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.

Denial

It's so devious, isn't it? Everything's going well and so it creeps in and you start thinking, "they have to be wrong." Jesse had his assessments yesterday by the senior therapist (ST) and her supervisor yesterday. It went so well! He was so compliant with the testing (which mostly just resembled structured play) and was so interactive. ST and her supervisor were really pleased with how things went and how easy it was to work with him. He seemed so normal. I mean, really normal! There were things that he couldn't do, of course, like identify colours, and he did have trouble with one of the matching games, but so would neurotypical 2 year olds, I would think. So all day yesterday I kept thinking that they must have made a mistake when they decided Jesse has autism.

Then last night he started spinning. And he's been doing it today as well.

I guess it's a good think his ISSP is next week.

Now we're getting somewhere

So sorry for slacking on this blog. There's just so much going on right now. My husband, Steve, was in a car accident on Thursday. Steve is mostly OK, though he's having some back pain and had to take some time off work. The car is toast. We were really hoping to get another couple of years out of Steve's car, so that we wouldn't have to be making 2 car payments, but God/fate/karma/whatever had other plans. I'm sure we'll get through, but we've been really busy trying to get all of this straightened out.

In the meantime, Jesse is doing really well. His language is really coming along. His list of words, both imitated and spontaneous, grows daily. His SLP is really happy with his progress. I also have a book I'm reading that is giving me some great ideas on how to help this along at home as well. It's called Motivate to Communicate. It's written for kids on the spectrum, but I have a feeling it would really work well for kids with a "simple" speech delay as well. I'm not that far into it yet, but I'm hoping to have it finished by the weekend, and can give you a review of it.

We've also been assigned a senior therapist! Yay!!! She's actually still training, so her supervisor will be coming along with her and helping her, which is great. They both paid us a visit this morning. We mostly just went over Jesse's history and what our main concerns were. They also gave us a bit of an overview of what the next few weeks will consist of. On April 12th, they'll return and do Jesse's evaluations, and then on April 19th (tentatively) we'll have Jesse's ISSP (Individualized Supports and Services Plan...I think that's what it stands for). That's when we'll come up with the plan of attack for Jesse. It's only when we have the ISSP that we get funding for the home therapist. (Speaking of which, we still haven't hired anyone yet. I have about 40 resumes here, though, to look through.)

I also keep meaning to do a little book report, of sorts, on the book I just finished a couple of days ago. It's called Changing the Course of Autism: A Scientific Approach for Parents and Physicians. It's not an easy read by any stretch of the imagination. There's a lot of anatomy and physiology and immunology knowledge needed to understand it well. It did challenge me to recall a lot of what I learned in my B.Sc. and my B.N. I think it's worth reading though, for any parent who has a child on the spectrum. (And for any doctor treating a child on the spectrum.) Jesse's waking up from his nap, so I can't get into it now, but I will definitely give a review of this book later.

What a breakthrough!

I feel like the big brick wall I've been bashing my head against for so long has started to crumble. We had Jesse's weekly speech therapy appointment this morning. Jesse's SLP, M., was THRILLED with his progress! I took my Flip video camera with the video of Jesse talking in the bathtub from last night and showed her. So right away she tossed her plan for incorporating signs into his therapy and wants to dive right into increasing his vocabulary and getting him saying things spontaneously. 

During the appointment she got him to say "eat" and "bus." He's also now saying "bye." I can hardly keep up! She gave me some tips for how to play with him and encourage spontaneous talking and new words. Such a productive 1/2 hour!

In other news:

We had our follow-up with the physiotherapist. She gave me some more information sheets on how to deal with the sensory issues. We have some proprioception work to do with him. She's pleased with his range of motion in his ankles, but thinks that he could tighten up if he continues to toe walk so much. She advised me to do some stretches with him and keep an eye on his range of motion. She'll keep his file open, so that if I need to, I can call her up and make an appointment and we can get Jesse right back in to see her without the
wait. She did think Occupational Therapy would be a good idea though, to help with the sensory issues, and I will be asking for a referral to OT at our appointment with Dr. C on Wednesday.

I also spoke with the social worker, J., this morning. We still don't know when we'll be assigned a senior therapist. It was supposed to be a 2-3 week wait. It's now been 4 weeks. And J. said that she "hopes" it'll only be "another week or so." So frustrating! I told her that this makes it REALLY difficult in terms of hiring a home therapist. They want someone hired by the next ABA training session (April 6-8). But how am I supposed to hire someone when I have no idea how many hours I'll be hiring someone for? I don't know if it'll be 15 hours, 20 hours, 30 hours? Something in between? Who would even be willing to take a job if they have no clue what kind of hours I can offer them? So I'm sort of at a loss as to what to do about that right now. I guess I just have to keep my fingers crossed that someone will get the lead out get moving on this.

I have to focus on the positive though, right? And I am. I'm going to work on Jesse's speech with him and do as much as I can. He's already come SO FAR in just the last couple of weeks. It's actually really exciting!

Frustration

It's been 4 weeks since our initial meeting with the social worker. We were told then that a senior therapist would be assigned to us within three weeks. It's now been 4 weeks. Four LONG weeks. I called and left a message with the social worker, but she hasn't called me back. This is just not sitting well with me! The senior therapist is supposed to do 3-4 weekly appointments with Jesse to help determine his therapy needs. Until then, we don't know how many hours of ABA therapy per week Jesse will need. How are we supposed to hire someone when we have no if we're hiring for 15 hours per week, or 30? And a little bit of guidance as to what qualifications or characteristics of skills to look for in a home therapist would be helpful. 

Somebody needs to get with the program! Argh!