Update

It's been such a long time since I've updated this blog. Jesse is doing remarkably well, given his diagnosis. He's now 6 years old and in Kindergarten. He's in a regular classroom with no extra assistance. I've been told he's a bit of a leader in his class. His energy and enthusiasm for learning is contagious. We've had two wonderful report cards thus far.

Due to my work schedule we haven't been able to fit in much in the way of extra-curricular type activities. We do have a family membership to the Y, and both kids are in swimming lessons. Jesse is quite the little fish, and is now swimming in the deep end of the pool. He's fearless. Which does tend to freak me out at times, but I know he's in good hands with his instructor.


Autism Services with Eastern Health closed his file about a year or so ago. We had been doing "direct home services" for a bit, but they deemed him no longer in need. He had his last speech therapy appointment about a year ago and haven't been back. We also haven't seen his developmental pediatrician in nearly 2 years. I'll be calling once Kindergarten is over to make an appointment.

So we just keep on keeping on.

If you're looking for family updates, please visit my other blog Here Comes Trouble.

Just awesome

I had to share this. It's an Open Letter to Parents Facing a Diagnosis of Down Syndrome written by an internet friend of mine, Lisa Morguess. (She blogs about her life on Adventures in Motherhood and Finnian's Journey.) I think that all parents of Special Needs kids can probably relate.

These kids will teach us more about ourselves and the world than we could ever dream was possible.

Sweet

Our little family went to the beach today for a fall photo session with my wonderfully talented cousin, Tracy. While there, Jesse saw a little girl, maybe about 14-16 months old, crouched down, crying. Obviously concerned, he went over to her, crouched down next to her and put his hand on her shoulder, checking to see if she was OK. She stopped crying, looked at Jesse, smiled, and said "Hi, baby!"

I love the effect my sweet boy has on people.

Slightly OT - "....as long as its healthy"

The following is a post from my private baby blog, which is currently available to friends and family by request. I thought it belonged here as well.

I don't know how many times I hear this or read this in the run of a month. Some expectant mother is asked, "Are you hoping for a girl or a boy?" And she invariably responds, "Oh, I don't care, as long as its healthy!" And I hate it. Once again, I'm sure to be accused of being overly sensitive. But really, would you love your child any less if it wasn't healthy? As someone who has a child with "special needs", who has seen more specialists and therapists than most senior citizens, I can absolutely say that such a child is a blessing in disguise. You come to appreciate those milestones and successes so much more than the parent of a normally developing child...because you don't take it for granted that walking/talking/playing/reading/whatever are just going to happen naturally. And it truly teaches you more about yourself and your capabilities as a parent than almost anything else possibly could.

So when I'm asked whether I'm hoping for a boy or a girl, I usually respond with something ridiculous like, "Oh, I don't care, as long as it doesn't have 2 heads." Gender does not matter to me. And whether or not the baby is healthy doesn't either. Quite honestly, I'd have another 10 just like Jesse if I thought that I could keep up with them!

Ch-ch-ch-changes!

We fired Jesse's home therapist this past week. While it really sucks, in a way, it was a huge relief in another. Since May, we've put up with multiple lates and sick days, coffee being continuously spilled on our carpets, schedule changes to accommodate her, and a decreasing level of patience on her part. The straw that broke the camels back, however, was her posting about Jesse (using his name even) on her Facebook page. (Not to mention that it was post DURING his therapy session that day.

So, we're going to try without therapy for a few months. We're going to do playdates and playgroups and biweekly speech therapy. We may enroll in toddler Mother Goose or some other more structured activities. Jesse's language has come so far these past few months that it's now within the normal range for a child his age. So we're going to focus more on play and socialization, which he's been really missing out on, in my opinion.

Other big news is that Jesse's is starting to seem ready for potty learning! In the past couple of days Jesse has requested to use the potty to pee and he pooped on the potty without any suggestion from me or his father. This is so exciting, because I would *love* for him to be out of diapers before the next kiddo arrives. Which is the other big change we're expecting. "Trouble" is due to arrive some time in March.

I guess that's all for now.

Boiling Point

I can't remember if I've written about this before or not, but I'm writing about it now.

We're having issues with Jesse's home therapist.

Since we hired her, she's been either late or sick nearly once a week. And sometimes twice a week! I've actually been pretty understanding, I think, in regard to bus schedules and whatnot. I understand if the bus is running a few minutes behind. That doesn't bother me. What bothers me is that she sleeps in or misses her bus FREQUENTLY. And she's sick a LOT, and often it's because she "couldn't sleep last night." I've already talked with her about it. Actually it was an email, since I thought it would be good to be able to proof read what I wanted to say, have it be objective, and then get a reply from her, and have a record of it all. It went well, I thought, with me suggesting starting therapy an hour later in the morning, and running an hour later. This would, I had hoped, put an end to the issues with "sleeping in" and "missing the bus."

No such luck.

Today she called about half an hour before start time and said she'd missed the bus, and it would be another hour before the next bus, so she'd be an hour late. Well, start time is 9 am, she'd get here at 10 am, and the senior therapist, who's only here once a week to review Jesse's programs, gets here at 9:30 on Monday mornings. This is just not acceptable.

If it were me, I would have called a damn cab and gotten to work on time. There is no way in hell that being an hour late for work on anything other than a once-in-a-blue-moon basis would be acceptable in any other job. I'm sure she doesn't do this at her retail job. I can't imagine her still being employed there if that were the case.

I'm so pissed off. Why can't people take this job seriously? I hear of this issue with home therapists from other parents a fair bit. And I think it's ridiculous! What's even worse is that she's SO good with Jesse and he loves her to pieces. I know he's going to really miss her if we let her go.

***sigh***

I'm just so frustrated.

Wow, it's been a while!!!

I've been a very bad blogger this summer! I guess I just have so much to blog about that it keeps building up and building up and I need such a huge chunk of time to do it all that I keep putting it off....you know how it goes. I live by the Procratinator's Creed: Never do today what you can put off until tomorrow.

Anyhow, there are a few things I want to post about, including Jesse's 6 month follow-up with Dr. C (developmental pediatrician). But right now I'm posting about Jesse's speech therapy.

We FINALLY, after FIFTEEN MONTHS of waiting, got Jesse in to see the SLP, Kim, that works with the development program at the Janeway. It was a good appointment in all...and it lasted for about an hour and forty-five minutes, which was kind of surprising to me. I figured it would be an hour at the most.

At first the way she spoke to Jesse was very exaggerated and simple, but after about a half hour she seemed to get the fact that there's nothing wrong with his receptive language. (I did also tell her that his private SLP had just tested his receptive language a few weeks ago and found it to be perfectly normal.) She played with him a lot to get a grasp of what he was capable of, and she spoke with Jesse's home therapist quite a bit too. She wanted to know what programs he was currently doing and how he was doing with them.

Overall, she thinks he's doing really well. He's rapidly gaining language. Right now she wants us to work more on verbs, which we've been doing anyways (and are coming along!). She thinks speech sounds should take a back seat to more general language development. I don't think I really agree with this though, since he's rapidly gaining language fairly naturally as it is now. She had some suggestions for his therapy, too, which was great. She's very familiar with ABA therapy and so can make suggestions for programs to work on. And we're planning a home visit for later this month.

My one big concern though is that she generally only sees her patients once every 2 months. I'm not liking this, since he's been going weekly and it's obviously working. But Kim said that she generally works in more of a consultative role with the whole therapy team. I think that could be partly true, but I'm also pretty certain it's in large part due to lack of resources. So, we've made the decision to keep up our sessions, on a biweekly basis, with Jesse's private speech therapist.

Hopefully tomorrow I'll get a chance to update on Jesse's appointment with Dr. C.

Receptive Language

At last Monday's speech therapy appointment the SLP tested Jesse's receptive language. What she expected to take 2-3 sessions took all of 20 minutes. His attending was awesome! And it turns out that Jesse is right on target! He scored 50th percentile for 2 - 2 1/2 year olds. I'd always thought that his understanding was pretty normal, and now we know it is.

New look

I've changed up the layout and look of the blog. What once was dark and scary is no longer so. I figured I'd change the look of this blog to reflect the fact that there is so much happiness and hope in our lives right now. Jesse's made so much progress in the past few months that it's becoming increasingly difficult to tell him apart from "normal" kids. We're constantly smiling and laughing at stuff he comes up with. I wish that all of you out there who haven't met Jesse in person could, just so you could understand how awesome this kid is.

Looking forward

Last night at our parents support group the topic of Kindergarten came up. A couple of the parents that were there have kids heading to kindergarten either this year or next. Autism services are reduced for kids when they start kindergarten, and then stopped altogether for kids as they head into grade one. It's a big deal. But honestly, it's not even on my radar screen right now. I said as much and the other parents tried to impress upon me just how close it actually is. It actually *is* still 3 years away, and to tell the truth, I'm not even sure we're going to send Jesse to public school. I'm of the mind right now that home schooling is definitely an option.

But beyond that, I don't see Jesse still having a diagnosis by the time he's five. (No, I didn't mention this to the other parents at the support group.) I may sound like I'm in denial or have my head burried in the sand, but the fact is, some children diagnosed with ASD at a young age eventually move off the spectrum. Jesse's developmental pediatrician has suggested that she thinks this will be the case with Jesse. And with the gains he is making in speech and communication, I'm very hopeful this will be the case.

I've always said that optimism was over-rated, but my views on that might be starting to change. And truly, it's difficult not to be optimistic about Jesse's development. The kid is blowing us away every day.

Racing for Autism

Targa Newfoundland takes place in September of each year. For the last 3 years, the Halleran family from Paradise has entered a team, which they've called Racing for Autism. (Here is their website and here is their Facebook fan page.) They started the team after their daughter was diagnosed with autism. To raise awareness for Autism Spectrum Disorders, they place puzzle piece stickers all over their racing cars. These puzzle pieces that hold the names of children around the world who have been diagnosed with autism. This year, Jesse's name is on the car. And so is his picture. I cannot wait to see the car in person later this year.

For your viewing pleasure...

This picture shows Jesse's puzzle piece (the pink one at the bottom)

And here's his sweet face. 

Many, many thanks to Ray and Julie Halleran for all that they do to raise awareness for all children on the spectrum.

A lesson in futility

Prior to being seen by a developmental pediatrician when there's a significant speech delay and/or other developmental issues, a child should have their hearing tested. This is pretty much a standard thing. Our family doc only suggested this AFTER she heard of Jesse's PDD-NOS diagnosis. So she fills out the referral, we leave the office, and we wait to hear from Audiology. The call never came. I call our doctor's office, and the office staff tell me that they were never passed a referral to send. (See why I want to find a new family doctor for Jesse?) So we head back to the doc a couple months ago, and she refers Jesse to ENT because we can get in to audiology faster that way. (This time I personally handed the referral letter to the secretary.)

We had our ENT appointment yesterday. The ENT looked in Jesse's ears, and didn't see anything troubling. He then sent us straight over to audiology. The first machine they tested Jesse with tested his middle ears. No problems there. The second machine they tested him with tested his inner ears. No problems there either. Then she sends us to this booth where I have to play with Jesse with some Play-Doh and the audiologist in the adjoining room (she could see us through a window) played some sounds at different frequencies and every time Jesse turned to the sound a toy would light up and I'd have to reinforce him. She was really pleased with how well he did, both in terms of learning what he was expected to do, and with the results of the test. No problems with his ears. The audiologist then sent us back to the ENT, and he told me that Jesse had no hearing issues whatsoever.

Which I already knew.

Lazy

I'm too lazy to post right now, so I'll just link a post from Hartley's Life with 3 Boys (which I just love) titled We Are Just Human. I think all moms and dads of special needs kids will be able to relate. Enjoy.

Learning with Uncle Josh

My brother came home from Germany this week, and he and Jesse have enjoyed spending time together. I didn't realize though, that Josh has been "helping" Jesse with his vocabulary. Well, I did, but I thought it was limited to words like "nudge." Nope. I wonder how suprised Jesse's SLP will be to see "titties" on his vocabulary list on Monday? LOL

Playing catch-up

I've been slacking on this blog. Big time. So I'm going to give some brief up-dates of a few things we've been up to.

ISSP
From the ISSP meeting we came up with the following three major goals:
1. To increase expressive vocabulary to 100+ words. To be implemented by family, home therapist (HT), and senior therapist (ST) in the home environment. To be reviewed October 2010.
2. Jesse will navigate his environment using heel-toe pattern. To be implemented by family, HT, and ST in the home and in the community. To be reviewed October 2010.
3. Jesse will understand and follow one and two step commands regarding safety. To be implemented by the family, HT, and ST in the home and in the community. To be reviewed October 2010.

As of now though, I think Jesse has likely already met goal #1. His vocabulary has just exploded. Jesse's SLP has told us that we're not going to be able to keep up with writing down his new words. And it's true! I'm going to try though. Probably tonight at work. I'd like to have a better idea of exactly how many words he does have. I suspect though, that it is around 100 words. Jesse's already come a long way in terms of meeting goal number 3 as well. I can actually hold his hand in parking lots now, whereas I used to have to carry him. He's much more compliant about important things, like holding my hand, and not running off. I'm still cautious, of course, and hold his hand tightly, but it so much better.

I think that the most difficult goal to meet is going to be #2 - dealing with the toe-walking. We have activities and exercises in play to encourage heel-toe walking, but so far, he goes straight back to toe-walking. I'm hopeful, but not convinced, that this goal will be met by October.


Home Therapy

Our HT is working out really well thus far. She's here from 8 am to 12 noon Monday - Friday. Jesse really seems to like her, and she's really patient with him. He's even saying her name. The therapy is going well and Jesse is mastering his programs without much trouble at all. He's working on puzzles, letters, matching, body parts, animal sounds (he knows a ton!!), prepositions, and following instructions.

My only concern with the home therapy, and it's a big one, is that the ST and her mentor seem to be very reluctant to move Jesse's therapy outside. The weather's getting nicer, and I don't want Jesse stuck inside this summer. Yes, his therapy is only in the morning, but Jesse naps for 2-3 hours every afternoon. That leaves little time for getting out and about. So right now I'm trying to come up with ways of doing his home therapy outside the home. I need to do some research on this over the weekend.


Chiropractor

We've decided to start taking Jesse to the same chiropractic clinic Steve and I use. One of the chiropractors there works with kids with developmental issues. She's trained in Brain Gym. We had our first appointment yesterday. She did a physical assessment and asked me lots of questions about Jesse and his development. It was interesting to say the least. She does think that she can help with the toe-walking and the w-sitting. She wants to do some craniosacral work, and possibly do some adjustments as well. She assured us that adjustments in kids are nothing like adjustments in adults. I was very happy with how calm and respectful she was. She told Jesse everything she was going to do, and adjusted her assessment and treatment to suit Jesse's desire to be up and about and active. Some of what she does seems very strange (which she warned me of!) but I'm not going to discount it unless I see that it's not helping. I can't say that I understand chiropractic care very much, but I do know that it works for me, so I'm willing to give it chance to help Jesse.


And last, but not least, we took Jesse to feed the ducks at the park on May 24th. He had a blast! Here's a video. You can here him asking for "more" bird seed. Don't mind my voice.

Word Detective

I recently read a post on Hartley's Life with 3 Boys titled Sensory Detective. It was such an awesome post and I'm in complete and total agreement with it. This, along with recent developments in Jesse's expressive communication got me thinking about just how much of a detective I've had to become lately. In addition to the sensory issues, Jesse also likely has some degree of verbal dyspraxia. Since his vocabularly is growing by 1-3 words a day, and he's just now starting to put 3-word phrases together ("more juice please"), I'm constantly having to decipher what he's trying to tell me. And if I'm unable to figure it out, we're at risk of a meltdown. I'm getting better at it though.

For example, a couple days ago Jesse came running up to me in the kitchen holding a tiny piece of paper in his hand. He showed me and said, "babage!" I was stumped! He kept repeating it over and over, "Babage! Babage!" "What is it Jesse?" I asked. "Babage!" And then he started knocking on the cabinet door under the sink. Where we keep our GARBAGE can. I opened the childproofed cabinet door and sure enough, Jesse puts the tiny piece of paper in the garbage. "BABAGE!" He was so proud of himself! And I was so glad that I got it relatively quickly.

A few others that I've figured out recently:
"ma-mass" is Mickey Mouse
"doot" is both poop and milk
"dee" is Diego
"keys" is both keys and cheese

There are a couple others that come to mind, but I'm saving those for another post.

Book Review

I keep saying I'm going to get around to it, and finally I have! My first book review. Forgive me though, it's been about 15 years since I've done one of these and I don't believe I even remember how. So no critiques of my critique please! If you've read the book though, please feel free to add your own review or comments in the comments section. I'd love to know what other people thought.

Motivate to Communicate: 300 Games and Activities for Your Child with Autism
by Simone Griffin and Dianne Sandler

I'm going to put the cart before the horse here and just say that this is a fabulous book chock block full of ideas and resources for working with children with autism. The authors, Simone Griffin, a speech and language therapist, and Dianne Sandler, a specialist teacher, both have years of experience working with kids with autism. And it shows! They take into account children's sensory issues and needs, as well as the child's level of communication ability (which can range from completely non-verbal, to relatively "normal").

First and foremost, this book shows parents how they can create communication opportunities throughout the day, with very little planning of set-up involved. Keeping desired objects (toys, books, DVDs, food, etc...) out of reach or in difficult-to-open containers forces (in a good way!) an autistic child to interact with their parent/therapist/caregiver in order to get what they want. Doing something unexpected (like having the child's sibling get in the bathtub with their socks on) or using "creative stupidity" (i.e. doing something intentionally to get a reaction, but pretending it's a mistake) encourages the child to comment or communicate in whatever way they can that they know something's different or not right. This section of the book, though short, is probably my favorite. I think that we, as parents, can get so caught up in our busy lives (especially when you're in the midst of so many doctor and therapy appointments) that you can over look these learning and communication opportities so easily. By being mindful of how to take advantage of every day happenings, you're able to work in so many communication opportunities so easily!

And that's just the introduction!!!

The rest of the book is full of the 300 specific ways you can motivate kids to engage and communicate. Chapter 1 is Motivate Me with Food. You can use different foods, from bread and toast to spaghetti and jello to do little activities that teach things like simple instructions, teach concepts (such as yes/no, big/little, long/short, shapes, colours, etc...), and experience food in a way that is not negative (which is too often the case for kids with autism). My only concern with this chapter is that it relies heavily on foods that would be in a gluten-free diet (breads, pastas, flours). Luckily there are still plenty of other suggestions, and other chapters.

Chapter 2 is Motivate Me with "Party Toys". Party toys include things like bubbles, balloons, slinkies, balls, cars, wind-up toys, magnetic toys, spinning toys, vibrating toys, light up toys, and stretchy and squishy toys. Many of these toys are very motivating, especially for kids who need lots of sensory stimulation. These are your typical dollar store fare. Which I tend to really dislike. I'm personally not a fan of cheap, made in China, decorated with questionable paint toys. Or ones with batteries that are at all accessible. But there are better options out there. And if you're worried about the quality/safety of certain toys that your child just LOVES, then you can always put them in a box on a high shelf and bring them out only during therapy or one-on-one play time with a parent/caregiver/therapist.

Chapter 3 is Motivate Me with Social Games. These games typically require engaging with other children or adults on some level. Hide-and-seek, pass-the-parcel, tag, musical chairs, and "I spy", are some typical examples. I love this chapter because you learn how you can help your child interact and play more with other kids. Many of the games may be beyond your child's current abilities, but there are things you can do to help them or even practice ahead of time.

Chapter 4 is Motivate Me with Outside Games. This chapter is full of ideas on how to use outside play time to encourage communication. I'm so glad they included this in the book, because I think that too often parents, caregivers and therapists can rely on structured indoor therapy. But these are KIDS! They need to get outside and run around and just play! Many kids with autism are VERY active (like Jesse) and this is really a necessity. The activities in this chapter include play with sand, water, snow, and messy things (like slime/goop, sawdust, soap flakes, etc...).

The last chapter, Chapter 5, is Motivate Me at Home and School. This chapter focuses on using toys and other things that you already have in your home or at your child's school. Like puzzles, books, and shape sorters. The possibilities are nearly endless. My favorite from this chapter is the Mr. Potato Head. We just picked one up for Jesse and he LOVES it! Such a great tool to use.

Also awesome about this book is the list of online resources, including internet businesses that sell toys for kids with disabilities, and websites that have information on autism and communication. Many of the sites are based in the UK, but they're still immensely helpful.

Overall, I'm really pleased with this book. I think it's a great resource and I think that every family affected by autism should have one, as should anyone who works with kids with autism. Actually, I think it would be a great book for anyone with a child with  a speech/communication delay. Many of the strategies seem like they would lend themselves well to working with neurotypical children as well.

Amazed!!!

We had our weekly speech therapy appointment this morning. SLP was very impressed with Jesse's vocabulary growth over the past couple of weeks. In the two months since we started speech therapy, Jesse has gone from being about 14 months behind (12 month level at 26 months of age), to being just 4 months behind (24 month level at 28 months of age). I'm over the moon!!!

Oldies but goodies

I've talked a lot about Jesse's toe-walking. It's been a huge issue for us for forever. I didn't realize it at the time, but when Jesse started cruising around 7 1/2 months of age, he was constantly up on his toes. Of course, some degree of that is normal for babies. What wasn't normal was that his toe-walking caused him to develop a contracture in his right foot that prevented him from coming down onto his heel. And this prevented him from getting his balance enough to even stand unassisted, let alone walk.

Jesse had always met his gross motor milestones on time or ahead of time. So when time kept creeping onward and Jesse still walking walking on his own, wasn't even STANDING on his own, I *knew* something wasn't right. He wasn't lazy. He wasn't "too good of a crawler." It wasn't because I did everything for him. Or carried him everywhere. Those were all the reasons I was given when I dared talk about my concerns.

Eventually I made the following video. It was taken with a crappy digital camera when Jesse was nearly 16 months old. This video confirmed for me that there really was an issue, which is clearly visible to anyone who watches it. I showed it to a friend of mine who works with kids as a physical therapist and she validated my concerns. It gave me the kick in the ass I needed to demand that I be taken seriously and that Jesse be properly assessed.

So, without further ado:





I also wanted to throw in this video....the day Jesse finally stood on his own....took his first steps....and walked clear across the room!!! This was taken about a month after the first video. After a couple weeks of physiotherapy. He was still up on his toes, still had the contracture, but had finally managed to get his balance enough to stand, to WALK! Boy, was I a proud mama that day!!!

Jesse's ABA Client Report

I'm going to attempt to type this out, and post about the ISSP meeting as well. This will be pretty long. It'll probably be a hugely boring read for most people, but may be helpful to someone going through a similar experience.

The ABA Client Report was prepared by Jesse's Senior Therapist (ST). The report was based on her findings from the Brigance Early Childhood Screen II 0-35 months, and the Carolina Curriculum that she'd performed April 12, 2010. The following is taken directly from her report:

Findings and Service Plan:


The Brigance Early Childhood Screen II 0-35 months, as well as the Carolina Curriculum were completed through testing, and parental interview in April 2010. The results indicate that Jesse is showing the greastest delay in the area of Language development. My role as a Senior Therapist is to address these delays and in consultation with the therapy team, develop a program plan to assist Jesse with mastering skills appropriate for his age. 


The purpose of today's report is to share information regarding Jesse's present developmental skill level and to project the program goals for the next six months. 


Physical Develpment (Fine & Gross Motor):


This scale measures the child's ability to coordinate movements of large and small muscles of the body.


Jesse shows many strengths in both his fine and gross motor develpment. In terms of fine motor skills, Jesse attempts to solve problems by imitating adults, and is able to imitate sequences of two unrelated motor acts. He turns doorknobs with forearm rotation, puts small objects through small holes in containers, and builds block towers 8-10 blocks high. Jesse is able to put together and take apart pop-beads, and he demonstrates a right hand preference. He also demonstrates good tool use. He can hold a bowl and stir, and can transfer material with a spoon. Further, Jesse shows purposeful and well controlled scribbles and strokes. 


Jesse also shows many gross motor strengths. He can jump on the floor, he can walk backwards, can take many steps on his tiptoes, and can run at least 10 feet without falling. He can rise on his tiptoes and can stand on one leg with a stable posture for 1-2 seconds. Jesse can throw a ball, can climb both slanted and vertical ladders, is able to use a slide independently, and runs in a variety of environments. 


Goals:
-Jesse will unbotton large buttons found on clothing
-Jesse will imitate horizontal strokes
-Jesse will use heel-toe pattern when walking
-Jesse will walk up stairs, using an alternating pattern while holding onto a rail
-Jesse will pedal and steer a three-wheeled bike


Self-Help Development:


This scale measures a child's ability to cope independently with the environment and measure their skills with such tasks as eating and dressing.


Jesse shows many strengths within his self-help skills. He can use a fork, and can drink from a small glass held with one hand, but prefers a sippy cup. He is able to undress himself completely, is able to put on simple clothing such as pants, shoes, and socks, and can manipulate velcro and zippers. Jesse has strong grooming skills and is able to wash and dry his own hands, brush his teeth with assistance, and wash himself with a washcloth. 


Goals:
-Jesse will put on a t-shirt
-Jesse will undo fasteners (i.e. large buttons and shoelaces)


Social Development:

This scale measures the child's interpersonal relationship abilities.


Jesse has very good eye contact and will respond to his name most of the time. He tolerates being taken into a variety of environments and frequently explores different environments. Jesse knows what toys can and cannot do and uses them appropriately. He tries to comfort others in distress and spontaneously shares with peers. He shows determination in choosing and continuing activities and shows pride in his achievements. 


Goals:
-Jesse will share with another person
-Jesse will engage in simple turn taking games with another person
-Jesse will avoid common dangers in the home and environment
-Jesse will recognize himself and others in photographs
-Jesse will expand his play skills through imitation


Cognitive (Academic) Development


This scale meaures children at the preschool level and evaluates the child's development of skills pre-requisite to scholastic functioning.

Jesse is showing many strengths in the area of academic development. He sorts objects by size, builds block towers, and uses tools to solve problems. He can point to a hand that is hiding an object, and engages in adult role play. Jesse demonstrates good comprehension of cause and effect when playing, and understands the concept of "more" as an addition to some existing amount.


Goals:
-Jesse will demonstrate recognition of familiar objects
-Jesse will put together puzzles with four or five interconnected pieces
-Jesse will match identical pictures
-Jesse will attend to a story and repeat words and sounds
-Jesse will independently stack rings of graduated sizes
-Jesse will imitate block building


Communication:


This scale measures the child's expressive and receptive communication abilities with both verbal and non-verbal gestures.


Jesse is able to follow commands in familiar contexts and understands words used to inhibit actions, such as "wait," "stop," etc...He spontaneously uses words during play and spontaneously says familiar greetings and farewells at appropriate times. Jesse is able to point to many body parts, such as chin, neck, shoulder, and knee, and imitates the vocalizations of others.


Goals:
-Jesse will follow two-part related commands in novel contexts
-Jesse will use words to request actions
-Jesse will imitate two word phrases or sentences
-Jesse will increase his vocabulary to 50 words
-Jesse will increase his spontaneous communication


Summary:


Over the next six months Jesse will be followed by the Regional Autism Services division of the Direct Home Services program. I will conduct weekly visits to monitor Jesse's progress. Programs will be developed in accordance with the goals that will be outlined in the upcoming ISSP as well as parent priorities. At the end of this six-month period the assessments will be re-administered in order to assess Jesse's progress and to develop and implement new programs and goals for Jesse.