Thursday, June 14, 2012

Autism Report: The Good, the Bad, and the Ugly

I met with Deacon's autism doctors, who recently tested and diagnosed him, to go over their report. They were very nice and wanted to make sure I didn't have any more questions. They skirted around the issue when I asked what end of the spectrum he was on, saying that they didn't like to put a label on it because children with mild autism needed intervention the same way those with severe autism did and didn't want to send a mixed message to parents.

They handed me the 15 page report. I asked if I could stay in the room to read it, since my wonderful neighbor was watching the boys and I wouldn't have any interruptions. I obviously am not going to type all fifteen pages on here, but at least want to sum it up.

The Good:
Social Interactions- Deacon has improved eye contact, will play in the vicinity of other children, will initiate physical play with family, and displays appropriate range of facial expressions.
"When the examiner entered the room, Deacon didn't acknowledge her, but eventually approached her to touch her id badge and play with her hair. He transitioned to the examination room with minimal prompting."

"Deacon remained seated during the entire test without problem. He seemed to enjoy watching the toy car roll across the table and occasionally pushed it back towards the examiner."

"Deacon enjoyed participating in activities such as peek-a-boo, free play, and being lifted and tickled by his mother."

Communication- Deacon appears to understand some simple and/or gestured commands, like clapping and waving.
"Deacon reacted to loud noises, but his response was somewhat delayed. He also turned and coordinated listening with sound."

Repetitive and Stereotyped Behaviors- Deacon does not show a need for routines or upset with transitions.

The Bad:
Social Interactions- Deacon does not engage in parallel or initiate play with other children, doesn't initiate spontaneous joint attention (which means looking at an object that someone else is looking at or pointing to), doesn't respond to his name and is hard to get his attention, and doesn't engage in pretend play.
"Deacon appeared to be less engaged during tasks that required interacting with the examiner or engaging in pretend play."

"It was difficult to catch Deacon's gaze during the assessment and he rarely directed his gaze towards the examiners face."

"Deacon did not respond to his mother's attempts to make him smile until she physically touched him."

Communication- Deacon shows delays with receptive language, does not show, point, give, or bring items to others.
"Deacon did not appear to recognize his name, familiar words, or inhibitory words. His expressive communication consisted primarily of vocalizations. He made few vocalizations that were mainly vowel sounds, without any consonant reduplications. He did not point or gesture to indicate preference and it was difficult to catch and maintain his gaze."

Repetitive and Stereotyped Behaviors- Deacon shows an intense interest in musical toys, engages in repetitive behavior of dropping items on the ground, tapping surfaces with his hands, flaps hands when excited, mouthing objects, eating non-food items (dirt and paper), and visual inspection of toys.
"Deacon was observed to engage in self-stimulatory behavior with a water bottle (eg. mouthed, bit, and rubbed on his face and feet). Deacon approached his mother, showing sensory interest in her feet and sandals. He was also observed to repeatedly jump while flapping his hands coordinated with high pitched vocalizations."

"Deacon dropped the majority of items on the floor in a repetitive manner. He was not able to grip a pencil or crayon and attempted to eat the paper. Deacon licked multiple test kit materials throughout the evaluation."

The Ugly:
Because it was so hard to administer tests on him due to his deficit in communication and vision and difficulty engaging, his scores came back horrible.

Visual Reception- 6 months. He was able to coordinate problem-solving and fine motor skills to look for a hidden object and retrieve a distal object by pulling a string to bring it closer. He did not show interest in a book or attend to pictures. Also, he was not observed to look for an object hidden and then displaced.

Fine Motor- 10 months. Deacon used appropriate pincer grasp and two hands together to manipulate objects. He was also able to take blocks out of and place them into a container. He did not bang objects together, place pennies into a slot, or imitate simple lines drawn.

Receptive Language- 3 months. He showed the ability to attend to his environment, including listening and turning, responding to faces and voices through vocalization, and coordinated listening with looking. He was not observed to enjoy a reflection of himself in a mirror, recognize familiar words or names, or attend to words and movement.

Expressive Language- 5 months. Deacon laughed, made vocalizations, and played with sounds. He was not observed to babble, or produce three consonant sounds.

Autism Spectrum- The ADOS test results indicate patterns of:
1)Moderate to Severe Concern
2)Mild to Moderate Concern
3)Little to No Concern

Deacon's score was consistent with a classification range of Moderate to Severe Concern. :(

The report also gave suggestions of things to work on at home, and goals for teachers, therapists, and even IEP goals for when he enters school. It also again suggested ABA therapy, but more, 25-40 hours each week. We have worked out the insurance information, and will have to pay a $30/day co-pay. What's hard is that Deacon still needs naps each day, so it's not like he can have an 8 hour day of therapy. I think we will start with 3 days a week of like 6 hours a day, but we meet with the clinic on the 25th and will decide then.

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