- Regarding school issues: is there an IEP? Is the IEP up to date? Is the IEP descriptive and realistic about how the child's issues should be addressed? Are the goals measurable (and not subjective)? Was an autism specialist involved in developing the IEP? Is there a behavioral plan, and if so, is it measurable and realistic? Was there a Functional Behavioral Analysis (FBA) and if so, was it performed by a board certified behavior analyst (BCBA?) (Many schools have employees who have taken an in-service do FBA's, which I don't recommend. FBA's can be complex.) Does the teacher receive the proper in class support to implement the IEP? Might a change in classroom placement help your child succeed - whether to a more restrictive or less restrictive environment? If the school has already suggested it, consider re-evaluating the options. Has the child's diagnosis been re-assessed recently? Remember, according to practice standards, psychological testing should be repeated every 3 years for children who have disabilities. Was the testing done by the school or by an independent psychologist? Some school psychologists do a great job, but you can always request a second opinion (and often the school has to pay for it.)
- If your child is having behavioral challenges, might they be modulated with the use of medication? Remember, trying a medication is not marriage, a short trial of medications is overwhelmingly safe (no I'm not an MD, but your MD will say the same thing re: most of the first line medications used for behavioral or emotional issues) - and there's decades of data on most of the medications used that have not indicated serious side effects. If medication is currently being used, are you sure your child is taking it? Has the dose been adjusted? Remember, many of these meds are weight based, and as your child grows the dosage may need to be re-assessed. Have you followed up with the prescribing physician per recommendations? If your PCP (primary care physician) is prescribing the meds, and you don't think it's working well, consider consulting with a board certified child psychiatrist. If you are already seeing a psychiatrist and feel that the meds have not been working, or that the psychiatrist is not paying proper attention, have you considered a second opinion? (Best practice supports second opinions, don't be intimidated that the doc will not like you, he or she knows it's part of the business.) If you're using herbal supplements to help with behavior, do your research. As the FDA does not monitor them, supplements may or may not have the ingredients you think you are buying. Have you researched the academic literature on the effectiveness of those supplements?
- At home: is there other stress in the home that could be negatively impacting your child (think behavior or mood changes) such as marital issues? Drug or alcohol use? Medical issues affecting a parent or sibling? Other mental health issues affecting a parent, sibling or other close family member? (Parents of kids with special needs are at very high risk for depression due to the great stress that can exist. Be honest with yourself and with your spouse/partner.) Other significant stress on the family such as legal issues, frequent job changes or moves (even if for good reasons these may be hard for your child to cope with.) Don't think that a child with more severe impairments doesn't "get it." They can and do. Has there been a divorce? Remember, no matter how "amicable" the divorce, kids always lose. Even when the divorce is needed, kids tend to want a reconciliation and tend to take responsibility, no matter what you tell them. They need time, space and often therapy to absorb the reality that they really had nothing to do with it. If/as the marriage is struggling, seek help now! It's a whole ton cheaper in time and money to do so compared to the time and money involved in divorce. (Therapists are cheaper than attorneys!) Parents, don't forget the value of support groups. There's nothing like speaking to someone who's been there, and you don't know that until you go, even if you're "not a group person." (In the metro Atlanta area, the Spectrum support group based in Gwinnett County is easily the best in the state and I'd not be surprised if it's the best in the nation. Certainly it's among the best in the nation and worth checking out.)
- Socially: Is your child being bullied by others (including siblings) in the neighborhood, the extended family or at school? Has your child's mood or behavior seen a significant change? Children with autism, whether high or low functioning, can exhibit signs of depression. Look for a change in their normal mood, onset of irritability or of crying or a sad affect. Have you considered the effects of puberty? Have you explained these changes in a way they can understand? Are they struggling with how to cope with their romantic feelings?
This is a bit of a thought "dump" but all of these "details" are important and need attention. The devil may be in the details, but ignoring the details can make life for you, your child and family a living hell.
