I've been getting some questions about Dawson, so I thought I'd cover more of that. I got a report from the Neurologist today. It's 3 pages of stuff Dawson doesn't do and behavior issues he has. Not too fun to read through when they type it all out like that. While it seemed like the Dr didn't seem to listen well or do much, his report was very detailed and it seems he was observing stuff while asking questions so maybe that's why he had to repeat some questions.
His findings were pretty close to the school's. His physical/gross motor skills are great, he's right on track with no low muscle tone. His developmental exam showed severe delay in language, personal and social areas. The reason he is thinking Autism is because the 3 main problem areas are language, personal/social and behavioral. The Psychologist will further investigate those problem areas since that's their specialty. They don't always agree with the Neurologist, so it'll be interesting to see what they say. The Neurologist recommended that the Psychologist evaluate his signs of Autism, attention deficit problem and his aggressive and oppositional defiant behavior.
Someone from the school wrote up some stuff about Dawson to help with his diagnosis. She works closely with him in school 2-3 days a week, so knows him much better than any Dr would see in a clinic during 30 minutes. She's the Speech/Language Pathologist and Autism Resource Specialist. Here's her list of concerns (parenthesis is my own comments):
Social Interaction:
Does not appear interested in peers
Inconsistant / does not respond to his name
Takes items from adults and peers and does not look at the person
Plays by himself, actively avoids situations
Does not imitate when imitation is desired (he will on his own terms, but not when asked)
Responds negatively or walks away from requests or directives
Limited joint attention in activities
Unusual eye regard
Communication:
Does not use words to communicate wants and needs (I think he does, but it's limited)
May label an item such as car, but not for communicative intent
Just started to point to items (he does point a lot when we're out and about though, he seems very aware of his environment)
Repeats the words of others on occasion (I would say he does this a lot!)
Limited amount of social language (hi-bye)
Limited response to questions, basic wh-questions (who, what, where, why)
Making sounds just for the purpose of making sounds
Does not respond to yes/no questions (I do hear "no" a lot, but never yes)
Restricted, Repetitive or Stereotypical (of Autism) Behaviors:
Difficulty with unstructured time - wanders
Short attention span (really though, he's 3! lol)
Throws objects, sometimes for no apparent reason such as anger
Play skills limited to cars, more interested in watching them than driving and playing
Difficulties with transitions, may be resistive to going with schedule
Putting items into his mouth such as stickers (I'm always taking paper and other things out of his mouth)
An intense preoccupation with electonical toys or devices
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I first wondered about Dawson when he was about 9 months old. Of course with my Child Development degree and other involvement in Special Ed, I already had knowledge about Autism. The first time the thought crossed my mind was when he sat against the wall and banged his head against the wall. I dismissed the thought after a few weeks when the behavior really wasn't that often or repetitive. When he got more into toys he always wanted the ones that spin. He wouldn't drive cars, he would turn them over and spin the wheels. This was ongoing and very often. He didn't start driving cars around until he was 2, but even then he would get down closer to the car and watch the wheels spin as it was driving. He also had little to no language. Still to this day he's obsessed with toys that spin. His favorite toy is his gear toy, you push a button and there's music, lights and the gears turn. He got it for his 1st birthday and it's been his favorite toy ever since. I'd been asking the pediatrician about it since a year old, mostly focusing on his communication delays. He just said Dawson would pick up more language as time goes on. Said the same thing at 15 and 18 months. When his 2 year appointment came, Tyler had been diagnosed a month before and we weren't home. The Dr did agree that Dawson (who had 5 words he wasn't even using much at all) was definitely delayed and that we should take some action, but since we were in the hospital with Tyler, it'd be impossible to have any regularity for therapy. So I got him in at 2 1/2 when we were finally out. He's been learning very well and now knows many words and even puts them into 2-4 word phrases.
He still doesn't come up with phrases on his own. He uses the same words and phrases each time he wants something, so it's hard to explain, but his speech doesn't seem to be original. It's all stuff he's gotten from me and held onto. By now he should be moving onto creating his own sentences and being able to more freely figure out how to communicate his needs, ask and answer questions, etc. He'll sometimes repeat a phrase over and over, even if we've already answered him. Moments like those can be tough, it just makes it more obvious that there's something going on with him. For example when I went in to get my lungs checked out in the ER, we were walking down the hallway and he said to the nurse "hi, how ya doin?". It's a common thing for him, he seems to pull that one out when he's not sure what else to say. She answered him and asked him a question, but he just repeated the phrase. She continued trying to talk to him, pointing out things and asking him things about himself, but he repeated the phrase over and over. She finally gave up and asked me how old he is.
The attention deficit concern is mostly his lack of staying with anything for very long at all. He'll move from one toy to the next. He'll often push a tune on the piano and then go play with another toy while listening to it. Or he'll have more than one toy going at the same time. When he has movies in, he rarely ever sits and watches them. He does watch, but it's usually while he's up and around the room playing with toys and being active. What really bugs me is when he can't decide what movie he wants to watch and he goes through streaks of wanting me to change to a different movie many times before he settles on one. He sometimes doesn't even get 2 minutes into something before changing his mind and throwing a tantrum if I insist it stays in for a bit longer. When we're in the store and he's walking, he can't stop and get something with me, he's constantly moving. He goes from one end of the aisle to the other until I've moved on, then he joins up with me again. Most of the time. Other times he'll just wander off and I'll have to run and get him. He rarely ever responds to his name, especially in those situations. While pregnant, this hasn't been a fun thing to deal with! It's hard to tell if that's behavioral or mostly just attention related. I used to think it was a behavior, but he rarely runs or tries to hide, he just wanders off like he's bored and just wants to keep walking. His teacher agreed that unless you're in close range to him, he usually ignores his name being called. Except for at home, he will usually come when asked even from across the apartment. But maybe that's still considered close proximity since it's home and a comfortable place for him.
The aggressive and oppositional defiant behavior is mostly at home. At least the aggressive part. When he's upset he'll take it out on Tyler. He'll take his toys and often go shove him over for no apparent reason. It rarely has anything to do with Tyler at all, it's just who he decided to focus his anger on. Poor kid. Thankfully Tyler has learned to move out of the way when Dawson seems to be in a bad mood! We haven't had quite as many issues lately but I think that's a lot of Tyler staying out of his way! I do see a lot of toys being taken away. It's rarely ever because he wants to play with them, but mostly to make Tyler mad. He'll throw toys when he's mad too, but not as much as he used to. These days the toy throwing is mostly to get attention. He does many of those purposeful defiant things. He'll push buttons on my computer, throw toys and do many other things just to be defiant. It's very frustrating and seems way more frequent than kids normally would do things like that. Lately if we're out and about and things aren't going his way, he'll do the full on-the-floor tantrum. That he hasn't done in a while and it's getting quite old very quickly. I can't easily lift an almost 40 pound toddler off the floor these days!
Something I'm going to bring up to the Psychologist is Empathy. It's supposed to be one of the higher defining symptoms of Autism, is lack of empathy and not recognizing feelings. Yet if Tyler falls down, he notices and says "you ok Tywer?". Or he says "you ok Dawson?" when he gets hurt and wants us to notice. If he throws a toy that hits me and I make a big deal out of it being an owie, he'll often come up and give me a hug. I think he notices feelings. When he's having a lot of fun he often says "I so happy!". If Tyler is crying he'll often look his way, especially if he had taken a toy from him. If he seems really upset, he'll go quick try to give the toy back to Tyler. When talking to another mom, she said that having empathy was the deal breaker for the Autism diagnosis with her son. So it will be interesting to see what the Psychologist says on Thursday!
When they did bloodwork at the Neurologist, they said they're doing a test for Fragile X. I had heard of it, but didn't realize it was so closely related to Autism. Thankfully it's just a genetics test, so no wondering and guessing about that one. Sometimes Fragile X can cause Autism, the statistics say 2-6%. After Tyler's diagnosis, nothing seems impossible! So it will also be interesting to get those results, though my first reaction was that he couldn't have it. All I originally knew about Fragile X was that the kids have low muscle tone along with delays. Dawson has no muscle tone problems or physical delays, so I never even thought to look it up. I'm still highly doubting it. I'm not really sure if there's a range of Fragile X that would include good muscle tone, but even looking at the checklist of symptoms, he really didn't have very many at all.
Hopefully that was informative and not too confusing! It's a lot to take in and I'm glad I already knew a lot of this stuff, so it's been pretty easy to understand and his teacher and I have been on the same page without much confusion or even needing to explain much. Even though there's a lot of focus on this at the time, it is important to remember that he's still the same Dawson we've known for the last 3 1/2 years. We're just trying to gain some more understanding so we can better know how to work through things and to get him some more specific therapy that will be more to the areas he's struggling with.
To add some color to this post, here's my 33 week belly pic. Getting bigger, but I don't think I'm quite as big as I was with Tyler. Only 6 weeks left!
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