't be a big issue. OTs/PTs don't really give diagnoses anyway (at least not the ones we have seen), other than very generic ones for insurance purposes, like "muscle weakness". You might decide to take a "wait and see" approach, but I think evaluations in the areas where you have concern would be a good idea, esp. if your insurance covers it. You can also request an eval from the school system. I would take the referral from the pediatrician for an OT assessment (at least). If you have other concerns as well, then ask for a referral to a neurodevelopmental pediatrician or neurologist.

If you are also concerned about behavior, socialization, a motor disorder like dyspraxia, etc., most OTs will not diagnose anything. If there is any possibly he has aspergers or an autism spectrum disorder, you'll want an eval for that from someone who is qualified to diagnose. We started out with a neurodevelopmental pediatrician who then gave us referrals for a psych eval, OT/PT eval, etc. A few months later I took DS to a pediatric neurologist because of tremors in his hands and she's the one who first mentioned dyspraxia.

It could potentially be very bad if a child is misdiagnosed as having a condition they don't actually have, and the label sticks with them for the rest of their life.

Thanks everyone. Yes, most of it is because he is a very strong willed 4 year old. That does factor into my decision. What concerns me most is the sensory stuff. The screaming and uncontrollable crying when loud noises happen. Or total shut down when there are strangers or a large crowd. When his routine is off by just 15 mins, he looses it.

We will wait and see for the most part. I am hoping that this school year will help him and we will see how he is doing entering Kinder.

I would still love to hear everyones ideas and thoughts.
Thanks!

amielynn38, it's really tough for most of us to know from a post here if your ds would benefit from an evaluation, simply because we don't know him personally and we don't know the degree to which challenges are impacting his life. I could read your description of him on the one hand as sounding like a fairly typical 4 year old stuck in perhaps a preschool that isn't a great fit (too much seat work and not enough play)… or I could read it as a child who isn't fitting in at preschool due to social challenges who would potentially benefit from an eval and possibly some type of therapy. My only recommendation there is to trust your gut feeling - if you feel there are challenges then yes, I'd go for an eval. I'd also put a bit of weight in what your ds' preschool teachers are saying - if they are telling you he's having difficulty with sitting or socializing that are beyond what they see as typical for his age, then I'd look for an eval.

I'll also add - it's not always straightforward knowing what type of eval to pursue or in catching what's up at your ds' age - but I don't see that as a reason for not pursuing answers when you have questions - just keep in mind that you might still be pursuing answers later on also.


FWIW, I could have written this same paragraph describing my older dd when she was 4 years old. I was, quite honestly, worried I'd never get her into a kindergarten classroom when she was required to go to school the next year - her apparent sensory issues were that huge. We did take her for an eval and she did go through sensory OT - and it helped a huge amount, which was wonderful. It didn't, however, catch what was really going on - for her, it was a vision challenge (double-vision among other issues). We didn't catch that until 2nd grade. It was, however, worth the time invested in sensory OT, our insurance did cover it, and the OT was fun and did reduce her sensory reactions in new places etc.


You only have your filter on whether or not it's needed at this point - you don't really know - and going to see your ped with your ds is nothing more than that, having a visit, asking for the ped's opinion. If the ped feels OT would be worthwhile (or some other therapy), you will still have to have an initial eval with that professional too - and again, that is just one professional's opinion that you can choose to either accept or reject and move forward as you see best fit. It's all really just collecting data and ideas and opinions from professionals with experience in seeing young children your ds' age at this point in time. If you visit and find out that there really isn't anything to be concerned about, that can be very reassuring in and of itself, and if you find out there's something to watch or something to get help with, that might be incredibly important to your ds to catch as early as possible.

Re labels - I have children with diagnoses. The diagnoses don't impact their lives at all in terms of being "labels" that cause negative consequences. The diagnoses give me an understanding of how to best help them, the diagnoses give my children an understanding of what the nature of their challenges are (prior to their diagnoses they formed an inner opinion on their own that something was "wrong" with them compared to other children), and the diagnoses give us a way to explain what's up with my kids to other people they interact with.

While a label may not seem like a "good" thing - what's really going to cause problems for any child long-term is having challenges that are ignored or not dealt with completely because a parent is overly worried about "labels".

Also, fwiw, labels given once don't necessarily last forever- an understanding of what is going on with a child may change as he/she grows and becomes more able to adequately express frustration and can explain to a parent or teacher or whoever what they are feeling or experiencing. My ds was diagnosed with ADHD at 7, and within a few years it became obvious that the ADHD-like symptoms he'd experienced at 7 really had nothing to do with ADHD. We had him re-evaluated by our pediatrician and he was officially "undiagnosed". His neuropsychologist followed up with another look at ADHD a few years later and again agreed, he does not have ADHD. So labels aren't necessarily for a lifetime - unless they fit the child.

I'm also not exactly sure if it's the sensory etc behaviors that you are seeking the ped's advice on or giftedness (based on your previous post). If you're primarily interested in testing for giftedness, honestly, I'd hold off on that at this point, and also not over-worry about academics until you have to. If that's what you're after, let us know and I'll add details about why I wouldn't pursue the testing now - or I'd at least be cautious about it.

Best wishes,

polarbear

In my limited experience people labeled DS on their own based on what they saw and their own experience and background (more often inexperience and very limited background). We had people ask if he was autistic, ADHD or assume he was simply just a result of horrendous parenting (I'm thinking of the random strangers glaring at me at the grocery store...). Testing and starting to figure out a proper label for him was THE BEST thing we could have done to help us help him. It also helped DS better understand himself (he's gifted/LD and he had come to the conclusion that he was "stupid" because of the school struggles related to the LD). I say starting to figure out because I see this as a continuous process. Kids change and we change and adapt over time. He has learned to overcome some challenges and mature so we move on to the next thing. The label hasn't changed who he is but it has allowed me to better focus on how to help him. I also don't see the labels as a permanent box that he must fit in.

I would also add that we tested privately with someone we respected and trusted. We have been able to control exactly who and how we share the results with. In our case we chose to share the full report with his school because honestly the new labels were a better fit than the incorrect labels the teachers were assuming.

I'm not sure I understand the huge avoidance/dislike of labels. Maybe due to not being in the USA, our systems work differently. But here, there's no central database (that I know of anyway, who knows!) where they are storing every diagnosis/label and sharing it across the board with every medical professional and school in the area. Unless we choose to share what we learn via various tests/assessments, then no-one has to know.

I always kind of thought of a diagnosis/label as a tool that helps me to help my child - or to get him the help he needs. As we have moved away from some "labels" I'm finding we often jump to another, and I'd guess it's going to probably continue like this for a while as we seem to have layers of issues and as we deal with one we start to notice another.

IME... I wish we had taken DS7 to an OT earlier for a sensory evaluation. I wish we had worked on his issues earlier, before K instead of at the end of K, start of 1st. I think that would have made for a much easier start to his school career. That said, the school is just completely unwilling to consider anything other than ADD as a reason for poor concentration, and they only have 1 answer to "ADD" = medicate. So maybe we would still be where we are now. But looking back at how the meltdowns/shutdowns disappeared, I still wish we'd done the OT earlier. So I'd side with the get-in-early crowd I guess.

Thank you everyone. I have read your responses a few times over. Just soaking it all in. We are still waiting on the Pedi to confirm an appointment. It's taking a bit longer then I expected. DS is still having some trouble socializing in school but it doing very well in my book. Will keep you posted.

My DD is 4 and in Kindergarden this year. Per teachers request she is also in OT (was requested at the end of last year during the mid-year skip). She loves it and calls it gym. There is no "labeling" of her as far as I can tell. They skipped her at the same time.