Dr.T

東尼爸爸

Dr.T,

I'm very appreciate for your contribution because you raised out many professional questions. I'm also quite interesting about YOU. You used "Dr. " as your label. Are you medical officer, resident, SMO, consultant or COS?? If yes, I'm want to know about where you practice? Let us know you are so free/have so much time to raise out many many topics! Let our relative to visit you when we're waiting for a "Doctor" so long time!
If not, what is your doctoral degree? PhD in Engineering? Dr. :  :

Dr.T

I am an educational psychologist with a doctorate and have been in this field (education & psychology) for almost 20 years.

I don't think it's OK for me to mention the whereabout of my practice here. The last thing I want to do is self-advertising here.

I mainly wrote my messages at night and at times I have to force myself to turn off the computer. In fact it's quite difficult to do as I always want to answer queries that I (think) might be of help.

Comparing with my other web friends here my contribution is minimal...

Dommom

Dr. T,

Perhaps your practice is on a very steep street in Central ?

Dr.T

Dommom 寫道:
Dr. T,

Perhaps your practice is on a very steep street in Central ?

No. I know this other Dr. T though and he's a clinical psychologist.

Well, no prize for those who get it right  :

diaryman

No matter who you are, you can help parents is very good la.

kyy

Dr. T,

我的bb現只有6個月大, 一直很healthy(except he has g6pd) , 亦較其他同期bb大隻 (現已19磅).

近日我開始注意到他與其他同age 的bb有很多不同, 我見其他bb很容易被別人引到發笑, 別人(esp. 父母)說話時bb亦會望向說話的人, 亦會有intention伸手拿野-------

1) 但我的bb很難先會笑, 要玩得好癲先笑
2) 仍未有intention伸手拿野
3) 最令我擔心的是他好像好唔喜歡望人, even我抱住他臉向我, 他亦好小會望我, 而是多數會四處看, 目光很小會在我臉上停留 :-|

我看過一些自閉症文章,所decribe 的systom 與我bb有些相似, (esp " avoid eye conyact"), 我很擔心, 想問現在可否/是否需要帶他去做assessment or consult doctor ???
can you give me some advice ???

Dr.T

Dear kyy,

Thanks for your message. I think it's a bit too early to tell whether a child is autistic or not at the age of only 6 months. Your reaction is normal as a new parent. The more we know, the more we'll afraid of...

In fact it's not uncommon to find autistic-like features in infants as that's their "normal" behaviour. The concepts of self and others (the outside world) are not inborn but develop with age. Don't worry too much at this stage and most likely your kid will start showing intertest in others when his physical abilities are ready for him to do so.

I have started another topic- the CHAT checklist for interested parents. Please refer to it for more details on identifying autism (but not diagnosing) in early age (18 months!)

carolsin

Dr. T,

Re: ADHD

My son is now 18months.  When we saw 兒科 for his cold illness, the doctor suspected he may be ADHD as he walked around his clinic and appeared very happy and excited about the environment.  

Before that, I also searched information about ADHD as I found that he is very active, moves around, always "on the go", cannot sit still, does not pay enough attention to what I say, plays each toy only short time and then switch to another one.  He still cannot speak and just yells.
He fidgets and squirms, does not have good temper, etc.  My mother also found that he is too active and different from others baby similar to his age.

I am quite worried about it these few weeks.  His head circumference is smaller than average which is also one of the characteristics of ADHD (info. from some research).  He is also a restless sleeper.  Even when he is sleeping, he moves around during the nite, he doesn't require us to carry him but just turns around a few times per nite.  I guess his active to quiet sleep ratio is high.  I tried to see doctor just for his sleeping problem, but the doctor simply said it is normal.

It's true that his attention span is short for overall general things, always need stimulation, new things and attention.  But I can read a few books to him, or read the same book to him a few times.  For something he's really interested, like screw driver, clips, milk spoon, bottle, etc. he can play longer time.  He can have long attention span on watching TV (I know it is no good and trying to reduce the time).

Please kindly generally advise me.  When I asked the doctor what should I do, she recommended me to assess him continually myself.
At what age, should I bring him to assess professionally by expert?  Where should I start?
and what should I do now to help him?
Many thanks for your generous help.

Carol

Dr.T

Dear carolsin,

I think it's a bit too early to decide whether a kid is ADHD or not at the age of 18 months. As you have mentioned your boy still has moment of being concentrated so I'm not too worry about him. May be his inattentive behaviour is only a reflection of his immature intellectual abilities at this stage. Not being able to use language to communicate yet might also be part of the reason.

May be you can ask your family doctor to write you a referral to the CAC but I doubt whether they will have any conclusion at this moment.

For me, may be I'd pay more attention to his cognitive development and check whether his performance is comparable with others. Heep Hong's 兒童發展手冊will be a good reference.

mcc88

Dr. T.
我之前已於PM請教過你, 我亦問過視障兒童家長資源中心的那位.  以下是我囝囝的情況(just to refresh your memory). OT所教的練習他完全唔合作, 其實EP可否幫到他呢.


1. 4歲3個月,K2
2. 3歲4個月時發現有先天性遠視, 當時約只有5成視力, 帶眼鏡後,現視力回復正常
3. 他不能認讀A-Z及1-5(1及2可免強認到), 中文字認到很少, 如 "人"及"山"就可以, "口"字常說是"嘴".
4. 數量概念很差, 多個兩個只會說"好多". 明明同他一齊數到3,問他有幾多,他只會亂講
5. 同他溝通絕對無問題, 他能清楚表達自己,但有些字音經多次糾正仍然未有改善, 如反覆問他他又識自己改正.
6. 老師懷疑他有讀寫障礙, 因未有為4歲而設的讀寫障礙評估, 現已於醫管局排期做OVERALL的評估.
7. 劃畫只是在塗鴉程度,免強有人形.
8. 扶輪社的評估是手眼協調出現問題, 尚待跟進
9. 請了私人OT約2個月,一星期一次, OT的評估是FINE MOTOR SKILL behind約一年.
10. 我覺得他怕失敗, 失敗了便不肯再試, 所以好難要求他合作做訓練或TEST.

Dr.T

Dear mcc88,

A qualified psychologist's role in your son's case is to determine his current level of cognitive functioning, i.e. IQ. Despite I still suspected that his current problem might due to his weak eye-hand coordination skills, it should be worthwhile to find out his intellectual potential and also strengths and weaknesses, at least at this moment.

For a 4'3" kid, what you described above, especially #3, #4, & #7, is quite worrying. May be what he's taught now is a bit difficult for him...

mcc88

有無人可以susgest 好的EP呢.    Dr.T又唔肯disclose 自己的工作地點及真正身份.

Miumiu2001

Hi Dr. T,

Need your help for some professional advice.  

My son is now 3 years old, and he has been quite aggressive since he was 2.....hitting people when he's not happy, when we refused to follow his "order", or told him that he has done something wrong.  I realised that the problem has become worse recently, but we seldom hit him.  Except that my husband hit him 2 or 3 times after my son has continuously hit him for many times.

Besides, I've sent him to a few playgroups (English, music, just for fun).  He just run around in the classroom and seldom listen to what the 'teacher' said.  However, the kindergarten teacher said that he is very well-behaved at school.

I wonder whether he is hyper-active or is he just normal, and what can we do to change his behaviour?  Does he need to get some professional assessment?

Thanks!

Dr.T

Dear Miumiu2001,

Without seeing your child in person and purely through your description, I'd say your child's performance is quite normal as a 2/3 years old.

Apparently he only displays his "bad" behaviour in certain location and also when he is with certain people. My guess is his current KG is quite a traditional one while the playgroups are run in a relatively "free" manner. Also most likely he attends the former daily but the latter once a week. May be he has difficulties understanding what is expected in the playgroups which is not unusal.

Regarding his "aggressive" behaviour towards family members, "consistency" is the key word and all adults must use the same approach towards him. Also maintaining a straight face when he's doing things you consider naughty, not laughing at him in the beginning (he will think you are playing with him) but eventually hitting him at the end when you cannot stand it (he will not have a clue why he is hit ).

Again, hope it helps.

Miumiu2001

Thanks Dr. T.  I feel much better now....

mcc88

DR. T.

我想再問下, 我囝囝已於扶輪社及OT做過TEST, 又約了將快在大口環做TEST. 以上全部在3個月內做,如再找EP做TEST是否需要相隔一段時間呢, 會否影響RESULT.

Dr.T

mcc88 寫道:
DR. T.

我想再問下, 我囝囝已於扶輪社及OT做過TEST, 又約了將快在大口環做TEST. 以上全部在3個月內做,如再找EP做TEST是否需要相隔一段時間呢, 會否影響RESULT.

I don't think it's necessary to have your child tested by EP at the moment as some of the assessment might be overlapped.

faith

Dr.T
      SORRY，想問問，想知道在政府做5歲的智能評估，與私人的有何差別，例如1. 兩者都一樣是詳細評估？兩者都有詳細報告？其實六歲做會否好一點呢？如果5歲做了，評估中心可以幫到甚麼忙？如是資優，也可以替我們找適合的學校嗎？如果不會為資優找學校，那麼是否6歲做會好些。因我孩子在咬字發音上評定為中度發音障礙，語言表達上MAYBE DELAY大半年(但在報告上也註明可能不準，因為當時仔仔不太合作，很扭怩)。怕在語言上會影響評估。
另在3歲快10個月做的測試準確度高嗎？報告說他智能有4歲至5歲半的認知能力，為何會有咁大個RANGE，阿仔在認時鐘和數星期時有點不專心，問了幾次先答得好，但我知道他早在半年前已很熟悉了。
又拼圖形時，遇到一個有很多輪齒的圖形，由於拼下去的位置很寬鬆，他就很固執的要拼得輪齒對正為止，浪費了很多時間在這個齒輪拼合上，但評估的醫生只掛住望著個評估表計分，看都冇看一眼，我們忍不住叫他那個不用對準，他才又拼另一個，結果浪費掉很多時間在一個計時的評估上。
想知道這些評估會高估或底估孩子嗎？如果他達5歲半的認知能力(當時他只有3歲9又3/4個月)，到長大一點會退步嗎？
因為我不知何故，他兩歲半可以拼一幅近60塊的JIGSAW PUZZLE(九巴那一幅不是很易拼的)，甚至七十塊...但他愈長大愈退步，三歲多時連四十多塊都不容易拼完，記憶力也比小時候差，會不會有甚麼毛病？(他曾患鼻炎)，例如腦退化......我是不是擔憂過多。並不是要他很叻，只是擔心別的孩子愈大愈有進步，但他卻相反。這使我對於為他評估有點卻步，而且不知真正的評估目的為了甚麼？除了有助知道能力的強弱幫助他學習。但社會上並不是每個家長都會拿錢為小孩做評估啊﹗評估後對於他的行為情緒上有何幫助？
SORRY，次次都咁長氣....

Dr.T

faith 寫道:
1. 想知道在政府做5歲的智能評估，與私人的有何差別，例如:兩者都一樣是詳細評估？
2. 兩者都有詳細報告？
3. 其實六歲做會否好一點呢？
4. 如果5歲做了，評估中心可以幫到甚麼忙？如是資優，也可以替我們找適合的學校嗎？
5. 另在3歲快10個月做的測試準確度高嗎？報告說他智能有4歲至5歲半的認知能力，為何會有咁大個RANGE
6. 又拼圖形時，遇到一個有很多輪齒的圖形...想知道這些評估會高估或底估孩子嗎？
7. 如果他達5歲半的認知能力(當時他只有3歲9又3/4個月)，到長大一點會退步嗎？
8. 因為我不知何故，他兩歲半可以...三歲多時連四十多塊都不容易拼完，記憶力也比小時候差，會不會有甚麼毛病？
9. 這使我對於為他評估有點卻步，而且不知真正的評估目的為了甚麼？

1. Supposingly they should use the same tests but govt might not spend sufficient time explaining to you what has been done. IMHO that's the most important part of the evaluation, not the scores.
2. Govt- no, you'll only get a simple classification and nothing else. Though I once had clients "buying" back the detailed report later.
3. Then the child will be admitted to primary school already (at 6). The purpose of having the child tested will be lost.
4. For an experienced psychologist with some understanding of the education system, s/he should be able to suggest suitable schools to your kids. BTW, I seldom allow parents into the testing room unless really necessary. Usually child will behave badly with parents around. Possibly the CP is rather green.
5. The younger the child, the less you can get out from them. As you'd noticed most of the items were related to eye-hand coordination.
6. I doubt whether your child was tested by a CP, may be a pediatrician only. The test items that you mentioned did not look like Stanford-Binet or even Merrill-Palmer to me.
7. I think it's a bit misleading to say the child is functioning at 5.5 years when he's 3'10" in your case. May be the CP meant "some" of his ability is comparable with a 5.5 years child but not all of his cognitive abilities.
8. Possibly the nature of the puzzles is different. You can't just compare them by the number of pieces.
9. As I said, a thorough evaluation should help you to understand the child better, if and only if the examiner can explain to you what exactly your child can or cannot do. As you can see the so-called "mental age" is rather misleading...

faith

Dr.T
    還有一些教育栽培上的問題想問；不過先要感謝你不厭其煩的回答我們的問題。 :wink:
    撇開eq情緒上的問題，想知道應該如何栽培孩子。由於他才四歲，仍不能做正式評估。現在是否甚麼也不幹除了等待呢？
     孩子自一歲始便有些不一樣，未夠二歲半便自己會用畫板寫哂五十二個大小楷字母和數字。定期到健康院檢查，護士都會有點訝異他的能力，說他比一般孩子超前。甚至學校面試時，老師主任都會訝異他的能力，會寫字和計數。
但很多時其它人只會說成我訓練他(和說我逼他無分別)，個個個都問我點訓練他的。因此，，為免讓別人覺得是我訓練他，我更沒有刻意教導他，以為以他的聰明自己便會學得很好，要證明他不是我訓練的 。但慢慢卻發現其它人已給他們讀幼稚園的仔女學了很多東西，還會溫習功課，那些說我訓練仔仔的媽媽常說﹕「我就唔會逼我的仔女了。」但我發現她們"訓練"得比我多上千倍呀。我突然覺得自好像驕傲的rabbit....怎麼咁stupid呢﹗

我堅持了好一陣子讓他自由發展，愛學就學，唔愛學就唔理(唔想俾人話我有逼佢，他是自然聰明)，功課都幾乎是自己獨個兒做，連功課寫字唔靚我也不擦掉他，任由老師改(出了小小界也改)。
想問這樣的小孩是否真的可以放鬆學習嗎？
有個小學校長告訴我不要教他那麼多，否則上小學便不好，
但轉頭又話一定要栽培他(因三歲的小孩會計除數)，不要浪費。很多人都認為不要教他(如數學)，我要由他停下來嗎？等到評估後再栽培？大家都在學珠心算，而我，除了piano，我甚麼都沒有給他學。人家又話不要浪費了他。還有一年(距離評估)我可以怎樣做？不教他以免上小學更距離遠(他已懂找數字的因數和分別很多合成數和質數)我知道如果我肯教，他很學，腦子冇退化，當上小學前，二年後，他應已學會五六年級的數了，我要教嗎？聽邊個講先正確？
還有我們家經濟並不是很寬裕，沒有太多能力栽培他，他piano有天份，光是培養他這方面已花不少了，數學和piano可以怎樣取捨？數學不給他學任何東西如珠心算、公文數、史丰收，或一再讓他鑽上去。這會浪費他嗎？
sorry，這些問題似乎應要俾錢才得到答案吧﹗但距離還有一年，要讓時間白白過去？可以給點意見嗎？
因為我己浪費了他很多可以好好學習的時間了。這問題困擾了好一段長時間了。
thanks
thanks