*REVISED* (Post #1) Anyone w/ emotionally disabled 4 year old child?

[Luckymomoftwo]

3/15/08 - REVISED - I spoke to my daughter's teacher yesterday. She said that she is doing very well and her behavior has been MUCH better. And I had THE MOST EXCITING NEWS to share with her teacher. My daughter is FINALLY potty trained! She's been in "big girl panties" for about three weeks now and has gone an entire week with absolutely no accidents. In my opinion, WE ARE POTTY TRAINED!

Not to worry, I am still going to talk to her doctor about everything we've been going through with the daycare and the special ed program she's been in.

Thanks again for all of your replies and helpful hints and suggestions.

My daughter is very smart academically. She's also very routine oriented. Her daycare thought she may be Autistic or have Asperbergers. I took her to meet with a school psychologist through the special education program at our local elementary school. It is a free program - I could not afford a "regular" psychologist. They are WAY too costly and our insurance plan only pays half of it after a $1,000 deductible!!

So, the school psychologist said no way is she at any spectrum of the Autism chart. They diagnosed her with having a communication disorder. Now that she's been in that class for a couple of months, they are concluding that she may have an emotional disability. They are going to have the behavior counselor observe her periodically and then have a conference with me in April.

I'm just wondering...is this something that can be treated through therapy/counseling? Is it something that she can overcome and be in "normal" school classes? Right now they don't think she'll be ready to go to kindergarden in the Fall.

This is all new to me...my brother has ADD (was diagnosed about 20 years ago...he is a classic textbook case...but we still love him! ) So, dealing with him growing up with ADD is the closest I've ever been to any type of "disability".

I also have no idea what could have caused my daughter to develop this emotional disability. Is it something that happened during my pregnancy with her? Is it something that happened during the first years of her life? Is it just a personality trait type thing? We've never had anything happen in our lives that I would think would make her emotionally disabled!

Oh...she's also not potty trained yet. We've been trying for over two years. I guess, in a sense, we're lucky because she goes #2 on the toilet, but not #1. I'd rather be cleaning up wet pants than poopy pants!

Thank you in advance for your replies. Sorry this got so long, I'm just trying to get a better understanding of what's going on with my little princess!

 

[lucigo]

I recommend you take your daughter to a developmental pediatrician, or at least get another opinion. I realize you have a high deductible but its not in your daughter's best interest to rely on the school system to diagnose your daughter. I have a 4yo son with autism. Every child is different. Every child with autism is different. If you are still concerned that your daughter could be on the spectrum I encourage you to visit the autismspeaks website and watch their educational videos and learn more about it.

There is a key difference between having a communication disorder and an autism spectrum disorder called joint communication. It has to do with the interaction between your child and others. Does she bring you things to show/share them to you, does she point at something, look at you to make sure you are looking and then look back at the item? If your answer is "uhh my kid is 5 of course she does" you have much less to worry about than if you have to think about the answer.

 

[LuvsTinker]

I totally agree with the prev. post.

My son at 3 & 4 had evals done through the school and I was told he was not on the spectrum - language delay only.

Now at 8 yrs. old, it's so obvious they were wrong. I would not depend on the school only (we did not), please see a dev. ped. who can steer you in the right direction with therapies and advice.

 

[KirstenB]

I agree 100% with what Lucigo said!! She's given you wonderful advice. Start with your pediatrician. Have them recommend a developmental pediatrician (usually affiliated with a Children's Hospital). You need and deserve much more information than just "communication and emotional disorder". I hope you're able to find a good doctor and get some answers.

 

[Luckymomoftwo]

Thank you for the replies...maybe I'll talk to my sister, too. After she graduated from college she went to work for the school system in this program. I'll see if she thinks these "specialists" that my daughter is being evaluated by are REALLY spending enough time with her and diagnosing her correctly. (She doesn't work there anymore, so I don't think her answer would be pursuaded by employee loyalism)

After reading your replies, I agree that a pediatric psychologist would probably evaluate her much more thoroughly and accurately...but I just figured that a program through the school system would be just as good because they want to get the children ready for school. And if their program isn't successful, then it would show in their students' test scores, etc.

Her daycare has also praised the program she is in and said that they had other students attend that program that did very well.

I have talked to other people who are very familiar with autistic children (through their jobs or other people they know) and they were all in total shock that the daycare was even suggesting autism to begin with. I didn't persuade the psychologists either way during the evaluations...if my daughter is autistic I don't want to deny it, I want her to get the help she needs...I would not be doing her any justice if I ignore it. So, even though everyone was shocked, I went into the evaluations with an open mind and was (somewhat) ready for any diagnosis they gave me.

ANYWAY...she has a doctor's appointment at the end of March, so I'll talk to the doctor at that time and see what she recommends.

 

[lucigo]

Sounds like a good plan, good luck, and keep advocating for your child!

 

[KirstenB]

They want to get the kids ready for school, but at the same time, they don't want to spend one more penny than necessary! I don't mean that in a mean way, but it's just the truth. Schools are always strapped for cash. I think an independent assessment would be helpful in understanding your daughter's needs.

 

[OneLittleSpark]

Good luck with all the tests and things, and well done for pushing to get your daughter whatever help she need. I don't think you need to worry that her conditions are 'your fault'. Very little is known about conditions such as ASD and other emotional and language problems, but they're not caused by 'bad parenting' (other than distress seen in abuse cases, but I know you don't fall into this category). It sounds like you're doing all you can to help her, so don't go beating yourself up; that'll just make you miserable, which won't help anyone. Your little girl is different, which is sometimes hard to accept, but it doesn't make her any less special, or you any less of a mother.

 

[Earstou]

I have talked to other people who are very familiar with autistic children (through their jobs or other people they know) and they were all in total shock that the daycare was even suggesting autism to begin with.

ASD children range from mild to extreme. My ds is mild, and it took awhile before he was diagnosed. Many adults have no idea my ds has Aspergers. I had a close friend who was a reading specialist who told me there was no way my son was autistic. Another who was an aide (in school) to an autistic child told me the same thing. His current doctor, who unlike the other doctors, spent more than 45 minutes with him before making a diagnosis, is shocked that he wasn't diagnosed before.
The friend who was an aide, started asking me questions, like "does he take his shoes and socks off as soon as he gets home from school?". She finally realized that he WAS autistic, just not at the same level she worked with.

If I had relied on other people's opinions (instead of a doctor's), I wouldn't have the understanding and knowledge I now have to help my ds.

 

[Luckymomoftwo]

Sounds like a good plan, good luck, and keep advocating for your child!

Thank you!

They want to get the kids ready for school, but at the same time, they don't want to spend one more penny than necessary! I don't mean that in a mean way, but it's just the truth. Schools are always strapped for cash. I think an independent assessment would be helpful in understanding your daughter's needs.

Without going into a huge rant about how I don't understand how schools are always so broke when so much of my tax dollars goes to the schools, I just want to say that I see your point here.

Good luck with all the tests and things, and well done for pushing to get your daughter whatever help she need. I don't think you need to worry that her conditions are 'your fault'. Very little is known about conditions such as ASD and other emotional and language problems, but they're not caused by 'bad parenting' (other than distress seen in abuse cases, but I know you don't fall into this category). It sounds like you're doing all you can to help her, so don't go beating yourself up; that'll just make you miserable, which won't help anyone. Your little girl is different, which is sometimes hard to accept, but it doesn't make her any less special, or you any less of a mother.

WOW! You sound JUST like my mom...this is pretty much exactly what she told me!! Thank you so much for the words of encouragement!

ASD children range from mild to extreme. My ds is mild, and it took awhile before he was diagnosed. Many adults have no idea my ds has Asbergers. I had a close friend who was a reading specialist who told me there was no way my son was autistic. Another who was an aide (in school) to an autistic child told me the same thing. His current doctor, who unlike the other doctors, spent more than 45 minutes with him before making a diagnosis, is shocked that he wasn't diagnosed before.
The friend who was an aide, started asking me questions, like "does he take his shoes and socks off as soon as he gets home from school?". She finally realized that he WAS autistic, just not at the same level she worked with.

If I had relied on other people's opinions (instead of a doctor's), I wouldn't have the understanding and knowledge I now have to help my ds.

That's exactly why I didn't want to go into her initial evaluations with any type of opinions...I know everyone was surprised at the suggestion of Autism, but I didn't let that pursuade my feelings towards it, and I made sure to keep an open mind. But, your story and the rest of the posts make me even more confident that I should just take her to a regular child psychologist. But, I will wait until she sees the doctor next month to get a referral.

Thanks to everyone for your thoughts and kind words!!

 

[ireland_nicole]

You've gotten some great advice, and since I agree with it, I won't completely repeat it. But I'd like to add just a little.

1. Don't trust every Dr. you talk to. We have had many many many diagnoses, and often they will contradict each other. There's no clear and simple test, like a blood test or x-ray that can definitively say anything, and especially if a child isn't severly affected, diagnosis is often a matter of interpretation and what they happen to see in the time they're with your child. If your gut tells you that something is missing or not right, TRUST IT. There is no better advocate for your child than you, no one who loves her more, or knows her more. Some Doctors understand how important and powerful that is, but a lot don't.

2. Allow yourself some time to be sad. To grieve what your child may not do, or have, and dreams that may not come true. Give yourself some time to recover from the shock of what has been said. Understand that just because someone uses the term "emotional disability" doesn't mean that there isn't a biological and often neurological basis. It doesn't mean that you or your child did anything wrong. It's just the way she is. The unique, special, fantastic, non average way she is. She can do more than you can imagine right now. She has a plan for her life, just like we all do. She is who she was created to be. And you were destined to be her mom. And that means that you are going to have what you need to raise her, even when you think you don't. This is just part of your journey, not the end. You're going to make it. Nicole

 

[Forevryoung]

2. To grieve what your child may not do, or have, and dreams that may not come true.

I'm not a parent but I want to say that I sort of disagree with this statement.

I guess I have an "emotional disability" but I'm not on the spectrum (from what I've been told).

A doctor told me/my parents that I would never be able to form meaningful relationships (friendships and dating/marriage), wouldn't be able to hold down a long term job, and probably wouldn't be able to live on my own. Well I've clearly proved him wrong. And that was said to me 8 years ago.

So someone may say that your child won't do, won't have, whatever and you may watch those original dreams come true...

 

[PrincessKell]

You've gotten some great advice, and since I agree with it, I won't completely repeat it. But I'd like to add just a little.

1. Don't trust every Dr. you talk to. We have had many many many diagnoses, and often they will contradict each other. There's no clear and simple test, like a blood test or x-ray that can definitively say anything, and especially if a child isn't severly affected, diagnosis is often a matter of interpretation and what they happen to see in the time they're with your child. If your gut tells you that something is missing or not right, TRUST IT. There is no better advocate for your child than you, no one who loves her more, or knows her more. Some Doctors understand how important and powerful that is, but a lot don't.

2. Allow yourself some time to be sad. To grieve what your child may not do, or have, and dreams that may not come true. Give yourself some time to recover from the shock of what has been said. Understand that just because someone uses the term "emotional disability" doesn't mean that there isn't a biological and often neurological basis. It doesn't mean that you or your child did anything wrong. It's just the way she is. The unique, special, fantastic, non average way she is. She can do more than you can imagine right now. She has a plan for her life, just like we all do. She is who she was created to be. And you were destined to be her mom. And that means that you are going to have what you need to raise her, even when you think you don't. This is just part of your journey, not the end. You're going to make it. Nicole

I think that the grieve statement might scare some. Since everyone has their own opinions, I will share mine. For me, I looked at it like this... yes she is different, but that doesn't mean bad or wrong, its just different. Although Georgia doesn't do things that "normal" kids her age do, she does things that are "normal" for HER! I still get to have those wonderful proud moments when she over comes a fear or doesn't have a meltdown during a transition change. With each stage of her life as she grows she overcomes something. It maybe small and so tiny to a parent of a typical child but its HUGE to us.

I never looked at her dx and had to "grieve" I looked at it as, ok, what do we need to do, and celebrate things she does do and will do! I know not everyone can do that. I also think that if I hadn't been working in the field for ten years since I was 18 I might feel different.

With all that said you are doing a great job. We went through her school, our local regional center, and her dr. Its a long road and even longer if you have a dx. But its so rewarding. I wouldn't change my child for anything. Yes, she may have hardships, but that is who SHE is!

 

[tw1nsmom]

Does your DD have an IEP?

If she does, and has already had an evaluation through the school, you need to request (in writing), an IEE (independent educational evaluation) at district expense. You may need to request this at a CSE meeting (committee on special education), or you may just need to address your request to the head of special ed. Either way, put everything in writing. They may balk, but it's within your rights to request this and their responsibility to pay for it. They should provide you with a list of providers or at least with the credentials that they require an evaluator to have.

If your DD doesn't currently have an IEP, you need to immediately request (again in writing) a full evaluation and a subsequent CSE meeting to determine your DD's needs. They have to have a chance to do a full eval. before you can request an independent eval. They have 60 days from the date of your request for evaluation to complete the district eval and hold a CSE meeting.

I'm also perplexed by the fact that they say she may not be able to attend kindergarten. What are they proposing she do instead?

As others have said, there is a wide range of behaviors that would indicate an ASD.

 

[MarieS]

Hi! I live in your area and have experience with the Northwest Special Education Coop (NISEC) which handles the special ed in our area ( including Hobart schools) if this is who you are dealing with. I am on the parent network for NISEC. I agree with the previous post--especially the suggestion of an IEE. It is very important that your daughter be evaluated by someone outside of the schools. I am also wondering about why the school thinks she won't be ready for knidergarten? Are they proposing to keep her in preschool?

I completely understand your concerns about the deductible, but if there is a problem I think the earlier it's addressed the better.

Feel free to pm me if you want.

 

[Luckymomoftwo]

You've gotten some great advice, and since I agree with it, I won't completely repeat it. But I'd like to add just a little.

1. Don't trust every Dr. you talk to. We have had many many many diagnoses, and often they will contradict each other. There's no clear and simple test, like a blood test or x-ray that can definitively say anything, and especially if a child isn't severly affected, diagnosis is often a matter of interpretation and what they happen to see in the time they're with your child. If your gut tells you that something is missing or not right, TRUST IT. There is no better advocate for your child than you, no one who loves her more, or knows her more. Some Doctors understand how important and powerful that is, but a lot don't.

2. Allow yourself some time to be sad. To grieve what your child may not do, or have, and dreams that may not come true. Give yourself some time to recover from the shock of what has been said. Understand that just because someone uses the term "emotional disability" doesn't mean that there isn't a biological and often neurological basis. It doesn't mean that you or your child did anything wrong. It's just the way she is. The unique, special, fantastic, non average way she is. She can do more than you can imagine right now. She has a plan for her life, just like we all do. She is who she was created to be. And you were destined to be her mom. And that means that you are going to have what you need to raise her, even when you think you don't. This is just part of your journey, not the end. You're going to make it. Nicole

Nicole,

Thank you so, so, so much for your kind and beautiful words!!! I understand what you mean about what she may not do or dreams that may not come true...I've already thought about these things in my mind. I realize that it IS possible that there will be dreams that may not come true, but it's in the back of my mind. I will not let anything stop her and I will not hold her back from doing anything she wants to (obviously I'm talking about pursuing her dreams...not going out partying all night when she's 16). I think I will try to get several Dr's opinions. I just don't know which doctors in my area to trust...I haven't had much luck with the ones my kids currently go to.

I'm not a parent but I want to say that I sort of disagree with this statement.

I guess I have an "emotional disability" but I'm not on the spectrum (from what I've been told).

A doctor told me/my parents that I would never be able to form meaningful relationships (friendships and dating/marriage), wouldn't be able to hold down a long term job, and probably wouldn't be able to live on my own. Well I've clearly proved him wrong. And that was said to me 8 years ago.

So someone may say that your child won't do, won't have, whatever and you may watch those original dreams come true...

I think she meant it as a worst case outcome....I think most parents will do whatever they can to help a child accomplish their dreams and overcome any obstacles life may throw at them. It sounds like you had parents that definitely did this for you. I LOVE stories like yours that just prove the doctors wrong. (I said "most parents" because I know there ARE parents out there that would probably just give up on trying to help their child overcome a disability...obviously none of us are those parents!!)

I think that the grieve statement might scare some. Since everyone has their own opinions, I will share mine. For me, I looked at it like this... yes she is different, but that doesn't mean bad or wrong, its just different. Although Georgia doesn't do things that "normal" kids her age do, she does things that are "normal" for HER! I still get to have those wonderful proud moments when she over comes a fear or doesn't have a meltdown during a transition change. With each stage of her life as she grows she overcomes something. It maybe small and so tiny to a parent of a typical child but its HUGE to us.

I never looked at her dx and had to "grieve" I looked at it as, ok, what do we need to do, and celebrate things she does do and will do! I know not everyone can do that. I also think that if I hadn't been working in the field for ten years since I was 18 I might feel different.

With all that said you are doing a great job. We went through her school, our local regional center, and her dr. Its a long road and even longer if you have a dx. But its so rewarding. I wouldn't change my child for anything. Yes, she may have hardships, but that is who SHE is!

I wouldn't change my daughter for anything either. She is such a sweet little girl. She's full of love and her smile just lights up my world. Sometimes I just want to make time stop so she'll stay just the way she is right now forever.

Does your DD have an IEP?

If she does, and has already had an evaluation through the school, you need to request (in writing), an IEE (independent educational evaluation) at district expense. You may need to request this at a CSE meeting (committee on special education), or you may just need to address your request to the head of special ed. Either way, put everything in writing. They may balk, but it's within your rights to request this and their responsibility to pay for it. They should provide you with a list of providers or at least with the credentials that they require an evaluator to have.

If your DD doesn't currently have an IEP, you need to immediately request (again in writing) a full evaluation and a subsequent CSE meeting to determine your DD's needs. They have to have a chance to do a full eval. before you can request an independent eval. They have 60 days from the date of your request for evaluation to complete the district eval and hold a CSE meeting.

I'm also perplexed by the fact that they say she may not be able to attend kindergarten. What are they proposing she do instead?

As others have said, there is a wide range of behaviors that would indicate an ASD.

I'll check into these evaluations you're talking about...I might PM you if I have any questions. Thanks!!

Hi! I live in your area and have experience with the Northwest Special Education Coop (NISEC) which handles the special ed in our area ( including Hobart schools) if this is who you are dealing with. I am on the parent network for NISEC. I agree with the previous post--especially the suggestion of an IEE. It is very important that your daughter be evaluated by someone outside of the schools. I am also wondering about why the school thinks she won't be ready for knidergarten? Are they proposing to keep her in preschool?

I completely understand your concerns about the deductible, but if there is a problem I think the earlier it's addressed the better.

Feel free to pm me if you want.

I'm sending you a PM.

They feel she is not ready for kindergarten because of her behavior (mainly the meltdowns that she has) and the fact that she is not potty trained yet. Academically, she is ready...she's very smart. She can do most of the things required to enter kindergarten such as spell and write her name, she recognizes most of the letters of the alphabet, she can SAY the alphabet without SINGING it, she knows all of her numbers (1-10), she can count at least up to 30, she knows her phone number.

I agree with them that I don't think she's ready for kindergarten - I just don't think she is reaching a maturity level that she needs to be at for kindergarten.

Which brings me to a very important point I forgot to mention: Her daycares (she's been at two) always keep her with the younger age group because of her size. For example, when she turned two they kept her with the one year olds. Her current daycare wouldn't keep her in the Pre-K class because it was too hard for them to deal with her not being potty trained yet. Yeah, crappy excuse, but I can't switch daycares now...a new daycare won't accept a 4 (almost 5) year old who isn't potty trained. It's a State Regulation that they have to be potty trained by the time they enter the three year old classroom.

Sorry to make this so long...lot's to say...this is such a complex issue to be dealing with!!

Thanks again, for all the replies and the words of encouragement and advice!!

 

[ireland_nicole]

I understand that everyone has different experiences and responses. Let me first say that I love my children without reservation. I rejoice in all that they can do, and they continue to surprise me. However, for me, and for many parents like me, one day I had dreams and expectations, and the next, I had to accept the fact that I was not going to have a "normal" pregnancy, birth or bonding moments. That my life was not going to go exactly as I had so carefully planned and hoped. I think Welcome to Holland says it very well. The landscape of my future and the future of my family had inexorably altered. Although not necessary for everyone perhaps, letting go of my old dreams was an important step in accepting and appreciating my children and their experience without bitterness. I think its important to realize that grieving does not make one weaker, but stronger and more able to fully embrace what lies ahead. In Love Nicole

 

[westernmom]

Oh, I've spent the past two weeks agonizing over posting a reply. I have a 5 year old with a serious emotional disability. He has Post Traumatic Stress Disorder, severe anxiety, panic attacks, Sensory Integration Disorder, and some developmental delays.

Like the OP's daughter, he is not yet fully potty trained.

My hesitation with posting was for this reason, I did not want the OP to think that I am equating what happened to my son with her daughter in any way shape or form. My son was adopted from foster care and suffered some pretty severe abuse and neglect at an early age. Again, a disclaimer, I am in no way saying or even implying in the least that the OP's daughter has been in any way abused or neglected.

My reason for posting is this:
When we got "M" at 25 months of age, we were told he probably had autism. An example, he would stare at the ceiling fan in an unresponsive state. (Obviously there is more to autism than that.) He would scream, have meltdowns, had very little language, in short, he appeared to be in his own little world. In my son's case, he was having dissociative episodes, he couldn't cope and would "check out." Only after seeing a pediatric psychiatrist who specializes in children under 7 yo was the real mental health issue diagnosed.

Mental health issues are not commonly diagnosed in young children and it takes an expert to figure it out. (My son's school still swears he has ADHD and I have to explain, no, it's severe anxiety.) Many behaviors in children with mental health issues are also found in children with ASD. (Meltdowns, delays in toilet training, sensitivity to sounds, lights, etc.)

My point in posting is not to scare you but to encourage you to see a psychiatrist for very young children. (I am not implying that the OP is anything other than a great mother.) There are treatments available for children with mental health issues.

Best of luck to you.

I'd be interested in hearing from other parent's as to how day care centers can get away with requiring all children to be potty trained when for some children with disabilities, that isn't possible at 4 yo. My son goes to preschool through the school system so he can't be "required" to be potty trained.

 

[Luckymomoftwo]

Oh, I've spent the past two weeks agonizing over posting a reply. I have a 5 year old with a serious emotional disability. He has Post Traumatic Stress Disorder, severe anxiety, panic attacks, Sensory Integration Disorder, and some developmental delays.

Like the OP's daughter, he is not yet fully potty trained.

My hesitation with posting was for this reason, I did not want the OP to think that I am equating what happened to my son with her daughter in any way shape or form. My son was adopted from foster care and suffered some pretty severe abuse and neglect at an early age. Again, a disclaimer, I am in no way saying or even implying in the least that the OP's daughter has been in any way abused or neglected.

My reason for posting is this:
When we got "M" at 25 months of age, we were told he probably had autism. An example, he would stare at the ceiling fan in an unresponsive state. (Obviously there is more to autism than that.) He would scream, have meltdowns, had very little language, in short, he appeared to be in his own little world. In my son's case, he was having dissociative episodes, he couldn't cope and would "check out." Only after seeing a pediatric psychiatrist who specializes in children under 7 yo was the real mental health issue diagnosed.

Mental health issues are not commonly diagnosed in young children and it takes an expert to figure it out. (My son's school still swears he has ADHD and I have to explain, no, it's severe anxiety.) Many behaviors in children with mental health issues are also found in children with ASD. (Meltdowns, delays in toilet training, sensitivity to sounds, lights, etc.)

My point in posting is not to scare you but to encourage you to see a psychiatrist for very young children. (I am not implying that the OP is anything other than a great mother.) There are treatments available for children with mental health issues.

Best of luck to you.

I'd be interested in hearing from other parent's as to how day care centers can get away with requiring all children to be potty trained when for some children with disabilities, that isn't possible at 4 yo. My son goes to preschool through the school system so he can't be "required" to be potty trained.

I'm sorry to hear that your son has such severe emotional disabilities. I'm sure you are supplying a great home for him and I think people like you are wonderful to adopt children who obviously need good parents. I truly believe that the Lord will not give us more than we can handle.

It's not necessarily the day care centers that have the potty training requirement, it's the State Health Department that mandates that in the daycares. I don't understand it either...it's just about one of the most ridiculous requirements I've heard!

Thank you for the post, I'm glad you decided to post your thoughts. I would never think that anyone would compare their child's circumstances to anyone elses...I think most of us on here just post their experiences and suggestions to help each other out. And not to worry, I would never have thought that you were implying that I am not a great mother. If I wasn't on here looking for advice then you could imply that I a not a great mother.

I am going to talk to her doctor to see about a child psychiatrist. I'll keep everyone (who's interested) posted with what happens and what I find out.

Best of luck to you, too!!

 

[ecki]

Regarding the potty training, I believe there are a lot of regulations regarding preschools/day care centers, especially depending on your state. My older DD went to a private Montessori preschool and they HAD to be potty trained to attend. My younger DD goes to a special needs preschool. They have a ton of regulations, for example the changing/toileting area has no door, I suppose to prevent abuse. And of course everyone has to wear gloves and immediately sanitize the changing area.

My older DD was dx'd with PDD-NOS at age 3. She had a ton of sensory and emotional issues. She used to have 20 meltdowns a day in preschool, sometimes lasting 30 minutes. She's in 1st grade now and the first three months of school she was melting down several times a day. We're finally down to 1 or 2 times per week and they only last a minute or so. Thank goodness! She's very intelligent (scored in the 96th percentile) but what good is that if you can't function socially? She does see the school social worker 2 times a week and she sees a psychologist privately. We also see a developmental pediatrician every 3 or 4 months. The dev ped put her on Prozac which I think has made a world of difference.

Good luck, I hope your daughter gets the help she needs!