Update

Hey all,

Sorry for the infrequent updates.

Brad is doing well. Progress continues to be slow but steady. It's like we had a language explosion from age two through 2.5 years, but from 2.5 through 4.5, it's been really slow language-wise. Just trying to be completely honest.

That having been said, and without further ado: we had our IEP meeting last week, and it's official: Brad's going to kindie next year. Full on mainstream, only he will be in a class with an aid. Not his private aid, but a teacher's aid. Accommodations include wait time and prompting and the like.

And private speech therapy continues to hum along. Same type of inference/"how do we solve the problem" drills.

On the social/friendship front, not a whole lot going on there. But he had a blind date - a playdate where the mom didn't know Brad has a dx - and it went okay. That was just two days ago. I might try to fix him up again. The suitor is the little brother of one of Jeremy's friends, and he's age-matched and in the same school district. I think he's a good catch.

So that's what we're up to. Hope everyone in the blogosphere is doing well. I will try to post a video soon.

One Person Book Club Revived

Once upon a time, I was new to the world of autism. I was very calm and deliberate back then. (Not.) Anyway, I charted my reading adventures under the tag One Person Book Club.

Here, I will list some of the other books I have read, but don't particularly recommend, along with a relatively new title I recommend highly.

First, the books I've kicked over the past few years that I can't recommend without qualification:

Quirky Kids - A decent basic reference for parents, but for me, normatively, it was too focused on remediation.

Smart Moves, The Dominance Factor, Brain Gym - These are OT-themed books. The skeptic in me can't recommend them without qualification - not evidence based enough. ("It worked for Johnny! That's all we know.") But they are interesting, and if lateralization and the mind/body connection are areas of interest for you, you might enjoy these books.

And now for a book just published in May of this year that's a must-read for parents, particularly if your child is hyperlexic: Autism and Talent. Where so much of the research and so many of the parent resources are focused on deficits and remediation, this book focuses on talent, and in doing so, sheds light on the nature of autism itself.

The introduction is available for free online here. The book includes contributions from Simon Baron-Cohen and his research team, Temple Grandin, Laurent Mottron et al, whose research team includes netizen Michelle Dawson, and Allan Snyder (whose research the Eide Neurolearning Blog discussed here).

And to be clear, I recommend this book both from an intellectual perspective (interesting read!) and from a personal, parenting perspective. This book gave me a glimpse under the hood, and I'm not referring to talent (because to do so with a 4 year old is a little silly). I'm referring to the bias to local processing and the differences in sensory discrimination and processing. The entire book is evidence-based theorizing by some of the world's most respected researchers, but it's written in non-technical speak, so the every-mom or every-dad can understand. It also includes information (and, I think, messages) specifically directed towards us parents, as to how to develop talents. (Hint: regarding talent as maladaptive is not encouraging to the subject!)

Gone fishin.

I hope everyone is having a nice summer. Breaking news on our end: Brad is swimming!

A Lie Becomes the Truth (Alternative Title: "What Happened?!?")

Lo and behold, lie #3 - older sib speaks for younger sib - has become the truth.

By way of background, Jeremy is 22 months older than Bradley, and Jeremy is about as typical as they come in terms of childhood development. I knew Jeremy would be a great big brother to Brad. He's nurturing and caring, and likes to lead in play. Jeremy is also a good peer model, with good social skills and language. What I didn't call is what a great friend Brad would be for Jeremy. Jeremy always seeks out Brad to play. It's not a one-way street, at all. They're like two peas in a pod, and I couldn't be happier.

They often play together, sometimes unattended, and inevitably there's some sort of conflict. After all, they are ages 4 and 6, so play requires some referee-ing.

Into the room I barge.

"What happened?!?"

The problem: Jeremy does all the talking. Perhaps I'm facing Jeremy instead of Brad when I demand an explanation. Perhaps I'm at fault here too.

I've noticed this a lot lately. Sometimes Jeremy reports aches and pains to me, on behalf of Brad. And sometimes, Brad needs help (wiping) in the potty, and rather than holler, Jeremy will come get me.

Now that this revelation has dawned on me, I'm going to make a conscience effort to elicit speech from Brad and tell Jeremy to shush when he goes into spokes-brother mode.

I'm not sure what else to do by way of remediation here. But at least now I know what lie #3 is all about.

Lies I Told Myself

When Brad was flagged for autism spectrum at 24 months, I was floored. Floored. I had no clue. Even though he displayed early signs of autism.

How did I keep my head in the sand? Here, I present the top 3 lies I told myself:

Lie #1: "He's just a boy." I got a lot of denial mileage out of this one. After all, boys speak later than girls, and are less socially attuned. As the 24 month mark approached, that lie became less viable.

Lie #2: "He's independent because he's a younger sib and my attention is divided." This is the way younger sibs are supposed to be, I reasoned. Even though he had no - and I mean zero - separation anxiety as a baby. I rationalized that this is because I didn't carry Brad around as much and cater to his every cry, as I did when Jeremy was a baby.

Lie #3: "He's late to speak because his older sib talks for him." Seemed reasonable enough. No reason to be concerned about language delay.

Speech Update: Four Years, Three Months

I received the written report from his most recent speech evaluation. (A post on last year's evaluation here.)

Bad News First: Overall, his expressive communication was pegged at two years nine months. Over the twelve months from May 2009, he only progressed five months. He scored a 63 on the expressive language portion of the Reynell Developmental Language Scale, a test in which the mean for his age is 100 plus or minus 15. So that's discouraging.

His deficits appear to stem from four types of issues: verbal/visual association errors, paragraph comprehension, semantic errors and rigidity. The examiner also observed "as expressive language tasks became more complicated and Brad was ask to describe pictures or re-tell narratives, he began to resist." Go figure. He's four years old!

Excerpted from the report, for your information and amusement:

Although Brad responded accurately with regard to production of grammatical skills, errors were noted in semantic abilities. For example, when asked to label an illustration of a group of men, Brad responded, "children." When shown a picture of several people trying to escape the rain and asked, "What's happening," Brad responded, "It's not raining." The examiner continued "It is raining. And the people are getting ____" and Brad responded, "frozen." He provided definitions for concrete or abstract concepts with inconsistent accuracy. When asked, "what's an apple - what do you do with an apple?" Brad responded correctly by showing the examiner eating. Error responses were predominantly reiterations of the targeted concept. For example when asked, "What does cold mean, "Brad responded, "I'm cold." Brad's motivation waned when asked to describe a group of illustrations depicting a family engaged in various tasks. He fell out of his chair and told the examiner that the task was "so so hard. It might take a very long time." With encouragement, Brad provided short sentences that in general described the pictures. For example, in response to a picture of a family washing the dishes, Brad responded, "She's making a recipe." In response to a picture of the same family setting the table, Brad provided, "He's making dinner." Brad substituted "he" and "she" pronouns thoughout.

The picture card sequence probe outlined in the language comprehension section of this report was used to assess Brad's formulation skills for sequenced activities. Brad experienced difficulty on this task. He repeatedly pointed out numbers on the cards that existed outside the illustrations. He appeared to focus on pictured details and neglected salient features of the illustrations. For example in the sequence that depicted a girl making her bed, the line that the sheet's border had created intrigued Brad. He ran his finger along this line and asked the examiner about the "rope."

That's Brad in a nutshell. Marching to the beat of his own drum. Falling behind in communication but getting ahead in numeracy.

As a parent reading the report, it was hard for me to figure out how much was attributable visual/verbal association problems versus semantics versus he's four years old and the exam was taxing on his attention.

The good news: The perpetual tough grader wrote:

In contrast to previous testing, Brad made several improvements in nonverbal and verbal pragmatic skills. During current assessment, Brad followed the examiner's gaze and engaged in joint attention.

He also did very well with object identification, sentence completion, syntax construction and pragmatic judgment, scoring within the average range for each of those assessments.

Quick Hit

Psychology today muses: Not Quite Autism - At the Borderland of ASD. (Hat tip or...er....belly rub...to GoodFountain.)

It's all there: intersecting spheres, blurry lines and a slew of vaguely defined conditions. I've resigned myself that this is all there is until and unless epigenetics makes a quantum leap.

Have a great holiday!

Epilogue.

Thanks for the well-wishes and the insight.

Brad actually passed his depth perception test. Imagine that. One result one day, and a different result six months later. Well that never happens! Except when it does.

At the end of the day, I've learned to place less stock in two-dimensional medical opinions, positive or negative, good or bad. The truth most likely lies somewhere in the middle.

Annual Physical.

Like most kids, Brad gets an annual check up around his birthday, which is in January. Two notable aspects of his most recent appointment:

• He failed the depth perception test. He passed the eye exam, meaning his eyesight, in the conventional sense, is fine. The nurse practioner administers a test with multi-directional Es and special glasses aimed testing depth perception, and he failed. Which means he wasn't trying, he didn't understand or, what I suspect, he has issues with ocular musle control and visual perception that interfere with depth perception.
  
• I unbundled one of his vaxes. Since, for better or worse, there is a "vaccine debate" (although I don't think the debate is debatable, meaning, I think it's well-settled that vaccines don't cause autism), I thought I'd share my views. Although I don't buy into the vax-autism link and I'm very pro-vax, I don't have a problem with a modified schedule, so I unbundled varicella from the other shots he received at his 4 year appointment. I don't follow the Dr. Sears modified schedule; I just follow my intuition, but in any event, I make sure he is fully vaxed - it just takes an extra appointment. I'm happy with my decision.

Why am I posting now? Because Brad goes for his varicella shot this upcoming week, and I'm going to have him re-tested for depth perception. I'll post the results. Wish him luck!

I'm Back.

Sorry for the prolonged absence. I'd provide a good reason but I don't have one. I just needed to focus on all of the rest of life's demands. I missed you all!

We're still here, and we're doing well.

Brad is coming along nicely. Still ever the joy to parent, mellow and happy as ever. I wish I knew what makes him so perpetually happy. I'd bottle it up and drink it myself.

On the cognitive front, he's reading now - not too shabby for a 4.5 year old. At this stage, it's beginner reading, mostly three letter words, but not just sight words or rote learning. He's legitimately sounding things out and reading new words. From a parenting perspective, our goodnight ritual is pure joy, with Jeremy and Brad taking turns reading kiddie books.

So I suppose I've been smelling the roses lately.

But all sun and no rain makes for a desert, doesn't it? On the speech/communication front, he was recently reevaluated by his private speech therapist (not the public school), and the results were not great. (Click here for his evaluation from a year ago.) His delay is still in the "severe" category for expressive communication. The SLP had expected him to progress to the "mild" category by now. But there were gains. The perpetually tough grader said he is showing a budding imagination. For those of you who want to understand how this is evaluated: "typical" children narrate a play scheme while they play. The first time Brad was evaluated, he didn't do this, but during the most recent evaluation, he did. But according to the SLP, he still isn't getting the big picture, choosing to focus on details and losing out on concepts and meaning.

On the motor front, he's progressing, I suppose. A big milestone: he can take off a shirt effortlessly now. He's pedaling, just on his big wheel. But he's as floppy as ever, and continues to be unmotivated to move, characteristic of hypotonia. He's been in a big boy bed for a year now, and he has never attempted to leave the bed on his own. Not once. He just waits for us to show up and tell him to get up. Maybe that's in part a routine issue. But still. The good news: he's overnight potty trained. Weird, right? He doesn't get up overnight to go potty; he just holds it in all night. This is me, not complaining.

On the physical front, his pigeon toed-ness seems to be getting worse, not better. His natural standing posture is with his feet twisted inward, a lot.

So what's new with you and yours?

Quick Hit

Been away from blog for a week and will probably be away from blog for a little longer - pardon the absence. I hope all is well with my bloggy friends. I will be catching up next week.

I leave you with a quick hit: The Junior Meritocracy. It isn't PDD-related, but does relate to childhood development. And absurd parenting. Enjoy.

[Via Gawker: Dear Helicopter Parents, Your Gifted Child May Actually Be Dumb]

What To Expect Age 4, PDD Edition: Sensory-Motor

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.

(Not) A Very Special Episode

Just because.

A snippet featuring aspergian character, Abed, from the show Community.



And this.



And this.



And this.

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.

What To Expect (Almost) Age 4, PDD Edition: Introduction

I've long complained that there isn't a What To Expect (WTE) book for PDD. So every now and then, I blog about milestones and such in an attempt to distill Brad's experience WTE style.

Which brings me to my next series of posts. With Brad's birthday approaching (he turns 4 on January 22), I'll be writing about Brad's progress in the following areas: speech, motor, social and feeding. This is Brad's PDD trajectory; it may or may not be representative of any other child PDD or otherwise.

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.