"You sound so hoarse!" See a speech therapist, ENT doc, audiologist...

MCPS tried to account for why a student would have vocal cord nodules from the age of three, even with speech therapy that failed to help with self-perception of loudness. Kennedy Krieger chose appropriate objective assessments to confirm the diagnosis. Gratitude to the professionals who followed through with their hunches!

The remaining child educators and clinicians pointed to the child's hoarseness or loud voice, refusing to look at the over-all picture of the child's difficulty interacting with changes in his environment. Schools asked the child to engage in self-reflection; sent the parents for more speech evaluations; asked the child to remain outside the classroom to pray alone while the class prayed with their rebbe; and required the parents to sign a statement that the child would refrain from wearing clothes that were tight.

There was no discussion of whether the preference for tight clothing was a sensory compensation engendered by a rigid environment. It would have been prudent had we asked in advance whether any of these had experience in working with children on the autism spectrum, but of course, we felt we were only dealing with the referral, which was for hoarseness and a voice loud enough to bewilder peers and teachers.

1. Nope: https://childrensnational.org/departments/center-for-neuroscience-and-behavioral-medicine/programs-and-services/hearing-and-speech
2. Nope: http://www.tsgw.org/
3. Never heard back from: https://www.tsgw.org/parent-resources/enrichment/resource-room/
4. Nope: http://mjbha.org/
5. Never heard back from: http://mjbha.org/Beyond_the_Classroom/Sulam/Sulam_a.cfm
6. Nope: https://www.rchsd.org/programs-services/otolaryngology/
7. Nope: https://www.sandiegounified.org/audiology
8. Nope: http://www.hebrewday.org/
9. Nope: https://www.sandiegounified.org/early-childhood-special-education-ecse
10. Nope: http://www.westcoastspeech.com/
11. Nope: http://drmichaelmantell.com/

The flexibility to change came when our child was working with professionals who recognized his challenges. Look for an environment that is not rigid because your child already has expertise in being rigid!