Tag Archives: autism diagnosis

Autism 101

For parents who are wondering why their child interacts with the world differently than some other children do, and are wondering whether it might be autism, it can be hard to understand all the different ways that autism might present. This post is intended as an overview of: the clinical definition of autism, understanding what “the spectrum” means, some of the signs and symptoms of how autism might present, information about screening and diagnosis, and resources to support parents of neurodiverse kids.

The Diagnostic Definition

When I was a kid, we tended to think of autistic people only as the people who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking, flapping their hands).

Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky” or “odd ducks” or said they “march to the beat of their own drummer.”

Then the term Asperger’s syndrome appeared, and was often applied to kids who were gifted and “quirky.” And we would talk about people in terms of “where are they on the spectrum” or “are they low functioning or high functioning?”

Now, Asperger’s is no longer a distinct diagnosis. It’s been pulled back under the umbrella of Autism Spectrum Disorder (ASD).

The criteria for an ASD diagnosis in the DSM-V require showing symptoms in both of these categories:
A) Persistent deficits in social communication and social interaction (deficits in social-emotional reciprocity, in nonverbal communicative behaviors used for social interaction and in developing, maintaining, and understand relationships) and
B) Restricted, repetitive patterns of behavior, interests, or activities (as manifested by at least two of: S
tereotyped or repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior; Highly restricted, fixated interests that are abnormal in intensity or focus; Hyper- or hypo-reactivity to sensory input.)

Or to put it in a less deficit-based language: A) may have challenges interpreting and following the same social rules as their neurotypical peers or expressing / responding to emotions in the same ways neurotypical people might  and B) strong preferences for predictable routines, specific interests and repetitive movements. Reactions to sensory input and external demands may be more intense than typical.

About 1 in 44 children is diagnosed with autism. Within the diagnostic criteria, there’s a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home.

What is a spectrum disorder?

When autism is described as a spectrum, it doesn’t mean this. (source)

continuum labeled not autistic at one end, and very autistic at the other end

Or this (source)

continuum, labelled "a little quirky" on the left, "definitely autistic" in the middle, and "tragic" on the right

Autism is a more complex way of interacting with the world that can’t be described on a simple numeric scale, and can’t be simplified to either “not a problem” or “tragic”.

I’ll share a few different ways that it has been illustrated, so you can find the one the best resonates with your experience.

The autism spectrum can look something more like this:

An illustration of a circle where the "pie pieces" are labeled language, executive function, etc. and dots indicate where the person might have more strengths vs. more difficulties

(That image comes from this great comic on “Understanding the Spectrum” by Rebecca Burgess – I highly recommend reading it.)

This graphic (source) breaks the spectrum into five categories, similar to Burgess, though the colors and the way they break things out are a little different:

GAO

And they explain that “the type and severity of characteristics varies from person to person” as seen in this diagram of three individuals’ ‘spectrums.’

Picture1

C.L. Lynch on theaspergian.com uses this illustration

spectrum

Then gives a few examples of how this would apply for an individual person.

spectrum 2

I don’t know which one of these graphics might be helpful for you, but I find it very helpful to think of these more nuanced descriptions rather than a single axis of “a little quirky” to “tragic.”

I know that if someone asks me if my son is “high functioning” or “low” or asked “how autistic is he”, I would find it difficult to answer those questions. It’s much easier to tell you – “here are the things he’s good at, here are some behaviors he does that might seem odd to you but don’t harm anyone or anything, and here are some challenges he has and some accommodations you could make that might help him to manage them.”

More Zones to Consider

The DSM-V criteria are two-fold: a) social-emotional differences, and b) restricted, repetitive patterns.

You’ll notice in the illustrations above that they each split the signs of autism a little differently, but here are some of the typical patterns that some autistic people might display. [Note that all autistic people are individuals, so any individual may have some of these signs and not others. As a parent, I found that if I went down any checklist of signs, I had many that I said “nope, that doesn’t describe my kid” and others where I went “ooh boy – that is exactly what I see!”]

  • Social-emotional: may have challenges reading social cues, inferring what behavior is expected in a social situation, expressing their emotions in the same way a neurotypical person might expect them to or understanding / responding to other people’s emotions. Some may avoid eye contact. May be content playing / working by themselves and not appear to need the same social connections that others might. (Or might long for social connections and be very sensitive to rejection.)
    • The Floor Time approach to child-directed play can help an autistic child connect with others in play.
  • Sensory Processing: some autistic people may be hypo-sensitive to stimuli; many may be hyper-sensitive.
    • Tactile stimulation (like tags on clothing or seams on socks or being touched) may distract and distress them. Or, they may seek tactile input, banging their heads, pressing up against others, wanting lots of hugs and loving weighted vests and blankets.
    • Some may have lots of oral sensory issues. They may be super picky eaters or may gag easily. Others seek sensation, sucking and chewing on a variety of items.
    • Many autistic people can get overwhelmed by sounds – they may be less able to filter out all the noise that neurotypical people ignore (traffic on the road, the hum of the refrigerator…) and may be happiest with noise cancelling headphones on in loud situations.
  • Emotional regulation challenges: may have bigger reactions to a situation than typical. This could mean being so excited they bounce up and down, gallop around or flap their hands because the joy is too great to contain. It can mean meltdowns where too much stimuli, too many demands, or big disappointments overwhelm them and they react by screaming, hitting, or other behaviors for a prolonged period of time. (Note: the Zones of Regulation tools can be very helpful for autistic kids to work on emotional regulation skills.)
  • Preference for routine / difficulty adjusting to changes and transitions. Many thrive in an environment with lots of structure, and very predictable routines. When a transition between activities is coming, they need a little more warning that it’s coming and help letting go of one thing and moving on to something new. Sometimes even with all the help you can give, an unexpected change or hard transition from a beloved activity to anything else can cause big meltdowns.
  • Specialized Interests: A common characteristic is long-lasting, all-consuming  interest in specific topics, whether that’s dinosaurs, astronomy, flags, Rubik’s cubes, or collecting memorabilia. When they start to talk about that topic to someone, it may become a prolonged monologue where they may not recognize when the other person has lost interest and is ready to move on, because they cannot imagine ever losing interest in that topic. They may also love repetition and repetitive movements.
  • Impulse control and executive function may be harder for some autistic people. Discipline techniques that work with neurotypical folks may not be as effective with autistic children. (I find the Incredible Years and Ross Greene have the most helpful approaches.)
  • Language / communication: some autistic people are less verbal or non-verbal.
  • Motor skills: some autistic people may have motor challenges, ranging from “clumsy” to limited ability to control their movements,

Not everyone who has a few of these behaviors is autistic. And not everyone who is autistic has all these characteristics. And all of these characteristics can manifest in subtle, barely noticeable ways or can be blatantly obvious to the casual observer. Again, autism is a spectrum disorder that can be a bit hard to pin down.

It’s also worth noting autism can present differently in girls and be more difficult to diagnose especially for gifted girls).

Awareness vs. Acceptance

In much of popular culture, autism is viewed in a very negative light. You’ll hear people talking about it as a tragic diagnosis, and people seeking a “cure” for their child’s autism, and using deficit based language, even a supposed “advocate” may do so during events like Autism Awareness Month.

The Autism Self-Advocacy Network recognizes Autism Acceptance Month, which “promotes acceptance and celebration of autistic people… making valuable contributions to our world. Autism is a natural variation of the human experience, and we can all create a world which values, includes, and celebrates all kinds of minds.”

Autistic people have unique strengths. For example, many have intense attention to detail, a high degree of persistence, and ability to analyze data. Their “obsessive” interests can lead to stunning expertise in their chosen career fields. And “Sometimes being autistic means that you get to be incredibly happy. And then you get to flap. You get to perseverate. You get to have just about the coolest obsessions.” (Source)

A Note on Co-Morbidity and Social Issues

Autism also has several co-morbidities: conditions that often occur with autism.  “Over half of autistic youth [also had] attention deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter had depression, and 60 percent had at least two comorbid conditions. Other common comorbid conditions include sleep disorders, intellectual disability, seizure disorders, and gastrointestinal ailments.” (Source) Many of the challenges we think of as being due to autism actually come from these co-morbidities. We should think of them as separate issues and handle them separately.

And many of the “challenges” of autism actually come from societal attitudes toward autism. For example, if a child jumps up and down with excitement, is that really a problem behavior that needs to be corrected? If a teenager gets overwhelmed by noises, so chooses to wear noise-canceling headphones in many situations, is there a reason anyone else should care about this? If someone can’t stand it when the different foods on their plates touch each other, isn’t it easy to use just a little extra care when dishing them up instead of using a lot of energy telling them that “you just have to learn to cope with that”? If the neurotypical community understood more about neurodiverse people, and made simple adjustments, it would greatly reduce the “challenges of autism.”

Screening and Diagnostic Testing

If you’re wondering about your child, or a child you know, start with this list of symptoms, or red flags to watch for. https://www.cdc.gov/ncbddd/autism/signs.html

If you’re still concerned about possible signs of autism, use a screening tool:

If you’re still concerned, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system. Look here for all the details about how to access testing.

In King County, Washington, some resources for diagnostic testing include: Kindering (especially for kids under age 3), UW Autism Center (this is where my daughter was tested at age 20), and Seattle Children’s Autism Center. Some private practice psychologists also offer testing. For example, our son was tested by Heather Davis at Brook Powers Group, who had worked with him in their Incredible Years program.

Here is a podcast with tips for what to do when you’re waiting for an autism diagnosis or a PDF on the same topic.

Are you debating about testing?

Some parents debate about whether or not to test. Or they test, and get a diagnosis of “we can’t say it’s autism but we can’t rule it out.” They wonder about whether to seek out special education services. For more on those topics and on what to do while waiting for a diagnosis, check out my post on “Autism? ADHD? Delayed? Or just quirky?

What was the Cause? Is there a Cure?

It can be tempting to ask “what causes autism” and for many parents, that’s a quest to understand whether they “did something wrong” that led their child to be autistic. There’s no one cause for autism. There may be genetic factors, or environmental factors, or a combination of environmental factors with genetic susceptibility. Personally, I have not found it helpful to look backwards and wonder about the cause – it’s better to focus on what we need to do to move forward into the future.

I also do not seek a “cure” for autism. (Partially because that implies it is a problem that needs to be fixed rather than just a different way of being in the world which benefits from accommodations.) Some parents spend a great deal of time and energy seeking a way to fix their child. There are some effective treatments which can help make things more manageable for the family, but there are also some “treatments” you’ll find on YouTube videos or random people’s blogs that can either cause harm, or simply just take more time, energy and money than they are worth.

For example, many parents have reported significant improvements in behavior problems with dietary changes. If you find diet changes that are generally considered nutritionally sound and they prove helpful for you, then hurray! But if a special diet is prohibitively expensive, or if it deviates from mainstream nutritional advice and might cause nutritional deficits, or if your kid is just a super picky eater and it’s a huge battle, it’s worth knowing that there’s not a lot of research that proves this is essential.

Resources on Autism

General Resource Guides

There are lots of resource guides from various organizations. Try these from the Seattle Children’s Autism Center, Autism Parenting Magazine, and the AAP. Plus these communication resources. Note: I have not vetted all these resources. If you discover any materials that approach autism as a terrible disease to be cured, or focus on ways to “fix” autistic kids, set those aside. I personally choose materials that talk about autism as a neurological difference that shapes who they are and how they interact with the world, and talks about ways we can increase accessibility for them. 

Autism Navigator has a free online class (approx 3 hours) on Autism in Toddlers. They have handouts you can print on everyday learning activities, how parents can support language and emotional skills, and Q&A for parents.

Discipline and Behavior Challenges

  • This article is short and helpful: 15 Behavior Strategies to Help Children with Autism.
  • There are tons of helpful resources at challengingbehavior.org: visual schedules, tip sheets on making daily routines easier, handouts on teaching emotional IQ, addressing behavior like hitting or biting.
  • If it’s available in your area, I highly recommend the Incredible Years program. (We worked with Shanna Alvarez in Seattle, who was fabulous.) While the parents meet, the kids attend “Dinosaur School” which teaches social and emotional skills. Note: my Discipline Toolbox is highly influenced by what we learned at Incredible Years.
  • Ross Greene has some really helpful tools, summarized as “Kids Want to Do Well – If they’re not doing well, ask yourself what skill or resources they are lacking.”
  • If emotional regulation is a challenge for your child, check out my post on Big Feelings and the Zones of Regulation approach.

Building Connections with Your Child

Floor Time, or Child Directed Play, is a powerful way to connect with any child, but especially children who have challenges with social-emotional connections. Click here to learn about Floor Time: child-directed play. On Autism Navigator, learn how to support social communication development, and transactional supports to promote learning.

More resources

There are helpful resources at https://brightandquirky.com which has webinars with leading experts on how to support kids who are gifted AND autistic (or have other behavioral issues).

And for your child, here’s my list of Children’s Picture Books about Autism and other “quirky kids” stories. Seeing themselves reflected in a book might be helpful for them.

If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.” If you’ve got a shy child who observes more than they engage, check out my post on the slow to warm up child.

Autistic? ADHD? SPD? Or Just “Quirky”?

As a parent educator, and as a parent of autistic children with ADHD, I’ve had multiple discussions with parents who are wondering whether their child is autistic or has ADHD or “just” sensory issues or whether there are developmental delays. Parents who are wondering whether they should have their child tested. Parents who received testing results of “well, we can’t say it’s autism, but we also can’t rule out autism.”

I’ve also had conversations with colleagues about children in their classes, where they’ll wonder about a child’s unusual behavior, but also say things like “I see some symptoms, but I don’t think they’re autistic, because they don’t ______.”  [fill in the blank of a stereotyped assumption about how “all” autistic people behave].

It’s tricky to figure out what to do about these “maybe?” cases, and trickier still when parents see that their child has challenges, and think they would benefit from support (like occupational therapy or social groups) but their insurance won’t cover it unless they have a diagnosis.

The Spectrum / Gray Areas

When I was a kid, we tended to think of autistic people as ones who showed significant impairment in multiple domains: non-verbal, developmentally delayed, frequently stimming (e.g. rocking). Then there were a bunch of other kids who were skilled in many areas, but had some unusual behaviors. We called them “quirky.” I don’t remember anyone being called ADHD when I was a kid, but there were absolutely “hyper” kids, and “head in a cloud” kids.

We understand far more now, and have clear diagnostic criteria for ADHD, a better understanding of autism and sensory processing disorders, and solid research-based developmental milestones which help us more accurately diagnose delays.

But within these criteria, there’s still a spectrum…. a range of behaviors from subtle to blatant, and from minimal impact to major impacts on school and home. Some children present very obvious symptoms very early and get a quick referral for services. Many take longer to figure out.

When you look at any behavior scoring, there’s the “typical” kids. In this bell curve, the kids in the green zone of scoring are considered normal. The kids in the red zone are two standard deviations off of “normal” and typically qualify for things like IEP’s (or gifted services) or SSI disability payments. The kids in the yellow zone – one standard deviation off – would often benefit from some services / accommodations, but may not get diagnosed early or ever.

deviations

To Test or Not to Test

I have been a childbirth educator for over 20 years. In that field, we often say – before you get a test, think what you will do with the results and whether it will be helpful to you to have the results.

If you are a parent deciding whether to test, or an early childhood professional deciding whether to refer for testing, it’s worth asking that same question.

If there are services that you believe that a child would benefit from that they can only access if they have a diagnosis, then they should be tested. If you believe they are being labeled as lazy, or spoiled, or whatever judgmental label, and you are wondering if there may be an underlying cause, they could be tested. If it would be helpful to you as a parent to have a “label” that helps you better understand your child and learn more about what they need, then it’s worth getting them tested to learn more from a professional, whether that’s a diagnosis or just resources for more ideas and support.

I’ve talked to parents who worry that having a diagnosis will harm the child’s self-esteem, and wonder if it would be better to try to “pass” and get by without the diagnosis. I have talked to multiple adults who received diagnoses as adults (whether it’s a diagnosis of autism, of ADHD, of dyslexia, of auto-immune diseases…), and they pretty much all said that receiving a diagnosis was a relief. They’d always thought, or been told, that there was something wrong with them, and if they just “tried harder” or “quit whining” they would be successful. When they had a diagnosis, they were better able to understand their needs and felt more able to ask for the accommodations they need to be successful. And they’ve also discovered more about what their unique strengths are now that they’re not trying to be just like everybody else. They wonder how much further they could have gone in life if they had the diagnosis and the correct accommodations earlier in life.

To refer or not to refer

As a parent educator, I observe the kids in my class. I had one toddler where I had no doubt she was on the autism spectrum and would benefit from early and intensive services. I spoke to that parent early in the year, encouraged her to seek testing, and got her connected to services.

I’ve had lots of other students who were “quirky” or have asymmetrical development issues.

I do developmental screenings in my classes, and this can start the conversation with parents about developmental issues. If there’s a minor delay in one area at one time stamp, I just talk about ways to enhance learning in that area, but if I see more delays or persistent delays in that one area, we have a broader conversation about what might be going on there. Sometimes, I have shared “here are some things about your child that are a little different than what we see in other kids their age. It could just be a temperament thing or just where they are in their development, but it does make me wonder a bit, so it’s something you could keep an eye on, and check in with me again if it becomes a concern.”

If I suspect a specific condition, I use the word, because I’ve spoken to parents of 7 year olds who have said things like “I can’t believe no professional we worked with ever mentioned the word autism to us before last  month or told us that those behaviors might be signs of autism. If anyone had the courage to have that conversation with us, we wouldn’t feel blindsided now, and we could have learned more about accommodations that would have helped us parent him more successfully and access services earlier.”

Re-Framing A Diagnosis

I also talk about autism, ADHD, and SPD differently than the common dialogue. Autism is often treated as a tragic thing. ADHD is often viewed as bad behavior which would be fixed if the parents only ______. Kids with sensory processing issues are viewed as over sensitive and told they just need to get over it.

I think it’s better to just think about these as a developmental difference which creates some challenges but can also be accommodated. If a child is blind, or deaf, we don’t expect them to be able to change that, just by “choosing to behave better.” We don’t assume that “learning to act normal” will “cure” them. We try not to let their label limit them and try to maximize their access to a full life. We figure out what accommodations they need to move through the world, and to maximize their potential for a successful life. It’s an accessibility issue. The same is true for all accommodations.

And many of the “challenges” of these conditions actually come from societal attitudes or lack of understanding. If the neurotypical community understood more about neurodiverse people, it would greatly reduce the challenges of each condition. It turns out that some of the things we do to accommodate them also benefit all the other people in the room.

Screening

If you’re wondering about your child, or a child you know, start with a list of symptoms, or red flags to watch for. Or with a screening test. Here are some resources to try:

  • Milestones Checklists from the CDC. (And here’s info about other developmental resources)
  • Overall Developmental Screening: the Ages and Stages Questionnaire assesses fine and large motor skills, communication, problem-solving and social emotional development. Here’s how you can do your own ASQ screening and the ASQ-SE which focuses on social-emotional development.
  • Autism screening: For children under 2, check out Baby Navigator. If your child is 16 – 30 months old, try the Modified Checklist for Autism in Toddlers, available at www.autismspeaks.org/screen-your-child
  • For ADHD, consider the checklist of symptoms. Think about other children the same age as your child. Compared to them does your child have several of these challenges? Do they have these challenges only at home? Only outside the home? Only when doing things they don’t enjoy (like cleaning) or that don’t interest them (sitting still at a restaurant table)? If they have these challenges in all circumstances it is more likely to be ADHD. If you only occasionally see the symptoms, there may be another cause.

Diagnostic Testing

  • If you’re still concerned after completing a screening, talk to your child’s health care provider, and/or contact your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. If your child is under three years old, look at the ECTA website. If your child is 3 years old or older, contact your local public school system.

I have a full post here on: Accessing Testing for Developmental Concerns.

What if they’re NOT diagnosed with a condition?

Sometimes you go through the steps of testing to be told your child is fine. Or that they’ll outgrow the challenges. Or they’re a quirky kid but only one standard deviation off, and thus don’t qualify for services.

If you feel strongly that your child needs services now and you can only access them if you have a diagnosis, you may have to do a fair amount of advocacy and may need to seek second opinions. Know that some clinics will refuse families who have already had an evaluation elsewhere – they worry that some parents may just be shopping around for someone who will give them the diagnosis they want. That wouldn’t be in the best interest of the child.

If it is possible for you to wait to pursue a diagnosis, that may work out better. A few months or a few years down the road, you may discover that they did outgrow it. They moved through a phase, and are now doing well in school and social occasions. Or, you may discover that things have gotten more challenging for them, and more professionals are on board with a diagnosis, given more evidence.

In the meantime, try not to be overly focused on finding a label – an answer to “WHY is my kid different than other kids.” Or on how to “fix” them.

Instead, you may find it more helpful to think: “given that my kid is who they are, what can I do to support them?” Learn more about how other people have accommodated kids with similar challenges, and try those those things. Figure out simple things that help them be more successful. Adjust some things so they’re not under continuous stress and pressure, while still giving them appropriate challenges so they learn and grow and reach their potential. Don’t let the possible label limit them more than necessary.

More resources

  • To learn about autism, read my overview of autism which includes a lot more info on signs and symptoms, and also on supportive tools that help make it more manageable.
  • For possible ADHD: If you’ve got one of those kids whose brain and body are always moving super fast, leaping from one thing to the next, make sure to check out my post on “the race car brain.”
  • If you have a very “shy” kid who holds back, hovers on the edge, and observes, check out my post on the Slow to Warm Up Child.
  • Read about Accessing Developmental Testing.

A sample decision-making process

I can share my own experiences about developmental testing for my youngest. I’m not saying it’s the ideal story or the only approach, just one example.

As a parent, I suspected something was unusual about him from when he was about six months old – signs like when he got overstimulated, he’d purposely bump his head into things. If the usual routines were disrupted, he’d have big meltdowns. When he was a toddler, he would perseverate – like during one gymnastics class where he told his coach “I am an ankylosaurus” at least 20 times. He had singular obsessions – like the month where he wanted nothing but Cat in the Hat, or the periods where he only wanted to talk about the planets and could easily be calmed out of a meltdown by just handing him 8 objects and asking him to decide which one was Mercury and putting them all in order.

However, he didn’t fit some key stereotypes of autism: he’s very verbal, OK at eye contact, and seeks out social connections. So no professional ever told us that we should seek an autism diagnosis, but I suspected that was where we’d be someday.

I learned  about autism and sensory processing disorders, and what accommodations help kids with those challenges, and I just did all those things for him. We chose preschools and activities that were a good fit for him, not ones that we knew would push his buttons. We didn’t have him tested yet, because having results wouldn’t have changed anything about what we were doing.

However, when he started kindergarten, things got more challenging. Luckily his kindergarten teacher was fabulous with him and just naturally did the accommodations he needed. But all of school didn’t accommodate as well. So, at that point, we had the testing done, and received an autism diagnosis, and that has made it easier for us to access the services he needs. For school, he has an IEP which ensures he gets extra support. And now our insurance will cover OT treatment and therapeutic social groups for him. Having access to therapies and supports are the upsides of having the official diagnosis. (There is a downside… some summer camps and other programs say they can’t take children with autism or can only take a limited number, so there are some programs that are no longer an option for him.)

In second and third grade, when kids are expected to sit still and pay attention for longer periods, he was having challenges with that, so we then learned more and had him evaluated for ADHD. That diagnosis allowed us to adjust his IEP for more accommodations which has helped him be more successful in school. And when he was 10, he was assessed to determine whether ADHD meds would be helpful for him, and they have, in fact, been very helpful. So, doing each of those evaluations when we did worked out for us. Your needs may be different.

We were hesitant to choose ADHD medication for my son, but again talked to adults we know with ADHD, and they universally recommended them, saying “on days without my meds, my brain just spins and spins and I can’t get the things done I need to get done and then I feel bad about myself and then I get less done… having my meds helps me be more the person I want to be.”

He will start middle school next year, and is far more focused and more organized than he used to be. We know that’s partially due to his meds, partially due to the extra supports he’s gotten from us and from school in learning organizational skills and executive function skills that might come naturally to others. He has far fewer emotional regulation issues and meltdowns than he had in the past. We know some of that is developmental, but most of it is due to the additional supports we have sought out (like pyramid model tools, Floor Time, ideas from Ross Greene and the Zones of Regulation) and the extra supports he has gotten from school due to his IEP.