January 17, 2011

A Little Pediatric TLC and An Awesome Follow-Up


Today is MLK Day and, since I work in a company that deals primarily with municipalities and those municipalities close for federal holidays, we close too.  Day off!  And daycare is still open, so that means today is the one true day off I have all year.  Not so this year.  I already had an afternoon appointment set up with Jessica to go over her observations and get my questions answered about his autism diagnosis and it just so happens that when I called the OT to find out why no one had called me back when they said they were going to call back, they had a 10am evaluation opening that Emerson could have.  So with two appointments lined up, I was going to lose some of my free time, but that also meant I didn't have to lose any work hours to do the same things.

We left the house this morning at 7am--about 20 minutes later than we normally leave the house--and we got back at 5:30pm--30 minutes earlier than we normally get home.  And yet it seemed as if I had been away for a lifetime.  I thought that I was going to be able to come back, maybe grab a quick nap or get a page scrapped, in between the 10am OT eval and the 2pm Psych meeting, but that just wasn't in the cards.  Heck, I didn't even get a bite to eat until after 12:30!

So here's what happened today:

I dropped the boys off at school and stopped in to my workplace to photocopy the sheaf of papers I had to fill out for the OT.  I also printed out a few things for the Almighty Emerson Binder, took some notes and received another helpful e-mail from Jennifer which I printed and filed in the binder to help me later.  By then, it was already time to leave to pick up Em.

We met with Allison Lebouef from Pediatric TLC (Therapy and Learning Center) who was just as nice in person as she was on the phone.  Emerson was very receptive to her, which always makes things easier.  She had him do a lot of the activities one would expect...he wrote his name, drew some shapes (circle, square, triangle, star and even a pencil), he drew her a brachiosaurus on his own, she had him color some shapes, fold paper, cut out a circle...all those fine motor skill tests.  She also had him place two rows of pennies on some circles and then timed him while he picked one up with his right hand, transferred it to his left and dropped it into a bowl.  She did this twice; he got 3 on the first try and 5 on the second. (BTW--I didn't see the result of any of his drawing, coloring, folding or cutting as I was sitting behind them).  Then she timed him putting pegs into a peg board.  Again 3 and 5.  Next was blue circle cards in one spot and red square cards in another spot, and he could only use his right hand.  I can't remember how many he was able to get done on that one, but it wasn't many.  Finally came beading a string.  Only 2 on the first attempt and either 3 or 4 on the second--I couldn't see the string.

He did well, but he was distracted a few times by a child crying in the gym/play area.  He commented once about hearing someone crying and another time about how he thought the child was upset...and he kept repeating that "I think he's upset...I think he's upset" until Allison got him back on track.  He also had a very hard time sitting still.  He fidgeted, got up and sat down, sat on one leg, sat on his knees, sat n his bottom--all the typical Emerson stuff.  At one point, he noticed the computer next to Allison and told her he wanted to look for dinosaur pictures on the computer.  It took a little while to get him back in his chair and back on track.  He kept telling her he wanted a break.

It was very difficult for me all during this time to keep my mouth shut and let Allison do her job!  I kept wanting to butt in and tell Emerson to sit back down or to stop writing numbers on Ms. Allison's sheet or to promise a treat if he'd sit still and finish.  I'm proud to announce, though that I did manage to keep my trap shut for once!

Next, we moved into the play area.  I was dismayed to see that no other children were in there.  I had hoped there would be so Allison could see his utter lack of respect for personal space when it came to other children as well as his distractibility.  I just knew that if at least one other child had been in there, she would have had her work cut out for her in getting him follow directions! 

As it was, he again did fairly well.  She let him move around and choose his own activities to see both what he would choose as well as to observe whether or not he would use each "activity" correctly.  The first thing he did, of course, was jump on the trampoline.  I was surprised that he got off it as quickly as he did, and I think the only reason he did was that there was just so much gosh-darn interesting stuff in there!

He climbed into a ball pit area and eventually figured out how to climb on the edge of it and then onto a platform so he could slide down a slide.  He spent a fair amount of time in the ball pit and the slide or on top of the platform.  At one point, Allison got on the platform with him and asked him if he wanted to stand and jump into the ball pit.  I could tell he was nervous, and he held her hand while he did it, but he did do it.  He climbed up for a second jump and he was even more hesitant on this one, but he jumped again.  She tried to get him to swing on a sort of trapeze bar like Tarzan and drop into the pit, but he wouldn't do it.  Nor would he sit criss-cross applesauce (how is it that that's the first time I've heard that???) on a platform while she swung it from side to side.  That one didn't last long at all!

She called someone out to stay with Emerson while she talked to me (which was difficult because I wanted to keep watching him and when I got over that urge I had to try to tune him out because he was instructing the other woman on what she should do! "First you jump like this on the trampoline. Then you come over and get in the ball pit. Then you slide down. Then you come over here to this small trampoline and bounce three times")  She said he could tell immediately that he had issues with sensory processing and with poor motor planning (I'll explain both of those later. I'm too tired tonight to get into it!).  She gave me a sheet to order some items to get him started on Listening Therapy (explanation to come later....) which I have looked into a little and had run across in my various books, but want to look into a little more.  The headphones alone are $165!!

Allison wants to start him on therapy, so we're going to squeeze him in here and there as they have cancellations while we wait for a standing appointment slot.  His next appointment is already a week from today.  We ran out of time before she was able to complete all of the gross motor exercises, so she'll do them next time.  She also wants us to look into getting him evaluated by a speech therapist (they have one there) because she thinks they can help with his echolalia.  Emerson enjoyed himself and wants to go back, so that's a plus.

Our appointment ran over and I realized it made no sense to go home in between appointments because I'd have to leave again an hour after doing so.  So, after dropping Emerson off, I decided to head to good ol' Barnes & Noble for lunch, a look-see for a few books I wanted, and to start writing my letter to the school board.

Did I mention that I was advised to write a letter to the school board laying out all our concerns about Emerson and about how they scheduled testing for him despite the fact that I have yet to meet with them to discuss our concerns?  Did I even mention that we had our testing scheduled already or that we have to be evaluated by the school again?  I don't think so...let me back track a bit....

I get a call from a woman at the Parent Child Center.  They received Jessica's referral and they have do their own evaluation to determine if he's eligible for help.  Why?  He already has a diagnosis of autism...why wouldn't he be eligible for help???  Again, Nicole gets pissy.  Again, Jennifer comes to the rescue with a perfectly logical explanation.  Yes, he might have received that diagnosis, but now it's the education system's responsibility to see if that transfers to necessary aid in the classroom setting and exactly what kind of help is required.  Add one more to the IOU Jennifer volume I keep with me! :)  Anyway, the woman goes on...your appointment to update his records is on Jan 20th and his testing days are the 24th, 25th and 26th.  Great...we're getting in fast and can stay on schedule with lining up what Emerson needs for this autumn.  Not so great...how can they schedule testing before finding out our specific concerns?

That's when I called the Autism Society of Acadiana and asked for advice which was to write a letter outlining all our concerns, requesting specific people to be present, letting them know that I knew what they were supposed to be looking at, and then hand deliver it and get a signature that it was received.  Jennifer had gone through the trouble of looking up the eligibility criteria on the Louisiana Department of Education website and doctored a pdf to highlight the area she felt were of interest to our particular case and made notes on she felt--as best she could never having met Emerson--he fell into each categories criteria.  Didn't I tell you that the woman is awesome???

I used this list as the basis of my letter.  And now we're back to Barnes & Noble where I had gone to start it.

And start it I did, after purchasing 2 books I had wanted--one by Temple Grandin and another about Out-of-Sync children, and after eating lunch (or should I say inhaling it?), and after visiting with the mother of 2 adorable girls, Cheta and Mezita, whom I ran into.  Cheta was in Emerson's class and Mezita was in Parker's.  I always wanted to photograph Parker and Mezita together because Parker is so very pale with blue-blue eyes, almost white hair that is all fluffy and is constantly smiling, while Mezita is the opposite, very dark skin, close-cropped hair, black as ink eyes and the most serious face you've ever seen on a toddler!  It would have been a beautiful photo, but the mother switched them to a different daycare.  But I digress...

After writing for what seemed like an extremely short time, I packed up and headed for Aucoin & Associates for my meeting with Jessica.  And what a very pleasant meeting it was.  She let me look through the GARS and CARS tests again and clarified a few things for me.  She reviewed her observations with me and told me a little about Thom and Emerson's "playdate."  We talked about Em had gone to see an OT and about this blog.  We discussed possible solutions for his Social Skills training, and she thought it would be wonderful to have Jennifer send some age-appropriate Social Stories for him (again, be patient, I'll talk about Social Stories somewhere down the line. I ought to be keeping a list!), and she also said that if I met others with children Emerson's age, or put the word out at the Autism Society, she would be interested in forming a Social Group to help work on skills.  We also talked about Emerson's sudden increase in violent behavior when feeling upset or frustrated and different ideas to help him with those negative emotions.  We threw around ideas for visual charts for our daily routines and a sticker reward board, both of which I'm going to try to create and implement soon.

All in all, it was a very satisfying follow-up.  Jessica is so very kind and said she would be willing to be involved in helping write his IEP should we want her.  I felt much better after being able to discuss all this with her.  I had my questions answered and I had my closure.  All is well.

After I left her, i ran a quick errand to Target and then back to Barnes & Noble where I first went in search a few books Jessica suggested for Emerson, and then went into the coffee shop to start writing again.  I was able to write the majority of my letter between my 2 Barnes & Noble visits and while sitting in the waiting area before my meeting with Jessica. 

Then it was time to pick up the boys and head for home, which I felt as if I had been away from for at least a week.  It was a blessing to come home to our same night time routine!  Well, almost the same...I did still have to finish typing my letter to the school board, after all, so I could have it ready to bring to them tomorrow.

I finished the last of it, and sat at Thom's laptop to type up all 6 pages of it (that's 6 typed pages...I think it was about eleventy billion handwritten pages) before starting on this blog post.  And, of course, ran into another snag.  I left by thumb drive at work and Thom's Wi-Fi doesn't work out here, so he will have to e-mail it to me tomorrow morning once he gets to work and then I can print it out a deliver it.

<sigh>

And now I am going to go collapse in bed for approximately 20 minutes when Emerson will come in and ask me to go sleep with him in his bed or will start telling me about one dinosaur or another.  Then again, I think I hear him stirring already!  Oh good...saves me the trouble.

Good night all. 


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