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Old 07.12.2011, 23:43
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Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

I wondered if anyone knows how to go about it? It would be great if I could rule this out or get a confirmation and then deal with it...
My son is only 2,9 and doesn't speak German (he is growing up bi-lingual and hence speaks relatively little for his age anyway).
What should I do if I want him assessed? (we live in central CH)

Thanks for any advice/suggestions
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Old 07.12.2011, 23:51
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Take him to your doctors(pediatrician) and they should refer you to the correct people. That what happened for us. We ended up at the kjpd in zürich, they are the specialists.
Good luck.
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Old 08.12.2011, 00:00
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

A multi disciplinary team is now considered best practice for a comprehensive diagnosis. This will include paedeatric neurologist, pyschologist and pyschiatrist. (not sure if spelt these properly .. its very late). You will be referred to one of these and they should get the others involved.

New clinical guidance has just (or is just about to be) published for diagnosis in pre schoolers, so it is a very current subject.

Beware, it is not a quick process .. we are 8 months in now and still at it.
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Old 08.12.2011, 00:21
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

Thanks!

I just wondered how they would be able to assess him correctly if he doesn't speak German and has a speech delay due to his bi-lingual environment? I actually started looking into assessment centres in the UK, but luckily we have a pediatrician appointment for my younger son this Friday - will discuss this matter with the "GP" then...
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Old 08.12.2011, 00:34
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

My son speaks very little and they have no problem assessing him. It is not what he says (or doesn't in our cases)that is actually of importance. There is an exhaustive parental questionnaire which gives the basic information on behaviours, then you will be asked to bring him for various play sessions. We had some videos of play sessions with our special needs therapist which were useful too. They all spoke in English to him. They were never looking for verbal responses - more engagement, responsiveness and receptiveness.

At almost 3 years you are right to think that the speech delay might be linked to something else. The problem with living here is that the multilingual environment often hides other problems ... our family doctor kept saying it was because we speak 3 languages at home. But like you we had other suspicions.
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Old 08.12.2011, 10:35
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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My son speaks very little and they have no problem assessing him. It is not what he says (or doesn't in our cases)that is actually of importance. There is an exhaustive parental questionnaire which gives the basic information on behaviours, then you will be asked to bring him for various play sessions. We had some videos of play sessions with our special needs therapist which were useful too. They all spoke in English to him. They were never looking for verbal responses - more engagement, responsiveness and receptiveness.

At almost 3 years you are right to think that the speech delay might be linked to something else. The problem with living here is that the multilingual environment often hides other problems ... our family doctor kept saying it was because we speak 3 languages at home. But like you we had other suspicions.
oh, well.. please wish me luck tomorrow - I hope I can be convincing enough to get the referral!
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Old 08.12.2011, 10:43
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

What makes you think he might have ASD? Speech delay could be indicative of many things, or none. Are you concerned he isn't speaking much at all, or that he doesn't speak much German?
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Old 08.12.2011, 11:02
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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oh, well.. please wish me luck tomorrow - I hope I can be convincing enough to get the referral!
You don't need to be convincing .. if you have concerns and wish to be referred than that is all you have to say. If I had waited for our family doctor to think the referral necessary, I would still be waiting when the child was 18. Delayed development for whatever reason is a very complex area and family doctors cannot be expected to have the knowledge to assist, which is why even if they do not see what you see, getting a referral should not a problem.

PaddyG is right, there are very very many reasons why speech can be delayed that have nothing to do with ASD, but seeing as you mentioned that condition upfront, I am taking it that you have observed other issues which make you wonder what is going on. Your instinct and observations as his parent are the most accurate. They trump a family doctor any day.

But good luck anyway.
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Old 08.12.2011, 12:23
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

I just wanted to chime in and say that speech delay is not a major factor for bilingual or multi-lingual children. The speech development process follows the same stages whether the child is learning one or more languages.

There was a big psych study many years ago that showed that the average speech delay between a monolingual child and a multilingual child was only one month.

On the other hand, if your child has a speech delay caused by 'structural' issues of the brain, or processing or motor-coordination, or a weakness in the facial structures, or hearing problems, then the delay will occur in both languages.

Some kids talk a lot, some not much at all. At 2-3 years we don't look for kids who 'talk a lot' but when they do talk, we note their stage of development of language. A good speech pathologist/therapist, can hear/see the problems even if the child only speaks a little...

Either way, though, the advice is the same. Start with your Paediatrician, ask for a referral, and keep going on with the process until you are satisfied that your child's needs are being met.

Whatever the 'cause' of the speech delay, speech therapy can be extremely helpful - I once worked with a 2 year old who was a massive talker, but because of my observations, I mentioned in passing to her mum that it might be worth having an assessment done. Mum was a little affronted (I would be too!)....but a year later I saw her again, and she bowled me over with praise for mentioning it, because with a little speech therapy they had gone from 'only mum understands me' to 'now everyone understands me.

The risk between 2-3 for that child, was that she stopped talking when she realised that people couldn't understand her - this happened along the process of that year - but with the therapy, she found her confidence again, and was absolutely on the right track...

Point is, speech delays happen even for kids who speak heaps, or kids who don't speak at all...not talking much is not necessarily a 'speech delay'...but as you have already noticed some things, it's definitely worth looking further. We use 'speech therapy' techniques with toddlers in the early childhood setting, anyway, regardless of whether a child is ahead, middle, or behind on their developmental milestones...

Hope that helps...
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Old 08.12.2011, 12:54
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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What makes you think he might have ASD? Speech delay could be indicative of many things, or none. Are you concerned he isn't speaking much at all, or that he doesn't speak much German?
speech delay is not what worries me - he makes progress, he can distinguish between two languages and addresses me in one language then turns to his dad and says the same thing in the other language

what worries me are the following "things":
- he never smiled or laughed until he was over 2 years old (not a single time! I remember having a conversation with my husband because both of us felt it was difficult to bond with a child that never smiles at you) it improved gradually but i don't have a single photo of my son laughing until the age of 2.5!
- he never was too interested in any toys but could play for 30 minutes with a wooden spoon turning it into all directions
- he sometimes just drifts of into a dream land with eyes looking inwards, even at a very young age when they don't have a vivid imagination to get lost in
- he always pushes children, all children. never in anger but simply when he is overwhelmed (even from joy). before he pushes he clinches his teeth quite strong and then explodes in a push. he always been like that even with 1.5 years in baby playgroups and he is like this now, so it's not age specific
- his most favorite past time is water - may be the only thing he would play with for 30-40 minutes (i tried sand but no, it's only water that is so fascinating to him)
- two kindergardens in the last 4 months asked us to "take him out". both said they can't provide him with the level of attention he needs (one to one because he pushes so often). The last kindergarden (a Montessori one) also noted that he is happy if he can play on his own with animals and in the nature but get totally "out of control" in a small room with other children...
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Old 08.12.2011, 14:00
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

I just wanted to add my encouragement to what has already been said above ... take him to your pediatrician and get a referral. The signs you list should all be mentioned. I think things will be better with your son if you can understand what is going on in his world!

Best of luck to your son!
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Old 08.12.2011, 21:52
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

Same as Bookworm said. Good luck!
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Old 09.12.2011, 11:54
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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speech delay is not what worries me - he makes progress, he can distinguish between two languages and addresses me in one language then turns to his dad and says the same thing in the other language

what worries me are the following "things":
- he never smiled or laughed until he was over 2 years old (not a single time! I remember having a conversation with my husband because both of us felt it was difficult to bond with a child that never smiles at you) it improved gradually but i don't have a single photo of my son laughing until the age of 2.5!
- he never was too interested in any toys but could play for 30 minutes with a wooden spoon turning it into all directions
- he sometimes just drifts of into a dream land with eyes looking inwards, even at a very young age when they don't have a vivid imagination to get lost in
- he always pushes children, all children. never in anger but simply when he is overwhelmed (even from joy). before he pushes he clinches his teeth quite strong and then explodes in a push. he always been like that even with 1.5 years in baby playgroups and he is like this now, so it's not age specific
- his most favorite past time is water - may be the only thing he would play with for 30-40 minutes (i tried sand but no, it's only water that is so fascinating to him)
- two kindergardens in the last 4 months asked us to "take him out". both said they can't provide him with the level of attention he needs (one to one because he pushes so often). The last kindergarden (a Montessori one) also noted that he is happy if he can play on his own with animals and in the nature but get totally "out of control" in a small room with other children...
I was involved in Autism research for a couple of years (mostly looking at animal models) and some of these behaviours could certainly be attributable to ASD; the apparent deficiencies in social interaction, the restrictive, repetitive playing behaviour etc.
Good luck with the assessment and I hope you get some definitive answers.
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Old 09.12.2011, 16:46
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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speech delay is not what worries me - he makes progress, he can distinguish between two languages and addresses me in one language then turns to his dad and says the same thing in the other language

what worries me are the following "things":
- he never smiled or laughed until he was over 2 years old (not a single time! I remember having a conversation with my husband because both of us felt it was difficult to bond with a child that never smiles at you) it improved gradually but i don't have a single photo of my son laughing until the age of 2.5!
- he never was too interested in any toys but could play for 30 minutes with a wooden spoon turning it into all directions
- he sometimes just drifts of into a dream land with eyes looking inwards, even at a very young age when they don't have a vivid imagination to get lost in
- he always pushes children, all children. never in anger but simply when he is overwhelmed (even from joy). before he pushes he clinches his teeth quite strong and then explodes in a push. he always been like that even with 1.5 years in baby playgroups and he is like this now, so it's not age specific
- his most favorite past time is water - may be the only thing he would play with for 30-40 minutes (i tried sand but no, it's only water that is so fascinating to him)
- two kindergardens in the last 4 months asked us to "take him out". both said they can't provide him with the level of attention he needs (one to one because he pushes so often). The last kindergarden (a Montessori one) also noted that he is happy if he can play on his own with animals and in the nature but get totally "out of control" in a small room with other children...
i can feel your worry and pray to God for you
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Old 10.12.2011, 00:07
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

we got referred to the ambulanter psychiatrischer dienst and have our 90 minutes initial interview in two weeks time. Quite surprised how quickly it went - couldn't imagine it be so simple and quick in the UK :-)
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Old 10.12.2011, 08:28
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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Your instinct and observations as his parent are the most accurate. They trump a family doctor any day.
If only this were always the case. Whilst I agree with your other comment, that a doctor cannot be expected to see everything, the unfortunate thing is that some parents do not see delays/ syndromes etc that have the symptoms to arouse suspicions in the moind of the doctor - or of a teacher, or perhaps even other family members. Sight, hearing, speech, physical abnormalities, ( not just delays) even epilepsy, are just some of the things that I have had to support parents in acknowledging, during my years of teaching.

For parents who worry about behaviour along the autism spectrum, also see if you can find some reading on the subject of "sensory integration delays." I am NOT saying that it will be the answer, but there is somei nteresting ongoing research in this field now - some of which I have found very useful in assisting a few children whose behaviour patterns had been pointed to as being ADHD and/or autistic issues.

Best wishes to all those parents who are caring for achildren.
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Old 10.12.2011, 08:53
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

Good luck Sunny - you are on the right track now to best help your little boy. If you wish, please let us posted. Thinking of all your family.
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Old 10.12.2011, 09:10
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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If only this were always the case. Whilst I agree with your other comment, that a doctor cannot be expected to see everything, the unfortunate thing is that some parents do not see delays/ syndromes etc that have the symptoms to arouse suspicions in the moind of the doctor - or of a teacher, or perhaps even other family members. Sight, hearing, speech, physical abnormalities, ( not just delays) even epilepsy, are just some of the things that I have had to support parents in acknowledging, during my years of teaching.
You are quite right. I myself was in denial for a while, or more like seeing the symptoms but not wanting to realise what it added up to.

But in this instance what I was trying to highlight is that the OP has real and concrete concerns backed up by an array of behaviours that should be investigated further. Her instinct is that she needs further assistance and she should not let any doctor (with their all too frequent "wait and see" policy - we suffered from that!) tell her otherwise.

I suppose what I was really trying to say is that when a parent's instinct is that there is something wrong, do not let a doctor tell you to wait and see. We did. I regret it. Deeply.

The good news is that her doctor has listened to her and it is going further. It may be a long road me4Sunny, but where ever it leads to, it can only be for the best for your son. Well done for getting this far.

Last edited by ecb; 10.12.2011 at 09:34.
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Old 10.12.2011, 09:26
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

It is important to know that many autistics have a very normal life when take in charge early. It is possible to live like anyone else. They are usually extremely cleaver and many did accomplish great things in very intellectual field that put many of us at an hamster's intelligence level.
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Old 10.12.2011, 19:57
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Re: Diagnosing Autism Spectrum Disorder in a toddler in Switzerland?

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The good news is that her doctor has listened to her and it is going further. It may be a long road me4Sunny, but where ever it leads to, it can only be for the best for your son. Well done for getting this far.
well actually the doctor said paraphrased that he thinks in our case it's bad parenting but he's not an expert so we should see a psychologist (at least thanks for that). Also, my husband is convinced that I am making an elephant out of a tiny fly. Hence, I am kind of assuming that that's exactly what I will be told in two weeks time
My son is a free spirit and I never taught him to follow hat grown ups say (myself included) just "because I said so" (I myself had and still have a problem with authorities not based on merit by merely on job title). So some of his behavior is due to my own doing, but the pushing with teeth clinched, the difficulty to deal with any strong emotions are similar to my own experience in childhood. When I was 4.5 i killed a kitten because I couldn't cope with it being so nice to me, I couldn't cope with the feeling, with the emotion that overcame me at that moment (I still remember it vividly and I still feel horrible that I did that.
The teeth thing, that he learned from me because it is my own response to how to deal with overwhelming emotions (also in my case it is most of the time positive emotions in particular "love"-type feelings) so he saw me doing it a lot when I would cuddle him or kiss and suddenly feel overwhelmed by the intensity of my feelings - maybe I just taught him something and it's not a similar reaction because he feels the same, but rather a learned thing to 100% - so my hope is that more then anything else someone helps me to untangle this particular issue
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