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[DS3]

I recently came upon your site while searching the internet for a place to gain some support. My family, friends, et cetera don't fully understand my frustrations, or my situation for that matter - and I'm at my wits end.

So here's the situation. I have a 4yr old difficult child who has ADHD and ODD. He's on Adderall 5mg 2x daily. They're going to change the dosage this weekend when we go see the Dr. I just don't know to what. (I called this week to let them know that it doesn't seem to be working, and the Dr. said last weekend, that he would change it this weekend if that was the case.)

I say I am at my wits end because I feel I have tried everything to get him to behave, to follow the rules, to follow through, and nothing seems to be working. (Mind you he sees a play therapist, a pediatrician, and a psychiatric doctor).

For example, his play therapist told me to ignore his behavior when he is screaming, or throwing small items because it is his way of gaining attention from me (any attention better then no attention). So the other day, he got upset because his show was no longer on (I'm sorry, at 1800 is goes off and something else starts playing on the channel. I can't change that). So he started his normal screaming 'I don't want that' and throwing legos. So I ignored it. 15 minutes later, he picked up his solid wood rocking chair and threw it at me. I put him in his room so I could calm down about that. Then we discussed how throwing a chair is dangerous. He hasn't done it since, but it still scares me.

Another example: He refuses to eat unless it is something he chooses/gets on his own. I will give him dinner, and he will flat out refuse to eat it. So his therapist said to send him to bed hungry and he would stop. Didn't work. He figured out how to get over 3 baby gates, and get into the pantry and get what he wanted. So I removed all of the 'junk food' and things that he likes, and hid them. He then decided to pull the dining room chair into the kitchen to get into the ice cream in the freezer. So I got rid of the ice cream, and put him back to bed. About an hour later, he had gotten back downstairs, and was going through my baking cabinet (sprinkles all over the place...). So I got rid of whatever he liked in there.

He doesn't listen or seem to understand when something is potentially harmful. I have a 'normal' 2 year old who is now mimicking his older brothers behavior of climbing, and not eating, and throwing things. I've tried to explain that my difficult child is the 'older brother' and needs to set an example for his little brother. I often have to separate the two of them for fighting and biting.

I can't get my difficult child to follow any orders what so ever. I have asked him to pick up his toys and he flat out refuses. I've tried reward charts, taking the toys away, throwing out the broken ones (he breaks at least 1 daily), bribing, offering bigger rewards... nothing works. I make sure I spend one on one time with each of the boys through the day, but its getting to the point where I am so tired I don't know what else to try. by the way- my difficult child has decided that 11pm - 12am is a good time to finally fall asleep, and that 5-6am is a great time to wake up. I have to stay up and make sure he isn't getting downstairs, or playing in the bathroom, et cetera. So I'm not getting a whole lot of sleep. And he doesn't take a nap.

Right now, I'm on my own with these two. My husband is military and deployed. My family lives 3800 miles away. And I just feel overwhelmed, desperate, and in need of someone who understands. So thanks for reading this, and I would appreciate any advice anyone could give.

 

[Ktllc]

I SO understand. We have so big food issues as well. The advice of your therapist is not for a difficult child! I ahve try the "go hungry" technique... mine wil also climb counters, furnitures, etc... and then also have to deal with tantrum because he des not get what he wants!
Honestly, I have yet to find some that works... One thing though: there is no junk or sweet food in my house anymore. Just not worth the drama. If we want something sweet, we have to bake it. difficult child usually helps me bake. Maybe, try to get him involved in food preparation and choices? As far as snacks, just healthy stuff, so at least if I don't feel like fighting one day, I know he is still eating healthy (fruits, nuts, cereal bars, no sugar added apple sauce, etc).
Our therapist suggested a "cool down spot" when difficult child gets in that fighting mood. It requires quite a bit of teaching on how and why to use it, but I do see some results. I had to take the "cool down spot" down (remodeling the house) and difficult child has been super hard this past week. I've just built a new one (to his liking) and I hope he will go back to a more manageable behavior. The idea is to teach him to recognize when he feels to calm down and go there on his own until he feels better. Don't make a punishment, but a suggestion. Make it very attractive but soothing.
WELCOME!

 

[TeDo]

I agree with Ktllc. Sending him to bed hungry isn't going to work with difficult child's. Reading about the food issues, I wonder if he is like my difficult child. Mine has sensory issues that cause food issues such as certain textures, certain smells, and some taste. You might want to do some experimenting.

I also agree with having him help prepare meals. Maybe if he "helps" and has some input, he is more likely to eat. Let him "feel" like he has choices (within your boundaries). He might have some interesting ideas.

It also sounds like he has problems chaning his mindset, meaning he gets an idea into his head and nothing will get rid of it. This is especially hard to deal with sometimes.

I don't necessarily think that his throwing things is to get your attention. Mine used to do that and I thought along the same lines. However, I now know it was because my difficult child lacked the "correct" words to verbally express how he was feeling and didn't know how to deal with the feeling appropriately. Once we started on teaching those skills, things have gotten much better. This is all part of his Asperger's Disorder (which was diagnosis'd as ODD before that).

My son was put on Adderall when he was 4. It made things SO much worse. Apparently he cannot take stimulants for his ADHD. He takes Strattera (there are other non-stimulant medications out there) and I have seen a HUGE improvement.

It also sounds like your little guy is like mine in a couple other ways. My difficult child has to learn things the hard way, for himself. There are many times (when it's safe) I let him try the idea he has in his head and when it fails, I don't say "I told you so", I say "how about if we try it this way" (the way I said in the first place). He also has to know the "why" of my decisions. He needs to understand why I said no he can't do something because my no doesn't make sense to him. When I explain the why, a lot of the time he accepts my decision. Other times, the change in mindset gets in the way.

Anyhow, these are just some things that popped into my head. Take it for what it's worth. You have found a wonderful place with lots of experience and knowledge at your disposal. Welcome to the "family".

 

[DS3]

Thanks for the ideas, and the support.

I have tried having him help me with meals, and he still refuses to eat. And everyday it's something different. One day he will like pizza, the next day, he won't. He use to eat broccoli by the bagfuls, and now refuses to touch it. What use to be known 'favorites' he refuses to touch. Honestly, if he had his way, he would eat cereal and pop tarts all day long and nothing else.

I have heard it before that throwing things wasn't just for 'attention' and he appears to be more frustrated then anything. Often he will tell me to 'leave him alone' or 'don't talk to me' while he is in one of his 'moods'. So I leave him be, unless he starts getting really out of control. Then I have to intervene before someone (him, me, or his brother) gets hurt.

The adderall started out working really well, but I think the dosage needs to be adjusted.

He does has a 'cool down' spot that he can use, and he use to use, but now doesn't.

My difficult child also has to learn the hard way. There have been many times I have told him not to play on top of his dresser because he could fall and get hurt. Eventually he did fall and get hurt (nothing bad), and when I asked him if he was going to do it again, he said 'no'. Not even two days later I caught him ontop of his dresser again.

I have tried to explain the 'need' of things to him, and sometimes he understands and others, he just seems to not hear what I'm saying. For instance, I asked him to pick up his toys. His answer was 'no' and a tantrum. When he was calm again I explained that I needed him to pick up the toys so that I could clean the floors. He did agree that the floors were dirty. So I asked him if he thought he could help me out by picking them up. He said that we needed to buy a new house. (funny, yes, but not really a good solution). I ended up picking up the toys to get the floors clean. Same situation still there today. I won't normally pick up his toys for him unless the cleaning really needs to be done (ie: the floor is waaay to sticky, company coming over, et cetera). I just wait to see if he'll do it. I don't know what else to try.

 

[TeDo]

One day he will like pizza, the next day, he won't. He use to eat broccoli by the bagfuls, and now refuses to touch it. What use to be known 'favorites' he refuses to touch. Honestly, if he had his way, he would eat cereal and pop tarts all day long and nothing else.

My difficult child goes through this all the time. He will eat the same thing for DAYS and then not eat it again for MONTHS/YEARS. The Occupational Therapist (OT) told me this was a type of sensory issue and to not let him have it more than once a week. My problem is that difficult child is SO underweight (65 lbs at 13 yrs) that as long as he eats, I don't care as long as it's healthy. When he's out on his own (SOME day), he will be able to eat what he wants when he wants so the best I can do is try to teach him good things to eat.

I have heard it before that throwing things wasn't just for 'attention' and he appears to be more frustrated then anything. Often he will tell me to 'leave him alone' or 'don't talk to me' while he is in one of his 'moods'. So I leave him be, unless he starts getting really out of control. Then I have to intervene before someone (him, me, or his brother) gets hurt.

Way to go. Pick your battles. Once he's calm, have you ever tried to talk to him about what made him so mad to begin with? I realize he's only 4 but you can try it. Sometimes my difficult child will say I don't know or I don't remember. When he does that, I start by stating what I saw/heard before he got mad and then we back-track to find the "real culprit". Kind of like, "You were talking to your friend on the phone for 5 min. Then you hung up and walked into the living room and sat for another 5 min. Then all of a sudden you yelled at your brother across the room when he didn't say or do anything." It sounds like your little guy IS struggling to put his feelings into words or to identify the feeling and what to do about it. That will take some teaching.

He does has a 'cool down' spot that he can use, and he use to use, but now doesn't.

You might have to teach him to use it again. Or maybe he needs a different one somewhere else or maybe he needs to "redecorate" the one he has.

My difficult child also has to learn the hard way. There have been many times I have told him not to play on top of his dresser because he could fall and get hurt. Eventually he did fall and get hurt (nothing bad), and when I asked him if he was going to do it again, he said 'no'. Not even two days later I caught him ontop of his dresser again.

At times, mine can do this. He thinks it was only a one time thing and as long as it doesn't happen AGAIN, he's okay. Or if he didn't get hurt bad then it isn't BAD or dangerous because nothing BAD happened.

I have tried to explain the 'need' of things to him, and sometimes he understands and others, he just seems to not hear what I'm saying. For instance, I asked him to pick up his toys. His answer was 'no' and a tantrum. When he was calm again I explained that I needed him to pick up the toys so that I could clean the floors. He did agree that the floors were dirty. So I asked him if he thought he could help me out by picking them up. He said that we needed to buy a new house. (funny, yes, but not really a good solution). I ended up picking up the toys to get the floors clean. Same situation still there today. I won't normally pick up his toys for him unless the cleaning really needs to be done (ie: the floor is waaay to sticky, company coming over, et cetera). I just wait to see if he'll do it. I don't know what else to try.

But how does that affect HIM. He's at the stage where if it doesn't bother/affect him, why should it bother anyone else. At our house, we have implemented a rule where everything needs to be put away every day before they go to bed. That way the mess doesn't get too big and overwhelming and it has become a routine with the added bonus of it being picked up so I can clean as soon as they're in bed. I started this because bagging up all the toys in garbage bags (to throw in the trash - wink wink) and hiding them so they thought I'd really thrown them out didn't work. They just made do with what WAS left.

Keep trying. Others will be along to give other suggestions that have worked for them. I can only suggest you try things I have found helpful (and some not so much). I have tried many things over the last almost 8 years and am only now finding SOME things that work.

 

[HaoZi]

He will eat the same thing for DAYS and then not eat it again for MONTHS/YEARS. The Occupational Therapist (OT) told me this was a type of sensory issue and to not let him have it more than once a week.

I have yet to see any kid who hasn't done this at some point, that at least is one that almost every parent has had the joy of a few times. Ours might just do it more often or to a greater degree.


Has The Explosive Child by Ross Greene been recommended to you yet?

 

[DS3]

I have yet to see any kid who hasn't done this at some point, that at least is one that almost every parent has had the joy of a few times. Ours might just do it more often or to a greater degree.Has The Explosive Child by Ross Greene been recommended to you yet?

I found it through my searches on here and have begun reading it. For the first time in a long time... I actually have some hope for him. And some support. .

 

[nvts]

Hi! Welcome! I'd recommend a full blown neuropsychologist for him OR a developmental pediatrician. I'm of the belief that ADHD combined with ODD in such a little guy is more like explaining symptoms rather than a diagnosis of something causing it.

It would give you a great baseline and the testing is done on an outpatient basis. On Occupational Therapist (OT) evaluation would be a good idea too if there might be sensory issues. Sometimes a weighted vest or a brushing regimin might help as well - an Occupational Therapist (OT) would handle the recommendations and would coach you on how to do the brushing.

Welcome again!

Beth

 

[DS3]

I looked up 'sensory dysfunction' and printed out a checklist. It's funny, where my one child is hyper-sensitive, the other is hypo-sensitive. The one that is hyper-sensentive is the one with the ADHD/ODD. I don't know if its a specific characteristic of the ADHD or not. It's one of the questions I'm going to ask tomorrow, as well as taking in the checklist for it to show where the actual issues are. I'm also going to take my information that I've gathered from some sites about possible 'diagnosis' with him. I'm also going to be asking for a CT scan. The reason being, is my difficult child is a preemie. He was born at 26weeks and spent 74 days in the NICU. From the studies that I've seen, preemies are more likely to have a mental disorder and I just want to make sure his brain is developing the way it should be. Otherwise, I don't know how I would get him into seeing a neuropsychologist, or to see an Occupational Therapist (OT). Suggestions?

 

[TeDo]

Otherwise, I don't know how I would get him into seeing a neuropsychologist, or to see an Occupational Therapist (OT). Suggestions?

You should be able to simply ask your pediatrician for a referral. You want an evaluation. Plain and simple. It's that easy. Way to arm yourself. If the person you have your appointment with tomorrow isn't willing to look at diagnoses, I would find a different one. Good Luck.

 

[InsaneCdn]

Food issues are not uncommon even in "normal" kids... so you might want to research that as a separate issue.
Some things I've heard about (from other Moms) and/or had success with...
- turn it into a game... see if you can get him to "steal" it from your plate... example: "Boy oh boy, is this broccoli ever good. Nobody had better touch my broccolli 'cause I want to eat it all by my self. Yumm..."... and then leave the table for a sec (had to grab some more butter, or milk or something)... "Hey, who stole my broccoli...!". and then you slide another morsel over to the edge of your plate closest to the child, and repeat. (one mom spend 6 months like this, until her easy child learned to like all sorts of veggies... I'm not quite that patient!)
- offer a wide variety of healthy foods, in a mini-muffin tin (8 or 16 to a tray) - a few grapes in one, some carrot rounds in another, a few raisins, etc. - all healthy stuff, some that you think he might eat and some that you hope he'll try... one can be yogurt or similar, as a "dip". This way, he can choose - you've already "chosen", and he can pick from that. You can offer this more than just at meal time - works great for snacks - just vary the contents.
- its "allowed" to hide foods inside other foods, but not to force a particular food... for example, if the kid loves mac'n'cheese, you can sometimes sneak some very-finely-chopped cauliflower in there (white blends with color of pasta) - he chooses to eat the mac'n'cheese, he has then chosen to also eat whatever else is in there (didn't work with ME, but did work with my kids)
- offer frozen veggies... still frozen. Its a novelty treat - especially peas and/or corn. Same food value as raw and/or cooked - but it doesn't taste the same. (my kids still love this)
- mix up the order of the meal... start with a small serving of desert (as in, really healthy... fruit salad and yogurt, for example) - then offer the rest of the meal. For some reason, kids sometimes don't want to eat because they are worried about being too full to enjoy desert.
- get a high chair for his favorite teddy, and let him discuss what "they" should eat, with his teddy - gives a feeling of control

Any other creative ideas out there?

 

[BusynMember]

Hi! Welcome! I'd recommend a full blown neuropsychologist for him OR a developmental pediatrician. I'm of the belief that ADHD combined with ODD in such a little guy is more like explaining symptoms rather than a diagnosis of something causing it.

It would give you a great baseline and the testing is done on an outpatient basis. On Occupational Therapist (OT) evaluation would be a good idea too if there might be sensory issues. Sometimes a weighted vest or a brushing regimin might help as well - an Occupational Therapist (OT) would handle the recommendations and would coach you on how to do the brushing.

Welcome again!

Beth

What Beth said. See a neuropsychologist. Also a suggestion: Stop trying to use normal parenting techniques (sounds like you need a new therapist). The normal techniques don't work with our kids. We need to use creative parenting, however first we need to know what is going on with our kids. ADHD/ODD is vague and often a first (but rarely a last) diagnosis. It describes behavior more than the reason for the behavior. I'm giving it an 80% shot that more is going on. NeuroPsychs are great diagnosticians who test kids in all areas of function and can give you a blueprint of your child's strengths/weaknesses/possible diagnosis.

Good luck, whatever you decide to do.

 

[DS3]

We are headed to the doctor here in a min. I'll let everyone know how it goes. I'm going to bring up the neuropsychologist exam, a CT scan (he is a preemie and should have another one done), and the possible need for an Occupational Therapist (OT) (sensory issues), as well as the ADHD/ODD diagnosis, his medication dosage, and his sleeping patterns (He has not slept this week... so neither have I). If he says he can't help, then I'm going to take it up with his pediatrician tomorrow (he takes walk-ins first thing in the morning). The problem I have with finding another doctor is that I already have to go out of state to see the one I am. When I did a search for the ones that take our insurance, one in this area (El Paso) came up. Which is why we end up in NM to see the one that we do. If need be, I can go to Alberqurque (it's like a 3-4 hour drive one way), but I want to see what this one says today. Wish me luck.

 

[HaoZi]

Good luck!
Have you been keeping a journal? Foods, moods, weather, moon phases, medications, sleep, allergens, you name it. A lot of things most people never give much thought to can affect our kids. Mine has been going to sleep late and getting up early last few days as well.

 

[DS3]

I haven't kept a 'compelte' journal. I need to get better at it.

Anyways; How we made out-

The doctor did give me a referral to a neurologist to have him examined. He's offically diagnoses with ADHD and ODD, and he says the neuropsychologist will be able to tell if there is anything else going on. IE: lack in skills, sensory issues, et cetera. He kept him on the Adderall 5mg in the morning and then added a anti-psychotic medication called Risperidone at .25 mg two times a day. I don't know if I really want him on these medications, but we'll see what happens. I have to say that I don't believe more medicine is the answer.

I'm a little frustrated at the doctor for not listening to what I had to say about the CPS model and implementing a 'Plan B' methodology at the house (which has helped a little, but we just started so I'm expecting more progress to be made in the future). His only response was that is wasn't support by the american psychiatric association and to basically push me out of the room. I know not everyone has to agree with this type of intervention, but I would have hoped that he would hear me out. I don't have many options for psychiatric doctors in this area. Just is a bit frustrating. My husband said not to take it personally, and to give the idea some time to work with the doctor. Perhaps if he can see how well its working, then maybe he would be more open-minded about it. So we'll see.

 

[keista]

I have to say that I don't believe more medicine is the answer.

You are correct, more isn't always the answer, but if you find the RIGHT medicine, it may be.

Was this a psychiatrist you saw? If so, I'm not surprised that he wasn't interested in CPS. psychiatrists deal with the medication, tdocs deal with the therapies.

Good luck with the neuropsychologist evaluation. I hope it shed some light on the issues you are dealing with.

 

[SRL]

I haven't kept a 'compelte' journal. I need to get better at it.

Anyways; How we made out-

The doctor did give me a referral to a neurologist to have him examined. He's offically diagnoses with ADHD and ODD, and he says the neuropsychologist will be able to tell if there is anything else going on. IE: lack in skills, sensory issues, et cetera. He kept him on the Adderall 5mg in the morning and then added a anti-psychotic medication called Risperidone at .25 mg two times a day. I don't know if I really want him on these medications, but we'll see what happens. I have to say that I don't believe more medicine is the answer..

I just want to clarify that a neurologist and a neuropsychologist are different specialty areas. People here readily throw the abbreviated forms around and just in case there's confusion, a neurologist is a medical doctor who typically will spend an appointment or two and maybe order a diagnostic test such as an MRI before giving a diagnosis. A pediatric neuropsychologist typically spends the first appointment doing a parent interview and then follows up with 8-12 hours of testing, depending on the age of the child. They also refer out to other specialty areas, such as speech and Occupational Therapist (OT). A neurologist doesn't sound like a bad idea in your child's case but I definitely would pursue the neuropsychologist given the behaviors you are describing. All too often routes such as psychiatrists and play therapists before a complete and thorough evaluation lead to medications and parenting recommendations that lead you off the path of the true diagnosis or may even make the situation worse. Honestly it infuriates me--if it were a regular medical condition often we refer to medicating without a full diagnostic workup as shoddy doctoring or even "malpractice".

Please consider backing off of the everyday issues while waiting for some answers. I always regretted pushing some issues like food and discipline before knowing specifics that were revealed during assessments. Refusing to eat a certain food or wear a certain garment may truly be a matter of "I can't" instead of "I won't". Keep him safe, keep others safe for the time. You can backtrack later when you have more information on him and can determine how to better approach it.

Also, some things that you should know:
ODD and sensory issues rarely ride alone, but usually fall under the umbrella of other disorders. In the end that may turn out to be ADHD in your child's case, but it may not be. Untreated sensory issues can look like ADHD. Children who fall within the Autistic Spectrum frequently display ADHD symptoms. I'm not saying either of these are what's going on with your kiddo, but if your doctors aren't helping it will be in your child's best interest to educate yourself. I'd suggest picking up a copy of "What Your Explosive Child Is Trying to Tell You: Discovering the Pathway from Symptoms to Solutions" by Dr. Douglas Riley.

I'm a little frustrated at the doctor for not listening to what I had to say about the CPS model and implementing a 'Plan B' methodology at the house (which has helped a little, but we just started so I'm expecting more progress to be made in the future). His only response was that is wasn't support by the american psychiatric association and to basically push me out of the room. QUOTE]

That's a doozie of an answer! I haven't heard that as an "official position" before, and believe me I've heard a lot in my years here. in my opinion, that basically translates to "It isn't my job to help you learn to manage behavior on the homefront--it's quicker and easier to medicate." I wouldn't burn any bridges with this doctor right now since you likely don't have a lot of choices, but I wouldn't look for him for non-medication behavioral help either. In the end when given a full set of data turned up through assessments, some parents opt to start or continue on medications, but with some diagnoses (such as sensory issues) medications won't help, and may complicate or make things worse.

 

[DS3]

I appreciate the clarification. He's sending him to a neurologist. Not a neruopsych. So I guess we'll see the neurologist, and see about getting him into a neuropsychologist. (this road seems to be getting longer and longer...) How do I go about getting him to see a neuropsychologist?

I've been doing quite well with the 'Plan B' approach. Since I started (it's now day 4), we've only had 1 or 2 explosions. Which is a change since he use to explode multiple times a day. I've 'Plan C'd' a lot of the things that aren't priority, which I think is helping as well.

Honeslty, I just want to know what the actual 'problem' is with him. That way I can work on 'fixing' it. I say it like that because no one wants to know that something is possibly 'wrong' with their child. But its obvious that ignoring it isn't going to change anything, and that I need help figuring out what is going on so that I can help him. I know how I feel on a daily basis, and I know it has got to feel about the same if not worse for him. I just want to get him the help he needs. Is that so much to ask? Doctors can be so frustrating!

 

[InsaneCdn]

I just want to get him the help he needs. Is that so much to ask?

I'm going to make a guess that there's hardly anybody on this board that doesn't feel the same way.
Reality is... for most of these kids, one diagnosis isn't going to do it - even if it is "correct".
There are often layers of dxes... and so you start solving one, and that only sort-of works, so you start digging again, and find something else... and so on.
Someone else on another thread said that it takes an average of 7 years to get a correct/complete diagnosis. For us... its 10 and we're still not there. (getting closer, though)

The second challenge is that we (the western world, for starters...) have a medical system that specializes in specialists. Which means, each doctor is looking for a certain range of problems - and if you don't "fit" the range he/she works with, then that person doesn't have an answer for you... and often doesn't know where to send you. It also means that one specialist's recommendations to solve one issue, may be in conflict with what is needed to solve another issue... There is no holistic approach.... its up to us parents to try to pull it all together. And we're not specialists, and have almost no power in the medical (or school) system. But we do have the power to push, pull, experiment (within reason... of course - diet, different parenting strategies, different learning styles, etc.), document, research... WE have to be the generalists!

We're here because we don't believe in giving up...

 

[SRL]

I appreciate the clarification. He's sending him to a neurologist. Not a neruopsych. So I guess we'll see the neurologist, and see about getting him into a neuropsychologist. (this road seems to be getting longer and longer...) How do I go about getting him to see a neuropsychologist?!

It depends on the neuropsychologist as well as your insurance coverage. Sometimes you need a referring doctor in order for insurance to cover the testing, but sometimes it's not required. I'd call your insurance to check.

Oftentimes neuropsychologists will be associated with Children's Hospitals, larger hospitals, larger behavioral clinics, or university hospitals. I'd start looking there.

Glad to hear you're finding some improvement using TEC methods. It sounds like you all needed some relief.

I agree with INsanceCdn that the reality is one diagnosis usually isn't the full answer, but a reputable specialist can point out things and have suggestions that even very observant parents might miss. It's good to cover wide bases.

If there have been any speech delays, "different" sounding speech patterns, issues such as very repetitive or halting speech, you will want to look into a speech-language assessment as well.