Garebear, The Mashed Potato Eater

It wasn't just a fluke! Garrett will happily eat mashed potatoes now.





*note: The spoon is just for show. I always put utensils with his food just in case, but he never uses them.

Look what my boy can do!

I've had these on my camera for the past month, but I just had to share.





I'm so proud of Garrett!

It takes a lot of concentration for him to put the blocks together. He gets easily frustrated if he can't figure out how to turn the block at just the right angle so he still needs some help. This is something else that we're still working on.

For Christmas, Garrett got some toys that he's used in therapy over the past six months. We'll be playing with those from now on, too.

What a difference a month can make.

Garrett did not do well with this move. He was at a few different houses on the day that the movers came. By the time we got him home, he went straight to bed. When he woke up, I changed his diaper and then let him loose to run around. He walked around the living room and dining room and noticed that everything was gone.

He flipped.


Luckily, we had kept his little chair that he eats in. I sat him down and put his tray on and all was right with the world for a little bit.

It took him a few days to get settled into the new house. Once our household goods were delivered he did much better. He has his own room here, which is a great improvement for him.



Since we've been in the new house, Garrett has made a great discovery. He can take me by the hand and guide me to something that he wants. This is much better than dealing with a twenty minute screaming fit and having to guess. We're still working on it, because he doesn't point or gesture, he just takes you to the general area of what he wants. It's not perfect, but we'll take it!

He has not started his early intervention therapy yet. We're waiting on referrals and couldn't get in to see his new developmental pediatrician until January. We have met his new primary care manager and he is awesome. He put in for our specialty referral and asked about Garrett's improvement with speech and OT. When I mentioned the dietary intervention, he listened. He didn't look at me like I was crazy, so he gets a thumbs up from me.

Great progress!

Garrett began following simple directions this week. He still doesn't respond to his name 100% of the time, but that one's gonna take some time. He will bring me an item and he'll sit down in his chair when asked.

I took him to the Ophthalmologist on Wednesday. These appointments are challenging for a kid that doesn't like his head touched. It took two of us to hold him still, but they were able to get what they needed pretty quickly. He is farsighted, but within a normal range for his age. No glasses for now, but they said he should be tested in 18 months.

Garrett's speech pathologist brought us some visual helpers yesterday. We've used them successfully for snack time and are working to build his understanding. I'm hoping that we can eventually use these helpers so that he can understand more routines.

Garrett is cutting molars and just wasn't up for his occupational therapy session today. He played with some Mega Blocks for a few minutes and then spent the rest of the time snacking and watching Bronson build a big tower.

This was our last week with these providers. We've loved working with both of these ladies. I'm hoping that our providers in Virginia will be just as wonderful. We've been spoiled here.

Garrett loves muffins!

I've been making muffins for the past two weeks or so, just to hide fruits and veggies for Garrett. We've tried a few different combinations, just replacing the oil with baby food purees. I've also chopped up some apples into some of them.

It's working. He'll eat any muffin I throw in front of him, with the exception of pumpkin. Which is just fine, I'll keep my pumpkin puree for myself. :)

STOP THE PRESSES!

This may be a totally lame thing to get excited about. Typical parents of typical children don't usually get excited about little things like this. But I am no typical parent.

Garrett ate mashed potatoes with his dinner tonight. He has avoided anything with that texture for over a year. I always put them on his plate anyway and am not surprised when he doesn't even touch them.

Not so today! He dug in with his fingers, wiped his hands off on the tray and then licked his thumb. I thought for sure that he would spit it out and make a huge deal of it like he normally does. Nope. He just kept going back to load up his fingers.

So what did this mommy do? I changed my facebook status and twittered about it.

STOP THE PRESSES! Garrett just ate mashed potatoes! Take that, Oral Motor Sensory Issues!

Developmental Peds - Visit Two

We met with Garrett's Developmental Pediatrician yesterday. It was a follow up visit to go over the tests that had been ordered 2 months ago.

Genetic testing, hearing and the MRI all came back normal, which we already knew. Our ABA referral had fallen out of the system while we were waiting for the EFMP and ECHO paperwork to be filed. The doctor put that referral in again, but now it's close enough to our move that I doubt Garrett will start ABA until we're in Virginia. I asked the doctor about a nutrition consult and he gave us a referral to the pediatric dietitian at Walter Reed.

The doctor also filled out paperwork for us to get a disabled placard through the Nevada DMV. That will make things a little bit easier while Todd is deployed.

GFCF cupcakes were a hit!

Garrett loved his birthday cupcake!

I used a gluten free yellow cake mix from Cherrybrook Kitchen (using canola oil instead of butter) and Pillsbury Vanilla Funfetti frosting. I now have eleven unfrosted cupcakes in the freezer that I can pull out for special occasions (like our Halloween playgroup on Friday).

One thing that I learned from this is that Garrett will eat cupcakes. We've given him cake before and he usually just smashed it into crumbs. I'm going to try to make some GFCF muffins using fruit and veggie purees to see if we can get something besides chicken, pretzels, chips and apples into his tummy.

Back on the diet and my baby is now 2

Since I got my commission checks from my end of September Pampered Chef shows, we can put Garrett back on the GFCF diet. This time, we're going slower and following the "Going GFCFSF in 10 weeks!" recommendations on the TACA website.

Garrett has been dairy free since Wednesday. He's drinking fortified almond milk now. We're still looking for a good margarine/butter replacement. We have the Smart Balance with Flax Oil, but haven't been impressed.

Garrett turns 2 today! I'm making a regular cake for the family and some GFCF cupcakes for Garrett. We'll see how they turn out. I'm a little nervous.

Garrett has been off his diet for a week.

It was a family decision to take Garrett off of his GFCF diet until after we move. Todd said that he can't tell a difference. I think he's just not paying enough attention. I can tell a difference. Garrett's speech pathologist could tell a difference when she met with him on Thursday. His eye contact is pretty much non-existent now. He wouldn't engage with us during his speech session. He spent most of the time staring at the floor.

Small update

Both boys were sick last week, so Garrett did not have therapy.

This week, we started Garrett on probiotics. We're using Nature's Way Primadophilus® Kids. I picked the 30 ct bottle up at Whole Foods Market for around $7. I also purchased some xanthum gum and potato starch so that I can do some GFCF baking using the flours that I bought a few weeks ago. One of the TACA moms gave me a copy of Special Diets for Special Kids and I'm very excited to start using it.

Garrett had a great OT session yesterday. He referenced Bronson a few times while Bronson was playing with a different toy.

Today, the speech pathologist brought the More Than Words dvd. We went over some goals for Garrett (like more eye contact, taking turns, etc.) and showed a few ways to get some interaction and give him an opportunity to communicate.

This week's OT and Speech sesions.

Both of Garrett's therapists mentioned some great improvements in his attentiveness and interaction.

From Garrett's Occupational Therapist:

Garrett is now on a GFCF diet and mom feels he's really responding well. He is now pointing!

Garrett played with us for an hour with just one trip to his room to get a book. We introduced brushing with a sensory brush and he enjoyed it, especially on his hands. He played and explored a variety of toys and showed true joy when playing with the accordion tubes. He also let us help him with a hammer toy and shape sorter. He did much more referencing of mom and big brother.

From Garrett's Speech Pathologist:

Great Session! Garrett was both easier to engage and stayed engaged for longer periods. We were able to get Garrett to let us intrude on his play with a magnetic writer and beads. We imitated him and then he imitated us! ... Garrett loved Row Row Your Boat. A slow version with lots of pull & push calmed him. Garrett said "down" at the end, playing up/down from mom's lap!

He did say something that sounded like "down" after I said down and let him fall backwards. He wouldn't repeat it again. I am going to keep working on it.

Garrett is making excellent progress.

Garrett flew to California with me for a week to attend my sister's wedding. He did very well on the flight there.

I am constantly amazed at the progress that Garrett is making. He gave us a lot of good eye contact this week. He even played a face to face game with my sister, Stephanie. I had to get it on video because I wasn't sure that people would believe me.





He would not have done this a month ago.

Garrett's occupational therapist came yesterday. She was so proud of him for staying with us. He had to get away for a few minutes, but he came right back. He attended to the activities and even let me take turns with him for a little bit.

Garrett started pointing!

While at the TACA "coffee talk" last night, Garrett grabbed someone's phone off the table. He pointed to the screen.

That was the first time that I've ever seen him point. I wasn't sure if it was intentional or not, so I didn't make a huge deal about it.

But he did it again this morning! We were playing with the See n' Say and he pointed to a few of the animals. Now I'll just have to focus on getting him to point to things that he wants and we'll have some non-verbal communication going on.

I'm so excited!

We've gone GFCF!

We are on day three of the GFCF diet. Garrett doesn't have much variety in his diet anyway because of his food aversions and sensory/texture issues.

Things he will eat:

waffles
pancakes
cereal
yogurt
chicken nuggets
cold baked or grilled chicken
peanut butter sandwiches
french fries
popsicles
candy

I have found GFCF replacements for most of those items, but our go-to meal for Garrett has always been a peanut butter sandwich. If he wouldn't eat what we were having, he would have a sandwich. I refuse to pay $6 for a little tiny loaf of gluten free bread, so he's going without right now.

One of his other problems is that he won't eat what he doesn't recognize.

For breakfast this morning, I gave him GFCF waffles, scrambled eggs, banana and rice milk. I knew that he wasn't going to eat the eggs, so I spread some peanut butter on his mini waffles. He wouldn't touch them. After watching him pushing them around the tray for 10 minutes, I finally stepped over and shoved a piece in his mouth. I know that it's something he'll eat, but he doesn't recognize it as something he likes. We have to do that a lot.

Official Diagnosis

Garrett had his appointment with his Developmental Pediatrician today. We weren't sure what to expect at this visit. We weren't sure if he would just be gathering information for a future diagnosis or if we would be jumping right in.

The doctor took Garrett's history, some family history and asked us questions about his development. He then did some tests with Garrett (a peg board, cup and blocks, etc.) and did a quick physical exam.

Then came the hard part.

Although we were expecting it, I don't think we could ever be fully prepared to hear it. Garrett is autistic. We've known that for 3 months, we just needed an official diagnosis.

Now that we have a diagnosis, we can enroll him in the Exceptional Family Member Program. He will also qualify for ECHO, which will cover his Applied Behavioral Analysis.

Audiology, appointment #3

Today we went to Walter Reed for another pediatric audiology appointment. They asked us at our last visit to have Garrett practice wearing headphones to prepare for the tests. Garrett doesn't like having things in, on or anywhere near his ears.

They tried inserts and Garrett pulled those right out. I held his hands, but he still rubbed his head and moved all over so that the inserts would fall out.

The ditched that idea after a few minutes and started the normal testing. Garrett remembered this part and was looking for the bear and the bunny as soon as we sat down. They brought out the pegs to get his attention centered. Unfortunately, with Garrett there is no middle ground. He is either not interested in the toys and is looking around too much or he's so focused on the toys, he doesn't turn at all when they start the sounds.

They tried the individual ear testing again, but with headphones. That lasted all of 30 seconds. Garrett wanted nothing to do with them.

They tried to get a fluid reading. This is when the meltdown started. He had already put up with us putting things in and on his ears, but holding him down and sticking stuff in his ears... He was done.

They want us to come back next month for a PABR (Pediatric Auditory Brainstem Response) test.

General Testing Information:

For some children, reliable results from behavioral hearing tests cannot be obtained. The ABR can provide useful information about the amound and type of hearing loss and the function of the auditory nerve.

During the ABR, sounds are presented to the child's ears through earphones while he/she sleeps or rests quietly in a bed or chair or in a parent's lap. Small electrodes are taped to teh ears and head to measure the response. The test usually takes about one to one-and-a-half hours.

The ABR is a noninvasive, safe and painless test. It requires that the child remain still and quiet. Some children will lie quietly or sleep, but many will require a light sedation. If sedation is indicated, your child's appointment will be coordinated with the Pediatric Sedation Unit; a pediatrician will evaluate your child prior to the sedation and give medical clearance.

They want to sedate him. I don't blame them. Todd isn't too thrilled with this idea.

Speech Therapy session 3

Garrett is still not talking, but we're really working on getting him to communicate in other ways. Eye contact is a big thing right now. We've been trying to wait until he looks at us to do what he wants.

Today during speech therapy, he was playing with a Little People house that has a bell on it. He can't make the bell ring by himself. He needs either Chris or I to do it for him. He would try to push it and when it didn't work for him, he would grunt. Chris would wait until he looked up before she would ring the bell. At first, he would only look as high as her hand, so she raised her hand up to her cheek. That brought Garrett's attention upward and he began to look up at her to communicate that he wanted her to ring the bell again.

I've been doing the same thing when he wants to jump. I'll make him jump once. I know that he wants more because he bends his knees, but I wait until he looks up at me before I will respond.

Garrett loves it when Chris brings out the beads. He loves to shake them around, or put them on the ground and rake him fingers across them. Chris would like me to put some beads in a container that Garrett can't open. He'll need to communicate to me that he needs help to open it if he'd like to play. I have a plastic shoebox that I can use, but I'll need to go buy some beads for him.

Occupational Therapy session 3

Garrett is making great strides with his early intervention services. He played with Bronson for a few minutes today. He never shows any interest in what his brother is doing, so this is a HUGE thing. Our OT brought some Peek-a-blocks today, and since Garrett was so interested in them, she's leaving them with us until she comes back next month. He likes them because of the texture. He gets that sensory input on his hand when he pushes them together.

Here are the OT's notes for today:

Garrett did not leave us at all today. He was engaged in toys and focused. Does less spitting when engaged in play. Approached brother who was playing with a toy and started playing at same time. Held up toys to get eye contact - then gave to Garrett.

He takes me by the hand

This past week, Garrett has started taking my hand. He started doing it when we were getting ready to leave the apartment. Friday, we had some company, including two boys around Bronson's age. The three of them were running around the apartment playing and just having a good ol' time.

Their good ol' time was too much for Garrett.

He walked over to me, grabbed my hand, and lead me to the front door. There was too much going on and he wanted to leave. Garrett spent the remainder of their visit in his crib by himself. He was completely content to just sit there and stare at his sheet.

He has lead me to the door a few times since then. He doesn't lead me to anywhere else, just the front door.

Occupational Therapy, session 2

We had another great OT session this morning. I'm so happy that I'm learning how to join his play and attend to his sensory issues.

We got some great people games in today. He let me sing to him. He played wrestle the ball with the therapist. He even chased Bronson down the hall a few times.

I learned to do deep joint compression on his knees and ankles. He really responded to that. He communicated that he wanted more by touching the therapist with his leg or raising his leg up to her hand. He also liked it when I held him under his arms, picked him up off the ground and made him jump, but he didn't like facing me when I did it.

We were able to redirect stimming twice. I've involved Bronson in this process. When he sees Garrett spitting, he gives him his teether or chewy tube. It doesn't work every time, but I also tried to make Garrett understand that he can spit all over his mouth toys, but he's not allowed to spit on the furniture.

Structured Play - block sorting

I've been working with Garrett and doing some structured play. He's usually okay with putting blocks into a cup and dumping them out again, then he goes into his sorting mode. Today, he didn't want the cup. We went straight for turning, sorting and throwing. I pulled out the camera so I could document his process.

Garrett will play now!

It's only for a few minutes when I sit him down to do it, but he's not protesting nearly as much. I sit him down twice a day for a few minutes to play with his blocks or his stacking rings. He will take the rings off the pole, but he doesn't want to put the blue ring on first. He always tries to put the orange or the yellow ring on and then gets mad because the others don't fit or that there's empty space at the bottom. This morning, he put the yellow, orange and red rings on. He then picked up the green and blue rings and took off down the hall and threw them at the front door.

He will put blocks into a container if I'm doing it. If I just pull the blocks out, he starts taking them out of the bucket and placing them in front of him. He turns them around so that the red side is up. If there isn't a red side, he chucks it behind him. It's something that if you weren't looking for it, you wouldn't really notice, but once you realize what he's doing, you think about how weird it is.

Garrett's first occupational therapy visit

The OT came by this morning. It was more of a meet and greet to see what he can do than an actual therapy session. He did more for her today than he would for the evaluators last week. He was pretty mad, though. We wouldn't let him out of the living room. Once we got him to calm down, he would play for a few minutes.

He put blocks into a cup with a 2 inch opening, then turned it upside down to get them out. His OT said that he can play, we just have to get him to sit down and do it. She thinks that he is taking in information, just not doing anything on queue. He also played with the stacking rings. Usually he just throws them, but after some protest, we were able to get him to take them off and put them back on once. He had no interest in doing it again.

She is going to change our service plan and have Garrett do therapy once a week. She is going to start with fine motor skills and build from there. She wants me to make him sit and play twice a day for 5-10 minutes; just to get him used to sitting and playing. She sees a lot of potential and is glad that we're getting him started now.

She also said that Bronson scares her with the things he can do. She thinks that Garrett may be just as intelligent, we'll just have to bring it out.

Therapy

Garrett has been approved for two hour long sessions of occupational therapy. He is also being set up for speech therapy once a week for two months.

We got a call from the occupational therapist today. She wants to come by on Wednesday and meet Garrett.

YAY!

Present Developmental Levels

Garrett had another evaluation today by two members of the early intervention program. They used the M-Chat, Mullen Scales of Early Learning and 20 month ASQ (Ages and Stages Questionnaire).

Here are some stats from their report.

Cognitive Development - 7 months
"Explored the puzzle but did not place pieces, turned cup upwards, showed interest in book as hinge, turned a few pages at one time. Did not attend to pictures."

Receptive Language - 1 month
"Enjoyed looking in mirror, attends to words and movements, put arms up to be picked up. No response to whistle, does not turn to name. Does not follow simple directions."

Expressive Language - 8 months
"Does not play peek-a-boo, plays with sounds, vocalizes when he wants something. Plays with consonant sounds "g", "d", "t". No real words, shook his head no (Mom had not seen this before)."

Social-Emotional - 8 months
"Prefers to be by himself. Does not acknowledge 2 1/2 year old brother. Does not take interest in toys. Will watch ball bounce. Does not like to be cuddled. Goes off by himself often."

Self-Care - Dressing 14 months, Feeding 18 months
"Cooperates with tooth brushing. Allows Mom to wash his face. Does not use utensils but will finger feed. Drinks water from open cup with assistance. Sleeps well. Sucks through straw."

Fine Motor - 11 months
"Took 4 blocks out. Did not stack blocks today. Turned pages several at a time. Used hand as rake to pick up penny, partial pincher grasp. Transferred toys from one hand to another. Did not use 2 hands together."

Gross Motor - 17 months
"Can walk up and down stairs non-alternating. Runs stiffly. Not kicking ball yet. Threw ball underhand. Stands, squats. Will roll over onto stomach from back."

Summary Statement and Recommendations:

"It was a pleasure to meet Garrett and his family this morning. Garrett is a 20 month old little boy who was difficult to engage. He was interested in test items on his own terms but did not appear to understand directions given. He sometimes later imitated actions made with test items. Garrett did not respond well to auditory stimuli in general. Garrett makes a few sounds that he frequently repeats in strings. Garrett qualifies for service with infant and toddlers by showing a 25% delay in several areas: receptive and expressive language, problem solving, dressing and hygiene, fine motor and social skills. M-Chat indicates a need for further evaluation. Parents have already scheduled an evaluation with a developmental pediatrician in August 2009."

Follow-up strategies and activities:

• Try some deep pressure to calm or prepare Garrett for activities. Gently push down on.
• Offer choices of food. Begin with 1 he likes and 1 you know he doesn't want. Reaching or looking at 1 is okay.
• Imitate the sounds Garrett makes then model the one word that seems appropriate. ie. "yes", "apple".
• Give Garrett more opportunities to communicate by waiting for him to indicate by sound, word or gesture that he wants more of a food he can see in a clear container.
• When Garrett is playing, try to join in his play.

Both evaluators commended us on following through with our instincts and getting Garrett the help that he needs. The earlier we can help him, the better.

One of our evaluators was a Speech Pathologist. She showed me how to imitate Garrett and model a word for him during our snack time. Because we're moving, we'll miss the next session of their More Than Words class, but she is going to come to our house and do it privately.

Garrett's Story

At Garrett's 18 month well child visit, his pediatrician was concerned about his speech delay. She referred him to audiology and told us to contact our county's early intervention program. It was shortly after this visit, that my husband and I started noticing that he didn't do a lot of things that other children his age were doing. It wasn't simply the fact that he didn't talk. He had no communication at all. He didn't gesture. He didn't sign. He didn't even pull you in the direction of something that he wanted.

He still doesn't.

As I was blogging some things that he was or wasn't doing on our family blog, I had a few friends and family members mention autism. The more I thought about and researched characteristics of a child on the autism spectrum, the more overwhelmed I became.

At the end of June, he has his intake evaluation with the county early intervention program. He was now 20 months old. That was the first time that I had ever seen him stack 4 blocks and draw a line with a crayon. Both of those took some prodding and a lot of reminders to not put them in his mouth. The results from that evaluation were not surprising.

Communication - 0
Gross Motor - above cut-off
Fine Motor - cut-off is 40, Garrett scored 30
Problem Solving - cut-off is 30, Garrett scored 10
Personal/Social - 0

Garrett has also had two hearing tests. His first test was not valid because he was throwing a fit. We went in again at the beginning of July and he tested within a normal hearing range. They have now ruled out a hearing deficit as the cause of his speech delay.

He has been referred to a Developmental Pediatrician. He also has another evaluation to see which early intervention programs and therapies he qualifies for.

Welcome to Garrett's Journey.