<p>I need a little help on how to tactfully (but forcefully) deliver a message.</p>
<p>My nephew will be 3 in December. He has very little language skills. He does not acknowledge anyone who speaks directly to him. He does not react to loud noises. In a nutshell, his development is off-kilter.</p>
<p>His parents seem to think this is in the normal spectrum (they have 2 older children 13 and 9). They are resistant to having him tested.</p>
<p>I need to at least get them to consider that my nephew needs to be tested.</p>
<p>As a mom of a mild Aspie, noise is a big factor in determination.</p>
<p>Aspies, which are a form of autism, can’t stand loud noises, it really upsets them from n emotional standpoint.</p>
<p>Other factors are fine and gross motor skills, on top of social skills.</p>
<p>Our niece is 80% deaf in one ear and 50% in the other, her parents refused to address this until she was around the same age. Later on they acknowledged that the ped was addressing it from an early age, but they were not ready to accept the fact.</p>
<p>One way to truly tell is their voice. Is it monotone? Autistic kids are not known to have a monotone voice when they speak. If your nephew does speak with a monotone voice and no inflection, I would lean to a hearing disability.</p>
<p>There is no way to address this, because in your post they have made their decision regarding his health care. They are unwilling to be open to opinions. You need to be supportive for them as parents. They will get there in time, just be prepared to assist them to get your nephew up to speed when they are ready.</p>
<p>Just be direct. Tell them what you noticed–that kid isn’t responding, isn’t talking and that they should probably have hearing and speech evaluations. Sometimes parents are “in denial” about such things. They get used to the way their kid is, and don’t really recognize that something is “wrong.” Many kids don’t go to a doctor regularly, and the problem may not have been picked up.</p>
<p>Years ago, I was that parent in denial about my kid’s communication problems. My aunt told me her granddaughter had similar behavior–and it turned out she had a hearing problem. That motivated me to get my kid’s hearing checked. His hearing was fine.
Then I had his speech evaluated. He was below average (age 3 1/2) but the therapist said it was still in normal range for a boy. So I let it go. When he was 7 he hadn’t made much progress and I had him checked again–after another relative basically shook me by the shoulders and said “THIS ISN’T NORMAL, YOUR KID NEEDS HELP!” By then he was at the bottom of the chart–he went through a year of intensive speech therapy. (He’s 17 now, his speech is fine, he is a top student, though he does have some mild communication/social issues.)</p>
<p>I am a Speech Language Pathologist (slp) and currently much of my caseload includes early intervention and pre-school aged kids. </p>
<p>Getting friends and family members to take action with their children can be very touchy. I will list some websites with good milestone information. I suggest that you print the articles out for them. (They are more likely to look at the information if it is already in front of them rather than just give them the site addresses.) Tell them you saw an article in a magazine and it made you think of their child and that you took the liberty of printing the referenced information for them. Tell them that you are concerned and gently request that they read over the information and talk to their pediatrician about the child’s development. </p>
<p>They may thank you, they may be resentful for a while. Try not to pry for too much information if they are not willing to talk about it and hope for the best. Maybe someone else in the family can find out if they followed through. This is a scary admission for parents, but early intervention is very important…and quite honestly, after 3 it is not even considered early intervention.</p>
<p>I have been working many years and have seen a real change in the population of kids with the types of communication delays/disorders. Improvements come with hard work and patience. Intensive therapy is needed from the professionals and family members. It does work. You don’t give a lot of information, but a silent child at that age is not good.</p>
<p>If these websites are not allowed to be on CC just PM me and I will send them to you.</p>
<p>I would be direct with a relative, indirect with a friend or neighbor.</p>
<p>When Son was in 4th grade, he had quite a few tics…my MIL decreed that he had Tourettes. Her “diagosis” irrirated me…however, it also sent me to the computer to research Tourettes to prove her wrong…which led me to web sites that discussed Asperger’s (that I’d never heard of) which led me to make an appointment at a child study center, which led to the Asperger’s diagnosis. </p>
<p>It’s never a good thing to hear any version of “your kid isn’t normal” but sometimes it’s okay to endure a relative’s wrath or irriation for the sake of the child.</p>
<p>My cousin is mentally challenged. My old world grandmother, upon seeing him (and the shape of his head) as a newborn, said “there is something wrong with that kid.” No tact. She said it repeatedly for years, while his parents were in severe denial. Didn’t talk and didn’t talk. When he wasn’t talking when it was time to enter kindergarten, his parents finally agreed that there might be an issue. (He started talking at age 12! It was so cool to hear him!)</p>
<p>Anyway, grandma was right, even if her message was tactless and not well received.</p>
<p>piggle’s mom-As a Physician I see many red flags. I also recall my cousin who refused to test her son ( she knew something was wrong, but did not want to address the issue ). Does he watch TV,play with toys which make sounds? Does he ever get startled by a noise ? If not deafness should be considered strongly.In the case of my cousin we ( couple of family members ) sat down & did an intervention with parents. Turned out child was profoundly deaf with uncorrected astigmatism ( so he was not focussing on faces,environment etc).right now he is learning sign lang & in agood special ed. program.</p>
<p>In my state, there is free testing and free pre-school for kids with any sort of learning or other disability. Is this child in pre-school? The pre-school teachers are great about picking up potential issues and referring the child for treatment.</p>
<p>I did once have to tell one of my best friends that there was something “different” about her son and he needed some help. It was very awkward, but this child really needed the help. I was very clear that I was not an authority (although the A-words were banging around in my head) but that I felt her son needed an evaluation by people that actually knew their stuff. He’s now a young adult, and he is still different, and his parents are still in denial, but he did get some treatment and accommodations throughout his school career. I would consider this a success.</p>
<p>Thinking that perhaps your nephew will not hit preschool until next year since he is so late in the year for his birthday?</p>
<p>’ My old world grandmother, upon seeing him (and the shape of his head) as a newborn, said “there is something wrong with that kid.” No tact."</p>
<p>The exact same thing happened with my old world grandmother. She looked at my newborn cousin, whose eyes appeared anatomically normal, and said “Something’s wrong. He’s not seeing right.” She kept saying it, and finally at 6 months they took him to an ophthalmologist. Turns out he had a congenital eye problem that was blocking light from reaching his retinas, and the doctor was able to intervene. He is now a legally blind adult, but had many years of partial vision thanks to my grandmother’s lack of tact and the resulting treatment he received in infancy.</p>
<p>By public law when the child turns three the local school district is responsible for his educational needs. Their local school system should be contacted. The parents can request to have the child tested and placed in a special needs preschool if that is what is recommended or receive supplemental services at their own preschool or home if that is what is preferred (not recommended by me). This is provided at no cost to the family other than through their tax dollars which they are paying anyway.</p>
<p>Many kids on the Autism spectrum are hyper sensitive to sounds, but some show no reaction at all.</p>
<p>My MIL spent her career as a psychologist doing pre-k assessments; she saw lots and lots of kids who had been mis-diagnosed in various ways. Hearing loss being mistaken for cognitive/developmental delays was a big one.</p>
<p>With advances in audiometric technology severe hearing impairment can be ruled out even without the cooperation of a child. An audiologist’s evaluation is indeed part of the comprehensive evaluation that would be recommended here.</p>
<p>^This is not true at all, however I agree with the rest of your post…</p>
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<p>There is only so much you can do. If you have brought it up and mentioned what behaviors concern you and they weren’t open to hearing it, there is nothing more you can do. However, if at any point an inkling of doubt creeps in there, they will remember what you’ve said and may be able to act on it then. So if you say something and they are not immediately receptive, don’t assume you didn’t help. It’s also entirely possible they also think something is wrong but are trying to save face in front of you, perhaps because they are still struggling with denial, or are distressed that you noticed it before them-- my mom was in denial about my autism diagnosis for a while because it killed her as a parent that she didn’t see it when everyone else could. You just have to give these parents some time and see what happens. If you’ve said something, they know your opinion on the matter and when they are ready to hear it they will remember. That’s not the ideal situation but that’s all that can be done. If this child is seeing a pediatrician and things with the child are as you say, someone is going to pick up on this and it may be easier to take it coming from them than you.</p>
<p>I am planning on addressing this with the mother this weekend. As always there is a back story.</p>
<p>When the 13 yo was a toddler, she was constantly holding her ears. When we got together for birthdays, she’d cry when we started singing, even now she leaves the room. We (the family) suggested there might be a problem, but the mother insisted that the doctor said there wasn’t. We backed off. Flash foward to kindergarten…the child was diagnosed with mild autism by professionals in the school system.</p>
<p>An aunt and I will try again with this child. We expect massive pushback.</p>
<p>The fact that he doesn’t react to loud noises suggests that his hearing is muffled – which happens sometimes to kids who have fluid in their ears after an ear infection. Such kids should be evaluated to see whether they need ear tubes. Most of us parents have known kids who needed ear tubes, and although it’s a nuisance and involves a minor surgical procedure, it’s not a hugely big deal.</p>
<p>I suggest this because maybe you might want to suggest it to the parents. It’s the least scary possibility, and it’s one that should be checked out. Of course, in the process of checking it out, the doctor will be looking at other possibilities, too. But there’s no need to mention that, I think.</p>
<p>It could be something or it could be nothing. If you are going to point things out to the parents I would not “diagnose”. They may have noticed these things also but are taking a wait and see attitude. With our dyslexic son we started noticing differences with that child compared to our other two and close friends and family members noticed a few things but it took 2-3 years to connect the dots and confirm with testing. There is much going on with three year olds. How this one functions in a pre-school setting with others the same age might be a big clue. The parents may not be in denial, but simply assimilating.</p>
<p>Audiologist here who works in a special needs preschool and with autistic, MR/DD children and adults.</p>
<p>Sounds like this child needs a full eval at a special needs preschool (paid for by the district). Includes speech, audiology, psych, etc…</p>
<p>Ruling out a hearing loss is key. If he can hear, then obviously there is more going on. Sounds like more going on regardless. Does he follow directions? Any obvious receptive language?</p>
<p>If the parents are resistive, I would possibly (as a Mom, friends, relative, not an audiologoist!!) call the Pediatrician myself and explain my concerns. He/she can then address them at the next visit, or sooner, and make the recommendation that the child be tested for services. Easier said then done though.</p>