Prickle (or That Time I sat on a Cactus)

We all know that cactuses are prickly but as a child I learned through firsthand experience just how prickly their prickles are, especially if they get you in an area that’s, uh…tender.

When I was seven years old I had a cactus of my own.  I don’t remember how I obtained this cactus but if I had to guess I’d say my father gave it to me.  He had a green thumb as well as a tendency to give strange gifts.  Some of the pets I kept in my room did not fare so well but this cactus seemed to do okay.  I kept it on my windowsill so that it would get plenty of sunlight and I watered it occasionally. To the extent that it’s possible for a cactus to be happy and to the extent that it was a possible for a child as prickly as me to be happy, I’d say my cactus and I were happy with each other.

Then disaster struck.

You know that nursery rhyme about the little monkeys jumping on the bed? I was familiar with that nursery rhyme as a kid but I did not appreciate it for the cautionary tale that it was and the consequences I suffered as a result of my foolishness were far more unfortunate than a bumped head. Ultimately it was more humorous than it was tragic though.

I’m not sure if those monkeys were clothed when they jumped on the bed but since they were monkeys it didn’t really matter. I, who was often more monkey-like than human-like, was jumping on the bed in my underwear. I’m not sure how to explain what happened next or if it even can be explained by the laws of gravity or physics but I’ve always been a klutz with a talent for injuring myself in bizarre ways.

Something went wrong on one of my jumps and I ended up falling off my bed and crashing on to my windowsill. Crashing in to a windowsill could have been painful on its own but do you remember what was on my windowsill? My cactus.

My underwear ( which never tends to fit me well to begin with) slipped down during my ill-fated jump, allowing my bare butt to make contact with the cactus. Suddenly my rear end was on fire with a thousand pricks.  I cried bloody murder.

My mother came dashing in to the room, her eyes wide with alarm and her voice filled with concern.

“What happened?”

I..I…sat on the cactus!”

“You… you.. what??!”

I pointed to the cactus on the floor with it’s cracked pot and scattered soil.  Then I turned around to reveal a butt that must have resembled a porcupine’s.

“How…how did you do that?’

“I was jumping on the bed..and..I fell and hit the cactus!’

“You shouldn’t have been jumping on the bed. ”

“Ahhh..oowwww..it hurts!”

“Ok..um..we’re going to have to take those cactus needles off of you”

“No, that will make it hurt more!”

“Well, we can’t just leave them in your butt!’

“I hate this!”

“I know you do. Come here.”

“This isn’t funny!”

“I know it’s not funny.”

“Then why are you laughing?’

“It’s just.. hold on, let me get your father.”

Upon examination of my butt, my father determined that those cactus needles were wedged in pretty deeply and tweezers would be needed to get them out. He returned with tweezers and set to work on my butt as my mom held me. My parents knew I was in pain and embarrassed so they tried to be kind and sympathetic but they couldn’t help but crack a few smiles and let out a few chuckles.

I can’t say I blame them. It was funny.  All these years later it makes for an entertaining story. How many people can say they sat on a cactus?

I don’t remember what became of that cactus after all its needles had been removed from my butt but I’m guessing I removed it from my windowsill and looked on it less fondly.

A few months ago while on a walk I came across a giant cloth cactus that a neighbor had left by the curb. I hadn’t had a cactus since the butt pricking one I had as a child but I was intrigued by this cloth cactus that I knew would be much softer on my rear end should worst come to worst. I considered taking it home. My mom said to forget about it. It could be infested with fleas, cockroaches or god knows what else. I knew she was right. It wasn’t worth the risk and that incident with the butt pricking cactus was enough for me. I’m set for life in terms of bad cactus experiences.Image may contain: plant, outdoor and nature

via Daily Prompt: Prickle

Fed up with Forty Five

As if the threat of nuclear war wasn’t bad enough, now we have this tragedy in Charlottesville, Virginia. We can thank Forty Five for that one too.  Anyone who thinks this was not a direct result of his hateful rhetoric is naïve, stupid or lying to themselves. Of course he condemned hatred and violence on “all sides”.  He wouldn’t want to call out white supremacists and risk alienating his biggest fan base!  The mother of the killer said she thought her son was going to a 45 rally, not a white supremacist rally. Guess what, lady, there’s a fine line between 45 rallies and white supremacist rallies.

The difference was that up until now 45 supporters were slightly more subtle about rallying for hatred and bigotry than the Ku Klux Klan.  Now when 45 supporters rally together they’re basically the KKK without the robes. Since these assholes in Virginia showed their faces alongside their Tiki torches, I hope they’re fired from their jobs, expelled from their schools and shunned by their communities. I don’t want to hear any ‘freedom of speech’ nonsense. Freedom of speech does not mean freedom from consequences. I also don’t want to hear any ‘slippery slope’ arguments.  Refusing to tolerate expressions of hatred and threats toward minority groups does not mean it’s only a matter of time before your neighbor is arrested for professing his dislike for a Backstreet Boys song.

You know what did send us down a slippery slope though? Electing 45 as president. And you know who I will not hesitate to profess my hatred for?  If you guessed 45 again, you’re correct. I despise him more than I’ve ever despised anyone in my life. I know I’ve never met the guy and that objectively there are people who are worse than him but those people aren’t constantly in my face, polluting almost every aspect of the world around me.

I’m sick of seeing his evil, ugly, smarmy disgusting face all over the internet and the newsstands. As you can see, I’ve mostly stopped using his real name when I refer to him because I don’t want to give his name any more power than it already has. His name should be treated in the same way the media treats the names of school shooters. Rather than glorifying the name of the criminal, focus on his victims.

And everyone is a victim under his presidency, even those who support him. I can’t believe Caitlyn Jenner or anyone else actually thought he would be an ally to the LGBTQ population.  I can’t believe any one does still support him, I can’t believe people are still defending his words and actions, I can’t believe he’s still president. Yes, I know he’s only been president for seven months but it’s been a long seven months and he’s managed to do so much damage in so little time. While I haven’t given up hope that he’ll be impeached or removed from office, I’m feeling pretty jaded at this point.

I never thought I’d ever see as many swastikas, confederate flags and KKK robes in one day as I saw today on Facebook. Many of them were memes protesting those things but the fact that we still need to protest those things in the USA in 2017 because they’re still being publicly displayed in the USA in 2017 is disgusting. I’ll also never look at Tiki torches the same way again but that’s the least of my concerns.

Can you imagine what the reaction of 45 and his supporters would have been if the driver of that car that killed one and injured 19 had been Muslim or Mexican? The reaction of the police if those protesters with their Tiki torches had been black? White privilege means getting away with doing those things without being injured or killed, without being labeled a thug or a terrorist.

Privilege is a subject for a whole separate blog but many of us are privileged and take our privilege for granted. I haven’t loved all the presidents I’ve seen in my lifetime but I assumed that as an American living in the 21st century I would always have the privilege of having my country led by a sane, mature, respectable, halfway decent human being who would adhere to the principles of justice, equality and democracy. How tragically wrong I was.

Profile of an NLD/ASD Child: Part 6

SPEECH EVALUATION

Age: 4-7

REASON FOR TESTING: Kira was seen for a psychological evaluation. Concerns were in the areas of immature behavior and perceptual-motor development, directly related to kindergarten readiness. A complete Child Study Team evaluation inclusive of speech and O.T. evaluations was recommended.

DIAGNOSTIC EVALUATION:

Behavior: Kira, a friendly responsive child, was attentive and cooperative. Kira became anxious when she anticipated difficulty with a task. She became somewhat oppositional and at times silly to avoid responding. Eye contact was elicited but Kira frequently looked away.

Oral-Peripheral: Examination revealed normal structure of the articulators. Dental condition and occlusion were good. The strength, control and coordination of the articulators were adequate for voluntary initiation and imitation of gross non-speech movements, syllables and syllable patterns. No drooling was observed.

Hearing: A pure tone hearing screening administered at 20dB revealed hearing to be within the normal range for speech, bilaterally.

Auditory Memory Span:

Non-Meaningful Language:  7-0 (5 digits)

Meaningful Language: 7-0 (14 words: 18 morphemes)

Receptive Language:

Peabody Picture Vocabulary Test: (Form B) MA: 5-9

Preschool Language Scale Auditory Comprehension Level: 4-0

Vocabulary recognition and understanding of language concepts were above age-level.

Expressive Language:

Expressive One-Word Vocabulary Test: 6-7

Preschool Language Scale Verbal Ability Age: 6-3

Word-finding skills and expression of language concepts were above age-level.

Speech Sample: Expressive efforts were through sentences of adequate length, characterized by very mild structural errors. Semantic usage was good and pragmatic intent, adequate. Speech intelligibility was judged to be good. The rate, pitch, volume, vocal quality and fluency were within the normal range.

Articulation: Responses elicited on the Weiss Comprehensive Articulation Test revealed a mild disorder involving a few sounds consistent with the five to seven year level. The following errors were presented in single words: b/v medial, t/o initial, s/o medial and final, d/j all positions, w/l all positions, d/z initial, w/l in blends and -/s in blends. Similar patterns were presented during conversational speech.

SUMMARY: Kira, a pleasant, responsive child, was attentive and fairly cooperative. She became somewhat oppositional and resistant when she anticipated difficulty with a task. Overall receptive and expressive language abilities were above age-level. Expressive efforts were through sentences of adequate content, form and intent. Although structural errors were presented, they were extremely mild in nature and not atypical for her age.

A mild articulation disorder did not interfere with speech intelligibility. Oral-peripheral structure and function were adequate. Hearing was within the normal range.

Speech therapy for correction of mild articulation errors was recommended should errors not self correct within six months.

 

 

Daily Prompt: Organize

I’ve never been very good at organizing anything- not my possessions, not my time and not my life. At school my desk was a mess, my locker was a mess and my backpack was a mess.  If you opened  any of them you would be met with a jumble of papers, folders, pencils, brushes and god knows what other objects. Those objects would often cascade to the floor and form a haphazard pile, prompting a frustrated but resigned sigh from me. One of my teachers labeled me the queen of disorganization.

Things haven’t been any better for me at home or anywhere else for that matter. My bedroom is usually in a state of disarray, my bathroom is usually in a state of disarray and I generally leave a trail of chaos wherever I go. Once I hit adolescence the jumble of items I kept and carried in a disorganized heap started to include money and tampons. My manual dexterity and attention are as impaired as my organization so I continue to drop my belongings on the floor on a regular basis, often in public. Dropping a tampon on the floor in public is pretty embarrassing but honestly it’s happened to me so many times that at this point it barely fazes me.

As you can  imagine, my disorganization has been rather frustrating for the people who are forced to live with me.  I’ve never lived with any extreme neat freaks (if I did I imagine I wouldn’t be writing this blog right now because one of those neat freaks would have murdered me) and most of my relatives are pretty organizationally impaired themselves.  Yet even the organizationally impaired tend to demand a certain level of order. I’ve discovered that dirty clothes all over the floor tend to push people past their tolerance limits. Wet towels on the floor are even less appreciated.

Being disorganized is pretty frustrating for me too. I’m constantly losing my possessions. I have about 101 brushes but when I need to brush my hair I have trouble locating even one of them  Asking where I last had my lost possession doesn’t help because if I knew that it wouldn’t be lost but sometimes praying to St. Anthony does.

I have all the free time in the world and yet I never seem to find time to do all the things I want to do in a day because I’m so bad at organizing my time. Time escapes me so easily and everything always ends up taking more time than I anticipate it taking.  I’ve yet to start certain blog posts I figured I would have finished about six months ago.

Everyone tells me I’m a good writer but in college I would have meltdowns over papers because I had such a hard time organizing my thoughts. When it comes to organizing social events such as parties, forget about it. Luckily I have some more organized friends who have stepped up to the plate for me there, as my family is just as useless as I am in that department.

A lot of people seem to think I’m disorganized because I just don’t give a damn and that I could become organized if I chose to. It’s really not as simple as that though. I think my brain is wired in a way that makes me and organization incompatible.

It would be nice to be organized but I’m afraid I’m never going to achieve that big O. I can’t even fake it.  Daily Prompt: Organize 

Profile of an NLD/ASD Child: Part 5

Psychological Evaluation

Age: 4 years, 7 months

Reason for Referral: Kira is being evaluated as part of a full child study team assessment. Parental concerns over perceptual-motor development and immature social/play behavior have persisted since Kira was first brought to the attention of Project Child one year ago. Currently there are questions about Kira’s readiness for Kindergarten.

Background Information: Kira was seen for screening by Project Child last year. Results at that time indicated possible deficits in gross and fine motor development, while age appropriate speech/language and cognitive skills were apparent. Kira demonstrates shy behavior in unfamiliar situations. An occupational therapy evaluation noted gross motor abilities within normal limits. However, delays in fine motor ability, including both quality of production and skill achievement were evidenced. Recommendations were made by the occupational therapist which were relevant to home and nursery classroom setting.

Currently behavioral concerns centering around socially reticent behavior, lack of peer relationships and immaturity are being noted by mother and classroom teacher. Delays in the fine motor area also appear to be hampering Kira’s development.

Observations: Kira is a very pretty 4 year 7 month old girl of average height and build. She was unwilling to separate from her mother and therefore Kira’s mother accompanied her throughout this assessment. Initially Kira remained seated on her mother’s lap but spontaneously moved to a nearby chair after approximately five minutes in to the session.

Kira was very interested in the testing materials and was cooperative with all tasks.  No spontaneous speech was apparent. Speech upon demand was sparse and not elaborate but effective in relaying information.

Kira’s attention was appropriate although she sometimes seemed to tune out. Kira interacted affectionately with her mother and was socially responsive with the examiners. Kira seemed quite interested in people but hesitance was noted in her interaction with them.

Results of Evaluation:

McCarthy’s Scales of Children’s abilities

Scale                             Scale Index               Scale Age Equivalent          Percentile

Verbal                                 60                                         5-6                                85th

Perceptual Performance  45                                    4-0                                 30th

Quantitative                       52                                   4-6                                  55th-60th

Memory                           55                                    5-0                                   70th

General Cognitive Index  105                            4-10                                  60th-65th

 

Results of this measure indicate overall cognitive development at the average level. Perceptual-Performance scores are an area of relative weakness, with scores at below average levels. Verbal and memory skills are at high average level.

Verbal: The verbal scale measures the child’s ability to express herself verbally and to measure the maturity of her verbal concepts. Age scores for subtests include: Pictorial Memory (4-6); Word Knowledge (4-6); Verbal Memory I: Words and sentences (5-6) Verbal Memory II: Story  (5-0); Verbal Fluency (6-6);  Opposite Analogies (5-6).

Kira recalled four out of six pictures. She identified or named nine out of nine pictures and defined the words “coat” and “tool”. She repeated a series of four unrelated words. Kira correctly completed five opposite analogies.

Perceptual Performance:  Kira achieved these subtest age scores in the perceptual performance area: Block Building (3-0); Puzzle Solving (4-0); Tapping sequence (3-6); Draw-a-design (4-0); Draw-a–child (4-0); Conceptual grouping (5-6). This scale evaluates reasoning ability through manipulation of materials. The child demonstrates skills of imitation, logical classification and visual organization which are generally below age expectations.

Kira copied block structures such as a 6 block tower and a 3 block chair. She correctly put together a three piece puzzle. Kira copied a circle, vertical and horizontal line and a right angle intersection. Her drawing of a person consisted of six scorable parts but the quality of her drawing was immature. Kira used the right hand for drawing tasks and a pincer grasp was inconsistent.

Kira identified the concepts of big/little, square-round and named nine colors. She was able to sort by three attributes.

Quantitative: The quantitative scale is designed to measure Kira’s number aptitude rather than the upper limit of computational skills. Kira’s understanding of quantitative concepts is judged to be at these age equivalents: Number Questions (4-0); Numerical Memory I: Forward Series (8-6);  Counting and Sorting (5-0).

Kira answered number questions such as “how many heads do you have?” to a 4-0 year old level. She repeated six digits, which is a notable strength for her age.

Kira was able to sort four and ten blocks by half. She correctly counted to five with one to one correspondence.

Memory: Visual and auditory memory are assessed by subtests on this scale. The following subtest age equivalents have been achieved: Pictorial Memory (4-6); Tapping Sequence (3-6); Verbal Memory I: Words and Sentences (5-6) ; Verbal Memory II: Story (5-0): Numerical Memory (8-6). Kira’s short and long term memories appear adequately developed.  A strength was noted in short term auditory recall.

Summary of Evaluation: Kira, a pretty and reticent 4 year 7 month year old girl, was cooperative and curious during this evaluation. She was able to maintain attention in a consistent manner for about fifty minutes.

Results of the cognitive assessment indicate functioning at approximately the 4-10 year level, with scatter to the 6-6 level. Perceptual-fine motor skills appear developed to the 4-0 level, which would be considered an area of notable weakness for Kira. Receptive language and expressive language appear well developed and were exhibited to the 5-6 level. Kira’s memory skills were demonstrated to the 5-0 level while qualitative skills appeared average.

These results suggest cognitive development at the average level overall.

Going Nuclear

Ever since I was a small child I’ve been afraid of nuclear war. Learning that we as humans have the power to destroy the world with nuclear weapons struck terror in my little heart.  The Cold War was over by the time I was born so I did not grow up in an era of school nuclear bomb drills, forced at least once a month to contemplate the possibility of a nuclear Armageddon and the uselessness of a wooden desk over my head in the face of it.

I’m a morbid person though so even though I wasn’t forced to contemplate a nuclear Armageddon, sometimes I contemplated it anyway.  I even read “On the Beach” and watched “When The Wind Blows” with horrified fascination.  While I could handle and even enjoy in a way fictional accounts of our planet’s nuclear annihilation, news about real life possibilities of nuclear attacks put me on edge and I did not enjoy it in any way, shape or form.

Luckily for most of my life, reports of the possibility of nuclear attack were fairly few and far between.  If I came across a report of the possibility of nuclear attack, closing my browser window usually solved the problem. In recent years North Korea has become an increasingly dire threat but their talk of development of nuclear missiles appeared to consist mostly of hot air.

I thought the threats North Korea made to us over that movie The Interview were ridiculous. I’m anti-censorship and pro free expression so although I felt I should support the release of that movie, there was a part of me that thought “Come on, America, is some silly movie really worth risking the possibility of nuclear war?” but once the movie was released, yet another threat from North Korea proved to be bullshit.

Fast forward about two years later to the election of our 45th president. I was very upset by the results of that election. One of my biggest concerns about having such a volatile, hot headed, immature, impulsive, egotistical, moronic buffoon as our president was that he would propel us in to a nuclear war. Fast forward a few months later and he appears to be doing just that.

When I first heard the news that 45 was making threatening, provocative, inflammatory statements to Kim Jong Un and Kim Jong Un was responding in kind, I felt dread in the pit of my stomach and a quickening of my heartbeat.  At first I tried to just ignore the news but it filled up my Facebook feed. I went off of Facebook and sifted through a digital collection of old photographs but was distracted by multiple pop up news alerts informing me that 45 had escalated his threats to North Korea. My mom suggested I come watch Colbert with her because he would joke about 45 and take my mind off my anxiety. One of the first things out of his mouth was “We’re all going to die!”

I posted a Facebook status about how anxious the threat of nuclear war made me and requested that no one respond by telling me we were going to get nuked.  Nevertheless a friend of mine informed me that she’d heard that North Korea would have its missiles ready to launch by mid August. Another friend told me that the only thing left to do was to turn to Jesus. Since I don’t believe in Jesus, I didn’t find that very comforting.

I did some mental math and realized that the time when North Korea will allegedly have its missiles ready coincides with my mini vacation to Block Island. I started thinking that maybe I didn’t want to be away during a time of potential nuclear attack. Than I started thinking about the trip to Chicago planned for next month. Then I realized that we could be in a state of potential nuclear crisis for years. I decided that in the meantime I don’t want to put my life on hold or stop doing things I enjoy.

I’ve been reading articles about 45 and North Korea.  Some say that the threat is very serious, other suggest that it’s not as serious as it appears on the surface. The one thing said by a friend about this issue that actually comforted me was “We survived the cold war, we’ll survive this.”

Maybe he’s right about that, maybe we’ll all go up in a ball of fire tomorrow. Regardless, this may be a good opportunity for me to start living like I’m dying, or at least to start blogging like I’m dying.

Why Saraha is a bad idea

There’s an app called Saraha that’s gotten popular.  The premise of it is simple. You set up an account and people leave anonymous comments about you. Some of my friends have gotten in to it but I have no desire to try it. I’ve had enough mean comments made about me on the internet without Saraha’s help.

Some of the comments about me have been made under identified user names, some of them have been made anonymously and some of them have been made by people who aren’t quite as anonymous as they think they are. If you want one example of this, look at the comments sections of some of my blog posts. A few months ago I wrote a blog post about a conflict I had with a former Facebook friend. I called him Dick for the sake of anonymity but he came on my blog under his own name to tell me off and threaten me with legal action. Some friends of his also showed up to defend him.

A few weeks ago someone left nasty comments on my blog under an anonymous user name. The snooty, condescending tone of the comments sounded familiar so I did an IP check. Not only did the IP match up with Dick’s, it also matched up with the IPs of his “friends”.  The funniest part is that he talked to his friends as himself and corrected information they gave about him in order to humble brag.

Dick, I know you’re reading this blog post because you’ve made it clear that you just can’t get enough of me. Now that you know I’m on to you, I hope you’ll refrain from further trolling the comments section of my blog. Even if you post from a different computer, your snooty, condescending tone will be a dead give away.

Anyway, now that I’ve said my piece about Dick, back to Saraha. It’s a bad idea because it provides a platform for cyberbullying. When people are given anonymity and thus have no accountability for their words, they feel more comfortable saying things that are cruel, horrible and threatening.  As annoying as Facebook’s real name policy can be, the reasoning behind it is sound.

Sarahah responded to criticisms of cyberbullying by saying that it was an app designed for adults that did not belong in the hands of children. Anyone who thinks cyberbullying or bullying in general is limited to children is naïve. Bullying happens all the time among adults and it can be just as bad if not worse than the kind of bullying that happens among children.

The intent of Saraha is to give constructive criticism and some people do use it for that purpose but if you’re going to give criticism that is constructive then it’s best to give it to the person under your own identity.  Direct, constructive communication is the basis for a healthy relationship in which both parties are satisfied with each other. If the relationship is a healthy one the person receiving the constructive criticism should be able to listen to and consider it without flipping out on or seeking to punish the person who gave it. I’m thinking that the kind of people who aren’t receptive to constructive criticism given to them directly probably aren’t too receptive to anonymous constructive criticism either.

If what you’re saying to the other person is just mean and not helpful it doesn’t need to be said at all. The whole anonymity thing leaves you guessing about who left the comments.  The person who received a mean comment might incorrectly guess that the mean comment was left by a certain person they know and as a result they might treat that person in a hostile manner, which is really unfair to the person who is innocent of any wrongdoing.

Saraha has also been used to leave nice comments. If you have something nice to say to someone then by all means say it directly to the person under your own name. It’s a sad statement on society when we only feel comfortable showing kindness anonymously.

Saraha was originally developed in Saudi Arabia, where direct constructive criticism is just not considered socially acceptable. I’m sorry that things are like that in Saudi Arabia and I’m happy if Saraha has helped them in that regard but please, let’s not encourage this kind of indirect, passive aggressive communication in other cultures. Let’s keep our lines of communication open and direct.  Let us be not afraid to give or receive constructive criticism under our own names. Let us be decent and tactful even when we’re criticizing and let us not resort to anonymous nastiness. Let us not hesitate to directly tell people under our own name that we appreciate them and think they’re wonderful.

Although I’ve never used any kind of anonymous comment app, I’ve been the victim of a nastygram through one of those things. When Googling myself I came across a message calling me a troll. The message was accompanied by pictures of trolls. I’ve had people call me a troll directly and that hurt but this anonymous message felt particularly low and immature. It was on an app called Whisper, which I’d never heard of. I Googled it and found that it was intended to combat cyberbullying. So, yeah, an app intended to combat cyberbullying was being used to cyberbully me. I can see Sarahah going in that same direction. I will be staying far, far away from it and I suggest you stay away from it too.

Profile of an NLD/ASD Child: Part 4

Initial Neurodevelopmental Evaluation:

Age: 4 years, 6 months

Reason for Referral: Developmental delays, hand flapping, not interacting well

Kira attends a preschool program at a daycare center. The daycare staff report that she does not initiate play, does not interact with other children or adults, does not listen and does not follow directions. They have also noted that she gets easily distracted, talks to herself, flaps her arms and is not functioning well enough to be in a group of 25 children. Mrs. Baker has observed all of these behaviors at home as well. However, she feels that Kira interacts very well with her and her husband and also with other people once she gets to know them well. She finds her too distractible, stubborn and shy. Kira is very affectionate with her mother and looks to her for comfort and security. Mrs. Baker feels that Kira’s social skills have improved over the past year but not to the point where she can function in a regular Kindergarten.

Kira has mild developmental delays for which she was evaluated by Project Child. At that time, hearing and vision were found to be normal. An occupational therapy evaluation revealed some delays in perceptual fine motor abilities. Occupational therapy was recommended.

Kira is the older of two children to her parents.  This was the first pregnancy for Mrs. Baker who was in good health prior to and during the pregnancy. She had onset of premature labor at 28 weeks and was hospitalized for a week. She was placed on Ritodrine and magnesium sulfate. She had a non-stress test every week and was then placed on oral Ritodrine. She also had decreased amniotic fluid. Kira was born at 37 1/2 weeks gestation by cesarean section due to breech presentation. Birth weight was 6 lbs, 6 1/2 oz. Apgar scores were 8 probably at the first minute.  No resuscitation was required. At birth she was noted to have congenital torticollis which resolved following some physical therapy. She did get evaluated at the Children’s Hospital of Philadelphia for the torticollis. X-rays of the cervical spine were done, which were normal.

Kira was breast fed. There were no feeding difficulties. She was not a colicky infant. Mrs. Baker recalls that she was never really a good sleeper.

Gross motor delays were noted early on. She did not lift her head up until 4 months of age. She rolled over at 5 months, sat alone at 8 months and crawled at 10 1/2 months. She walked alone at 11 1/2 months. She started riding a tricycle at 3 years. Initially she was clumsy and would trip frequently but this is much less now.

Her language milestones were achieved early. By her first birthday she was saying 5-10 words. By 15 months she had a vocabulary of 15-20 words. Before her second birthday she was speaking in short sentences.  She can narrate a story. She conducts a conversation, at least with her mother. She does not have any nonsense words. She does not speak out of context.  There is no history of echolalia.

Her fine motor skills have been of some concern. She is a little sloppy when it comes to handling a cup, spoon or pencils and crayons. She drooled until the age of 2 years.

She was toilet trained at 2 1/2 years.

Kira has had 2-3 ear infections per year.  She also gets frequent colds. She is on prophylactic antibiotics. She also has a history of eczema. There are no known allergies. She has had one episode of urinary tract infection.

Kira lives with her parents and younger brother Michael. Michael is 3 years old and developing well.  He is reported to be shy. Mrs, Baker, age 33 is in good health. She has B.S. and M.S. degrees and is a medical copywriter in an advertising agency. Dr. Baker, age 52, is in good health.  He is an M.D, , Ph.d and is the executive director of microbiology in a biotech company. There is no history of developmental problems on either side of the family.

Physical Examination: Kira was a pretty little girl. Her left eye was slightly smaller than the right, otherwise there were no dysmorphic features. Examination of the head and neck area was normal, including both ears.  Dentition was normal. Auscultation of the heart and lungs were normal.  The abdomen was soft, there was no hepatosplenomegaly. There was no scoliosis or midline defects. Genitalia were prepubertal female. There were no neurocutaneous lesions. Sidney crease was present on the right side. There was no major asymmetry of the extremities.

Neurological Examination: Kira was alert and active. As soon as the examiner entered the room she became suspicious and ran to her mother. She did not move away from her mother until she was ignored for a length of time and felt reassured. When she warmed up she became more sociable. She had a high activity level once she felt at ease.  She made good eye contact but it was not sustained. For each task requested she would cooperate briefly, then become oppositional again. She was whiny and her first response to any task was “No, I don’t want to do it.” During this entire session she was not heard talking to herself but she did flap her hands for a few minutes while jumping in place. She also twirled her hair for a minute or so.  She did not do any repetitive task such as turning the light off and on or turning the water off and on.  She did not hum to herself. She did not laugh or cry inappropriately. Although her social interaction was not normal, she was not in a world of her own.  She frequently asked her mother to read her a storybook and followed the story carefully, correcting her mother at intervals.

She did not initiate much speech except when asking her mother to read her a book but when she spoke she was fluent, appropriate and intelligible. Her sentences were 4-5 words long.

Muscle tone and strength were normal. Deep tendon reflexes were 2+ and symmetrical bilaterally. Plantar responses were flexor bilaterally. Her gait was normal. She walked on her heels and toes satisfactorily. She could not walk in tandem. She could not skip, hopping was limited. She stood on each foot for 2 seconds. She picked up a cheerio with a neat pincer grasp. No tremors were noted during fine motor tasks. She used her right hand predominantly , including writing, but used her left hand for building with blocks. She did not like to be touched, although she permitted the entire physical examination over a period of time.

Pupils were equal and reactive to light. Extraocular movements were full. Red reflexes were present bilaterally but discs were not visualized. There was no drooling. Other cranial nerve functions seemed normal.

On developmental assessment, delays were noted predominantly in the fine motor adaptive and personal/social areas. She built a tower of 8 cubes but could not imitate a bridge. She imitated vertical and horizontal lines and correctly picked the longer of two lines. She drew a person with three parts. She could not copy a circle or a cross. She recognized several colors. She comprehended prepositions and followed directions appropriately. She named opposites and defined words. She named the composition of a few items. She comprehended cold, tired and hungry.  She used plurals and gave her first and last name. She jumped in place and did a broad jump satisfactorily. She threw a ball overhand and kicked a ball forward.  She hopped on one foot for a few seconds. She could balance on one foot for only 2 seconds. By history she cannot dress herself completely and does not yet button her clothing. Kira correctly identified three letters of the alphabet.

Summary: Kira is a 4 1/2 year old girl with a history of poor social skills and mild developmental delays. She does not interact well with others, has a high activity level and is oppositional. Perinatal history is positive for premature labor at 28 weeks suppressed with medications, oligohydraminos, breech presentation and cesarean section delivery. Gestation was 37 1/2 weeks. Congenital torticollis was noted at birth and resolved with physical therapy. X-rays of the cervical spine done at the Children’s Hospital of Philadelphia were normal. Early motor milestones were slightly delayed, although she was walking without assistance by one year of age. Fine and gross motor coordination difficulties have been noted. Language milestones were achieved in the normal range, if not early. Family history is negative.

Growth parameters are in the normal range, including head circumference. Mild facial asymmetry is noted, the left eye being smaller than the right. General physical examination otherwise is normal. Neurological examination does not show any focal or lateralizing findings. Fine motor difficulties are noted. Behavioral observations include slow to warm up, lack of initiation of interaction, short attention span, easy distractibility, oppositional behavior and poor motivation to perform tasks. She makes good eye contact, though not sustained. There is no echolalia, no repetitive activities and no tuning out. She does show some self stimulatory behaviors in the form of jumping in place, flapping her arms and twirling her hair. Hand functions are purposeful. While she has impairment of social skills, they do not appear to be to a degree where a diagnosis of pervasive developmental disorder can be made at this time.

Developmental delays are noted in the fine motor adaptive areas but not in the language area.

Impressions:

1. Developmental delays in fine motor adaptive and personal/social areas.

2. Impairment of social skills.

3. Language skills tested are age appropriate.

4. Self stimulatory behaviors in the form of hand flapping and twirling of hair.

Recommendations:

1. Since Kira is not able to function in a regular preschool setting, she should be evaluated for placement into a preschool handicapped program. In the interim she may benefit from group play therapy and/or social skills program.

2.No neuroinvestigative studies are indicated at this time.

3. Neurodevelopmental re-evaluation in 6 months.

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Carousel

via Daily Prompt: Carousel

When I was a little girl, I attended a summer day camp called Camp Carousel, sponsored by the YMCA.  I assume that camp is now defunct because Google gives me nothing. It will just have to live on in my memory.

I was only four years old when I attended so I don’t remember much about it. What I do remember is that the camp shirts were yellow. I believe the logo was a carousel horse but I could just be making that up. Another thing I remember is that we sang a lot of songs. My favorite song was Down By The Bay. I love animals and making rhymes so that song was right up my alley. My least favorite song was “The Littlest Worm I Ever Saw”. The idea of sipping a worm through a soda straw was so gross and unpleasant that I wondered why anyone would write a song about it. I also wondered why the idiot in that song took a sip after the poor worm told him not to.

The songs were often sung by my godmother as she played her guitar. She was a camp counselor and she drove my brother and I to camp every day. One day in the car she said “Kira, why is it that you talk in the car but not at camp and Michael, why is it that you talk at camp but not in the car?” I can’t answer for my brother but for myself I can say that at that point I was a painfully shy kid who had a hard time socializing with her peers.

None of that was really about carousels though. Sorry, this is my first attempt at the daily prompt. Anyway…carousels…they’re okay, I guess. Around the same time of my life that I attended Camp Carousel, my babysitter took me to a mall that had a large carousel.  I rode it and enjoyed it.

When I was a teenager I heard a song called “Wall of Death”   Here’s a sampling of the lyrics:

Let me ride on the wall of death one more time
You can waste your time on the other rides
but this is the nearest to being alive
Let me take my chances on the Wall of Death

 

Well you’re going nowhere when you ride on the carousel
And maybe you’re strong, but what’s the use of ringing a bell
The switchback will make you crazy
Beware of the bearded lady
Oh let me take my chances on the Wall of Death
You are going nowhere when you ride on the carousel

 

For most of my childhood I stuck to slow, tame rides like carousels because I was afraid to go on fast and furious rides like roller coasters. That changed when I went on a class field trip to Hershey park at the end of 8th grade. My best friend Ava suggested we go on a roller coaster. I refused but once she’d assured me this roller coaster did not go upside down, she was able to convince me. Once we’d been strapped in to our seats Ava said to me “Kira, I’m going to tell you something that’s really going to piss you off.”

“What?”

“I was lying to you. This roller coaster does go upside down.”

“Ah! Why did you do that?”

“Because I knew it was the only way I could convince you to ride.”

“Oh no…”

“Don’t worry, you’ll enjoy it.”

And I did enjoy it. The roller coaster gave me such a rush of adrenaline and exhilaration, the kind that could not be achieved with a carousel  From then on I was an enthusiastic roller coaster rider.

A few weeks ago I was at a park in Jersey City that has a carousel. My father asked me if I wanted to ride it. I declined but if there had been a Wall of Death I would have taken my chances on it.

 

Profile of an NLD/ASD Child: Part 3

Occupational Therapy Evaluation

Child’s age: 4 years, 6 months

Reason for referral: Kira was referred for an occupational therapy evaluation as part of a full child study team evaluation. Kira was previously evaluated by this therapist last year. Concerns at that time centered around her social development and attention to task. Kira has attended preschool this year. While growth has been noted, concerns persist in the aforementioned areas.

Behavioral Observations: Kira entered the evaluation room with this tester, by herself, as her mother completed an interview with the social worker.  She was pleasant and friendly but announced that she did not want to play. Nonetheless, she was cooperative when asked to perform a variety of gross and fine motor activity.  While she preceded her performances with “I don’t want to” she could be encouraged to participate. This was Kira’s second evaluation on this morning.

Kira’s attentional behavior appeared to be diminished. Eye contact could be elicited but was fleeting in length and not offered frequently on her own initiative. Response time appeared to be notably delayed. Kira often appeared to be staring in to space. Sometimes she seemed to forget what she was supposed to do. On other occasions after a long delay, she would say “I don’t know how to do that.” While performing many gross and fine motor activities, Kira failed to watch what she was doing, which interfered with the accuracy of her work. Kira talked freely throughout the evaluation period: conversations were not always topical. Also noted was that Kira tended to hold her breath while concentrating, letting it out suddenly.

Gross Motor:  Kira displayed a full repertoire of primary movement patterns, with a fairly complete range of secondary, more integrated movement patterns. Active range of motion and muscle tone appeared to be generally within normal limits. Overflow observed last year (arms in midguard posture and hand flapping) seemed to have lessened. The quality of her movements in terms of speed and agility appeared to be within normal limits. Kira tended to move spontaneously, without careful regard to motor planning other directed movements.

According to the Michigan Preschool Profile, Kira functioned on a 4 year to 4 year 6 month level in gross motor development, with scattering of skills in the 3 year 6 month to 4 year 6 month level. Kira walked with heel to toe articulation.  She was able to walk backwards and in a heel to toe fashion.  She stood on one foot for one to two seconds. She jumped in a forward direction a distance of about twelve inches. By report, she pedals a riding toy, and uses the slide and swing, although she does not yet pump a swing. She was able to toss a ball, with inconsistent control.  Inattention interfered with her ability to catch the ball.

Perceptual/Fine Motor: Kira used her hands in a fairly coordinated, assistive fashion, displaying a preference for her right hand. Mild hypermobility of the joints of the hands was noted. Manipulation was usually performed in the fingertips, although when inattentive, palmar control was used. She displayed a wide range of grasp patterns with pincer grasps occasionally being lateral. Release appeared to be immaturely developed in both control and precision in placement, again being modified by inattention to task.

According to the Michigan Preschool Profile, Kira functioned on a 3 year 6 month level, with skills widely scattered in the 2 years 6 months to 4 year 6 month range. She stacked eight one inch cubes and duplicated building a four cube train and a three cube bridge using trial and error but did not build the five cube gate or six cube pyramid. She did not complete the rotated two piece puzzle but did complete the simple five piece puzzle. Again, Kira’s approach was not well organized, and she tended to retry the same piece in the improper place repeatedly. She placed six pegs in a pegboard in ten seconds.

Kira held a pencil in her right hand, in a digital supinated grasp. She copied a vertical and horizontal line and a circle and attempted to copy a cross.  She printed her name with some assistance. She drew a seven part man upon request. She attempted to trace within a square template. Kira attempted to cut on a line, with some success.

On the Ernhardt Developmental prehensile assessment, she functioned on a 3 year 6 month to 4 year level. On the design copying test from the SCSTI she achieved a standardized score of – 0.1 (where scores above + 1.0 SD and below -1.0 are considered increasing significant.)

Self Care: Mrs. Baker reported that Kira is completely toilet trained, including at night. She dresses and undresses herself. She can undo snaps and zippers. For feeding she uses a fork and spoon and can pour from a small pitcher.

Summary:  Kira was referred for an occupational therapy evaluation as part of a full Child Study Team evaluation. Her behavior was marked by inattentiveness and difficulty planning and organizing herself for movements and activities. Gross motor functioning was essentially within normal limits, although movements were spontaneous and not well planned. Perceptual/fine motor development was judged to be mildly to moderately delayed, with a wide scattering of skills up to age level. Inattention hampered her performance in all areas tested.