Saturday, July 29, 2006

As promised....

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

REVIEW OF DSM-IV CRITERIA FOR AUTISM (PARENT REPORT):
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!

Thursday, July 27, 2006

It is Official.....

Nick has Autism. I went to his developmental pediatrician's office today for the "official" report. I got a copy of it and will post it later as it is pretty lengthy. I won't post the whole thing, but excerpts of it. Nick was diagnosed with moderate autism with a global delay. Dr. Flake(yes, that is his real name) commented that normally they do not diagnose kids so young with autism(more or less PDD-NOS or the like), but Nick was more than 2 Standard Deviations below average on just about everything. Dr. Flake recommended Nick get private Speech and Occupational Therapy 2x a week, along with all the other therapies he recieves at the Birth to three center. He wants to load him up with alot of therapies now and then see where we are at in 6 mos. After Nick turns three, he will be part of the school system. Then he will go to a developmental pre-school 5 days a week.
We have a busy week ahead of us. Michael starts soccer camp on Monday, and swimming lessons on Tuesdays and Thursdays. Plus, Nick has therapy everyday, and we are hosting one of Michael's soccer coaches from the U.K. during the week of camp. I will try to get as many pics as I can of the boys doing their "things" and post them next week.

Tuesday, July 25, 2006

Finally some EXCITING news!!!

That is TOTALLY UN-related to autism!!! A few months ago when we signed Michael up for the soccer camp, we also signed up to be a host family for one of the coaches. It has been months since I heard anything from the sports company (www.challengersports.com) regarding hosting, but today I opened up my e-mail to find that we have been selected as one of the host families!! These coaches are coming all the way from the UK and will be here for one week. They are scheduled to arrive Sunday(I will inform you more as I get info). Michael is VERY excited to have a coach stay with us especially from another country...he thinks that is just neat.

Sunday, July 23, 2006

Smelling the roses


One of my favorite pictures of the boys!

















That is the only word to describe today! It was hot. 94 to be exact. I am almost wishing for the 50's and rain to return; but I know those days will be here before too much longer and then I will long for the warmer weather. We stayed indoors today and just relaxed after our day yesterday. Nick was in a better mood, and we only left the house to go for a romp in the neighbor's plastic pool! I might get one of those next weekend, Nick and Michael really liked it. I am also in a better mood today. Mike is usually able to cheer me up when I get down, and yesterday was no exception. He is now able to speak of autism in a more free manner, and it is not so "horrible" anymore. A few months ago he would not even say the word "autism", but now he will explain to people when Nick acts in a funky way (like screaming like a banshee because of a rotating fan) that he is autistic. He will mention in a movie or tv show if a character seemed a little "odd" that they could be autistic like Nick. In fact, one of his all time favorite shows is MONK....a show about a police detective who has major sensory issues on top of an uncanny ability to notice the smallest details. We have laughed ourselves silly over this show. We somehow find ourselves able to relate to these sorts of characters and see the humor in it. Nick teaches us in many ways, he does communicate...we just have to pay attention. He is not able to verbalize that he missed daddy this weekend, but he SHOWED that he did by following daddy around when he got home and "Hugging" him while he was on the couch. Mike was so touched that he called me over to see...Nick had placed his little head on his dad's chest and was just beaming. Mike was beaming as well. Nick had never "hugged" him before. A few minutes later Nick wanted to be tickled by daddy so Nick took his hand and placed it near him while he would curl up on the floor. Daddy tickled, Nick repeated. Yes, it is primitive, but it is communication at its most basic level, we just have to open our eyes. In some ways, Nick has taught us to take life slower...to stop and notice the patterns on the floor, the feel of wet grass on your barefeet(he walks funny with his legs near straight up in the air with each step), to "smell the roses". There is a scene in the movie "Little Man Tate" where Fred is riding a horse (again, Fred is a character with autistic traits) and he looks up and you see the world through his eyes. What he sees is a wonderful light show with the sunlight in the trees. That is how Nicholas will look at the sky...with the same face and expression as Fred. Just for one day I would love to get inside his head and *see* things differently.