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.