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.

I think potty training has wide variability but also multiple windows, regardless of high IQ. If you miss one window, another will come along, though it might be a while. DS was showing readiness at 24 mo but I was due with DD and the idea of regression due to sibling stress kept us from acting on it. I also felt he lacked the motor skills to dress himself at that time. He learned at 3, but night took far longer (deep sleeper). DD was fully self-trained by 20 mo, including nights.

Just to chime in on the potty training: if he's interested, why not go for it?

My elder was day trained by 22-23 mo (very sound sleeper once out, so nights took longer), and close-in-age younger sib self-trained by 21-22 mo (day and night) from watching elder. Younger probably would've been done even earlier but for falling off a toilet at 19 mo, which understandably set things back a bit. (None of this was pushed by me; I followed their leads.)

Putting myself in your kid's shoes: if he is orderly by nature and wants to be able to control things in his life, this seems like an easy give and a win both for him and for you.

Perhaps another option is to step back from needing advice/help from your pediatrician. We don't live in a place with good health care, so Dr. Google is about as good as the real version here. We've never discussed milestones or potty training with our doctors, just illness.

If you want to potty train, do it. Or wait. Do what works for you; no need to have a doctor agree.

With OCD or ASD concerns, like said above, bring those issues, and only those issues, to the appointment. Or better yet, find a specialist and just go. FWIW, mine have also looked OCD during the toddler ages (but never ASD); rigidity is inborn here but not all rigidity is pathological.

I agree with DianaG. I don't even ask my Pediatrician questions such as potty training or for that matter sleep training. I feel like I know more about these things than they do and I won't necessarily want to follow their advice on matters such as this.

Focus on the things that are worrisome to you, and discuss on those. The short visit time is not enough to cover everything when you have an agenda. I would just find a developmental pediatrician and go from there if you are worried.

I would change primary care for your child if you feel the mismatch between the advice and reciprocity you seek and receive is too wide. The value of a trusted adviser is high when you need an expert opinion.

We have a fabulous pediatrician for DS, and her lengthy experience has been valuable to us. DS' milestones as a baby were sufficiently far outside the norm (on the right tail) to merit a few questions about ASD, and his ped was diligent about ruling out ASD through early monitoring. That she was able to see the possibility of high intelligence and ASD behaviours in an under-1 infant was, I have learned, a rare gift. At his one-year well child check, she was proactively discussing how to optimally sequence multiple grade skips for social and emotional well-being.

I can't recommend enough that you find a trusted adviser. I can go to DS' ped with any concern and know that she will either provide a first rate evaluation or provide referral for one. As a parent of a child with atypical needs, having that kind of knowledge and support in your corner is validating and comforting.

Bad doctors can be anywhere, I know. I had to self diagnose myself with infectious endocarditis 12 years ago. It was the sub-acute form to be fair but even so!

Splinter hemorrrhages? Check. Roth's spots? Check. Janeway Lesions? Check. Osler's nodes? Check. Level 2 AV block out of nowhere? Check. Low grade fever and general malaise over a period of months? Check. Tachycardic? Check. Moderate aortic murmur? Check. And still I had to join the dots and check myself into an emergency room.

Dr Google literally saved my life and persuaded me to find another doctor LOL

First, I would try and find a developmental pediatrician, since I think you are going to need someone who understands child development. Secondly, does OCD, ASD, giftedness run in your family? I have been on these boards for a while, and read a lot here-but have no medical background -and what you describe to me sounds like giftedness frustration due to asynchrony (but if you are seeing toys being lined up, poor eye contact, etc. or you have it in your family and you know the signs for your particular situation then you should go to a pediatric developmental psychiatrist.)

Also, you spend more time with your child than anyone else, if you have alarms going off, there's probably fire. But, that said, since I started on this path, a lot of what I thought was true has changed over time.

OCD/ASD and giftedness does run in DH's family; quite heavily. A lot of his family tree is full of very-high achievers, innovators, Presidents, etc. A lot also have the 2e characteristics of ASD or OCD, as well. I'm adopted, so I'm not sure what is on my side but I was a MG kid and DH was a HG kid and his brothers were HG and PG. DS does not line up his toys, but he does pick them up and keep things neat. He has great eye contact, but at 12 months old, I expressed concern for ASD because I wasn't sure if DS was not responding to his name or if he heard and just was too into whatever he was doing at the time. We've since come to figure out it was the later. He's become much more gregarious since 12 months...mostly because I've been super diligent about getting him around LOTS of other kiddos and working on his social skills. I still wonder about the mild end of ASD and possible OCD, though. A developmental pedi sounds like the route to go for us, definitely!

Still sounds like PG but again, not an expert!

It goes without saying to make sure DP has seen PG kids and is familiar with them.. If you post in the regions forum maybe someone in your area will have a recommendation.

Our pediatrician has prestigious degrees but we picked him due to a personal connection - his office is managed by a friend. However, we only use him for medical issues and have never tried to bring up the issue of giftedness. If your concern is ASD rather than giftedness, then I would really narrow your conversation to ASD. Otherwise, it can be confusing for the doctor who is focused on dozens of medical issues at a time. From your descriptions, it sounds like the doctor does not understand what you want. For example, he thinks you are worried about potty training so he reassures you not to worry until 3. I don't think I ever brought up potty training with the pediatrician either as it isn't a medical issue unless there is a problem. You would get better advice from seasoned parents. In reality, many toddlers can be potty trained at 18 to 24 months and routinely used to be in previous generations.

Based on your brief post, you have not mentioned the most definitive autism markers and that may be why the pediatrician did not refer you immediately. It may be that your DS did not present as autistic at that brief office visit. You may need to tell the pediatrician point blank all the autism markers and why you are worried and that you need a referral now.

All great advice! Thank you, everyone. This forum has been so much help in the short time that I've been on it!

I think you've gotten some great advice so far.

I also second not to write off finding a good Pedi and/or make a requirement that they are from top tier schools. I know lots of bright people (Dr included) that for whatever reason did not attend top tiered schools and/or went into professions that are viewed as 'standard' and not speciality or highly selective. ( though a pedi is specialized! Lots of extra training to care for and treat young people- in many ways they are more complex than an adult) ) There are highly intelligent people in all fields of work.

We had a wonderful pedi that we had from age o-4.5. He advised us wisely but respectfully in all areas. I didn't feel rushed and he absolutely noted both areas of concern and areas my kids exceeded normal development.

I also agree that Potty Training is not related to GT. And readiness signs may lead to early training or may just be part of a personality trait & awareness of being dry if a child is sensitive to wet/dry/messy. The knowledge of sensation and controlling them are two different bodily functions/skills. One is a self-awareness and the other is a physical muscular control. It is similar to a child that might be able to cognitively spell out loud & read but has not yet mastered the physical fine motor skill required to make circles/lines for writing the same words/letters.

As a parent of a now 10 yr old, one of my kids was very quirky as a toddler and is likely both on the spectrum of ASD and is gifted. She was provided support for ASD spectrum from ages 18 m to 5. She had very asynchronous skills (not walking at 18 m) but could read 1st/2nd grade level at 3.

I would completely base your reaching out for support dependent on your DS frustration level and how his behavior impact his daily skills. I work with preschool/toddlers and some behaviors are typical (tantrums, repetitive actions, intense focus/listening,etc). It is the level, intensity,and frequency that would separate typical behaviors and not typical.

As for the developmental scales ( such as ASQ, Dial, Lollipop), they are for flagging skills not mastered or making sure a child is meeting milestones on a typical trajectory. They are not great at identifying/quantifying kids ahead of developmental skills. If a child has not mastered a skill for an age category- it is reason to further explore. Usually basic checklists are composed of skills mastered by x age for 90% or so of kids.


If you have concerns on ASD/OCD I would seek out a therapeutic center or Early Intervension. They can parse out skills and give a vague idea if Intervension is beneficial at that time. If OCD/ASD behaviors are interfering with his ability to interact with his environment, seek out support in the form of Occupational Therapy or Social Skills.

At 18 m, you will not find many places to address if he is GT and/or If he has OCD/ASD unless it is severe but rather they may identify if he would benefit from supports due to behaviors out of typical range that might impact future development . For example, sensory aversions (not getting dirty, messy) is not unusual but if intense can result in avoidance of textures/clothing/activities and/or cause a child to avoid doing things beneficial to growth (refusal to go in loud places, extreme distress to textures or sounds,etc).

We used our child's strengths to help her more difficult areas. For example: provided written schedules for her to help her transition activities, allowed her to engage in repetitive behaviors when she seemed stressed (sorting/organizing toys) , put shoes on to reduce toe walking on sensory averse flooring, organized her spaces (bed/room) to fit her needs, which have evolved over time but included items of whatever obsession she had at the time and kept room dim with soothing wall colors. We also provided tons of books and sensory toys since that is what appealed to her. She's had lots of labels,over the years and certain times or environments appears more GT or more ASD...it changes and really is complex. Kids don't fit into tidy boxes or checkmarks that are so often listed on developmental scales. That's OK.



A snapshot online of a very young child is tough, but I fully agree on finding health providers that support your concerns! I would also suggest not only a written list but also video clips of anything you think is important to make the Dr or provider aware of. It can be really helpful to visualize an action in a home environment vs describing it. It also will allow other people to see skills your child has mastered in a more objective way.

I have no experience with ocd / asd, but your son has some very similar milestones as my little boy ( just turned 18 months):) ...he carries around a stool so that he can reach what he wants and turns the lights off and on. He was pulling to a stand at 6 months and taking a step at 9 months, scribbling at 9 months etc. He is very similar to his sister who is 7 and tests consistently in the high 99 percentile. I have found that our pedi isn't as interested or perhaps equipped to discuss advanced kids....although we get much less skeptical looks with this one when we mention what he is doing (I got the feeling that the pedi initially thought we were just proud parents with dd lol). So I am not sure that I would expect the pedi to react a lot to an advanced kid, they are more looking for problems or failure to meet a milestone....however, if you do feel that there is something he is missing (which also may be masked by your son being precocious) don't back down until you get it figured out.
On precocious toddlers, I haven't found many resources for how to best nurture them other than follow their lead/ passions and be prepared to introduce concept much earlier than what you expect...with this being my second and last, I am just trying to enjoy the ride😀 Good luck!