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WTF? Assesing 2 year olds for special needs

(53 Posts)
TheRealMBJ Wed 06-Jul-11 08:55:22

Surely this is too young to 'label' a child as special needs and certain SN (like the Autistic spectrum) cannot even be diagnosed until 3. This seems like a step backwards to much for criticism of labour's 'Nappy curriculum'

Miggsie Wed 06-Jul-11 09:03:18

I don't think it is so bad, in America this is routine and they believe in early intervention and have shown massive improvements with AS children given speech therapy very early, rather than waiting for school age when they are then very behind.
In the US they don't diagnose this early but they look for possible "traits" and if they have a child who doesn't make eye contact at age 2 and isn't speaking they use teaching programmes to improve eye contact and speech which I think would be helpful. My friend's boy didn't get speech therapy till he started school age 5 and he was massively behind then and he still is, several years later which is now really hindering him in making social relationships. If he had had speech therapy at age 2 it might have been a lot better for him.

Miggsie Wed 06-Jul-11 09:03:19

I don't think it is so bad, in America this is routine and they believe in early intervention and have shown massive improvements with AS children given speech therapy very early, rather than waiting for school age when they are then very behind.
In the US they don't diagnose this early but they look for possible "traits" and if they have a child who doesn't make eye contact at age 2 and isn't speaking they use teaching programmes to improve eye contact and speech which I think would be helpful. My friend's boy didn't get speech therapy till he started school age 5 and he was massively behind then and he still is, several years later which is now really hindering him in making social relationships. If he had had speech therapy at age 2 it might have been a lot better for him.

MollysChamber Wed 06-Jul-11 09:06:32

If it leads to support for the child and family then surely it's a good thing?

QueenofDreams Wed 06-Jul-11 09:08:06

Well a little girl I know has just been diagnosed autistic at 2.6yrs. She is very obviously not 'normal' though - no speech, seems to pootle about in a little bubble. She'll happily walk over a baby while wearing boots, mum gets her off the baby, tells her to be careful and ten seconds later she does it again. She also lashes out at other children that intrude on her personal bubble. Her mum says that it's been obvious to them for ages, and it's taken a very long time to get through the whole assessment process. Surely it's best to intervene as early as possible when it's clear that there's a problem?

TheRealMBJ Wed 06-Jul-11 09:13:48

I suppose that I'm not convinced that it will necessarily lead to intervention. Ok, I concede that perhaps intervention will occur earlier than if left until the child goes to school but if there is a 'diagnosis' made and then the intervention is not forthcoming for months and months, I worry about the negative impact of the 'label'.

And surely this is just going to lead to increased stress for parents and more 'hot-housing' of toddlers?

biancacbwantsaquietlife Wed 06-Jul-11 09:22:28

I agree that early intervention can only be a good thing where it's actually needed. We are in Joburg and have almost the opposite issue. There is too much intervention here. In DS1s class of 18 kids (at a private pre-primary school) there are 7 kids on some kind of speech or occupational therapy. The is picked up by the staff and then the parents are told that their child needs to be assessed. Once the child goes for assessment I am sceptical as to whether the OT is going to say "No no your child doesn't need any therapy at all". they have a captive audience!

Case in point - one child's mother was told at the end of last year that because the child had missed a number of weeks of school that year that she was behind. No suggestions were made at the time as to what the parents could do for her to catch up. This child was only just 4 at the time. Parent teacher meeting took place in March and the parents were told that the child was doing very well and had caught up massively and was at the same level as the rest of the class. 6 weeks later, parents are told (by the same teacher) that child has not caught up. They are also told that as the child is going to Primary school in January and they do not want her to be behind then, that perhaps Occupational Therapy would be a good idea. No reason given as to what the OT is for, just that they don't want the child to be behind next year.

Surely giving the parents some extra worksheets / ideas on what to do at home would enable the child to catch up rather than sending the child for OT?

One week later, the same teacher suggests to parents that the child has issues with fine motor skills and the parents should consider OT for this. When questioned, the teacher suggests that the child has issues when playing with small mosaic puzzles. So the mother brings in examples of esactly the same mosaic puzzles completed at home. So the teacher switches focus - perhaps it's gross motor skills - so the child is taken outside and asked to do a number of things on the jungle gym, all of which she completes easily. No issues there then.

So what's the problem? The teachers here are simply not interested in spending a little extra time with a child who perhaps does not want to do things over and over again, or is perhaps bored? If a child has problems cutting, then spend an extra few minutes with them and practise. Tell the parents to practise it at home - but no, the child is referred straight away to OT.

I know things are vastly different country to country and I agree that early intervention is sometimes a godsend, but it can go too far the other way.

Sorry, rant over.

HarrietJones Wed 06-Jul-11 12:04:35

Its that difficult to get SALT/OT etc on this country I doubt they'll refer easily. Dd2 has speech problems and wouldn't have been referred if I hadn't contacted the HV with my concerns.

I doubt they have the staff to do assessment.
My town only has a PT HV who can't keep up with her CP stuff never mind anything else

flipthefrog Wed 06-Jul-11 12:09:07

way too early, my son was assessed for loads of things, all it did was stress me out no end and probably cause alot of work for someone who didn't need it anyway.

why are we so obsessed with labelling children in this country, yet children who really need help often have to fight to be heard.

silverfrog Wed 06-Jul-11 12:14:35

why on earth would you say ASD cannot be diagnosed until 3?! what utter bollocks (to put it mildly)

dd1 was dx'd at 2.7, having been in the system since she was 20 months old. she should have been dx'd a LOT earlier - all the info was there, but the nhs/early years like to delay, for little reasona lot of the time.

you are right that an early dx does not lead to early intervention - dd1 has never had OT or SALT offered (many assessments, no actual therapy on the SALT side, no assessment for OT). she is now nearly 7, so has been dx'd for well over 4 years, and is fully statemented, yet still no actual intervention (well, she has had plenty, all privately sourced and paid for, but ykwim)

BUT this is not a reason to not dx early - it is a reason to sort out early intervention.

there are some impressive stats for early intervention (am talking specifically wrt ASD issues here, as that is my area of interest!), especially from America - children who receive proper early intervention (not just parental education and coffee mornings) go on to achieve higher standards than ever predicted for them.

I do notunderstand why it shoudl be an issue that anyone would look out for issues as early as possible, and seek to rectify those issues as early as possible.

mind you, I was treated like an utter freak for daring to point out to my hv that dd1 was not progressing typically when she was 10 months old - they kept insisting she was lovely (she was, and is), and that I was lucky to have such a beautiful, well behaved baby - err, she was totally uninterested in anything at all - not people, toys, pictures, nothing. she was late meeting all milestones, and made little eye contact. she turned away from touch, and could not even chew food at 14 months+ - now THAt is stressful: repeatedly trying to tell professionals that you think there is something wrong with your child, and having them turn you away as it is "too early to tell" angry

a good, cohesive programme to pick up on any early difficulties, and point to appropriate interventions before school starts would be fantastic, imo.

RossettiConfetti Wed 06-Jul-11 12:21:26

I think this is only a good thing. Any parent who doesn't want the tests can say no - I imagine not many would though.

However, in practice LEAs are cutting jobs for SEN specialists and consultants and waiting lists for children to see one are growing.

This will only get worse under this current government and their policies. So by starting the process earlier, a child might end getting the same specialist advice and help (not necessarily a label - these things aren't fixed anyway) around the same time they would have done five years ago.

RossettiConfetti Wed 06-Jul-11 12:24:03

Also, I had always believe that a child with ASD can be spotted before 3. As there is no absolute test that gives a positive or negative result, and ASD is diagnosed depending on many factors which vary according to age and child, it's impossible to give a cut-off point of 3 for knowing or not knowing. Generally most children are over 3 when they are diagnosed; this doesn't make it impossible for experts to have a heavy expectation that a child under 3 will have ASD.

MarioandLuigi Wed 06-Jul-11 12:39:11

What silverfrog said. My DS was DXed at 2.5. With early intervention he has improved well and will be attending a MS school in September with 1-2-1 help. Diagnoses are not given out like sweets you know and most people will have to fight for a long time.

What experience do you have of SN op?

asdx2 Wed 06-Jul-11 12:44:21

My dd was diagnosed a week after her second birthday after being referred to a paediatrician at 13 months. Early intervention from seventeen months saved my daughter who had a developmental age of between six and twelve months at diagnosis and moderate to severe autism.
Today at eight she is exceptionally bright attends a mainstream school and the autism is unnoticeable.
Early recognition of her difficulties was the key and if screening at two made this happen more often then surely it can only be a good thing.
The early intervention dd received has altered her future, she will undoubtedly support herself, go to uni, live independently much different to the need for lifelong care that we were looking at.
Early intervention whilst high on costs initially could potentially save fifty years of care costs later.

MarioandLuigi Wed 06-Jul-11 12:50:43

Early diagnosis and intervention has meant that my DS has a chance at a brighter future.

NotJustKangaskhan Wed 06-Jul-11 13:06:39

As others have said, early intervention is quite hit and miss around the country. My son was first recognised at just before 2, but wasn't referred on to more help until he was almost six, and even now the assistance is, to put it mildly, crap. I've been waiting for months now just for them to send worksheets for him to work on.

A standard early intervention test may be of help, though I doubt we'll get it. The article itself said the test would be up to nurseries and childminders, which means it will vary wildly and seems to have forgotten all the children who are still cared for at home in that age group.

TheRealMBJ Wed 06-Jul-11 14:30:16

Sorry, I've taken so long to come back. Have been out eating ice-cream.

In answer to your question Marion - none whatsoever blush I'm just a mum with a toddler who is afraid that this programme will just turn into another 'tick-box' list of educational goals that will be assessed by (lovely and caring) people who do not have a real understanding of childhood development. That will end up putting parents and children under pressure and labelling very young children without providing intervention.

Isn't there a 2 year check by HVs already? Aren't they meant to be looking at broadly normal development? If their assessment is not enough surely what is needed is a lengthy and complicated individual assessment from someone like an educational psychologist?

I will admit that my reaction to the article is rather quick and perhaps not a well educated one, so I am happy to take on board all your comments. Yes, if I had an experience such as yours silverfrog I would probably look more favourably on this programme, but then I have massive problems with HCPs who do not listen to parents and take their concerns seriously, anyway.

I am sorry about my misinformed statement about diagnosis of ASD at 3yo. I was under the wrong impression.

TheRealMBJ Wed 06-Jul-11 14:33:30

Oops, I am going to offend someone with my statement about nursery staff and childminders not having a real understanding of childhood development, aren't I? Sorry, I really don't mean for it to spound so dismissive of their experience but asNotJustKangaskhan has said it would have to be standardised and the assessors would have to have proper training in administering the tests otherwise it will be of little or no value.

asdx2 Wed 06-Jul-11 14:39:26

If you are hoping that the vast majority of HV's will pick up any of the subtleties of a development disorder then you really do have your head in the clouds.
My HV after dd's diagnosis asked "are you sure she's autistic she just looked at me?" Dd's autism had been diagnosed and was in no way mild at that time hmm As the paediatrician once said if the GP and HV think this is normal then I wonder just how bad it's got to be before they consider a referral.

MarioandLuigi Wed 06-Jul-11 14:40:30

If your child is NT (neuro typical) then I think you have nothing to worry about. To diagnose this early there needs to be serious problems and concerns with a child.

At the time my DS was diagnosed (at 2.5), he has no speech (had lost some words at about 15 months), screamed most of the day. Wouldnt go anywhere with anyone except me, hated other children, headbanged and bit himself when he got upset, no pointing,. no eye contact, wouldnt play with anything and spent all day when he wasnt screaming running around crashing into things on purpose.

I think it would be very difficult to find these symptoms in a 'normal' child.

silverfrog Wed 06-Jul-11 14:41:12

thank you for listening, TheRealBMJ smile

the 2 year check is not administered in all areas, I don't think. certainly dd2 has never had one (or a 9 month, or an 18 month, or any other developmental check come to think of it!)

in the case of ASD, what is needed is for hvs to be trained in using screening tools such as the CHAT test (CHeck for Autism in Toddlers) - a tool to be used by 18 months, which flags up any areas of concern in social communication. failing the CHAT test does NOT mean the child is autistic - it is a screening tool to see which children need further investigation by a developmental paediatrician/team of SALT/paed/OT potentially (again depends on area)

the CHAT test was developed by experts, and is easy and quick to run through, but many hvs have never heard of it, and instead will turn away parents like me who are trying hard to get help for their children. by 16 months, dd1 was sociable (after a LOT of hard work on our part) and contented. but she failed the CHAT test when I insisted it was administered at 19 months (thankfully had moved areas and had a more enlightened hv!). before that, the hvs insisted she would "get there in her own time", was "lovely and bright", was clearly "a mummy's girl" (dd1 would not let me put her down a lot of the time) or a "contented baby" (this when she played with one brick for nearly an hour at 16 months old - I found it odd, the hvs merely commented I was lucky as surely it meant I could get on with the housework - wtf?! hmm)

it is this kind of ignorance that I would hope a properly introduced screening check would counter. dd1 missed out on a lot of early intervention because of the delays brought about by well meaning but clueless hvs (I was not a confident mum, and although not happy about my concerns being dismissed, they were dismissed with such authority and confidence that I began to doubt my own knowledge of dd1, and doubt my take on what a baby should be doing).

silverfrog Wed 06-Jul-11 14:43:31

asdx2 - my GP said, when I told him dd1 was ASD (post dx, a copy of which was on the desk at the appt) "really? but she's a girl!"


honestly, the ignorance is astounding at times.

we also got the "but she's so smiley", "but she makes good eye contact", and "but she can talk" (nevermind all she was saying was either nursery rhymes or reciting the Gruffalo!)

bullet234 Wed 06-Jul-11 14:46:03

"Surely this is too young to 'label' a child as special needs and certain SN (like the Autistic spectrum) cannot even be diagnosed until 3."

I'm sorry, but this is nonsense. My Ds1 was diagnosed with autistic spectrum disorder when he was two years nine months.

TheRealMBJ Wed 06-Jul-11 14:52:00

Yes, that's exactly my point asdx2 this is a lot more complex than just an assessment by nursery staff/childminders/HVs (not all children are in paid childcare then anyway). Like you said there very little understanding of these developmental issues in the mainstream HCPs. Yes a nursery nurse or childminder that spends a considerable amount of time with a child may pick up that something is wrong BUT surely it would be better if it was just that a parent's concerns were listened to and acted upon more appropriately that 'having an educational assessment' as it is the parent who will know their child best and pick up on the subtleties soonest.

TheRealMBJ Wed 06-Jul-11 14:52:55

Yes, bullet another poster has already pointed ot my mistake and I'm sorry blush. I was sprouting misinformation.

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