As promised, a WTE segment on Brad's sensory and motor profile. But first, a "happy birthday" to Brad and a thanks to his well-wishers. He had a nice day.
And now he is four.
We've seen his motor coordination skills improve significantly over the last year. His OT thinks he may be "caught up" on the fine motor side, based in part on his grasp and his pedaling.
There's still something wonky going on though. The "ho-hum" profile still describes him well; the low tone is still there. In the Out of Sync Child, Carol Stock Kranowitz refers to this as the "gravity monster." Well, Brad is four and he's still fighting the gravity monster. Here's another clip we made recently, which illustrates his tendency to lean or flop.
(As an aside, I know, I need to quit my ill-fated attempts at making conversation while holding the camera; Brad is not the only one who has trouble multi-tasking.)
We still do "wheelbarrow" exercises on a regular basis to build up trunk strength. We make it a game: Brad hides his favorite ball, and he leads me to it with a wheelbarrow walk. Not to be outdone, Jeremy plays too.
On the sensory front, the sensory-seeking behaviors at this stage appear to be mostly limited to face-touching. Emotional regulation appears good; he's still our chill little guy; we bring him to restaurants, etc. all the time.
Showing posts with label DCD. Show all posts
Showing posts with label DCD. Show all posts
Saturday, January 23, 2010
Friday, January 15, 2010
What To Expect (Almost) Age4, PDD Edition: Communication
As promised, a WTE post on speech and communication.
His most recent speech stats are here, but that doesn't really tell the whole story.
I'm proud to report...drumroll please...Brad is talking. Well that isn't exactly news, but it is a fair description of his ability. His progress on the speech front has been slow and steady. When exactly his speech took off is hard to pinpoint. At this juncture, he can express his needs and even his emotions, and his conversation skills are budding. Exhibit A:
And if it isn't obvious, the more he talks, the more he charms us with his sweet nature.
Not to take away from his progress, but there are still many challenges ahead. He's still scripting. Or something. For example, often our exchanges will go like this:
Me: "How was school?"
Brad: "The name of the day is Friday. Friday is a tuna fish day."
That having been said, on the whole, we're very pleased, and proud of his progress.
His most recent speech stats are here, but that doesn't really tell the whole story.
I'm proud to report...drumroll please...Brad is talking. Well that isn't exactly news, but it is a fair description of his ability. His progress on the speech front has been slow and steady. When exactly his speech took off is hard to pinpoint. At this juncture, he can express his needs and even his emotions, and his conversation skills are budding. Exhibit A:
And if it isn't obvious, the more he talks, the more he charms us with his sweet nature.
Not to take away from his progress, but there are still many challenges ahead. He's still scripting. Or something. For example, often our exchanges will go like this:
Me: "How was school?"
Brad: "The name of the day is Friday. Friday is a tuna fish day."
That having been said, on the whole, we're very pleased, and proud of his progress.
Wednesday, January 6, 2010
What to Expect (Almost) Age 4, PDD Edition: Engagement
In the coming weeks, I will be blogging about Brad's progress, but this week, I'm blogging about that which has been constant: his engagement.
Engagement is a difficult thing to describe.
I believe that Brad is easy to engage. In fact, several of his examiners (including his developmental pediatrician, his teachers and his speech language pathologist) have commended him on his ability to attend.
But the quality of engagement. It's different. It's not sharp, focused and sustained, like a typical child. You can see it in the videos.
This is the way it's been since he was a baby. I would never say "he's in his own world." But he's not always in my world either. He's somewhere in between, absorbing some pieces of his environs but disregarding others. I think this is part of what's vexing about A Little Bit Autistic. It's in between, neither here nor there.
Engagement is a difficult thing to describe.
I believe that Brad is easy to engage. In fact, several of his examiners (including his developmental pediatrician, his teachers and his speech language pathologist) have commended him on his ability to attend.
But the quality of engagement. It's different. It's not sharp, focused and sustained, like a typical child. You can see it in the videos.
This is the way it's been since he was a baby. I would never say "he's in his own world." But he's not always in my world either. He's somewhere in between, absorbing some pieces of his environs but disregarding others. I think this is part of what's vexing about A Little Bit Autistic. It's in between, neither here nor there.
Thursday, December 10, 2009
One is Silver and the Other Gold
This is the third installment in a series on interventions. Installments one and two can be found here, here, here and here.
***
Part of PDD/SPD/A Little Bit Autistic, what have you, is a deficit in socialization. In my view, what to do about social impairment draws on medical science, treatment philosophy, but also norms, in the general sense. From a normative perspective, I'm of the mindset that it's okay to not be social. If Brad likes solitude, then I don't want to project my preconceived notion of happiness (having a lot of friends) on him. Also, if Brad is quirky, I have no interest in de-quirkifying him. Normal is overrated.
That having been said, I want Brad to be happy, and if Brad wants friends but doesn't know how to make friends, then I want him to have the facility to make friends and if school can further that goal, then I welcome the help. My goal then for Brad is the facility to make friends.
So that's a high level description of our goals, from a parenting perspective.
As for interventions, at school Brad's speech language pathologist joins Brad in class (including on the playground) and focuses on social pragmatics. In english, this means she facilitates play, including greetings, turn taking, sharing, and the like. Sample progress note, from his SLP:
That having been said, there are a two social interventions which I disapprove of for Brad, from a normative perspective, and my disapproval is actually in Brad's IEP: (1) no "look me in the eye"; and (2) no social scripting.
Regarding "look me in the eye", at issue I believe is working memory. If you asked me to do long division in my head, either I wouldn't be able to do it, or I'd have to close my eyes or look away while I think about it. This is a normal response. For children who have a weak working memory, a lot of ordinary interactions tax them from a sensory perspective like long division taxes me. That's the way I see it. Also, I've read enough first hand accounts of autistic adults who recall being forced to look so-and-so in the eye, and it's a source of anxiety and instills a sense of failure. When Brad was two and a half, the specialty provider who came to administer Floortime starting doing the face touch, where the therapist gently touched Brad's face under the chin when he wouldn't make eye contact. I told her to stop.
As for social scripting, I just don't like it, and I don't think it's necessary for Brad. Social scripting refers to teaching a child to say, for example, "do you want to hold my hand and walk with me?" the idea being that typical children know to do this naturally and atypical children need to be taught. My thought is that holding another child's hand should come from a place of joy and affection, and not from a place of "if I do X, I'll get external reward Y." But, again, this is normative, in part, so I say live and let live. If another parent prefers that their child learn social scripts, that's fine. For me, I don't want that for Brad. As for prevalence, I don't know about other school districts, but I know that a few children in my district are taught social scripts (and it shows).
***
Part of PDD/SPD/A Little Bit Autistic, what have you, is a deficit in socialization. In my view, what to do about social impairment draws on medical science, treatment philosophy, but also norms, in the general sense. From a normative perspective, I'm of the mindset that it's okay to not be social. If Brad likes solitude, then I don't want to project my preconceived notion of happiness (having a lot of friends) on him. Also, if Brad is quirky, I have no interest in de-quirkifying him. Normal is overrated.
That having been said, I want Brad to be happy, and if Brad wants friends but doesn't know how to make friends, then I want him to have the facility to make friends and if school can further that goal, then I welcome the help. My goal then for Brad is the facility to make friends.
So that's a high level description of our goals, from a parenting perspective.
As for interventions, at school Brad's speech language pathologist joins Brad in class (including on the playground) and focuses on social pragmatics. In english, this means she facilitates play, including greetings, turn taking, sharing, and the like. Sample progress note, from his SLP:
Bradley did a GREAT job today on the playground! I was on the playground and I didn't even have a chance to go up to him to ask him if he wants to play hide-and-seek or tag. He came right up to me and said, "I want to play tag!". There were already two boys playing tag, so I told him to join them, and he just ran right up and joined in the game. He played for a few minutes and only needed a couple of prompts from me to keep going. Then, the boys started playing with a kickball, so I prompted him to keep after the ball in the group. The group then went over to play basketball and he needed prompts to keep up with the ball (someone throws the ball and all the kids run after it -- he just needed prompts to be more assertive and stay with the ball). He was actively engaged in games all of recess and feeling connected with the other kids. When you play tag at home, try having him chase you, and then teach him to run up to you and say in a nice loud voice, "Now you chase me!". After playing tag for a few minutes where he was chasing other kids, he wanted someone to chase him, and we practiced going up to a friend and saying, "Chase me!".And this:
When I was in class today, I sat with Bradley and made bat, cat, and pumpkins with him out of play dough. We used the language for rolling, pulling, pushing down, etc. Then, I prompted him to show friends what he made, which he did when I prompted him to do so. I prompted him to use a louder voice when talking to friends. He also told his friend that he liked his cowboy costume!To me, this seems like a nice, safe way to introduce Brad to social situations. I don't see any downside.
That having been said, there are a two social interventions which I disapprove of for Brad, from a normative perspective, and my disapproval is actually in Brad's IEP: (1) no "look me in the eye"; and (2) no social scripting.
Regarding "look me in the eye", at issue I believe is working memory. If you asked me to do long division in my head, either I wouldn't be able to do it, or I'd have to close my eyes or look away while I think about it. This is a normal response. For children who have a weak working memory, a lot of ordinary interactions tax them from a sensory perspective like long division taxes me. That's the way I see it. Also, I've read enough first hand accounts of autistic adults who recall being forced to look so-and-so in the eye, and it's a source of anxiety and instills a sense of failure. When Brad was two and a half, the specialty provider who came to administer Floortime starting doing the face touch, where the therapist gently touched Brad's face under the chin when he wouldn't make eye contact. I told her to stop.
As for social scripting, I just don't like it, and I don't think it's necessary for Brad. Social scripting refers to teaching a child to say, for example, "do you want to hold my hand and walk with me?" the idea being that typical children know to do this naturally and atypical children need to be taught. My thought is that holding another child's hand should come from a place of joy and affection, and not from a place of "if I do X, I'll get external reward Y." But, again, this is normative, in part, so I say live and let live. If another parent prefers that their child learn social scripts, that's fine. For me, I don't want that for Brad. As for prevalence, I don't know about other school districts, but I know that a few children in my district are taught social scripts (and it shows).
Wednesday, December 2, 2009
Label Junkies: University Edition
This week I'm taking a break from interventions to ponder another lofty subject - accommodation.
Law.com reports: Princeton Student Sues Under ADA for Refusal of Extra Time to Take Exams. The learning disabilities at hand read like a "best of" edition of The Mislabeled Child:
First, the rights of the learning disabled must be weighed against the rights of the nondisabled. Educational institutions should attempt to level the playing field without giving the learning disabled an unfair advantage. How to accomplish this, I'm not sure. I'll reserve judgement on this one since there is so much I don't know.
Second, the rights of haves must be weighed against the have nots. In many places, it costs thousands of dollars to obtain a diagnosis by a neuropsychologist. So what about those who have a learning disability who can't afford to get a diagnosis (or whose parents don't know to pursue one)? The current system rewards the haves.
Third, the slope is slippery when you consider extra exam time for ADD/ADHD. Where do you draw the line?
And last, on a personal note, I feel emotionally invested in appreciation for individual learning style. Obviously, because my life is touched by it. Take history, for example. Can't schools test a pupil's command of the subject matter without making it an exercise in speedwriting? Can't teachers in grammar school slow down and appreciate that not all children can follow rapid pace multi-step commands? I worry about these things!
I will close with some choice comments on the lawsuit, via the Blackbook Legal Blog. First, an impassioned defense of accomodation:
Law.com reports: Princeton Student Sues Under ADA for Refusal of Extra Time to Take Exams. The learning disabilities at hand read like a "best of" edition of The Mislabeled Child:
It appears that, in a policy shift, Princeton's Office of Disabilities gaveth and then tooketh away:• Mixed-Receptive-Expressive Language Disorder, which limits her ability to comprehend language, express language or recall material.
• Disorder of Written Expression, which leaves her ability to communicate in writing below the level expected based on age, intelligence or life experiences. When she writes, she has to repeatedly re-check what she has composed.
• Developmental Coordination Disorder, which leaves her ability to spell, punctuate and form sentences below the level expected based on age, intelligence or life experiences. She needs to read material several times over, isolate key words and highlight them so she can locate them again. Also under this disorder, her visual-motor processing skills are in the sixth percentile, "far below the average person, let alone the typical Princeton University student." She also suffers eye strain when taking tests and needs periodic breaks because of the way she reads passages over and over.
• Attention Deficit Hyperactivity Disorder, which limits her ability to focus. When reading, any distraction requires her to go back to the beginning of the passage.
Metcalf-Leggette learned of her diagnoses in 2003. Later, at the private school she attended, she received a 100 percent time extension for exams; a 100 percent extension on the SAT; and a 200 percent extension on the ACT.On the issue of accomodation, I hate to be wishy washy, but I can't help but see both sides.Her older brother, David, who also had learning disabilities, graduated from Princeton University in 2008 and was given 100 percent extended time for exams while there. Metcalf-Leggette says she was told his extended time was approved by the predecessor of Eve Tominey, the director of Princeton's Office of Disability Services. Tominey left the extended time accommodation in place for David Metcalf "as a courtesy," the plaintiff says in her suit.
First, the rights of the learning disabled must be weighed against the rights of the nondisabled. Educational institutions should attempt to level the playing field without giving the learning disabled an unfair advantage. How to accomplish this, I'm not sure. I'll reserve judgement on this one since there is so much I don't know.
Second, the rights of haves must be weighed against the have nots. In many places, it costs thousands of dollars to obtain a diagnosis by a neuropsychologist. So what about those who have a learning disability who can't afford to get a diagnosis (or whose parents don't know to pursue one)? The current system rewards the haves.
Third, the slope is slippery when you consider extra exam time for ADD/ADHD. Where do you draw the line?
And last, on a personal note, I feel emotionally invested in appreciation for individual learning style. Obviously, because my life is touched by it. Take history, for example. Can't schools test a pupil's command of the subject matter without making it an exercise in speedwriting? Can't teachers in grammar school slow down and appreciate that not all children can follow rapid pace multi-step commands? I worry about these things!
I will close with some choice comments on the lawsuit, via the Blackbook Legal Blog. First, an impassioned defense of accomodation:
Do some folks take advantage of the system? Sure. But the system is there to help those who really have a serious need and just require a bit of leveling the playing field to demonstrate they have the same knowledge as their non-disabled counterparts. If not for accommodations and technology I would still be a college fail out, instead of having 3 degrees with honors.And one commenter makes light of the label junkie-ness:
All I ask is a fair chance to show that despite my disabilities, I still know the law, and I can still practice the law. I know my limitations, I know my weaknesses, and I am not asking for anyone to feel sorry for me or give me an advantage over anyone else. All I ask for is the use of the technology I need and the time to use it, then let me rise or fall on my own. My grades, the vast majority of which were earned un-accommodated and my getting to within 11 points of passing the bar exam in half the given time show I know the law, I just need a bit of extra time to show I can write the law in a readable manner.
I was always a bit suspicious of these claims (I must admit that when I read the list of conditions the plaintiff was claiming it seemed like something from the Onion, I was expected to see "intelligence deficit disorder"). Even assuming they are 100% legitimate, I thought a fair compromise would be to allow the student to take the tests untimed but to make clear that these students could not receive a class rank without taking the tests under the same conditions as everyone else.I ressemble that remark.
Tuesday, November 17, 2009
Life is a Highway: Part I
This is the second installment in a series of posts on interventions. Last week, I explored a speech therapy exercise that Brad has tried. This week, I muse about something we haven't tried. This installment is divided into two parts.
"[I]t is remarkable that an intervention that is easily defined and implemented can have important lasting benefits at least to the end of middle school for all students."
To what is the quote referring? Floortime? Occupational therapy? Behaviorial therapy? Diet? A supplement?
Answer: None of the above.
The excerpt is referring to an intervention that is elegant in its simplicity: classroom size. Science Daily reports:
Which is also interesting because my school district is amidst a budget crisis and a school crowding problem. The town I live in is having an override vote in December to fund some needed school repairs. If it doesn't pass, the children from the sick building may be forced to fan out into the already crowded grammar schools.
While I can't control how my town spends its money, I can control how I spend mine. Which is to say, I can send Brad to private school, if he can get over the admissions hump and can function without an aid.
I may look back at this very idea as crazy talk, but for now, it's something I'm at the very least considering down the road. Not for preschool, but for K-5 or K-8, when classroom size makes a preciptious jump in the public school setting. Private school offers small classroom size and appreciation of individual learning styles, and some "typical" private schools offer special ed-type services, including services for language and social pragmatics.
That having been said, my husband and I are both public school graduates and believers in the public school system. For most.
* * *
"[I]t is remarkable that an intervention that is easily defined and implemented can have important lasting benefits at least to the end of middle school for all students."
To what is the quote referring? Floortime? Occupational therapy? Behaviorial therapy? Diet? A supplement?
Answer: None of the above.
The excerpt is referring to an intervention that is elegant in its simplicity: classroom size. Science Daily reports:
Small classes in early grades improve test scores in later grades for students of all achievement levels, but low achievers get an extra boost. That's the finding of a study on the long-term effects of class size in the November issue of the American Journal of Education.The study followed 11,000 students and found that:
...small classes—13 to 17 students—are most effective when they are consistent from kindergarten through third grade. Students in consistently small early classes had substantially higher test scores in grades four through eight than students who had been in larger classes. Students at all achievement levels benefited, but low achievers showed stronger benefits in reading and science.Which is interesting because at least one noted blogger has hypothesized that "sensory processing disorders are probably among the most common reasons children underachieve in school."
Which is also interesting because my school district is amidst a budget crisis and a school crowding problem. The town I live in is having an override vote in December to fund some needed school repairs. If it doesn't pass, the children from the sick building may be forced to fan out into the already crowded grammar schools.
While I can't control how my town spends its money, I can control how I spend mine. Which is to say, I can send Brad to private school, if he can get over the admissions hump and can function without an aid.
I may look back at this very idea as crazy talk, but for now, it's something I'm at the very least considering down the road. Not for preschool, but for K-5 or K-8, when classroom size makes a preciptious jump in the public school setting. Private school offers small classroom size and appreciation of individual learning styles, and some "typical" private schools offer special ed-type services, including services for language and social pragmatics.
That having been said, my husband and I are both public school graduates and believers in the public school system. For most.
Tuesday, September 29, 2009
Asked and Answered
Now let's consider dyspraxia, which is often used interchangeably with developmental coordination disorder or DCD.
Send in the adults! Early on, I discovered this video "playlist", entitled "Dyspraxia and Me." Not kids. Adults. Yes, they exist!
See, in the UK the "dyspraxia" label has been around for quite some time. The medical community and the schools recognize it. DANDA, the Developmental Adult Neuro-Diversity Association, provides support and awareness. Troll Amazon UK for books on dyspraxia and you'll find thousands, literally. Unlike SPD in the US, the "dyspraxia" label in the UK is evolved and accepted.
Why do I care? As I have blogged, I believe that "recovery" exists for PDD-NOS. To me, this means that the child met the diagnostic criteria and then at some future point ceased to meet the diagnostic criteria. Often this is referred to as "becoming indistinguishable from one's peers."
But I don't believe that PDD-NOS or SPD or DCD ever goes away. Rather, I believe that symptom severity decreases and it manifests itself in a different manner. And that's what I try, most often in vein, to wrap my brain around. What's left after the diagnosis goes away? Perhaps the video stream is a glimpse? Perhaps not, but at least it's something.
Send in the adults! Early on, I discovered this video "playlist", entitled "Dyspraxia and Me." Not kids. Adults. Yes, they exist!
See, in the UK the "dyspraxia" label has been around for quite some time. The medical community and the schools recognize it. DANDA, the Developmental Adult Neuro-Diversity Association, provides support and awareness. Troll Amazon UK for books on dyspraxia and you'll find thousands, literally. Unlike SPD in the US, the "dyspraxia" label in the UK is evolved and accepted.
Why do I care? As I have blogged, I believe that "recovery" exists for PDD-NOS. To me, this means that the child met the diagnostic criteria and then at some future point ceased to meet the diagnostic criteria. Often this is referred to as "becoming indistinguishable from one's peers."
But I don't believe that PDD-NOS or SPD or DCD ever goes away. Rather, I believe that symptom severity decreases and it manifests itself in a different manner. And that's what I try, most often in vein, to wrap my brain around. What's left after the diagnosis goes away? Perhaps the video stream is a glimpse? Perhaps not, but at least it's something.
Thursday, July 23, 2009
Brad in motion.
A quick update on motor development:We have pencil grasp!
We have pedaling!
Brad's motor developing is taking off. I wouldn't say he's caught up, but he's moving in the right direction (puns intended). That having been said, his fine motor is still a little wonky, and his tone is still low.
And we have another piece of the puzzle: turns out he has an orthopedic problem - he's pigeon-toed. His left foot turns in when he walks. His pedi assured me this is orthopedic, not neurological. In addition, he's flat-footed, and this apparently is neurological; it's like having low muscle tone in the arch of his foot. What are the odds of having both a neurological issue and an orthopedic issue affecting gait? In any event, this explains his walk.
The good news is that being pigeon-toed is very much a condition he'll grow out of on his own with no therapy. In the old old days, pedis used to prescribe orthopedic shoes. In fact, I wore orthopedic shoes when I was a child (for what, I have no idea). Turns out, those ugly shoes aren't actually therapeutic. Just ugly.
And so, I am on a mission. To keep Brad's therapy roster free of ugly shoes, actual and symbolic...
Thursday, March 19, 2009
Sunday, March 15, 2009
"A Little Bit Autistic"
Just a quick note to reflect on recent events. After going through denial and acceptance and all of the turmoil that came with that, and after having Brad evaluated and diagnosed with PDD not once but two times, the latest doctor opinion casts doubt on the PDD dx. In the immediate aftermath, I felt angry. Now, my feelings are somewhat indifferent.
When it comes to mixed messages, it looks like Brad may be in good company. In comments, Three Channels and Goodfountain report similar mixed messages, i.e. between doctor 1 and doctor 2, or between doctors and the schools. And Stimey blogs about early skepticism on behalf of one doctor before getting a dx for Jack. So, in some respects, I'm just following a path that so many before me have paved, online and offline. A path that I'm certain will have many twists and turns.
My long time blog readers may recall that when I started blogging, I called my blog "PDD-SOS." It was really more of a personal vent than it was a blog, but no matter. I retired that name when acceptance starting setting in. If there's any doubt in anyone's mind: this time, the name is staying. Wherever the journey leads from a diagnostics perspective, my sense is that we will be A Little Bit Autistic for quite some time to come.
When it comes to mixed messages, it looks like Brad may be in good company. In comments, Three Channels and Goodfountain report similar mixed messages, i.e. between doctor 1 and doctor 2, or between doctors and the schools. And Stimey blogs about early skepticism on behalf of one doctor before getting a dx for Jack. So, in some respects, I'm just following a path that so many before me have paved, online and offline. A path that I'm certain will have many twists and turns.
My long time blog readers may recall that when I started blogging, I called my blog "PDD-SOS." It was really more of a personal vent than it was a blog, but no matter. I retired that name when acceptance starting setting in. If there's any doubt in anyone's mind: this time, the name is staying. Wherever the journey leads from a diagnostics perspective, my sense is that we will be A Little Bit Autistic for quite some time to come.
Thursday, March 12, 2009
Mind/Body Connection
There's a school of thought that what Brad has is, and should be treated as, primarily a language disorder. I haven't blogged much, if at all, about speech therapy and communication issues. The reason: I regard Brad's speech delay as a symptom of something else. Of course I've blogged about that "other thing," whatever it is, ad nauseum.
But some one could probably present a similar case for the motor symptoms. That is, one might similarly argue that the motor impairments and hypotonia are just a symptom of something else, so why focus on those discrete symptoms?
Two thoughts on this:
1) I don't regard DCD as an isolated motor deficit. While the DSM-IV description of DCD points in that direction, in common parlance the alternate term "dyspraxia" is understood to engender a whole host of traits from speech delay to social impairment to disorganization of thought. And as I blogged, DCD is a set which overlaps with autistic spectrum disorders.
2) I've observed many therapy sessions, including speech, occupational therapy, developmental therapy and floortime. Hands down, without question, the most effective sessions by far have been the occupational therapy sessions. The occupational therapist, not the speech therapist, gets the most spontaneous speech from him. While I don't have proof of its effectiveness in a clinical sense, this mama believes that occupational therapy implicates some kind of mind/body connection.
Because the occupational therapy (OT) visits were so successful, the developmental therapist(DT) did a co-visit so that she could observe the OT's technique, and carry it over in her own sessions. And lo and behold it made all of the difference. For example, at first the developmental therapist would sit on the floor with Brad and play with him, and try to get him out of rigid routines, and to use imagination, etc. It just didn't work. I mean they played, but Brad mostly phoned it in, and veered into his comfort zone, i.e. blocks. After the co-visit, she started interjecting movement breaks into the play. It was simple: she put the wooden puzzle pieces on one side of the room and the puzzle on another. Voila! Such a small thing made such a big difference.
Brad's occupational therapist explained that it's tied to his arousal level. As I blogged, Brad presents as a sensory disregarder - "ho hum", difficult to stimulate and unmotivated to move. If Brad were a car, his idle would be on low. Seriously, by my count, he's had less than five full blown tantrums in his entire life and he's never had what can be described as a "meltdown." As I've blogged before, he has never once stood up in his crib, without prompting and assistance.
Brad's occupational therapist showed me that getting him to move increases his arousal level. And, in turn, when his arousal level is higher, so too is his level of engagement and spontaneous speech. So to make a long story long, this is why I don't blog about speech therapy. I regard the speech as intrinsically tied to sensory processing and arousal. To blog about communication without the other stuff doesn't make sense. To me, anyway.
Ever wonder why autism diagnosis shows a positive correlation to rainfall? I have a theory: these kids aren't outside much and therefore aren't moving enough. Moving the body forces the left and right hemispheres of the brain to talk to each other, which, in turn, promotes healthy neurological development in all respects. Just sayin. It's possible.
But some one could probably present a similar case for the motor symptoms. That is, one might similarly argue that the motor impairments and hypotonia are just a symptom of something else, so why focus on those discrete symptoms?
Two thoughts on this:
1) I don't regard DCD as an isolated motor deficit. While the DSM-IV description of DCD points in that direction, in common parlance the alternate term "dyspraxia" is understood to engender a whole host of traits from speech delay to social impairment to disorganization of thought. And as I blogged, DCD is a set which overlaps with autistic spectrum disorders.
2) I've observed many therapy sessions, including speech, occupational therapy, developmental therapy and floortime. Hands down, without question, the most effective sessions by far have been the occupational therapy sessions. The occupational therapist, not the speech therapist, gets the most spontaneous speech from him. While I don't have proof of its effectiveness in a clinical sense, this mama believes that occupational therapy implicates some kind of mind/body connection.
Because the occupational therapy (OT) visits were so successful, the developmental therapist(DT) did a co-visit so that she could observe the OT's technique, and carry it over in her own sessions. And lo and behold it made all of the difference. For example, at first the developmental therapist would sit on the floor with Brad and play with him, and try to get him out of rigid routines, and to use imagination, etc. It just didn't work. I mean they played, but Brad mostly phoned it in, and veered into his comfort zone, i.e. blocks. After the co-visit, she started interjecting movement breaks into the play. It was simple: she put the wooden puzzle pieces on one side of the room and the puzzle on another. Voila! Such a small thing made such a big difference.
Brad's occupational therapist explained that it's tied to his arousal level. As I blogged, Brad presents as a sensory disregarder - "ho hum", difficult to stimulate and unmotivated to move. If Brad were a car, his idle would be on low. Seriously, by my count, he's had less than five full blown tantrums in his entire life and he's never had what can be described as a "meltdown." As I've blogged before, he has never once stood up in his crib, without prompting and assistance.
Brad's occupational therapist showed me that getting him to move increases his arousal level. And, in turn, when his arousal level is higher, so too is his level of engagement and spontaneous speech. So to make a long story long, this is why I don't blog about speech therapy. I regard the speech as intrinsically tied to sensory processing and arousal. To blog about communication without the other stuff doesn't make sense. To me, anyway.
Ever wonder why autism diagnosis shows a positive correlation to rainfall? I have a theory: these kids aren't outside much and therefore aren't moving enough. Moving the body forces the left and right hemispheres of the brain to talk to each other, which, in turn, promotes healthy neurological development in all respects. Just sayin. It's possible.
Friday, March 6, 2009
What's the deal with that?
Why do I open my mouth when I apply mascara or eye makeup?
I ask because I think it's some sort of reflex. (Name of reflex? Anyone???) Brad has a similar reflex, but obviously not in a mascara context. When Brad attempts to cut paper with scissors (with his left hand), he splays the fingers of his right hand and opens his mouth. This happens every time, without fail, and he looks tense. His OT says he's overloaded or challenged or something. Maybe it has something to do with concentration?
Just wondering. Has anyone else noticed this with their child, typical or atypical?
I ask because I think it's some sort of reflex. (Name of reflex? Anyone???) Brad has a similar reflex, but obviously not in a mascara context. When Brad attempts to cut paper with scissors (with his left hand), he splays the fingers of his right hand and opens his mouth. This happens every time, without fail, and he looks tense. His OT says he's overloaded or challenged or something. Maybe it has something to do with concentration?
Just wondering. Has anyone else noticed this with their child, typical or atypical?
Sunday, March 1, 2009
One more comment on a comment.
I'm not all piss and vinegar here, and "losing the diagnosis" should be put into perspective. He's lost one dx (PDD-NOS), but he kept the other (DCD). As I blogged, I regard PDD-NOS and DCD as overlapping sets with blurry lines. Brad is just moving to a label that connotes a different type of difference. But I think DCD is a better label because Brad's social impairment can no longer be described as "severe", and the label itself may be setting us back at this point. Here in Massachusetts, an "autism" diagnosis is the kiss of death from an insurance perspective. We're losing OT coverage in a week. I'm going to try to appeal. Perhaps, DCD will help.
In the DCD continuum vein, Anything, Sweetie remarks:
In the DCD continuum vein, Anything, Sweetie remarks:
i have recently come to think of the spectrum as a colour wheel, and a term like DCD to be about as helpful as the word "blue-ish".Point well taken, but I like the word "blue-ish." So many children with autism and sensory processing disorder are hypersensitive, or a combination of hyper- and hypo-sensitive. On the metaphorical color wheel, maybe they're red for hypersenstive, or purple for hyper- and hypo-sensitive. I think Brad is exclusively hyposentive. Like the color blue, he's cool with his sensory intake and expression. I finally feel like we have a label that fits nicely. I have a good framework to understand him, and perhaps some direction to treat him. Sure there are lots of shades of blue, but we can at least say that blue isn't the same as yellow, can we not?
Saturday, February 28, 2009
"PDD-NOS not medically descriptive"
Welcome to my world. A world in which, the more I seek clarity, the more it alludes me. Case and point: in August, when I sought a second opinion for Brad's PDD-NOS diagnosis, the doctor told me she didn't think it was PDD, and then went on to tell me it was PDD. (He met the cutoff when the ADOS test was administered.)
Yesterday, I brought Brad back to that same developmental pediatrician for routine follow up. In the waiting room, I was given a one page intake form in which it asked for a brief update, and left a blank for "concerns." I wrote one simple note: "PDD-NOS s/b DCD?"
Well long story short, the doctor agrees. But rather than write, he no longer meets the criteria for PDD, she writes: "Hypotonia; DCD" and she continues: "PDD-NOS not medically descriptive."
So I think Brad has officially lost the PDD diagnosis.
Oh and we get another label. *eyes roll* "Communication disorder" which in theory connotes expressive/receptive language delay PLUS nonverbal/social deficit. I thought I had heard it all, but I had never heard of that one. She calls it the notch down from PDD-NOS. Great, another label. Yes, I googled it, but it isn't worth sharing.
I'm providing an objective account here, but yesterday was a moving day for me, emotionally. It brought back a lot of memories, some of them unpleasant. A lot of what I'm feeling is anger towards the first doctor who diagnosed Brad and suggested he needed 25 hours per week of ABA. She came up with that little nugget after observing him for an hour. I can say with 100% certainty at this juncture, that was a totally inappropriate prescription for treatment.
Anyway, I'm going to stew on this for a while. The journey isn't over for Brad but I think it may be a different kind of journey.
Yesterday, I brought Brad back to that same developmental pediatrician for routine follow up. In the waiting room, I was given a one page intake form in which it asked for a brief update, and left a blank for "concerns." I wrote one simple note: "PDD-NOS s/b DCD?"
Well long story short, the doctor agrees. But rather than write, he no longer meets the criteria for PDD, she writes: "Hypotonia; DCD" and she continues: "PDD-NOS not medically descriptive."
So I think Brad has officially lost the PDD diagnosis.
Oh and we get another label. *eyes roll* "Communication disorder" which in theory connotes expressive/receptive language delay PLUS nonverbal/social deficit. I thought I had heard it all, but I had never heard of that one. She calls it the notch down from PDD-NOS. Great, another label. Yes, I googled it, but it isn't worth sharing.
I'm providing an objective account here, but yesterday was a moving day for me, emotionally. It brought back a lot of memories, some of them unpleasant. A lot of what I'm feeling is anger towards the first doctor who diagnosed Brad and suggested he needed 25 hours per week of ABA. She came up with that little nugget after observing him for an hour. I can say with 100% certainty at this juncture, that was a totally inappropriate prescription for treatment.
Anyway, I'm going to stew on this for a while. The journey isn't over for Brad but I think it may be a different kind of journey.
Thursday, February 19, 2009
What is intelligence?
It depends who you ask. The "intelligence quotient" test itself has been the subject of much debate because it favors those with stronger language abilities.
In this blogger's opinion, procesing speed is one of many factors that determine one's intelligence. Other factors include analytical intelligence and emotional intelligence.
Women, in general, are faster at processing, and consequently have superior social abilities. But it's not fair to say, as a general matter, that women are smarter than men for that reason, just as it's not fair to say men are smarter than women because in general, there may be a general advantage in analytical thinking.
Brad has a slow and coarse processor, which probably accounts for his language delays, his hypotonia, his lack of coordination and his social impairment. Many children with DCD/dyspraxia share these qualities.
However, I don't think Brad is lacking in intelligence overall. Brad's school district noted he was above his age in "cognitive ability", e.g. shape, number, letter and color identification, which is common for high functioning autism. While the typical developing child has pretend tea parties and the like, the atypical child is developing spacial and visual sense, and other pursuits.
The takeaway here? I blogged below the impairments that DCD causes. But it's not necessarily all bad news...
In this blogger's opinion, procesing speed is one of many factors that determine one's intelligence. Other factors include analytical intelligence and emotional intelligence.
Women, in general, are faster at processing, and consequently have superior social abilities. But it's not fair to say, as a general matter, that women are smarter than men for that reason, just as it's not fair to say men are smarter than women because in general, there may be a general advantage in analytical thinking.
Brad has a slow and coarse processor, which probably accounts for his language delays, his hypotonia, his lack of coordination and his social impairment. Many children with DCD/dyspraxia share these qualities.
However, I don't think Brad is lacking in intelligence overall. Brad's school district noted he was above his age in "cognitive ability", e.g. shape, number, letter and color identification, which is common for high functioning autism. While the typical developing child has pretend tea parties and the like, the atypical child is developing spacial and visual sense, and other pursuits.
The takeaway here? I blogged below the impairments that DCD causes. But it's not necessarily all bad news...
Musings, Part II: Social Exchanges
Have you ever considered all that was involved in a simple social exchange? I didn't, until ASD became part of my family life.
"There's a lot of data in a face," one of Brad's therapists told me several months ago.
Data? Face? It seemed like an odd statement at the time because, as a typical person, I read faces intuitively, sometimes successfully, sometimes not.
Having a son with ASD forced me to consider the process of social intuition. Take, for example, happiness. How can I tell if some one else is happy? First, words help. If some says, "I'm happy," that's a clear indication of happiness. Second, laughter would be an indication. But what if there are no literal expressions of happiness or laughter. How can I tell? A smile. Eyes light up. It's easy to intuit, but hard to articulate the process.
What about less subtle emotions, such as apprehension. Eyes may widen. Mouth may open. Body may become stiff. There is a lot of data there.
Now consider when some one is talking to you: eyes widen, eyes narrow, mouth opens, body tenses, head turns, words are uttered, posture changes. Data, data, data, and more data.
Now consider a social exhange: you're on the receiving end of all of this data, and in a split second you have to perceive it (i.e. hear the words, see the face), process it (what do the words mean when combined with the gestural communication and the facial expressions) and give it back (i.e. with words or nongestural communication).
Now consider Brad's perceptual abilities: face in the background, appealing visual/spatial stimulus (e.g. letters) in the foreground. And consider Brad's processing abilities: slow and coarse. So when he's in a social encounter, he's bombarded with data which he can't process efficiently, and often that data will be in his background, so he'll disregard it the way we disregard background noise. Other times, he may process it, but very slowly.
Still, he manages to process some of it, and that's an accomplishment in and of itself; he does manage basic reciprocal social exchanges. I'll smile at him and say "Brad!" He'll smile at me and say "Mommy!" Mind you, he didn't start doing this type of exchange until recently, but that small exchange makes me so very hopeful.
"There's a lot of data in a face," one of Brad's therapists told me several months ago.
Data? Face? It seemed like an odd statement at the time because, as a typical person, I read faces intuitively, sometimes successfully, sometimes not.
Having a son with ASD forced me to consider the process of social intuition. Take, for example, happiness. How can I tell if some one else is happy? First, words help. If some says, "I'm happy," that's a clear indication of happiness. Second, laughter would be an indication. But what if there are no literal expressions of happiness or laughter. How can I tell? A smile. Eyes light up. It's easy to intuit, but hard to articulate the process.
What about less subtle emotions, such as apprehension. Eyes may widen. Mouth may open. Body may become stiff. There is a lot of data there.
Now consider when some one is talking to you: eyes widen, eyes narrow, mouth opens, body tenses, head turns, words are uttered, posture changes. Data, data, data, and more data.
Now consider a social exhange: you're on the receiving end of all of this data, and in a split second you have to perceive it (i.e. hear the words, see the face), process it (what do the words mean when combined with the gestural communication and the facial expressions) and give it back (i.e. with words or nongestural communication).
Now consider Brad's perceptual abilities: face in the background, appealing visual/spatial stimulus (e.g. letters) in the foreground. And consider Brad's processing abilities: slow and coarse. So when he's in a social encounter, he's bombarded with data which he can't process efficiently, and often that data will be in his background, so he'll disregard it the way we disregard background noise. Other times, he may process it, but very slowly.
Still, he manages to process some of it, and that's an accomplishment in and of itself; he does manage basic reciprocal social exchanges. I'll smile at him and say "Brad!" He'll smile at me and say "Mommy!" Mind you, he didn't start doing this type of exchange until recently, but that small exchange makes me so very hopeful.
Musings, Part I: Foreground/Background
We know that the perceptual abilities of those with autistic spectrum disorders is different. For example, as I blogged, one study showed that those with ASD tend to have eagle eye vision. Individuals with ASD report other differences, including differences in the ability to perceive sight, sound, touch and taste.
I have no idea exactly how Brad takes in the world. However, I do have a theory: his foreground/background are the reverse of typical. Not the exact reverse. But different. For example, I often sleep in an oversized shirt emblazoned with a large "Old Navy" logo. When I wake my typical son, he greets me - sometimes with a smile, sometimes with a frown, but I believe he sees me in the foreground, and my shirt in the background.
With Brad, I think it's the reverse - it's like he sees my shirt in the foreground, and me in the background. Drawn to the visual stimulus, he recites the letters. He may be interested in affirmation for getting the letters correct, which is great, because that's joint attention. He's not detached from me. He just doesn't take me in or experience me the way my typical son does.
Similarly, noises that are in my background, like a plane flying overhead, appear to be in Brad's foreground. And when we go to a restaurant, he has an uncanny ability to pick out a baby crying, even if it's just a dull wimper from across the room.
I have no idea exactly how Brad takes in the world. However, I do have a theory: his foreground/background are the reverse of typical. Not the exact reverse. But different. For example, I often sleep in an oversized shirt emblazoned with a large "Old Navy" logo. When I wake my typical son, he greets me - sometimes with a smile, sometimes with a frown, but I believe he sees me in the foreground, and my shirt in the background.
With Brad, I think it's the reverse - it's like he sees my shirt in the foreground, and me in the background. Drawn to the visual stimulus, he recites the letters. He may be interested in affirmation for getting the letters correct, which is great, because that's joint attention. He's not detached from me. He just doesn't take me in or experience me the way my typical son does.
Similarly, noises that are in my background, like a plane flying overhead, appear to be in Brad's foreground. And when we go to a restaurant, he has an uncanny ability to pick out a baby crying, even if it's just a dull wimper from across the room.
Monday, February 16, 2009
Relationship between DCD and Language Impairment
When Brad was first flagged with DCD, I was confused by the terminology and seemingly conflicting information. Dyspraxia, which is not an official diagnosis, is a broader term, and includes within its scope symptoms such as language delay and social impairment. DCD, by contrast, is defined as a pure motor coordination impairment.
Since then, I've discovered that, although DCD is defined as a pure motor coordination impairment, studies have shown a strong correlation between DCD and language impairment. See, e.g. Comparing Language Profiles: Children with Specific Language Impairment and Developmental Coordination Disorder; Early Identification: Are toddlers with Speech/Language Impairments at Increased Risk for Developmental Coordination Disorder?
Since then, I've discovered that, although DCD is defined as a pure motor coordination impairment, studies have shown a strong correlation between DCD and language impairment. See, e.g. Comparing Language Profiles: Children with Specific Language Impairment and Developmental Coordination Disorder; Early Identification: Are toddlers with Speech/Language Impairments at Increased Risk for Developmental Coordination Disorder?
Relationship Between DCD and ASD
Isn't this a PDD blog? What is DCD and why am I blogging about it?
Click here for a better look. (I couldn't quite figure out how to smoosh the graphic into blogger, and preserve the aspect ratio.)
I blogged about the basics of DCD here. The official term is DCD but it is often referred to as "dyspraxia." Its defining quality is poor coordination. However, there is a statistically significant correlation between DCD, and language and social impairment, as well as a litany of other cognitive issues such as poor working memory and poor ability to multitask.
As the graphic illustrates, Developmental Coordination Disorder/Dyspraxia and Autistic Spectrum Disorder are interlocking sets, meaning many individuals have symptoms of both. However, technically, from a diagnostics perspective, an individual cannot have both. That is, if an individual presents with PDD-NOS, DCD is ruled out as a discrete diagnosis. In her "impression" report, Brad's developmental pediatrician indicated an impression of PDD-NOS, and that he tested "signficant for" hypotonia and DCD, but the final diagnosis was PDD-NOS, not DCD.
Anecdotally, many individuals with asperger's and autism identify as "dyspraxic" even though it's not an official diagnosis.
If I were to put Brad on the graphic, I'd place him in the interlocking set between ASD and DCD, closer to the DCD side than the ASD side. And if I were to hazard a guess, I'd say he's going to cross from the interlocking set into the "pure" DCD bubble some time before he turns 6. (In August 2008, Brad's ADOS score was at the cutoff. Plus he has strength in the social domain, a predictive factor for growing out of the diagnosis. For these reasons, I think there's a very strong chance Brad will lose the PDD diagnosis.)
The graphic illustrates, in part, why I abandoned the differential diagnosis. Is he in this bubble or that bubble? In reality, the lines are blurry, the bubbles intersect with each other and Brad's brain is going to change over time. The bottom line is that he's neurologically different. What label is ascribed to that difference at any point and time is less valuable and probative than the overall developmental trajectory.
What does DCD mean to Brad? I blogged about it a bit here. For starters, he walks like he's drunk. Much less so today than 6 months ago, but he still has an uneven gait. He's got terrible fine motor coordination. He's very floppy, low energy, and unmotivated to move. As an example, he never - and I mean never - stands up in his crib. (Yes, he is still in a crib.) To get him up in the morning or at nap, he needs a lot of prompting and assistance. He has never once stood up in his crib unprompted or unassisted. He drooled persistently until he was 2-1/2. He has poor depth perception and poor ability to track things visually.
Each person who has evaluated Brad has noted he splays his fingers. Here's video of it. As I understand it, this is a result of low tone in his fingers and is an indication that he may have difficulty grasping a pencil in the future. The good news on that front is that there are very specific and effective therapies to develop grasping strength
On the speech front, he has delays and motor issues, such as getting stuck on the first syllable (like stuttering), and more recently "elongation" in the middle of a word or a sentence.
Last, he also is very slow at processing information, sensory data, social cues and language. More on that later.
Cue the graphic, courtesy of DANDA:
Click here for a better look. (I couldn't quite figure out how to smoosh the graphic into blogger, and preserve the aspect ratio.) I blogged about the basics of DCD here. The official term is DCD but it is often referred to as "dyspraxia." Its defining quality is poor coordination. However, there is a statistically significant correlation between DCD, and language and social impairment, as well as a litany of other cognitive issues such as poor working memory and poor ability to multitask.
As the graphic illustrates, Developmental Coordination Disorder/Dyspraxia and Autistic Spectrum Disorder are interlocking sets, meaning many individuals have symptoms of both. However, technically, from a diagnostics perspective, an individual cannot have both. That is, if an individual presents with PDD-NOS, DCD is ruled out as a discrete diagnosis. In her "impression" report, Brad's developmental pediatrician indicated an impression of PDD-NOS, and that he tested "signficant for" hypotonia and DCD, but the final diagnosis was PDD-NOS, not DCD.
Anecdotally, many individuals with asperger's and autism identify as "dyspraxic" even though it's not an official diagnosis.
If I were to put Brad on the graphic, I'd place him in the interlocking set between ASD and DCD, closer to the DCD side than the ASD side. And if I were to hazard a guess, I'd say he's going to cross from the interlocking set into the "pure" DCD bubble some time before he turns 6. (In August 2008, Brad's ADOS score was at the cutoff. Plus he has strength in the social domain, a predictive factor for growing out of the diagnosis. For these reasons, I think there's a very strong chance Brad will lose the PDD diagnosis.)
The graphic illustrates, in part, why I abandoned the differential diagnosis. Is he in this bubble or that bubble? In reality, the lines are blurry, the bubbles intersect with each other and Brad's brain is going to change over time. The bottom line is that he's neurologically different. What label is ascribed to that difference at any point and time is less valuable and probative than the overall developmental trajectory.
What does DCD mean to Brad? I blogged about it a bit here. For starters, he walks like he's drunk. Much less so today than 6 months ago, but he still has an uneven gait. He's got terrible fine motor coordination. He's very floppy, low energy, and unmotivated to move. As an example, he never - and I mean never - stands up in his crib. (Yes, he is still in a crib.) To get him up in the morning or at nap, he needs a lot of prompting and assistance. He has never once stood up in his crib unprompted or unassisted. He drooled persistently until he was 2-1/2. He has poor depth perception and poor ability to track things visually.
Each person who has evaluated Brad has noted he splays his fingers. Here's video of it. As I understand it, this is a result of low tone in his fingers and is an indication that he may have difficulty grasping a pencil in the future. The good news on that front is that there are very specific and effective therapies to develop grasping strength
On the speech front, he has delays and motor issues, such as getting stuck on the first syllable (like stuttering), and more recently "elongation" in the middle of a word or a sentence.
Last, he also is very slow at processing information, sensory data, social cues and language. More on that later.
Thursday, December 4, 2008
Another piece of the puzzle...
It's said that those with dyspraxia (which is often comordid with autism) suffer from poor working memory. But what does that even mean? I stumbled upon the relatively new blog of a researcher in the field. She writes:
It appears there's a correlation between Developmental Coordination Disorder (DCD) (a term often used interchangeably with dyspraxia) and poor working memory. See, e.g.: Working Memory and Learning in Children with Developmental Coordination Disorder and Specific Language Impairment. It appears that there is also a correlation between DCD and specific language impairment. See, e.g.: Comparing Language Profiles: Children with Specific Language Impairment and Developmental Coordination Disorder. For more information, see Dyspraxia and Working Memory.
My sense is that, with Brad, his motor coordination issues are connected to his cognitive issues. Perhaps the link is working memory. Perhaps it's not. Just another piece of the puzzle to consider.
Working memory is our brain’s ‘post-it note’. We make mental scribbles of bits of information we need to remember and also work with that information. For example, if you were baking a cake that fed only two people, but you had four people coming to dinner, you need working memory to remember the ingredients and to multiply them in your head so that everyone gets a slice. Without it we would be lost literally, we wouldn’t be able to juggle directions in our head to get to that important meeting at a new location and would forget important phone numbers and contacts. Working memory is just as critical for a variety of activities at school, from complex tasks like reading comprehension and mental math, to simple activities such as navigating around the school and taking the right books for homework.Anecdotally, I've heard that this is the reason why high functioning autistic individuals have difficulty with driving.
It appears there's a correlation between Developmental Coordination Disorder (DCD) (a term often used interchangeably with dyspraxia) and poor working memory. See, e.g.: Working Memory and Learning in Children with Developmental Coordination Disorder and Specific Language Impairment. It appears that there is also a correlation between DCD and specific language impairment. See, e.g.: Comparing Language Profiles: Children with Specific Language Impairment and Developmental Coordination Disorder. For more information, see Dyspraxia and Working Memory.
My sense is that, with Brad, his motor coordination issues are connected to his cognitive issues. Perhaps the link is working memory. Perhaps it's not. Just another piece of the puzzle to consider.
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