sorry , i know i have a lot of questions today but...

[thriftychic]

the doctor who assessed ds2 for asd told me that he thought he was asd and that ds2 couldnt understand simple jokes , he had said to him 'what did the zero say to eight ? nice belt' and another one which he didnt get.

i have tried myself , a few simple jokes and he definately did get them.

the doctor tested his literal thinking asking him if he knew what he meant by out of the frying pan and into the fire, he said he didnt know.

i have just tested him with quite a few like 'kick the bucket' and some others and he got them fine.

dont know what to think now!

what would you do/ think about it ?

[Chundle]

Sorry but even I had to think a few times to get the 'nice belt' joke!!!!! I just asked dd1 it and she didn't get it!!! She has dx of adhd and didn't score highly enough for dx of AS but def has some traits. I don't think that's a very simple joke tbh. How old is ds2??

[thriftychic]

i didnt get that joke at first either! ds2 is 13.

i am worried now. i was putting a lot of faith in this doctor after the last one turned out to be a bit rubbish

[coff33pot]

I still don't get it!

[thriftychic]

a figure 8 looks like a zero with a belt on . ha such a crap joke !

[Ineedalife]

Ha ha, that is quite funny

Sad soul I am.

Dd3 was tested on idioms by the SALT when she was being assessed for ASD, she had no idea what It's raining cats and dogs meant.but she did look out of the window just in case.

I think the Doctor is trying to find out where his difficulties lie. Not understanding complex language could cause significant issues for a secondary aged child.

Dd3 is 10 and her difficulties with language are impacting more and more on her.

Luckily we have just been told that she is going to get some more SALT and some more support in school.

Dont ever apologise for asking questions, the board wouldnt exist if we didnt

[madwomanintheattic]

I didn't get it either.

If that's really what they are using for diagnostic testing, then we are about to have a huuuuuuuuge surge in dx.

How about the professionals actually stick to the actual diagnostic tests instead of applying their own opinions? Radical.

[Ineedalife]

I meant to say, with idioms children can often be taught what they mean.

We have bought Dd3 a book about them written by a teenager with aspergers.

[NoHaudinMaWheest]

Also just because you do get it doesn't mean that you don't have Aspergers.

Ds 16 has an AS diagnosis. He actually enjoys pun type jokes and makes them up himself. As in 'What's the opposite of Katmandu? Dogladydon't.'

He understands most idioms etc. but will point out that they are illogical. e.g. in what world have cats and dogs ever fallen from the sky.

He is also very pedantic about grammar and pronounciation and will correct us. I hope he doesn't correct the teachers!

I think language problems can be very subtle and it needs an experienced SALT to work them out.

There must be more objective measures the paed can use surely.

[coff33pot]

Nope not funny to me and I just told my 11yr old who just gave me a pained look. They need to try harder on the jokes lol :)

[alison222]

Ok so I have just tried the 8 "joke" on my NT DD (9) who looked very blank and I had to explain it to her.
i thine tried it on DS (11, AS) who got it almost instantly after giving me several alternatives. Personally I liked his "next to you I am nothing".

[moosemama]

I would say the zero and eight joke is a very visual joke. Afaik, many children on the spectrum are visual thinkers, which means they are more, not less, likely to get that joke.

My ds1 is similar to NoHaudin's ds. He loves messing around with words and language and makes up his own jokes. He was also able to explain every idiom they threw at him during his assessment, having devoured several books on them over the years. At one point the Clinical Psych, trying to catch him out, said "I bet your pocket money burns a hole in your pocket doesn't it?". Ds answered "I know that one, it means you want to spend your money rather than save it, so you never keep money for very long". Psych's response was to look at me and say "I give up, there's no way I'm going to win with this one!"

[moosemama]

Alison, I like your ds's style.

[EllenJaneisstillnotmyname]

Why is 6 scared? Because 7 8 9! Ta da!

DS scored very low on idioms when he was younger, but it was a 'proper' test. He was shown pictures and had to say which went best with the phrase. Eg 'We can't go to the park because it's bucketing down,' he was shown pictures of buckets falling off a shelf and a rainy day etc. He'd choose the more literal description. Compared to children his age he scored on the 8% centile. Obviously other DC may also choose incorrectly, but statistically he scored fairly low. Most NT DC would pick up that there must be a reason why you couldn't go to the park that wasn't likely to involve buckets!

[EllenJaneisstillnotmyname]

That is, even if they hadn't heard of that particular idiom.

[thriftychic]

so , do you think that i should tell the psych hes wrong , that in fact ds2 can get simple jokes ? because he was quite sure he couldnt !

the psych said that he probably wouldnt need to see ds2 again . hes seen him for about an hour , interviewed us for an hour and is going in to school.

i was worried when he was questioning us that i may be answering wrongly as he seemed to want a yes or a no and it all didnt seem that black and white to me .

he asked if ds2 takes things the wrong way alot and dp said whenever he jokes about something ds2 thinks hes serious , thing is no one can tell when dp is joking , he even offends the neighbours that way !

I really do want the truth , a diagnosis of some sort. be it bad behaviour , asd , whatever. but i am worried that we might get a wrong diagnosis. it seems flawed to me . it didnt help that the psych kept looking at his watch either .

[EllenJaneisstillnotmyname]

Thrifty, is the jokes thing the only reason that the psych thinks maybe ASD? Or is there a pattern of other behaviours as well?

[thriftychic]

it all started really when he couldnt handle the move to high school. he was distressed , flipping out , angry and destructive , i thought he was being bullied and the head of year flippantly suggested he might have aspergers.

as ds2 was talking suicidal i moved him to another school and went to camhs for help.
camhs did the ados test but tbh were really rubbish , promising to observe at school , set up sessions one to one with ds2 which they didnt ever do.
the ados came back all fine .

2 years later his behaviour worse than ever for us. at the end of my tether and feeling that they really hadnt checked ds2 out at all properly , i complained to the manager about the shocking treatment we had recieved (hadnt even returned my calls for 6 months) and asked to be put with someone else.
the someone else thought he did sound asd and arranged for a second opinion with a different psych. which is where were at now.
the day ds2 saw the psych , he had had a massive meltdown and was rather sullen . the psych said he had seen things which led him to believe he could have asd such as no eye contact , little facial expression and the jokes and idioms thing.
he then spent the next hour firing questions at us.

after that first ados session they said the lack of eye contact was more likely awkward teen behavior as was the fact that when they mentioned they had been on holiday he hadnt asked where or anything . but tbh i would think loads of teens wouldnt ask , they wouldnt give a stuff would they ? sat there feeling embarassed as i know ds2 was.

jeez am i ever confused!

[thriftychic]

2 completely differing views , one a psychologist and one a psychiatrist but both only spending an hour or so with ds2 .

[mariamma]

"ADOS came back fine" can mean he gave unusual responses but overall he scored just under the diagnosis level. Or it can mean the scorer only has experience of non-verbal under fives, and therefore accidentally tends to under-mark older, more able children.

[bochead]

DS got a diagnosis on the 2nd opinion and observations as he scored clinically at the cut off for one item on the triad (think of it like a graphic equaliser). It was the bit where I personally think intensive coaching at home can perhaps make a difference. I also got the impression my local team are more used to dealing with non-verbal under 5's than very verbal older kids, and tend to look for stereotypes in their obs.

Can you afford to get a private assessment done somewhere like GOSH where they have more experience of the tricky cases & teens? Also there are lots of related disorders that they have the expertise to diagnose that can get overlooked by less experienced clinicians.

[moosemama]

Have they looked at anything other than ASD though thrifty? Non Verbal Learning Disorder, Social Communication Disorder, etc?

As Bochead suggested, could you go back to your GP for a referral to someone more experienced in complex cases and teenage presentation?

It sounds to me as if he needs a full multi-disciplinary assessment, rather than just the opinion of one psych. The mutli-discip team here comprises lots of different professionals and the assessment process is centred on the child, rather than a standard format.

The assessment often involves a few weeks of school observations and home visits by various professionals, then either a full day or half day at the assessment centre, depending on the results of the information gathering process.

This is from their leaflet:

^"THE OVER 6 TEAM is a multidisciplinary assessment team of health
and education professionals. We will create a unique ?team? based
on your child?s individual needs.^

^The team may include: a paediatrician, psychiatrist, specialist health
visitor, speech and language therapist, occupational therapist, clinical
psychologist, psychotherapist, family co‐ordinator, specialist teacher and
or an inclusion support practitioner."^

Ds had everyone except the family-co-ordinator and SALT involved in his assessment and SALT was done retrospectively, as it was an oversight on their part.

If your GP can't refer you to something similar in your area, you can push for a GOSH referral, but the problem with that is that you need CAMHS agreement for the referral before they will accept you. Referral info here. I think you can pay for a private referral, but you need to contact them directly for more details.