Saturday, July 29, 2006

As promised....

Here is some of the report from Nick's evaluation for those who are interested.

1. Qualitative deficits in reciprocal social interactions
1a. Difficulty using non-verbal behaviors to regulate social interactions: Mother reports that Nicholas does not look at parents or other people when talking or engaging in activities. When Nicholas wants something, he will not use gestures or words to indicate his desires;rather he will cry and parents have to guess what is wrong. Parents report that Nicholas does not demonstrate a range of facial expression. He does not shake his head to indicate yes or no, nor does he smile when another person smiles at him.

1b. Failure to develope age-appropriate peer relationships: Nicholas does not have any particular friends, the only other boy he will play with is his brother. Nicholas does not show interest in other children his age, and when other children are around, instead of interacting with them he will simply watch.

1c. Lack of spontaneous seeking to share enjoyment, interests, or achievements with others: Nicholas does not include his mother or father in his activities; he does not show his parents items that interest him, nor does he point to or share things just for enjoyment. Mother reports that he tolerates praise,but is not interested in recieving praise.

1d. Lack of social or emotional reciprocity: Nicholas does not typically respond to or interact with other people. Nicholas does not know when others are upset or happy, and he does not try to comfort others when they are upset. He has a strong preference for solitary activities. Nicholas will use his mother's or father's body as a tool to get or do something he wants.

2. Impairments in communication:
2a. Lack of, or delay in, spoken language and failure to compensate through gesture: Nicholas does not use words to communicate, and this lack of spoken language is not compensated for by gesture. This was observed and substantiated during the clinic assessment.

I am going to omit 2b and 2c because they both deal with speech, and Nick does not have speech.

2d. Lack of varied spontaneous make believe or social imitative play: Nicholas does not spontaneously copy what she or others do. The only exception to this is that he occasionally will fall down right after his brother falls down. He will sometimes play peek-a-boo. Nicholas does not act out scenarios with toys, nor does he pretend a toy is something else (e.g., a block is a car).

3. Restricted,repetitive, and stereotyped patterns of behavior:
3a: Encompassing preoccupations or circumscribed pattern of interest: Nicholas is interested in some things to an unusual intensity. He is intensely interested in lights,textures, and music to the point that it interferes with engaging in other activities.

3b: Talks about routines, and we all know Nicholas LOVES his routines. Wont bore you guys with that!

3c: Stereotyped and repetitive motor mannerisms: Nicholas has several odd mannerisms such as flapping his hands,making fists, spinning, and running on the perimeter of the room. Nicholas will also walk on his tip toes.

3d: Preoccupation with parts of objects or nonfunctional elements of materials. Nicholas becomes interested in the wheels of cars and prefers to play with them than the entire car. He also likes the sensory quality of objects, such as the noise or light an object may make. He also has an attachment to branches and rods (he likes to twirl them)

Summary: Nicholas meets the criteria for autism.

Now, the ADOS report:

ADOS Module 1: Nicholas was observed for 45 minutes during while he interacted with the examiner in a testing room. His mother and father were in the room with him and other team members observed through a one-way mirror.

Language and Communication: No discernable words or word approximations were heard during the ADOS. When vowel sounds were uttered it wasn't directed towards parents or the examiner. During all activities of the ADOS no attempts were made to request toys or continue an activity. When he became excited he would clench his fists together.

Reciprocal Social Interactions: Nicholas demonstrated poor eye-contact. He remained aloof with a blunt affect when the examiner tried to praise him. The facial expressions were flat and non expressive. They were not coordinated with eye contact towards others.

Imaginative play: Nicholas entered the room and initially was whimpering onhis dads lap. After a few minutes his dad slowly placed him standing and then engaged him in a telephone with lights and sounds. When his mom was asked to join him, Nicholas did not show any interest in her playing with him. During free play he was placed on a chair and remained there for the rest of the ADOS. When he was given toys he would spin them around in his hands. No imaginitve play was observed.

Prior to playing with the items during the ADOS he would often smell them or put them in his mouth. When Nicholas became excited he would clench both hands and tighten his upper extremity muscles for 5-10 seconds.

Other behaviors: Nicholas tended to be underactive and once placed in a chair he stayed there throughout the exam. He also appeared afraid of the remote control car and when it was directed to come towards him he began to cry.

Summary: Since Nicholas's developmental age is below 18 mos, the ADOS scoring algorithym is not valid for interpreting his diagnosis. However, the observed behavior throughout the ADOS allows the examiners to make the clinical judgements of whether the behavior would meet the criteria for autism. It is the team's conclusion that despite Nicholas' delayed developmental age the behaviors during the ADOS place him conclusively above the cut-off for an Autistic Spectrum Disorder.

Diagnosis: Autism and Global Developmental Delay.

There you have it. This is what will make it possible for him to recieve the full-monty of therapies. Speech,OT,ABA,Play groups, Special instruction, and when he is three-developmental pre-school 5 days a week.

Well, it took me forever to get this post done, so I think I will end it for today and go to bed! THe boys had a great day today...and Nick slept in until 9!

No comments: