Tuesday, February 7, 2012

Sequencing... and It's Not Autism

This morning was Garrett's second appointment with the speech pathologist. I was so excited to tell her about Garrett's progress: his new understanding of books, increased vocabulary, better understanding and follow-through of two-part commands, better following of direction and increased use of words in sentences.

I was feeling pretty optimistic about today's appointment.

We spent the first few minutes of the appointment talking about his progress and while the pathologist was impressed with his progress she didn't waste a lot of time praising us. Instead, she jumped right in to the next phase of his evaluation.

She sat down with him and a whole bag filled with laminated pictures of things. My kid ROCKS the nouns. Even things she would preface by saying, "Not many kids get this one," or "This one's a hard one," he'd name it with hardly a pause.

With that test Ace'd she moved on to sequencing.

And he failed miserably.

She put down four cards with pictures put in line to tell a store. In the first picture a little girl put on her boots. In the second picture she put on a coat. In the third she added a hat and in the last picture she walked out into the rain.

Despite going over the pictures with Garrett many times, when asked what the little girl was doing in each picture he would resort to simply naming items in the picture to include naming the pictures on the wall behind the little girl and the color of her boots and hat.

We took a step back from sequencing and tried instead to get him to name actions in pictures.

The pathologist brought out a couple dozen pictures of children performing different actions such as talking on the telephone, reading a book, drinking juice, etc.

Again, instead of naming the action Garrett plowed ahead with naming the things in the picture. "Juice!.. Milk!.. Chair!.. Baby!"

She went over every single picture with him and he was able to echo back the actions such as, "washing his face... drinking the juice... eating the sandwich," and when she tried again with the same pictures he responded perfectly with the correct answer. But when she added new pictures with the same actions he was stumped again.

When she tried to get him to work on one more set of pictures he wanted nothing to do with it and resorted to dumping her bag, knocking over chairs and tipping the play refrigerator in the room over all while screaming, "NO!" at the top of his lungs.

I was mortified by my child's destruction but she just smiled and said, "This is so typical of a child who's just come to the end of his understanding. He doesn't get it and so he's giving up."

We talked a little about preschool and she warned me that he is not ready for preschool at all at this point. She was afraid he would spend most of his time in correction because he wouldn't understand and would start acting out like he was with her and neither he nor the teacher or his classmates would benefit at all.

After a few moments of thinking she said, "I'm still not going to give you a diagnosis of what I think is going on here. There are some things I'm pretty sure it's not but there are a few things he's showing signs of that I want to see if we can work on and maybe narrow it down further or eliminate them altogether."

I asked her if she could be a little more specific and she said, "Well, not right now, but one of them does have to do with how he cannot identify the same action in different pictures."

She went on to explain that kids normally see a behavior, the behavior is named and when they see that behavior being done in another scenario they can correctly identify it as the same behavior. For instance: Johnny is brushing his teeth and later, when the child see Susy brushing her teeth the child can identify that the act of brushing teeth is not unique to Johnny. Susy is doing it, too. The child can figure that out on their own without being told.

Apparently some children need a little help expanding those connections of actions across several scenarios and it can effect understanding which then effects language.

She said he has a fantastic basis of knowledge with which to work with as evidenced by how many objects he could name. So now we can start to back off on working on naming objects and work more on naming actions and sequences such as, "I am brushing my teeth. First, I get out my toothbrush. Then, I get my toothbrush wet with water. Then, I get out the toothpaste. I put the toothpaste on the brush...." and so on. We're also supposed to point out those same actions in others and try to make the connection for him ("Daddy is brushing his teeth. Remember when I was brushing my teeth?") to try to help him make the connection to actions and just not things.

She sat him down with a puzzle and while he worked the puzzle we talked a little more about the next steps.

Finally, I asked her point blank, "Are you thinking autism?"

She said, "At first I was, yes. I won't lie. Part of my job is to work with kids with autism spectrum disorder and when I first met Garrett I was seeing some definite, isolated signs that I couldn't ignore. But the more I interact with him and the more I see him and how he relates to me and you and with the progress he's made I am no longer thinking that's what we're dealing with. He's so interactive and social. He shows a few isolated signs here and there but nothing close to the full criteria we would expect for someone who was truly autistic."

She added, "There are a couple of disabilities I have in mind but I don't want to get fixated on them without more time to work on a few things and see if it's not something else altogether or be able to better narrow it down. These things take time and I don't want to rush it and risk putting a label on him without knowing for sure what is going on or whether or not there really is a problem."

I was satisfied with that. I've been very glad to be working with someone who doesn't want to just put him in a box with a specific label on it and write him off as a disability or disorder.

I'm thrilled to have her working with me and giving me tips and guidelines and ways to help communicate with him.

One thing I must stop doing is asking him whether or not he "can" do something when I'm trying to give him a direction. When I say things like, "Can you get off the table?" I'm giving him the option of saying, "No." Instead, I'm supposed to make it the command it's meant to be, "Get off the table."

It was also nice to have her tell me to stop feeling guilty.

I mentioned how bad I felt that here we were, two adults just going about our merry way and not really noticing any problems, talking over him and just expecting him to catch up and she cut me off by saying, "Hey, that's how most children learn language. This was nothing you did or didn't do so stop thinking that right now. You are doing a great job with him."

We have two more weeks with these new guidelines. Here's hoping we can blow her away with his new mad skills!

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