Report from Consultant Paediatrician

Here's the latest report from Dr Irani after our last visit on Wednesday, 22nd October 2008. We received the report on Friday, 24th October 2008. 

I have only praise for Dr Irani as he is efficient and understanding. He knows what it's like for parents to constantly searching for answers and he try to explain to us and assure us that we are doing the right thing for Alex. 

Although the Internet is God sent, there are also many conflicting reports and very much out of date. It's best for parents to check with the Professionals before trying to make conclusions that may not benefit their child.

Dr Irani put us onto the right track with our latest doubt if Alex is Dyspraxic and may not be Autistic. If we persist that route, Alex may not get all the support he requires if the ASD label is taken away.

Here's the report:

MEDICAL DIAGNOSIS/CURRENT DIFFICULTIES:

1. Generalised developmental delay (Mummy's note: Thank God it's not Global Developmental Delay)
2. Speech and Language delay with severe phonological disorder and characteristic speech apraxia/dyspraxia
3. Delayed fine motor skills with poor bilateral coordination
4. Autism Spectrum Disorder

Alexander has made some remarkable progress with his social communication skills and has been attending the Rainbow Resource at Great Holland Primary School.

Following the recent Speech and language therapy review, you have somehow been given the impression that Alexander's improvement with his social communication skills and his prominent difficulty with speech phonology could mean that 'dyspraxia' is the unifying diagnosis to explain his difficulties. This is not correct.

In spite of recent improvement, Alexander's social communication skills remain impaired compared to another child of his age. He demonstrates ritualistic behaviours and motor mannerisms (and these were evident in the clinic today). Hence the diagnosis of Autism Spectrum Disorder is entirely appropriate.

'Dyspraxia' does not exist as a medical entity within international diagnostic classification systems, although we all understand what this means. Developmental Coordination Disorder (DCD) is a valid diagnosis for marked impairment in the development of motor coordination that significantly interferes with academic achievement or activities of daily living. However, for a diagnosis of DCD, the child should not meet criteria for Autism Spectrum Disorder and the motor difficulties should be in excess of the child's developmental delay. This is not the case for Alexander.

In my opinion, it is best that we do not all get too focused upon using complex terminology to describe Alexander's difficulties, but rather focus upon what approaches would be most appropriate to meet his range of developmental and education needs.

Observing how he struggled to form the appropriate words in the clinic today, I am  very supportive of the Speech and Language Therapist's observation about Alexander having an apraxic/dyspraxic speech difficulty.

Alexander also has significant difficulty with his fine motor, balance and coordination skills. Both of these would require that Alexander receives appropriate support from the therapists and also within the education setting.

I shall review Alexander's progress in my clinic in approximately a year's time. If you have any queries or concerns in the interim period, please do not hesitate to get in touch with me.