What brought you here?

This past month we visited a pediatric psychologist at Children’s Mercy to get a diagnosis for Tate that will be accurate under the new guidelines that are being used in the world of autism. In recent years, the American Psychological Association (APA) used a tool called the DSM-IV-TR to diagnose Autism Spectrum Disorders (ASDs). ASDs included Autism, Asperger’s Syndrome and pervasive development disorder-not otherwise specified (PDD-NOS). In May 2013 the DSM-5 was introduced as the new diagnostic tool. This manual has eliminated the three subgroups. Tate’s doctors have told us that the word Asperger’s will soon be obsolete. It is my understanding that the new diagnosis for a child with autism will be Level 1, 2, or 3, with 1 being the highest functioning and 3 being the lowest.  Tate’s new diagnosis is Autism Level 2.  For more information about the new terminology and the new criteria I found this article helpful: http://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

Some think the motive behind the new criteria is to make it harder to get an autism diagnosis, thus bringing the alarming numbers down. I do not really have an opinion on the reasoning behind the change. I do hope that the new criteria will not harm the autism community and prevent children who need support from gaining it. 

In order to get the evaluation and the new diagnosis, the psychologist had to spend several hours with Tate. He gave her a pretty accurate picture of himself from the introduction. He asked, “Do you know what brought us here?” The psychologist assumed he was asking her to reveal the purpose of our visit and she said, “What do you think brought you here?”  He answered, “a truck.”  It got better (or worse depending on how you look at it).  While testing with Tate, she needed him to define words. When asked to explain what a car is for, Tate said, "A car is something you drive around in because humans are loosing the ability to walk." She asked him about posture and he started speaking gibberish. She asked him what he was doing and he said he was speaking Spanish, also called posture. When asked what an American is, Tate said, “When you are from America, you laugh a lot and smile and play in the sunshine. You also speak English or Spanish." So, he got that right! Ha. The doctor showed Tate a lot of faces that illustrated a lot of emotions. Tate failed to identify almost all of them correctly. The doctor asked him what a smile and a frown had in common and he said, “Both faces are round.” There were many, many more gaffes and blunders over the two days of testing. Some made us laugh and some made me want to cry.

Age 3

After all the testing, Shawn and I met with the doctor alone. The results and the recommendations from the doctor were both helpful and discouraging.  Going into Tate’s appointment for his diagnosis at age 3, and again at age 12, we had our eyes wide open. We already knew both times that he had autism and we had a long, hard road ahead of us. The difference between the first time when we heard the diagnosis “PDD-NOS” and the second time when we heard “Autism Level 2”, was that we had a lot of hope at age 3 that we no longer have nine years later. Originally, we fell hook, line, and sinker, for the idea that kids can “recover” from autism. We spent the thousands of dollars it took to get best-practice, early intervention. We spent the hours and hours it took to get Tate kindergarten-ready academically. We even made progress with a lot of social skills. We worked so hard and saw a lot of growth but we didn’t get the “recovery” that we had hoped for. I am still one hundred percent for early intervention and believe Tate is much less handicapped than he would have been without the hard work. Perhaps if we had not hoped for recovery we would not have worked so hard then. Perhaps if we had not hoped for recovery the reality would not hurt so badly now. I have learned not to dwell on “what ifs.”   

Regardless of what we call Tate’s disability, it is still the same disability and he is still the same kid. Tate still struggles in all the same areas. Tate still needs the same supports he did before the new diagnosis. We continue to make progress and I see it come in leaps and bounds sometimes. 

Age 12

Over the Christmas break, Tate’s oldest sibling, Titus, was home for a visit. He is sometimes able to explain things to Tate that I have been unable to. I told Titus we were working on teaching Tate about sarcasm. I know what you are thinking… Why would a Mom want to teach her child the art of sarcasm? Why would any mother in her right mind go out of her way to try and help her kid become sarcastic? Well, in the first place it is age appropriate. In the second place it is much like figurative language and joking that is over Tate’s head, causing him to miss out on so much of the conversation around him. Thirdly, we are constantly trying to make Tate see that not EVERYTHING has a concrete, literal meaning. Sarcasm almost always means exactly the opposite of the words that are actually used. So, Titus gave it a shot. He gave Tate a definition of sarcasm and some examples. Then we asked Tate to try. Tate looked confused. I said, “Tate, look at Sydney’s hair. It is a mess. What could you say about Sydney’s hair that would be sarcastic?” Tate responded, “Sydney, your hair is sarcastic.” Lesson fail!! I’ve been hammering away at it ever since though and pointing out sarcasm whenever we use it or hear it. Sunday, we sang a really short hymn in worship and Tate leaned over and whispered, “THAT was a long song.” Then he looked at me and smiled. Now, normally would I praise one of my children for saying something sarcastic about a worship song? Would I ordinarily get excited about whispering and joking during worship? NO! I would not. BUT… I almost came out of my seat I was so ecstatic. I pulled Tate over to me and excitedly whispered, “Tate! That was sarcasm! You did it! You said something sarcastic! Good job!” I know that eventually I will probably regret these lessons in sarcasm. I know this because four of my seven children are now sarcastic, young adults who did not need my tutorials to become that way. I had a shot at mothering a child without ever having to hear those sarcastic comments that come so easily to the others, but I am a glutton for punishment because just today I said something sarcastic to Tate and then said, “Did you hear that Tate? That was sarcasm” and he smiled. 

This is another post you might enjoy about language: Who's on First?

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What is discrete trial training?

As soon as I discovered that Tate had autism, I began researching treatments. There are so many ideas out there. I wanted to find a treatment that was proven to have results. I wanted a “cure” for autism. I read the book "Let Me Hear Your Voice" by Catherine Maurice. In her book she told of the huge differences between her children before and after the therapy she provided. I wanted recovery for Tate! The only research based treatment I found was called Applied Behavior Analysis (ABA) therapy. This was the same therapy that Maurice had talked about in her book. The initial research was done by Dr. Ivar Lovaas and published in 1987. Lovaas had made great gains with the children he had worked with.  “Best practice” was 25-40 hours a week of discrete trial. Discrete trials are well-defined tasks with a beginning and end. Big tasks are broken down into small steps and are taught systematically. The end goal might be for a child to be able to recognize and match shapes, but it would be broken down into very small pieces. It might start with the child holding a card that had a black circle on a white background. The teacher would give very simple instructions, often just one word like “match.” The child would need to match the card he was holding to a card in front of him. There might be only two cards in front of him at first: one with a square on it and one with the circle that matched. When he mastered that task, a third card would be added to the table, then a forth card, making the task harder. When the child was able to match the circle correctly after five consecutive trials, the task might switch to matching squares. After all the shapes had been mastered, the teacher might introduce matching a blue square to a red square, showing the child that shapes were still shapes, no matter what the color. After switching colors and mastering several shapes in a variety of colors, we might try having the child match a three-dimensional shape, like a square block, to the card with the square or a ball to the card with a circle. There would be many small steps mastered so that the child with autism could see the much bigger picture. All these kinds of things are learned by the typically developing child during his regular play. It doesn’t take hours of sitting with a teacher to learn simple concepts. This discrete trial method of teaching is how Tate learned almost everything. It took many hours and it was tedious. The end results were worth every minute we spent doing these discrete trials. 

In my constant search for ways to help Tate, I read of many therapies that did not have research to back them up. I read about diets, vitamins, use of steroids, holding therapy, animal-based therapies, music therapy, and several other things. I was willing to try almost anything to help Tate, but nothing had research results behind it except the ABA. I do believe some of the other things help some kids. Swimming with dolphins would be a dream for a lot of kids and it might even help a child with autism in some ways but it is not a valid therapy in my mind.  Music therapy would be very valuable to the child that likes music as well. I know it would not have gotten the results we got with ABA and discrete trial though.    

I have had a few people try to convince me to take Tate off milk and wheat. There are about a dozen foods Tate will eat. If I took him off milk and wheat then there would be almost nothing left for him to eat. I know Tate well enough to know he would probably go for days without eating before I gave in and let him have his crackers, bread and milk back. If I really thought the diet would “cure” Tate’s autism then I’d throw out every last cracker and piece of bread in the house. The kids that I know on the diets, still have autism, most of them are lower functioning than Tate. They feel better on the diets and Tate probably would too. If you feel better then you behave better and can learn better, I am sure.  I just do not think the benefits, if any, would outweigh the difficulty in our home. There are few studies I've seen and no real research to back up the diet therapies that I've seen.  

When Tate was waiting to be diagnosed by a professional, I sent out a letter to our relatives and some close friends. We didn’t want to make dozens of phone calls, answering all the same questions over and over. I explained what we were going through.  We had already decided we would be jumping into ABA therapy with both feet. I asked my friends and family to support us in our decision and not to buy into all the theories about “cures” they would hear about. There were no cures and only one research based therapy we were going to use. Immediately, I started hearing back from people with the suggestions I had specifically asked them not to give me. I heard: Tate needed to be going to a chiropractor, begin homeopathic treatments, use vitamins, take him off milk, and sign him up for horse-back riding lessons. Lots of people were just sure the government gave grants and all kinds of money to parents to help kids with autism too. 

I am very happy with the outcome of the early intervention program we provided for Tate. I am confident he benefitted a lot from the things we did. I don’t think I will ever look back and say I should have done anything differently. Had I hoped for a complete “recovery” from autism? Yes. Is it realistic to hope for such a thing? Probably not. Did God answer my prayers for Tate? Absolutely! 

Also by this author: "15 Truths of Parenting Special Needs Kids."

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