A Valentines Dance

The weather reports are predicting snow. I keep checking my e-mail to see if tonight’s Valentines dance will be canceled but it appears to still be on.

I’ve never been to a Valentines dance before (or any holiday dance for that matter) and I originally wasn’t planning on attending this one but when my volunteer supervisor told me it would be fun and I should come, I decided to think about it. When I received an e-mail saying more volunteers were needed for the dance, I sent a reply saying I would be there.

I won’t have to worry about bringing a date or hooking up with anyone at this dance but I will have to worry about setting up the decorations. This is a worry for me because my fine motor skills are even worse than my social skills and anything that involves work with my hands is unlikely to turn out well.

At least my social skills have improved, even if my fine motor skills haven’t. Sometimes skills atrophy from lack of use and god knows I was quite anti-social in recent years. A year ago I wouldn’t have even considered attending this dance but I wouldn’t have even known about it because I wouldn’t have been volunteering in a special needs expressive arts class at the community recreation center. This dance won’t just include the students from my class but various other people from the special needs community.

My mother drops me off at the recreation center and points out that no one appears to be there. I point out that the dance hasn’t started yet and assure her that the people will come. Upon entering the building, I see the DJs setting up their equipment and the other volunteers decorating the walls with red paper hearts.

“Kira, I’m so glad you came !” Lois, the expressive arts teacher exclaims as she hands me a paper heart and some tape. The other volunteers are hanging the hearts throughout the room, one after the other, making it look easy.  It’s not easy for me though. As I feared, the hearts become useless in my hands. Rolling the tape so that it sticks to both the heart and the wall is too complex a feat for me. Eventually I manage it in a haphazard way, only to be told that I’ve taped the heart to the wrong wall.

“Kira, what grade are you in?” a volunteer asks me.

“Oh, I’m an adult.”

“Oh, I’m sorry.  You look so young.”

Exchanges like this are the story of my life.

The dancers are beginning to arrive. Quentin glides up to me in his wheelchair.

“Kira, you and I have something in common. We both go to Richards University!”

I’m attending Richards University for the third time after dropping out twice previously. This time I’m determined to finish my bachelor’s degree.

Quentin has a job at the Richards school cafeteria. I remember the times I spent eating in the cafeteria with my friends when I first attended the college-and I remember the times I spent eating alone there, feeling self-conscious. I remember when I found out that one of the girls in our friends group had asked the other girls not to invite me to come eat with them because I was “special” and she didn’t like that.

The music starts and the strobe lights are turned on. Glancing out the windows covered in signs that say ‘Happy Valentines Day’, I can see that snow is falling. Some people are dancing, some people are watching others and some are wandering around aimlessly making animal noises. One guy hoots and tears a heart off the wall.  Oh well, if it was one of the hearts applied by me it wouldn’t have lasted long anyway.

I’m one of the people dancing. On this dance floor I have no room for self consciousness.  I have this inability to sit still and am often ”dancing” around, no matter the time or place. This often gets me negative attention or expressions of concern from others who find my movements odd or socially inappropriate. Now that I’m in an environment where it’s considered socially appropriate to wildly move about, I’m not holding back. Several of the dancers are wearing flashing hearts around their necks. I find myself wishing I had one too.

An intermission is called and we head to the kitchen where refreshments are served. As I fill my plate with melon and a pink frosted cupcake, I notice a woman with short brown hair and glasses. She’s not one of the students from the expressive arts class I volunteer in but she’s a familiar face nonetheless.

“Hi, Maren. It’s Kira.  Remember me from Camp Everest?'”

“Camp Everest?”

“Yeah, we were in the same bunk at summer camp back when we were in high school.”

A flash of recognition passes over Maren’s face. She recites the first and last names of our camp counselors.

I remember how outraged I was when I first arrived at Camp Everest and saw that my bunkmates were Maren and people like her.  Yes, I knew this was a camp for disabled kids and I knew that I was disabled but I wasn’t that disabled, not in the way these people were disabled. My bunkmates were weird and you could tell they were disabled just by looking at them. I could pass for normal, at least at first glance. I had my fair share of problems but I was bright and articulate. My bunkmates were intellectually impaired and had trouble speaking in coherent sentences.

However, as time went on, I got over myself. I came to enjoy camp and the company of my bunkmates, especially Maren. I realized that I could roast marshmallows on the campfire, go boating on the lake, hike in the woods and it really didn’t fucking matter if the people I was doing it with were ‘”lower functioning” than I was. So what if the conversations were punctuated with random exclamations, questions and requests to go to Binghamton?  When it came down to it, my bunkmates were much nicer to me and more fun to be around than some of my more” typical” peers.

A few months after camp ended, I received a postcard from Maren.  It read “Hi, Kira. My name is Maren.  What is your mom’s name? When is her birthday ? What is your dad’s name? When is his birthday?….”and on and on until she ran out of room on the postcard mid question.

“Where do you live now? Where does your dad live? Do you drive?….Why don’t you drive….?'” I’m back in the present moment, on the dance floor with Maren. The final question she asks me is what my phone number is. I hesitate for a split second and then give it to her. She enters it in to her phone and then goes to tell one of the DJs that she wants her to be a plumber.

The music has resumed. The snow is picking up. A woman hands me one of those flashing heart necklaces. I pull out my phone and try to coordinate the flash of the camera with the flash of the heart necklace.

The swirl of colorful lights, the falling snowflakes, the rhythm, tempo and lyrics of the music are all coming together to create a dazzling, magical effect that leaves me feeling energized and giddy. A slow song comes on and the DJs instruct everyone to find a partner. I make my way to the other end of the dance floor. Two boys with Down Syndrome are dancing together hand in hand.  Maren has stopped dancing to gaze out in wonder at the rapidly accumulating snow.

“May I have this dance?” I ask Quentin. He smiles and takes my hands in his. I propel his wheelchair towards me and we sway with the music.

“Kira, you should join the special needs choir.”

“I’m not very good at singing.”

“That’s okay. They’d still take you.”

Now the dance is ending and people are leaving. They are thanked for coming and cautioned to be careful in the snow. The volunteers stay behind to take down the decorations. I am unable to get the decorations hanging from the ceiling off of their hooks.

“Kira, did you have a good time?” Lois asks me.

“Yes, it was a lot of fun. I think the snow added to the effect.”

“I was thinking the same thing.”

I reach for my winter coat.

“Thanks for your help. See you on Wednesday.”

“Yeah, I’ll be there.”

I zip up my coat and walk out in to the snowstorm, the flashing heart necklace thumping against my own heart.

Image may contain: outdoor and text

Image may contain: Kira Popescu, smiling, standing and hat

 

 

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.

 

 

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.

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.

:

 

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.

Profile of an NLD/ASD kid: Part 2

Occupational Therapy Evaluation

Child’s age:  3 years, 8 months

Background: Kira was referred for an occupational therapy evaluation by staff from Project Child’s Assessment service because of concerns with gross and fine motor development. Mrs. Baker originally brought Kira to Project Child because of concerns about her social abilities and questionable attention to task.

Kira is the product of a full term pregnancy, with delivery achieved through Cesarian section due to a breech positioning. Mrs. Baker reported her recollections of gross motor milestones being mildly delayed, although independent ambulation was achieved by one year. Medical history was remarkable in that Kira was born with congenital torticollis, which has since resolved. Health has been generally good. Kira attends nursery school.

Tests Administered: 

Michigan Early Intervention Developmental Profile

Michigan Preschool Profile

Ernhardt Prehensile Profile

Parent Report

Observation

Behavioral Observations: Kira entered the evaluation room with her mother, appearing fairly comfortable and interested in her environment. She sat at the table when directed to do so.  Eye contact could be elicited but was fleeting, particularly as language or task demands became more persistent. Kira was generally cooperative and happy, although she seemed to need to be encouraged to participate in dialogue. Mrs. Baker reported concerns that she needs to direct Kira’s play and that she frequently reverts to hand flapping episodes. Occasional episodes of hand flapping were observed during this assessment, but not in an uncontrollable fashion. She also held one hand in the air, while manipulating with the other hand.

Kira benefited from focusing prompters to direct and maintain her attention to task. She occasionally became fidgety in her chair. She seemed more distracted by her own movements and thoughts than by external stimuli.

Gross Motor: Kira displayed a full repertoire of primary movement patterns, with a fully complete repertoire of secondary more integrated movements. Active range of motion and muscle tone appeared to be within normal limits as well. Overflow was observed on occasion as noted previously, with shaking of the arms, as well as occasional fisting, and oral overflow. The quality of her movements was judged to be age appropriate.

According to the Michigan Preschool Profile, Kira functioned on a 3 year 6 month level. She walked with heel strike, and ran fairly smoothly. Mrs. Baker reported that Kira ascends and descends stairs in a reciprocal fashion. She was able to jump twelve inches in a forward direction and repetitively. She stood two to three seconds on one foot. By report, Kira uses the slide, climbing bars and swings on the playground. She pedals a riding toy as well.

Perceptual/Fine Motor: Kira could use her hands in a coordinated, assistive fashion, displaying a preference for her right hand. She manipulated objects comfortably in her fingertips. A very mild tremor was occasionally evident in the hands in unstable postures. Release appeared immaturely developed in both control and precision in placement. Kira had difficulty isolating the movements of her thumb and individual fingers imitatively.

According to the Michigan Preschool Profile and EDP, Kira functioned on a 30 to 32 month level in perceptual/fine motor development, achieving a basal score of 28 months and displaying a scattering of skills up to 3 years 6 months. She was able to stack 6 one inch cubes, and aligned the blocks. She did not actually duplicate building a 4 cube train. She completed the three piece formboard in a forward and reversed presentation. She did not complete the rotated two piece puzzle. She placed six pegs in a six holed pegboard in 19 seconds.

Kira held a marker in a static tripod grasp. She was able to copy a vertical, horizontal and diagonal line, and a circle. She drew an eye, an ear and some hair on a complete-a-man drawing. Kira held scissors in both hands, and is mastering snipping. Kira achieved a 3 year level on the Erhardt Prehensile Profile.

Self Care: Kira is toilet trained during the day, but not at night. She eats using a spoon, and occasionally fork. She spreads very little. She can take off her socks, shoes and underwear, and put on her underwear, and sweatshirts.  She is cooperative in dressing and not yet handling fasteners.

Summary:  Kira was referred for an occupational therapy evaluation because of concerns about hand flapping, difficulty involving herself in play, and delays in gross and fine motor development. Gross motor abilities were judged to be within normal limits. Perceptual/fine motor abilities are judged to be moderately delayed in both quality and skill achievement. Overflow, as noted by Mrs. Baker, was also observed. She will probably gradually outgrow this behavior.

Recommendations:

  1. Kira has been referred to the Perceptual/Motor Clinic. If vacancies are not available, she will be placed on the waiting list.
  2. Mrs. Baker may be able to gradually lead Kira to making her own decisions about play by providing two or three choices, start her on the activity, then encouraging her to play independently for increasing periods of time.
  3. Kira should be encouraged to give and maintain eye contact, by using the directive “Look” (point to eye) and delay speaking to her until she does look at speaker.
  4. Games that encourage Kira to follow directions, move slowly, or sit quietly may also help (i.e.-Giant Steps, Follow the Leader, Simon Says, etc,)

 

 

Profile of an NLD/ASD child: Part 1

Preface: Me and my father are both pack rats. Because of this I have found many treasures from my past in our houses. Among those treasures are my childhood psychological/neurological/educational reports. I have decided to publish them on my blog for the sake of education and enlightenment concerning the presentation of an NLD/ASD child. NLD stands for nonverbal learning disorder. ASD stands for autism spectrum disorder. I was diagnosed with NLD at age 12. I do not have an official ASD diagnosis. Some professionals consider NLD to be on the autism spectrum, others don’t. NLD is not currently listed in the DSM and there is debate over whether it is a valid diagnostic framework. For more information about my experiences with NLD/ASD see my blog post The problem with being smart and stupid at the same time

Disclaimer: Details of these reports have been changed and omitted for the sake of brevity and privacy. This is meant to represent my experience and my experience only. Everyone experiences NLD and ASD differently.

Now without further ado, let’s begin at the beginning…

Application for screening and/or assessment:

Child’s name: Kira

Child’s age: 3 years

What concerns do you have about your child?:  Doesn’t seem interested in playing with toys, drawing and coloring, etc, Won’t focus on an activity for more than a couple of minutes. Spends much of her time running through house flapping her arms and talking to herself. Doesn’t interact with other children much. Very shy.

What questions do you hope to have answered by this screening and/or evaluation?  Is she hyperactive?  Does she have an attention deficit disorder? Any other behavioral dysfunction?

 

 

Fidget Spinners

I got a fidget spinner last week. I’d heard a lot about them but I’d never encountered one in real life. When I saw a kiosk at the mall was selling them I decided I had to have one. The first thing I asked was if the batteries were included. Turns out fidget spinners don’t need batteries. Oops. Since I have manual dexterity issues my mother questioned whether I would be able to spin a fidget spinner. I did a test spin on a Batman fidget spinner and I managed well enough. I’m not a Batman fan so I did not want that particular fidget spinner. The guy who was selling the fidget spinner asked what my favorite color was and I settled on a purple one.

At first I was underwhelmed by the fidget spinner but as the minutes and hours wore on I grew to appreciate it. There’s something hypnotic, comforting and satisfying about the feel of its centerpiece in your hand, the vision of its blades spinning in a graceful arc, the gentle whirring sound it makes (can you tell I’m having a hard time describing it?) I soon found myself faced with the ultimate first world autistic problem: When you get a fidget spinner and you want to show off your shiny new toy on the internet but you lack the coordination it takes to spin with one hand and record a video on your phone with the other hand.

It took me a few tries but eventually I was able to upload a video of my fidget spinner on to social media. One of my friends commented that she was bothered that fidget spinners had become the next hot commodity because they were designed for a specific purpose and she felt that making them a toy for everyone was disrespectful to those with mental health conditions that required them. Another friend pointed out that perhaps with the introduction of toys like fidget spinners those with mental health issues and special needs would  no longer be seen as different and the stigma surrounding them would be lessened.

I can’t complain about fidget spinners being a hot commodity when that’s what enabled me to find them in a kiosk at the mall. I’m more annoyed by the schools that ban them because they’ve been deemed to be too much of a distraction. If they’re going to do that they should make exceptions for kids who have conditions such as ADHD and autism.  If fidget spinners are going to reduce the stigma surrounding special needs and mental illness, let’s make them as hot a commodity as possible.

For most of my life fidget spinners have not been a thing but I’ve found my own versions of fidget spinners. My fidget spinners have been leaves, weeds, wild onions and rubber bands. I’ve twirled them in my hands and flapped them in front of my face. I’ve enjoyed fidgeting with those objects but some people have not enjoyed watching me do so. They find it annoying, bothersome and baffling. One of my babysitters thought the onions I played with were snakes at first. These ‘snakes’ tended to give off an odor that some did not appreciate.

When I buy rubber bands I am not buying them for their usual functional purpose. I am buying them for fidgeting purposes. One time I was twirling a rubber band in a college algebra class when the professor said to me in an irritated voice in front of the whole class “Why are you always playing with that piece of string? It drives me crazy!” This was far from the first time in my life I’d been criticized for fidgeting but it was a particularly upsetting and embarrassing instance of it. I was angry that my professor had done that to me so I decided to write him an e-mail. I wrote that I had a physiological need to fidget as a result of being on the autism spectrum. I figured the professor would feel bad about what he said to me and would apologize.  The response I got from him was “Thanks for explaining.”

I hate that I owe the world an explanation for my fidgeting. For the longest time I didn’t know how to explain it. All I knew was that for as long as I could remember I had been driven to fidget in the same way I was driven to eat and sleep. I was driven to seek objects to fidget with in the same way my peers were driven to seek friendships with each other. My fidgeting and flapping  (along with my lack of peer interaction) were among the first signs that something was ‘not quite right’ with me. They were what led certain professionals to first suggest that I be taken out of mainstream educational settings and placed in special education.

One of my earliest childhood memories involves me, age four or five, sitting in the bathtub flapping my hands and my mother saying to me “Kira, why are you always flapping? Are you afraid something bad will happen if you don’t do that?

“No, I just like flapping and I like playing with things that are long” I replied.

“You like playing with things that are wrong?”

That was a pretty Freudian mishearing if you ask me. More than I hate that I owe the world an explanation for my fidgeting behaviors, I hate the way the world tells me such behaviors are wrong. I hate seeing my natural way of being described as ‘baffling’, ‘weird’ and ‘nonfunctional’. Trust me, I’m as baffled by the fact that other people don’t fidget as they are baffled by the fact that I do. For whatever reason my nervous system is wired in a way that makes me crave and need constant stimulation.  It would be pretty weird for me not to be respond by seeking that stimulation.

I hate being told that fidgeting behaviors that I find soothing and pleasurable need to be suppressed or eliminated because others are bothered by it. I do not think that by fidgeting I am infringing on anyone’s rights or liberties. I will play anyone who is annoyed by it a violin smaller than a fidget spinner.

What I hate most of all is that certain people feel entitled to be rude, cruel and insulting to me over my fidgeting. They feel entitled to mock, taunt and threaten me over it, to forcibly grab me to prevent me from doing it. Under the guise of helping me they remind me that what I’m doing is not normal, that it will get me locked up in an institution, that people would like me more if I stopped. Suffice it to say, no one is helping me by saying or doing those things.  To say that it’s taken a huge toll on my self esteem would be a huge understatement.

So many people with disabilities and differences suffer from low self esteem as a result of all the negative messages society gives them about themselves and their behavior. What we really need is a new spin on differences and disabilities in terms of the way they’re talked about, written about and hence perceived. We all know the best way to draw peoples’ attention to anything is through shiny objects so perhaps fidget spinners are a step in the right direction.

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