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Some information I’ve gathered for you about AUTISM, VERBAL APRAXIA and SENSORY INTEGRATION DYSFUNCTION...

Section 1 Autism
Section 2 Verbal Apraxia
Section 3 Sensory Integration Dysfunction
Section 4 Justin’s Evaluation at 3 years old
Section 5 Online websites to check out for more information

SECTION 1 AUTISM
Here is some general information, links, and tips I’ve compiled for you. Autism is a really broad definition and you may find some of the information below may not pertain to your child. Along with the autism spectrum disorder (which is aspergers, pdd/nos [pervasive developmental disorder], autism, etc) there can also be developmental delays, and especially sensory issues (Sensory Integration Dysfunction).

**FYI, my own son, Justin, has been diagnosed with Autism Spectrum Disorder, Verbal Apraxia and Sensory Integration Dysfunction in August of 2002.


AUTISM:
Autism/autism spectrum disorder covers a wide range of things, from typical autism to PDD/NOS to aspergers syndrome. There are 12 things that a developmental pediatrician will look for (see diagnostic criteria for autism below). Your child would need to have a minimum of 6 out of 12 to be diagnosed as having autism/autism spectrum disorder (ASD). In most cases, therapies stay the same as far as speech therapy, OT, PT, developmental intervention. (That is, if your child is already receiving these services.)

>>>Common Characteristics of Autism

While understanding of autism has grown tremendously since it was first described by Dr. Leo Kanner in 1943, most of the public, including many professionals in the medical, educational, and vocational fields, are still unaware of how autism affects people and how they can effectively work with individuals with autism. Contrary to popular understanding, many children and adults with autism may make eye contact, show affection, smile and laugh, and demonstrate a variety of other emotions, although in varying degrees. Like other children, they respond to their environment in both positive and negative ways.

Autism is a spectrum disorder. The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

Parents may hear different terms used to describe children within this spectrum, such as autistic-like, autistic tendencies, autism spectrum, high-functioning or low-functioning autism, more-abled or less-abled. More important than the term used is to understand that, whatever the diagnosis, children with autism can learn and function productively and show gains with appropriate education and treatment.

Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions. The person may have difficulty initiating and/or maintaining a conversation. Communication is often described as talking at others (for example, monologue on a favorite subject that continues despite attempts by others to interject comments).

People with autism process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may also exhibit some of the following traits.

-Insistence on sameness; resistance to change
-Difficulty in expressing needs; uses gestures or pointing instead of words
-Repeating words or phrases in place of normal, responsive language
-Laughing, crying, showing distress for reasons not apparent to others
-Prefers to be alone; aloof manner
-Tantrums
-Difficulty in mixing with others
-May not want to cuddle or be cuddled
-Little or no eye contact
-Unresponsive to normal teaching methods
-Sustained odd play
-Spins objects
-Inappropriate attachments to objects
-Apparent over-sensitivity or under-sensitivity to pain
-No real fears of danger
-Noticeable physical over-activity or extreme under-activity
-Uneven gross/fine motor skills
-Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

For most of us, the integration of our senses helps us to understand what we are experiencing. For example, our senses of touch, smell and taste work together in the experience of eating a ripe peach: the feel of the peach fuzz as we pick it up, its sweet smell as we bring it to our mouth, and the juices running down our face as we take a bite. For children with autism, sensory integration problems are common. Their senses may be over-or under-active. The fuzz on the peach may actually be experienced as painful; the smell may make the child gag. Some children with autism are particularly sensitive to sound, finding even the most ordinary daily noises painful. Many professionals feel that some of the typical autism behaviors are actually a result of sensory integration difficulties.

There are many myths and misconceptions about autism. Contrary to popular belief, many autistic children do make eye contact; it just may be less or different from a non-autistic child. Many children with autism can develop good functional language and others can develop some type of communication skills, such as sign language or use of pictures. Children do not "outgrow" autism but symptoms may lessen as the child develops and receives treatment.

One of the most devastating myths about autistic children is that they cannot show affection. While sensory stimulation is processed differently in some children with autism, they can and do give affection. But it may require patience on a parent's part to accept and give love in the child's terms.<<<
C&P’d from:
http://www.autism-society.org/site/P...haracteristics

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--->Out of those characteristics listed, Justin could be said to follow along with these:
-Insistence on sameness; resistance to change (he sees books in one place...if I move them to say, a new bookcase, he'll put them all back to the old place! LOL)
-Difficulty in expressing needs; uses gestures or pointing instead of words (Will say "hep" and sign help frantically, but won't let me know what he needs/needs help with)
-Repeating words or phrases in place of normal, responsive language (has his own *language* for things...but does use ASL for many things, along with part of the word...JOO for juice along with the ASL sign for drink, for example)
-Laughing, crying, showing distress for reasons not apparent to others (has laughing fits out of nowhere....WIERD!)
-Prefers to be alone; aloof manner (sometimes)
-Tantrums
-Difficulty in mixing with others (inappropriate social behaviors)
-Little or no eye contact
-Unresponsive to normal teaching methods
-Sustained odd play (such as will turn over a tricycle to spin the pedals/wheels, but won't RIDE the bike)
-Apparent under-sensitivity to pain (seeks hard touch, rough and tumble play...deep pressure kid!)
-No real fears of danger
-Not responsive to verbal cues; acts as if deaf although hearing tests in normal range. (since birth he’s been like this, and both hearing tests he’s taken are w/in the normal range of hearing.)

And many others not even listed here. But realize, that MANY things considered autistic, are sensory issues...they go hand in hand many times.

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SOCIAL SECURITY
Does your child get SSI/SSD? If not, under autism s/he may very well get it and then you may have better luck getting more services covered....even stuff like equine therapy or pool/water therapy if s/he has a fear of animals or water, or needs extra PT/OT for strength. SO COOL! We'll probably apply, but will need to find a lawyer specializing in it. It's getting harder and harder to get approved for it with autism as a dx, but our health ins won't cover the additional speech therapy Justin NEEDS for his verb dysp.....even WITH the autism dx. So we need the SSI/SSD/medicaid to cover the extra speech therapy (he gets one hour in school, but needs more intensive outside of school).
Here's a link for you about Autism and SS:
http://autism.about.com/library/week...htm?once=true&


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SECTION 2 VERBAL APRAXIA aka Verbal Dyspraxia

VERBAL DYSPRAXIA (may or not apply to child in question)
With verbal dyspraxia (aka verbal apraxia, apraxia of language and so many other titles! UGH!)...I explain it as this: Dyslexia is to the written word as verbal dyspraxia is to the spoken word. It's a neurological problem that can't be cured, but with early and INTENSIVE therapy (Speech Language Pathologist) that's knowledgable and has treated many other verbally apraxic kids), your child can be given the tools s/he needs to overcome it....caught NOW s/he will have more success at being a normal speaker by jr high/high school.
In simple terms, verbal apraxia, (also known as verbal dyspraxia) is as dyslexia is to the written word as verbal apraxia is to the spoken word. The child knows what they want to say, but it comes out jumbled up.

>>>
~~ What is apraxia of speech and how does it differ from a developmental delay of speech?
Apraxia of Speech is considered a motor speech disorder. A child with apraxia of speech has difficulty sequencing the motor movements necessary for volitional speech. Apraxia of speech may also be called verbal apraxia, developmental apraxia of speech, and verbal dyspraxia. No matter what it is called the most important factor is the root word "praxis." Praxis is the ability to execute skilled movement. So to some degree or another, a child with the diagnosis of apraxia of speech has difficulty in sequencing and executing speech movements. Apraxia of speech is a specific speech disorder.

A true developmental delay of speech is when the child is following the "typical" path of childhood speech development, albeit at a rate slower than normal. Sometimes this rate is commensurate with cognitive skills. In typical speech/language development, the child's receptive and expressive skills are pretty much moving together. What is generally seen in a child with apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. In other words, the child's ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is seriously deficient, absent, or severely unclear. This is an important factor and one indicator that the child may be experiencing more than "delayed" speech and should be evaluated for the presence of a specific speech disorder such as apraxia. However, certain language disorders may also cause a similar pattern in a child.

~~What is the usual prognosis for children with apraxia of speech?
Prognosis means how the child might be expected to do in the future if he or she receives proper treatment. The answer to this question is that outcomes vary. The factors that appear to contribute to prognosis include:
·individual characteristics of the child; these include receptive ability, cognitive ability, desire to communicate (communication intent), age at which appropriate treatment is begun (preschool age being desirable), and attention span.
·the extent to which other speech and/or language issues are present.
·the extent to which therapy is tailored to the unique issues present in the child.
·the extent of family participation and involvement in therapy and follow-through at home.
With appropriate help, many children with apraxia of speech make wonderful gains in their expressive speech ability. However, it is also true that in some situations, despite best attempts, a child may not evolve to be primarily a verbal communicator.
Be careful of those who want to make detailed projections regarding how your child will do in the future, especially if they have not worked with or gotten to know your child.

~~What is the usual method of treatment for apraxia?
It is possible to speak only generally about effective therapy practices. If you read the literature, you will find various techniques described, including PROMPT method, Adapted Cueing, Touch Cue, Melodic Intonation Therapy, Rate Control Therapy, etc. Although these therapeutic approaches differ somewhat, they do have common features. Most notably these include:
·principles of motor learning such as repetition and drill, correction and feedback, slowed rate, and a focus on targeted motor placement and productions
·heightened sensory input for control of the movement sequences and sensory cueing such as visual, tactile, and kinesthetic cueing; touch cueing; verbal cueing.
·use of rhythm and melody
·focus on speech movement across various spatial planes
Many experienced therapists use an eclectic approach rather than a "one approach fits all" notion, incorporating many of the methods mentioned above and using them based on the individual child's needs.

Children with apraxia of speech reportedly do not progress well in their actual speech production with therapy tailored for other articulation problems or with language stimulation approaches. Additionally, in young children the motor/sensory techniques, oral-motor exercises, drills, etc. should be woven into play activities that are highly motivational to them. What experienced therapists and families report is that children with apraxia need frequent one-on-one therapy and lots of repetition of sounds, sound sequences, and movement patterns in order to incorporate them and make them automatic.

Also, many therapists recommend the use of sign language, picture books, and other means to augment speech in the child who is not clearly understood. This approach may be called "total communication." Having the child pair a vocal word attempt with a sign enhances the chance that the listener will be able to "catch" the communication (if the spoken word isn't understood, perhaps the sign will be). Having others understand the communication can offer the child motivation and the feeling of success in using their voice to communicate. Many children with apraxia of speech, even at young ages, have some awareness of their difficulty. Providing successful communication experiences only encourages the child. Also, for children with apraxia of speech, signs can become important visual cues to help them know how to place their mouths, etc. in order to produce the desired word. When pairing of spoken word and sign is consistent, the child may come to associate the visual image of the sign with the placement of their articulators. Parents should not be afraid about using sign language with their child. Children will drop the signs on their own as their speech becomes understood.

~~What causes apraxia?
Apraxia of speech is felt to be a neurogenic (neurologically based) speech motor disorder. Many (or perhaps most) children with apraxia of speech have no abnormalities as detected by MRI scans. Others may have specific damage to a part of the brain that can account for the problem. In the latter case, some children are born with such damage and other children acquire damage to the brain by accident or illness. Through the Apraxia-Kids Internet Network we have learned that quite often children who later are diagnosed with apraxia of speech experienced some sort of incident prior to, during, or after birth. Medical doctors are either hesitant to acknowledge such a link or may even deny that such incidents are related to the speech problem; however, many parents on the Listserv find the possibility of such a connection interesting. Some of the birth problems reported in kids later diagnosed with apraxia of speech include: premature birth, placenta problems, umbilical cord around neck at delivery, meconium problems, or failure of a newborn to suck properly. This is not to say that all children born having any of these conditions will grow up to have apraxia of speech, nor that all children with apraxia experienced such problems. All that can be said is that some children diagnosed with this speech disorder have such histories. We know of no research that has been done on this link, only that through our discussion network we have seen this pattern mentioned repeatedly.

~~Will my child ever be able to speak "normally"?
With appropriate therapy (see above) and a lot of follow-through by parents and others, it is our belief that many children with apraxia of speech can become effective verbal communicators. Will speech ever be entirely "normal"? We do not know and research is lacking. We can report that we know of children who ultimately become good speakers and their "problem" is not detectable to nonprofessionals. Yet we want to be honest by saying apraxia of speech is a serious and challenging speech disorder. A lot of hard work on the part of therapist, parents, and child needs to occur. We can honestly say, however, that as parents use the Apraxia-Kids network to report on the successes and accomplishments of their children, we hear many reasons to hope for the best.

~~What are other associated features of apraxia?
Some report that "pure" apraxia of speech is quite rare. It appears that frequently children may experience other speech/language issues in addition to the apraxia. For instance, a child may have both apraxia and dysarthria, another motor speech problem involving weakness or paralysis to some degree of another. We know that apraxia of speech may be accompanied by diagnoses such as autism, Down syndrome, or cerebral palsy. Some children with apraxia of speech go on to experience difficulties in reading, spelling, or math while others do not. Many children with apraxia of speech also have fine motor difficulties with their hands, making certain tasks more difficult. Others do not have these problems. Some children experience sensory-related issues as well as apraxia of speech. These children may have sensitivities to sound, clothing, textures, getting their hands messy, etc. They may also have sensory integration difficulties in which they lack awareness of where their bodies are in space or are awkward or uncoordinated.

~~How do you know if you have a "good" therapist?
It is important to know that not all speech-language pathologists are equally skilled in providing treatment to children with apraxia of speech. Some are better-trained than others and some have evolved their expertise through years of experience. Parents should look for a speech-language pathologist who has experience and success in working with children with apraxia of speech. Don't hesitate to ask prospective therapists about their experience, credentials, and success with these children. A good therapist will take into account the uniqueness that your child brings. A good therapist will involve you in the therapy process and will understand how important you, the parent, are in the ultimate success your child will experience. Good therapists will invite you to observe therapy sessions, give you techniques you can use at home, listen to your ideas and concerns, communicate with others in your child's life, try to provide you with helpful information, and respect your knowledge about your child. A good therapist will readily admit what he or she doesn't know. A good therapist will be concerned if your child is not progressing and will not let unproductive treatment go on indefinitely. A conscientious therapist will then seek out additional information, change techniques, consult a colleague, or refer you to someone else.

It may be also helpful to identify some "warning signs" regarding speech-language pathologists. The following may be reasons you may want to consider finding a new therapist:
·the therapist tells you that children with apraxia will never develop intelligible speech.
·the therapist tells you it doesn't matter what your child's diagnosis is, their treatment will be the same as for other speech problems.
·the therapist does not include you or teach you how to help your child.
·the therapist is not helping your child to progress and doesn't seem concerned.
·the therapist does not have experience working with children who have apraxia of speech and appears unwilling to learn.

~~Will my insurance company pay for therapy?
This also is quite variable and depends greatly on your particular plan. We do know that many parents have difficulty getting insurance companies or HMOs to pay for treatment. One factor that seems to be extremely important is how the speech pathologist who did the evaluation describes your child's problem. Typically, it is wise to ask the evaluator to avoid using the word "developmental" in the diagnosis. Thus a diagnosis of "developmental apraxia of speech" is often challenged by insurance companies who say they do not pay for developmental delays. It is better if the evaluator uses terms like: apraxia of speech, oral/motor speech disorder, neurogenic speech disorder, oral and verbal apraxia. It is also important for the evaluator to describe the likely outcome for your child if they do not get appropriate treatment. Sometimes having the evaluator recommend a trial course of therapy in order to assess how the child does sits better with insurance companies.

If your claim is denied, always appeal the decision. Try to enroll your child's pediatrician and other medical professionals in advocating for your child. Find out why the claim was denied and resubmit the claim addressing these issues.<<<

C&P’d from http://www.apraxia-kids.org/faqs/faq.html

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SECTION 3 SENSORY INTEGRATION DYSFUNCTION

By sensory issues it could be that the child in question has a dislike of chunky textured foods, or dislike bright lights or loud, deep bass sounds, or dislike certain fabrics to touch him/her (silk or corduroy for example). Or it could be that he/she's sensitive to things touching him/her.

My ds is considered what I call a deep pressure/rough and tumble play kid....he SEEKS hard touch.....hard back rubs, running into you, being hugged hard, wrapped tightly in a blanket and dragged on a floor, a kids pop tent full of blankets and pillows to feel nice and tight and secure....heavy clothing, backpacks and shoes, likes to spin, swing, jumps REALLY hard (on floor, off the couch, off of his bed, jumps on his bed and on a mini trampoline we got at Wal-mart for $20- in the fitness section)...lifts heavy stuff, is VERY strong. So there are many different aspects of sensory issues....it's either hypersensitive (doesn't like something or is super-sensitive to it) or hypo-sensitive (like my son, LOVES and craves it, NEEDS it). These SID kids, depending on whether they are hypo or hyper in any of the categories (I can list them later if you like by looking at Justin’s evaluation and tests), either need the extra stimulation or need to avoid it in order to feel *right* and able to sit and concentrate. For Justin, the special needs teacher takes him right off the bus at school and into the gym for @ 15 minutes of really rough and tumble play. Then they go into the classroom with the 12 other kids (some typical preschoolers w/out disabilities, and some with) and he's able to play nicely, concentrate, not have temper tantrums, etc.

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What is sensory integration?

The senses work together. Each sense works with the others to form a composite picture of who we are physically, where we are, and what is going on around us. Sensory integration is the critical function of the brain that is responsible for producing this composite picture. It is the organization of sensory information for on-going use.
For most of us, effective sensory integration occurs automatically, unconsciously, without effort. For some of us, the process is inefficient, demanding effort and attention with no guarantee of accuracy. When this occurs, the goals we strive for are not easily attained.

Sensory experiences include touch, movement, body awareness, sight, sound, and the pull of gravity. The process of the brain organizing and interpreting this information is called sensory integration. Sensory integration provides a crucial foundation for later, more complex learning and behavior.

For most children, sensory integration develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to adapt to incoming sensations. But for some children, sensory integration does not develop as efficiently as it should. When the process is disordered, a number of problems in learning, development, or behavior may become evident.<<<
C&P'd from:
http://home.earthlink.net/~sensoryint/faq.html

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What are some signs of Sensory Integrative Dysfunction?

-Overly sensitive to touch, movement, sights, or sounds
-Underreactive to touch, movement, sights, or sounds
-Easily distracted
-Social and/or emotional problems
-Activity level that is unusually high or unusually low
-Physical clumsiness or apparent carelessness
-Impulsive, lacking in self control
-Difficulty making transitions from one situation to another
-Inability to unwind or calm self
-Poor self concept
-Delays in speech, language, or motor skills
-Delays in academic achievement
<<<
C&P'd from:
http://home.earthlink.net/~sensoryint/faq.html

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SID can be caused by/through.....
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Sensory integrative problems are not confined to children with learning disabilities, however. They transect all age groups as well as all intellectual levels and socio-economic groups. Consider the following human problems:

Premature birth - More and more premature infants survive today; they enter the world with fragile, easily over stimulated nervous systems and multiple medical complications. Parents need to learn how to give their premature infant the sensory nourishment their child requires for optimal development, and how to avoid detrimental over stimulation .

Autism and other developmental disorders - Although autism is rare, it occurs more often than blindness. Severe difficulty with sensory processing is a hallmark of the disorder. Autistic children seek out unusual quantities of certain types of sensations and are extremely hypersensitive to other types. Similar traits are often seen in other children with developmental disorders. Improving sensory processing leads these children to more productive contacts with people and environments.

Learning Disabilities - As many as 30% of school-aged children are estimated to have learning disabilities. Research indicates that a majority of these children, although normal in intelligence, are likely to have sensory integrative problems. These children are also more likely than their peers to have had a premature birth, early developmental problems, and poor motor coordination. Early intervention can improve sensory integration in these children, minimizing the possibility of school failure before it occurs.

Delinquency and substance abuse - Numerous studies indicate that learning disabled children are at risk for later delinquency, criminality, alcoholism, and drug abuse. Repeated failure in school opens the door to self-destructive activities. By interrupting the vicious cycle of failure, intervention to help children with sensory integration and learning problems may also prevent serious social problems later in life.

Stress related disorders - Sensory integrative difficulties that appear in childhood often are not outgrown. When sensory inefficiencies in adults do not allow them to perform optimally in the workplace, stress can build up. Additionally, there is mounting evidence that stress in parents can lead to child abuse, violence in the home, and problems that pass from generation to generation. Recognition of the sensory processing component of these problems contributes an important element in aiding people to achieve greater satisfaction in their home life and competence in their work.

Brain injury - Trauma to the brain from accidents and strokes can have profound effects on sensory functioning. People who suffer from these effects deserve treatment that will lead to the best possible recovery. In order for this to occur, their sensory deficits must be addressed by the health professionals who serve them.
<<<
C&P'd from:
http://home.earthlink.net/~sensoryint/faq.html
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Q&A: Sensory Integration Dysfunction

-What kind of behavior might indicate this condition?
Children with sensory seeking patterns may be hyperactive, unaware of touch or pain, touch others too often, engage in unsafe behaviors, such as climbing too high, or enjoy sounds that are too loud. Those with sensory avoiding behaviors may respond to being touched with aggression or withdrawal, be overly cautious or afraid to try new things, uncomfortable in loud or busy environments, or overly sensitive to smells. With children who have dyspraxia, some behaviors that can be observed are difficulty with fine- and gross-motor skills, clumsy and awkward movements and trouble with balance.

-How is Sensory Integration Dysfunction diagnosed?
Sensory Dysfunction is usually diagnosed by an occupational therapist, a speech and language pathologist or by a physical therapist. The primary standardized assessment tool for children ages 4 through 8 who may have learning, behavioral or developmental delays is the Sensory Integration and Praxis Test, which can be administered by a therapist who is SIPT certified. Therapists also use clinical observation and parent-teacher interviews to assess sensory integration dysfunction.
[NOTE: There is now an assessment test for toddlers for SID called "Infant/Toddler Sensory Profile' (ITSP)]

-How is Sensory Integration Dysfunction treated?
Occupational Therapy is used to treat the condition, with the goal of enabling children to take part in the normal activities of childhood. For example, therapists may evaluate how a child perceives sensation and how that affects his/her emotions, attention, motor skill or learning abilities. Treatment, which usually occurs in a sensory-enriched gym with tactile, visual, auditory and taste opportunities, can facilitate the development of the nervous system’s ability to process sensory input in a more normal way.<<<

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Another explanation of Sensory Integration Dysfunction (sensory issues)
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Sensory Integration
Cindy Hatch-Rasmussen, M.A., OTR/L
Therapy Northwest, P.C.
Beaverton, OR 97005

Children and adults with autism, as well as those with other developmental disabilities, may have a dysfunctional sensory system. Sometimes one or more senses are either over- or under-reactive to stimulation. Such sensory problems may be the underlying reason for such behaviors as rocking, spinning, and hand-flapping. Although the receptors for the senses are located in the peripheral nervous system (which includes everything but the brain and spinal cord), it is believed that the problem stems from neurological dysfunction in the central nervous system--the brain. As described by individuals with autism, sensory integration techniques, such as pressure-touch can facilitate attention and awareness, and reduce overall arousal. Temple Grandin, in her descriptive book, Emergence: Labeled Autistic, relates the distress and relief of her sensory experiences.

Sensory integration is an innate neurobiological process and refers to the integration and interpretation of sensory stimulation from the environment by the brain. In contrast, sensory integrative dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behavior. A general theory of sensory integration and treatment has been developed by Dr. A. Jean Ayres from studies in the neurosciences and those pertaining to physical development and neuromuscular function. This theory is presented in this paper.

Sensory integration focuses primarily on three basic senses--tactile, vestibular, and proprioceptive. Their interconnections start forming before birth and continue to develop as the person matures and interacts with his/her environment. The three senses are not only interconnected but are also connected with other systems in the brain. Although these three sensory systems are less familiar than vision and audition, they are critical to our basic survival. The inter-relationship among these three senses is complex. Basically, they allow us to experience, interpret, and respond to different stimuli in our environment. The three sensory systems will be discussed below.

Tactile System: The tactile system includes nerves under the skin's surface that send information to the brain. This information includes light touch, pain, temperature, and pressure. These play an important role in perceiving the environment as well as protective reactions for survival.

Dysfunction in the tactile system can be seen in withdrawing when being touched, refusing to eat certain 'textured' foods and/or to wear certain types of clothing, complaining about having one's hair or face washed, avoiding getting one's hands dirty (i.e., glue, sand, mud, finger-paint), and using one's finger tips rather than whole hands to manipulate objects. A dysfunctional tactile system may lead to a misperception of touch and/or pain (hyper- or hyposensitive) and may lead to self-imposed isolation, general irritability, distractibility, and hyperactivity.

Tactile defensiveness is a condition in which an individual is extremely sensitive to light touch. Theoretically, when the tactile system is immature and working improperly, abnormal neural signals are sent to the cortex in the brain which can interfere with other brain processes. This, in turn, causes the brain to be overly stimulated and may lead to excessive brain activity, which can neither be turned off nor organized. This type of over-stimulation in the brain can make it difficult for an individual to organize one's behavior and concentrate and may lead to a negative emotional response to touch sensations.

Vestibular System: The vestibular system refers to structures within the inner ear (the semi-circular canals) that detect movement and changes in the position of the head. For example, the vestibular system tells you when your head is upright or tilted (even with your eyes closed). Dysfunction within this system may manifest itself in two different ways. Some children may be hypersensitive to vestibular stimulation and have fearful reactions to ordinary movement activities (e.g., swings, slides, ramps, inclines). They may also have trouble learning to climb or descend stairs or hills; and they may be apprehensive walking or crawling on uneven or unstable surfaces. As a result, they seem fearful in space. In general, these children appear clumsy. On the other extreme, the child may actively seek very intense sensory experiences such as excessive body whirling, jumping, and/or spinning. This type of child demonstrates signs of a hypo-reactive vestibular system; that is, they are trying continuously to sti mulate their vestibular systems.

Proprioceptive System: The proprioceptive system refers to components of muscles, joints, and tendons that provide a person with a subconscious awareness of body position. When proprioception is functioning efficiently, an individual's body position is automatically adjusted in different situations; for example, the proprioceptive system is responsible for providing the body with the necessary signals to allow us to sit properly in a chair and to step off a curb smoothly. It also allows us to manipulate objects using fine motor movements, such as writing with a pencil, using a spoon to drink soup, and buttoning one's shirt. Some common signs of proprioceptive dysfunction are clumsiness, a tendency to fall, a lack of awareness of body position in space, odd body posturing, minimal crawling when young, difficulty manipulating small objects (buttons, snaps), eating in a sloppy manner, and resistance to new motor movement activities.

Another dimension of proprioception is praxis or motor planning. This is the ability to plan and execute different motor tasks. In order for this system to work properly, it must rely on obtaining accurate information from the sensory systems and then organizing and interpreting this information efficiently and effectively.

Implications: In general, dysfunction within these three systems manifests itself in many ways. A child may be over- or under-responsive to sensory input; activity level may be either unusually high or unusually low; a child may be in constant motion or fatigue easily. In addition, some children may fluctuate between these extremes. Gross and/or fine motor coordination problems are also common when these three systems are dysfunctional and may result in speech/language delays and in academic under-achievement. Behaviorally, the child may become impulsive, easily distractible, and show a general lack of planning. Some children may also have difficulty adjusting to new situations and may react with frustration, aggression, or withdrawal.

Evaluation and treatment of basic sensory integrative processes is performed by occupational therapists and/or physical therapists. The therapist's general goals are: (1) to provide the child with sensory information which helps organize the central nervous system, (2) to assist the child in inhibiting and/or modulating sensory information, and (3) to assist the child in processing a more organized response to sensory stimuli. <<<
C&P'd from:
http://www.autism.org/si.html

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Sensory Profile for Children Between Three and Ten
Edited by Shirley Sutton and Raena Rawlinson

This is a sample of a questionnaire based on research by Dunn and Westman, two Occupational Therapists from The University of Kansas. They based the questions on a sample of 1,115 parents of children without disabilities. The questions included here are helpful when a child begins to be evaluated by an occupational therapist. (Reprinted with permission.)

Think about your child and his or her reactions as you answer the questions. It is very helpful to consider how your child functions in different environments - in therapy, home and school. You may wish to make a copy for your child's teacher to complete. Check "yes" or "no" after each item on the parents' questionnaire. Many "yeses" suggest that sensory integration issues are a factor contributing to your child's overall performance, and you should explore this further with your child's professional team.

Sounds (Auditory)
Responds negatively to unexpected or loud noises (e.g.. vacuum, dogs, hand dryer)
Holds hands over ears
Can't work with background noise
Doesn't respond when name is called
Seems oblivious within an active environment


Visual
Prefers to be in the dark
Has difficulty putting puzzles together
Hesitates going up or down steps
Gets lost easily
Is bothered by bright lights
Stares intensely at people or objects
Avoids eye contact
Doesn't notice when people come in the room


Taste/Smell
Avoids certain tastes/smells that are typically part of children's diets
Routinely smells nonfood objects
Chews/licks nonfood objects (puts fingers or toys in mouth.)
Is a picky eater, will only eat certain tastes
Seeks out certain tastes or smells
Does not seem to smell strong odors

Body Position
Continually seeks out all kinds of movement activities (e.g. being whirled by adult, playground equipment, moving toys)
Hangs on other people, furniture, objects, even in familiar situations
Seems to have weak muscles
Tires easily, has poor endurance
Walks on toes
Moves stiffly
Can't lift heavy objects

Movement
Becomes anxious or distressed when feet leave the ground
Fears falling
Dislikes head upside down
Avoids climbing or jumping
Seeks all kinds of movement and this interferes with daily life
Avoids playground equipment or moving toys
Rocks without realizing it (e.g. while watching TV)
Takes excessive risks while playing, has no safety awareness
Twirls or spins self frequently during the day

Touch
Avoids "getting messy" in glue, sand, finger paint, tape
Is sensitive to certain fabrics (clothes, bedding)
Touches people and objects at an irritating level
Avoids going barefoot, especially in grass or sand
Displays unusual need for touching certain toys, surfaces or textures
Has decreased awareness of pain or temperature

Attention, Behavior and Social
Jumps from one activity to another frequently and it interferes with play
Has difficulty paying attention
Needs more protection from life than other children
Has trouble "growing up"
Is overly affectionate with others
Seems anxious
Is accident prone
Has difficulty making friends
Is overly serious
Doesn't have a sense of humor
Doesn't express emotions
<<<
C&P'd from:
http://www.apraxia-kids.org/topics/...ntegration.html


SENSORY ACTIVITIES:
Oral motor: blowing whistles, kazoos, recorders; blowing bubbles; blowing a leaf across the water. Teething toy for oral motor stimulation. Vibrating toy to help desensitize the mouth (for kids with the NEED for extra stimulation, or kids with extra-sensitive mouths)

Tactile play & fine motor movement: Shaving cream on a mirror and combs, plastic knives and spoons to move it all around. Or put shaving cream in a bucket and “hide” things in it....little rocks, counting bears, toys, etc. Markers on a mirror (the wipe off or washable kind of markers). Using a storage container, big pot or bucket, put in beans, rice, sand.....”hide” things in it and let kiddo dig in there and find them. Use shovels to dig, buckets and cups to pour...esp while holding one cup in one hand and pouring contents of one cup (in the other hand) into the first cup. Encourage them to bury things and then find them. Coloring on a magnadoodle, using magnets, etc for misc shapes. Finger painting, water color painting, coloring with pastels, colored pencils, markers, pens, crayons; cutting (Fiskars has a product that you squeeze the scissors, but they pop back open....my ds needs those as he has trouble with the opening them up part).....using glue sticks to make a collage of the paper/foam pieces they’ve cut. Building towers or rows of blocks. Connecting legos. Holding a book and turning pages individually (block books work best at first, then move to regular paper books). Helping mommy sort the clothing (socks in one pile, etc)...or matching socks (color/pattern recognition); setting the table (using large oak tag or construction paper, draw the places for a cup, plate/bowl, spoon, fork, knife and napkin....then use clear contact paper and make as many as there are people in your home....now your child knows what piece of tableware goes where!)

Gross motor movement/play: Swinging, climbing up the stairs or onto and off of the couch or chair. Make an obstacle course....drape a large sheet over your kitchen/dining room table so it’s a “tent”...stack some cushions on the floor, put a few books in a row.....you’ve got yourself an obstacle course! Start by stepping ONLY on the books step by step, climbing over the stack of cushions, then getting down on hands and knees to crawl under the table to the finish line! SO fun!

The blanket drag.....have your kiddo lay down in the center of a large blanket that is spread out on the floor. Then grasp one end of the blanket and drag your kiddo around a carpeted (SOFT!) area.

***There are lots of tricks for lots of things***
-taking digicam pics of items in your home and putting them into a 3-ring binder (like those photo albums with the plastic sleeves to slide pics into)....and then you can put pics of say, a gallon of milk with a glass/cup next to it....if your child wanted that and couldn’t sign or say it, he/she could open the book and find the picture.....thus meaningful expressive communication! You can use this concept to “label” where things go....such as taking a pic of books and putting the pic on the bookshelf, or taking a picture of blocks and using clear tape to secure it to the outside of the storage container. This will help the child identify what goes where, hopefully resulting in less frustration and confusion for the child!
-when the child eats (esp if they have food/eating issues) make a note of what the colors and textures of the foods are that they aren’t liking. There may be a connection! (don’t like green/yellow foods, or gritty foods, etc). Try making pictures with food....two peanutbutter crackers for eyes, raisins for mouth, pepper slice for ears, etc. Be creative or better yet, let your CHILD be creative! Getting your child involved in ANY part of the food-making process (stirring, helping to spread the pb on a piece of bread, etc) may help them see the foods and work with them, and may help them decide to try them or eat them!
-Put on some music....try different kinds from bluegrass to classical to ska or rap! Whatever gets your kiddo moving! Then dance yourselves silly!


No matter what, you need to figure out what your child’s sensitivities or needs lie. (such as are they sensitive to certain sounds or seek bright lights?) and then work around them....filling their needs and helping them cope with their sensitivities (sensitive to sounds? How about a pair of fluffy ear muffs to help muffle the sound?). Each child and family are different and you need to find and do what works for your child and family.
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>>>
Oral Defensiveness Activities
Young children who have feeding issues related to sensory disorder, tactile defensiveness, and poor motor coordination can benefit from stimulation activities at home by parents. Parents of children born prematurely who have sensory integration issues have found these activities to be helpful.

By Virginia Brick and Jacque Shatako

--->Virginia Brick suggests:
-A NUK oral massager for the gums (found in most pharmacies) We use this across his gum, tongue and around the sides of his mouth.
-A small finger brush (a little thing that fits over the finger and is used to brush baby's gums.
-A strong piece of sterile tubing (not sure where you get this as our OT gave it to us) C. bites down on it, under close supervision as he is 4 and I am always afraid he will chomp a piece off and choke. (fish tank aquarium tubing holds up well and is cheap!)
-We always offer him foods of different textures: pretzels, crackers, puddings, jell-o, ice cream, mashed potatoes, etc.
-Drinks of different temperature and "fizz". Ice water, warmer water and the odd "coke" which has that fizzle effect in the mouth.
-A regular toothbrush which we use the normal way plus brushing across his tongue and the sides of his mouth. The suggestion of the electric toothbrush would work too. We have only tried it once and found that the vibration of it startles him.

--->Jacque Shatako's son was oral defensive and was tube-fed until about 4 years old.

-One other thing our ST suggested was rubbing his face, around his mouth, with cloths of different textures of fabrics (like satin, velvet, etc.).
-Put peanut butter on his upper lip and have him lick it off...so he could learn to use his tongue to locate the food.
-One thing R. used to do when he as first learning to eat was to take french fries, dip them in ketchup and just suck the ketchup off. Eventually he learned to take small bites of the fries, too.
-We did a lot of positive reinforcement during eating attempts. I would read books to him at the table.Before I would turn the page, he had to swallow a bite of food. Or he would get tokens for eating a certain amount. Then he could cash the tokens in for something he wanted. Or we would put stickers in a notebook for him.<<<

The above was C&P'd Wrom: A
http://www.comeunity.com/disability/...ties-oral.html

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>>>Tactile Defensiveness Activities
Parents of children born prematurely have found these activities useful for tactile defensiveness.
(also for kids with hypersensitivity to things)

-I used a large Tupperware container and colored the rice and put small toys in and my daughter would look for them. (Linda Standiford)
-We used pudding and cool whip for finger-painting. I also got a plastic dish tub and filled it with various things such as rice, pinto beans, popcorn etc.. and we let him fill and dump with cups, bowls and spoons. I also let him use matchbox cars and action figures in there. I also have recipes for stuff called gak, goop, playdough that definitely had interesting textures. (Arla Vavra)
-You can put hair gel (DEP) in a gallon-size zip-lock baggie adding strong tape across the zip lock. Put enough gel so that the bag can lay flat. He can poke at it with his finger or feel the squishiness of the bag. A. (now 11) would draw pictures and letters on it with his finger when he was five to seven years. You can also do bags with different colors. (Dale Lips)

I try to plan A.'s day with SI in mind. For example, he snuggles on a big pillow in front of a heater in the morning when he is waking up. Sometimes I warm his clothes in the dryer right before he puts them on. He uses an electric toothbrush. During the day at school, the teachers have been asked to provide proprioceptive activities at least every hour -- erasing the blackboard, carrying heavy books, taking a short walk. When he comes home, I make sure he immediately has unstructured time. He usually goes in the backyard and plays for at least half an hour. Then he goes on a bike ride or walk. Idea -- he still loves to ride on a big wheel which gives him a lot of proprioceptive feedback. He also has always enjoyed pushing a cart on the sidewalk. Then by dinner time he is pretty tired. Ideally, he relaxes in the bathtub while I get dinner on -- does a lot of running the water, draining some and then running some more (one of his narrow, compulsive activities that some "experts" advise against and some say he obviously needs).(Dale Lips)
--Our OT is a big fan of vibrating toys, like Bumble Balls, back vibrators (they make one in the shape of Garfield), etc. (Bethe Danon)
-Walking on the grass and crawling on the beach were great exploration activities. A sand box and swing are wonderful in the back yard. I made playdough when he was younger and then used theraputty when his grip was stronger. I would hide pennies (he didn't put things into his mouth at that stage) and we would pull on the putty. He was a really messy eater - fingers in everything, throwing, and so on - so he provided his own tactile play, in a way. When using a towel after bath, especially on his head, we found that a quick and strong embrace worked best. I also held him on my lap a lot, especially for finger play, songs and reading books together. (Allison Martin)
-We used salt trays at one school I taught at. If you use enough, you can hide little things in it. (Suzi Gillen)
-The two things that seemed to help K. the most were glue, both colored and white. Just squeezing it on paper (good for finger strength, also) and smearing it around. It took a while, but I would make a big deal about how neat it was, and fun, to let it dry on the fingers and peel it off. Once I got her to do it, it made a big difference with other things, too (although her problem was mild, and now very slight at all). The other thing was getting her to find objects in a bowl of rice and/or beans. (Kathy Stanina)
-Sometimes when Katie's hands had something on them (glue, paint or even food at meal time) she would want to wash it off right away. I would distract her, making her wait to wash her hands for just a few minutes, so that she would see that it is not the "end of the world" to have something on her hands. It really worked well.(Kathy Stanina)
-Something that I found fun and practical was having my son help me with baking and helping me bake bread. K. loves to help in the kitchen anyway so this was a good approach for him. He was a bit hesitant about kneading the bread dough but after a while was willing to try. This definitely helped his tactile issues. We also baked cookies (rolled) so he would play with that dough as well. Of course, we still bake together and he is always eager to help. I passed this idea on to his OT specialist and she thought it was a great idea. (Vivian Skordahl)
-C., who is autistic, is very tactile defensive. Most of these things we do hand over hand, but he is improving. Not all of these things are "messy" but here are some things we do with him (Virginia Brick):
1. The shaving cream/foam as you mentioned.
2. A large bowl of beans/seeds with toys placed in them, similar to the rice suggestion.
3. A sand box outdoors for summer time.
4. A water table, in our case, bathtub. Filled with bubbles galore, this is done outside of bathtime as he will not go into it but we just "help" him to touch the bubbles. Sometimes we add colour to the water with food colouring but right now that is too drastic for Cameron.
5. We "brush" him with a surgical brush. (aka brushing)
6. We also rub him with other textures, terry towel, smooth fabric, etc.
7. Have him "attempt" to hold a "Kooshie" ball, those little rubber balls with, hard to describe, soft little rubber strings?!
8. Have him walk on the grass barefoot in summer.
9. Have him walk across different textures of carpet barefoot.
10. Play-doh and other types of clay.
11. Painting using not just paint but pudding as well.<<<

The above was C&P'd from:
http://www.comeunity.com/disability/...s-tactile.html
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>>>How do I get the diagnosis? Do I call his pediatrician, take him in & say I think it is this? Do I call the child psychologist & she evaluates him? Do I bring it up at his next evaluation for his IEP? Or, does it really matter if a professional gives the diagnosis? Can anything besides wearing him out with activity help? I would appreciate any answers anyone has.<<<

Okay, yes, a kiddo can be hyper (meaning VERY) or hypo (as in not very) sensitive/reactive to things. Let me try to find some more definitive info for you.....

Okay, below was C&P'd from: (ugh! Can’t find the link, but it was C&P’d from a site here on the web having to do with SID)

Sensory Overload
July 21 — For most children, the exploration of new sights and sounds is exhilarating.
But for 5-year-old Tanner, noise can be painfully overwhelming, setting him off on a temper tantrum. Even his own mother’s touch can be traumatic for him.
“There were times when I couldn’t understand how upset he would get,” says his mother, Karen. “It didn’t seem just behavioral to me. It seemed something else was going on.”
In fact, there was something else going on. After years of searching for answers, Tanner was diagnosed with Sensory Integration Dysfunction, abbreviated DSI (Dysfunction in Sensory Integration, so as not to be confused with Sudden Infant Death Syndrome, SIDS).
What Is the Condition?
DSI is a complex neurological disorder, manifested by difficulty processing sensations. DSI causes children to process sensation from the environment or from their bodies in an inaccurate way, resulting in “sensory avoiding” patterns. Children with DSI can also have “sensory seeking” patterns or “dyspraxia,” a motor planning problem.
Children with sensory seeking patterns do not always process that sensory input is coming in to the brain, so they may seek out more intense or longer duration sensory experiences. Those with sensory avoiding tendencies have nervous systems that feel sensation too easily or too much. They are overly responsive to sensation, so certain sounds and touches may feel painful, making them respond with aggression or withdrawal. Children with dyspraxia have difficulty with fine- and gross-motor skills and trouble with balance.
Like Tanner, 6-and-a-half-year-old Emma Reinhardt is overly sensitive to sensation.
“Things that can be just simply annoying to the rest of us, can actually be painful to her,” says her mother, Terri Reinhardt.
For example, Emma’s head is extremely sensitive to touch and she finds the sound of running water painful, so washing her hair generally involves kicking, screaming and crying. The size and feel of a bathtub also frightens Emma, so she usually takes a bath in a small bucket in the kitchen. Whenever her brother plays the violin, she screams, and clipping her toenails is an ordeal.

Improving Quality of Life
Though Sensory Integration Dysfunction can often go undetected or be misdiagnosed, it can be treated. Occupational therapy can facilitate the development of the nervous system’s ability to process sensory input in a more normal way.
In Emma’s case, an occupational therapist works with her to confront the sensation she fears. To change her reaction to sound, she is encouraged to blow a toy whistle while she swings an activity that calms her. To learn how to cope with her sensitivity to touch, the occupational therapist strokes her arms with brushes.
“If we can find these kids early, we can prevent them from losing self-esteem,” says Lucy Miller, Ph.D., an occupational therapist who directs the Sensory Integration Dysfunction Treatment and Research center at The Children’s Hospital in Denver. “We can prevent school failure, we can prevent all kinds of family problems.”
While therapy is not a cure, some experts speculate that it may actually change the way the brain experiences sensations, so that the child can begin to respond in a more normal way.
For Tanner, such therapy has made all the difference.
“Therapy for Tanner has completely given him quality of life back,” his mother says. Her son is happier, has fewer outbursts and gets along better with people.
And now the loving touch of his mother no longer leaves Tanner shouting in pain.


Books on Sensory Integration:

Sensory Integration and the Child, by A. Jean Ayres, 1979.
This is the original work from the person who first recognized and researched the concepts of sensory integration. Although continued research since the publication of this book has altered SI theory in some ways, this remains an outstanding work.

The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction, by Carol Stock Kranowitz, 1998, ISBN 0-399-52386-3.
This is an excellent, parent friendly presentation of the challenges involved in the diagnosis, treatment, and everyday needs of children with SI dysfunction. ***I personally HIGHLY recommend this book for a great beginning understanding of SID.

SenseAbilities: Understanding Sensory Integration, by Maryann Colby Trott, M.A., with Marci K. Laurel, M.A., CCC-SLP, and Susan L. Windeck, M.S., OTR/L, 1993, ISBN 0761642838.
This is published by Therapy Skill Builders, and therapists have the option of photocopying selected portions of the book for parents to take home. The pamphlets can also be purchased in sets of 5. Ask your therapist about it...

Out of the Mouth of Babes: Discovering the Developmental Significance of the Mouth, by Frick, Frick, Oetter, and Richter, 1996, published by PDP Products.
A 30 page pamphlet explaining the importance of the mouth in the development of life skills. Designed for parents and teachers.

The Child with Special Needs: Encouraging Intellectual and Emotional Growth, by Stanley I. Greenspan, M.D., Serena Wieder, Ph.D., with Robin Simons, 1998, ISBN 0-201-40726-4.
Billed as "The comprehensive approach to developmental challenges including autism, PDD, language and speech problems, Down syndrome, cerebral palsy, ADD, and other related disorders", this book includes methods for parents and professionals to interact in productive ways with children who have significant sensory disturbances. The focus is on building intimate personal relationships with the child, which is seen as the foundation for communication and learning.

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SECTION 4 Justin’s Evaluation at 3 years and 3 months old

FWIW, this is my son’s evaluation from the local UK Developmental and behavioral Pediatrics clinic that he had done in August of 2002.

>>> University of Kentucky
College of Medicine
Department of Pediatrics
Infant-Toddler Evaluation Center
1030 South Broadway Street
Suite 6
Lexington, KY 40504
Tel: (859)257-1958
FAX: (859)323-1004

Name: Justin Wheeler
DOB: 6-3-99
UKMC#(removed for security of my ds’ records)
DOE: 9/4/02 (date of exam)
Age: 3 years, 2 months

Reason for referral: Justin was brought in for evaluation by his mother because his physician wanted further evaluation for ongoing sensory integration and speech issues, as well as behavioral issues.

HISTORY:
The following information was obtained through an interview with Justin’s mother, Stacy Wheeler, a review of available records, informal observations, and physical examination.

History of Present Illness: Justin’s parents became concerned about his speech when he was two years old and was only saying single words. He was referred to First steps, where he received speech-language therapy, occupational therapy, and developmental intervention. There have been concerns throughout that he had poor eye contact, was not interested in peers except for rough, active play, and had difficulty with transitions. He was reevaluated for his transition to the public school preschool setting, and considerable delays were noted in communication, motor skills, and social competence. Mrs. Wheeler is specifically concerned about whether Justin has autism, although she notes that he is very different from the child who has been diagnosed with autism whom she baby-sits.

Pregnancy History: Justin was born to a 26-year-old mother. This was his mother’s first pregnancy and it was planned. Mrs. Wheeler had prenatal care and gained 80 pounds during the pregnancy. She reports that fetal activity was normal, and routine sonograms during the pregnancy were also normal. Mrs. Wheeler had gestational diabetes during the pregnancy, and she experienced pre-term labor beginning at 4 months gestation, for which she took Terbutaline. Her membranes ruptured one month before her due date. Mrs. Wheeler denies any alcohol, tobacco, or illicit drug use during pregnancy.

Birth History: Justin was born at 36 weeks gestation. Labor lasted less than four hours, and Justin was delivered by cesarean section because of breech presentation. His birth weight was six pounds, 12 ounces. After delivery he was tachypneic and spent five days in the Neonatal Intensive Care Unit (NICU). He was in an oxygen hood for two or three days, and he was treated with antibiotics for an unidentified infection. Justin’s neonatal course was also significant for jaundice, which his mother feels was related to breast-feeding. (*this was a part I thought needed to be reworded, but it’s a known fact that bfing can inhibit biliruben from leaving the body as fast as ff babes). He continued to breast-feed, and his mother put him in the sun by the window. Jaundice was resolved within two weeks.

Past medical History: Justin has had no hospitalizations. He was sedated for 10 cavity fillings but has had no other surgeries. He has had no (*another change will be made here..he went to all well baby checkups until 2 y/o, then only as needed..I’ve records to prove it) regular healthcare maintenance appointments, only going to the physician when he is ill. Justin has had frequent otitis media and possibly had lead exposure as an infant, which was never followed up. his immunizations are up-to-date. He has no allergies to medications; however he is allergic to latex and vinyl. He takes Poly-Visol vitamins. In the past, he has been on Nalex (guanfenesin and pseudoephredrine) and antiobiotics for ear infections. (*new allergies found: Ibuprofen [motrin/advil] & Zithyromax)

Review of Systems: Non-contributory.

DEVELOPMENTAL HISTORY: Justin’s parents first became concerned about him when he was about 24 months old and saying only single words, mostly limited to appropriate use of “mama” and “dada.”
Gross Motor: Justin sat supported at four months and walked alone at nine to ten months. He does not yet pedal a tricycle.
Fine Motor: Justin developed a pincer grasp by 12 months and was right-handed by two years.
Speech/Language: Justin had a social smile at four months and first used “mama” and “dada’ inappropriately at 12 months. He is currently receiving speech therapy and has been receiving this service for about one year. He has been previously diagnosed with verbal dyspraxia.
Adaptive: Justin has problems with gagging easily, and he dislikes mushy or soft textured foods. He has no problems with vomiting or drooling. He fed himself with his fingers by 10 months. He will use a spoon for cereal, but generally does not eat foods requiring a spoon, as these are usually mushy or soft. He uses a fork and drinks out of a sippy cup. Justin undresses himself and assists with dressing, and he sometimes puts clothes on backwards or inappropriately if left to do it by himself. Justin wears underwear during the day and pull-ups at night; however, he still has some difficulty with bowel movements in the toilet.

PREVIOUS EVALUATIONS: Justin has been evaluated as part of the First Steps program, and he received occupational therapy, speech therapy, and developmental intervention. He has just recently aged out of the First Steps program.

Justin had an educational assessment when he was 27 months old. Along with parent interview, he was assessed using the Early Intervention Developmental Profile (EIDP) and the Assessment, Evaluation, and Programming System (AEPS) for Infants and Children. In cognitive domain, he was functioning at the 24-month level, and in the social-emotional domain, he was functioning at the 23-month level, with scattered skills to the 27-month level. The examiner noted that “While Justin is close to age level with cognitive and social skills, his difficulties with sensory processing often lead to inappropriate social behaviors.” He was recommended to receive educational services in the classroom. At the same time, he had a speech-language evaluation using the Rosetti Infant-Toddler Language Scale (Rosetti). He demonstrated mastery of skills in the Interaction-Attachment domain at the 0-to-3-month level, with a range of skills up to 18 months; mastery of Pragmatics at the 6-to9-month level, with a range of skills up to 21 months; mastery of Gesture at the 12-to-15-month level, with a range of skills up to 27 months; mastery of Play at the 12-to-15-month level, with a range of skills up to 30 months; mastery of Language Comprehension at the 0-to-3-month level, with a range of skills up to 21 months; and mastery of Language Expression at the 0-to-3-month level, with a range of skills of up to 21 months. He was recommended for speech-language therapy.

Justin had a speech-language evaluation when he was 30 months old. On the Rosetti, he demonstrated mastery of interaction and attachment skills and pragmatic skills at that 9-to-12-month level; mastery of gesture at the 12-to-15-month level; mastery of play skills at the 15-to-18-month level; mastery of language comprehension at the 3-to-6-month level; and mastery of language expression at the 6-to-9-month level. He was suspected to have developmental verbal dyspraxia, but final diagnosis was deferred pending more observation. It was recommended that he have speech therapy.

When he was 34 months old, he was evaluated for assistive technology as part of his transition to the public preschool. The team recommended supplementation of speech with picture symbol communication, use of communication and literacy boards, a voice output device, and the use of a single-switch instructional software as specially designed instruction.

The Jessamine County School System evaluated his speech and language and need for occupational therapy when he was 35 months old. On the Preschool Language Scale, edition not indicated (PLS), he achieved a standard score of 57 in Auditory Comprehension, of 65 in Expressive Communication, and of 57 in Total Language. He demonstrated severe language disorder characterized by a limited expressive and receptive vocabulary and difficulty following directions. The examiner noted that he produced a variety of consonant and vowel sound spontaneously in words, but he had difficulty imitating speech sounds in isolation and imitating oral-motor movements. He had decreased eye contact and made no attempt at greeting. On the Infant/Toddler Sensory Profile (ITSP), his scores in the areas of vestibular processing, auditory processing, visual processing, tactile processing and oral sensory processing were in the Performance at Risk range. On the Peabody Developmental Motor scales (Peabody), he achieved a standard score of 9 in Grasping and 6 in Visual-Motor Integration, with a Fine Motor Quotient of 85. On the Vineland Adaptive Behavior Scales (Vineland), Justin demonstrated Communications skills in the low range, Daily Living skills in the moderately low range, Socialization skills in the moderately low range and Motor skills in the average range. Overall, his Adaptive Behavior Composite was in the moderately low range. On the Behavioral Assessment System of Children -Parent Rating Scales (BASC-PRS0, Mrs. Wheeler endorsed behaviors which indicated that Justin’s behaviors were within the Average range in the areas of externalizing problems, internalizing problems, atypicality, withdrawal, and attention. Recommendations included speech-language services, a focus in his instructional program on improving his toileting and self-care skills, encouraging interactions with adults and peers, instruction on appropriate behaviors for expressing wants and needs, and the minimizing of distractions in the classroom.

EDUCATIONAL HISTORY: Justin is currently enrolled in the Jessamine Early Learning Village. His class has both developmentally appropriate and special needs children. There are 13 children in the classroom, ranging in age from three to four years. He receives specially designed instruction under the classification of Developmental Delay, and he receives 30 minutes per week of occupational therapy for sensory processing, 60 minutes per week of speech-language therapy for expressive and receptive language delays, and 30 minutes per week of Assistive Technology for consultation for implementation of assistive technology.

When he was two, Justin attended the Child Developmental Centers of the Bluegrass (CDCB) two days a week. He received occupational therapy, speech-language therapy, and developmental intervention.

BEHAVIORAL HISTORY: Justin enjoys playing with trains and especially likes watching the wheels go around on them. He also enjoys watching the wheels on his tricycle spin around when it is turned over. In general, he does okay with new people, although he does not like men with beards. (*will be changed to read “does not like men without beards). He looks in the direction in which people are pointing things out to him, and he points things out to other people. He averts his gaze about 75-percent of the time, according to Mrs. Wheeler. She sometimes has to make him look at her. He leads adults to a desired object or area of the room. He has no stranger anxiety, and he is not clingy in non-stress situations. He does not play pretend, but he imitates movies, such as “Jimmy Neutron,” which is his current favorite. He does not show social reciprocity, although he will sometimes play roughly with other children. He does not share toys. He is not completely inflexibly and rigid, but he has trouble with transitions, and his parents make accommodations for him when they go on trips or change routines. These accommodations include having a movie in their van, so that he can watch his favorite show as they travel. Justin has temper tantrums if his mother takes him away from a preferred activity. He does not have a short attention span if he does some rough and tumble play first, as he does at school, or if he is doing something he likes. He is occasionally hyperactive. Justin has problems sleeping and he wakes up several times a night. His parents lock him in his room at night, because otherwise he goes through the house and gets into things. (*will be changed to read something like “Justin has to be locked into his bedroom at night for safety reasons, he awakens several times per night and would wander around the home and get into things.”) He does not bang his head or rock, but he grinds his teeth when he is awake. He comforts himself while watching television by twisting a lock of his hair and drinking from a sippy cup. He wears a weighted vest at school, carries a heavy backpack, and wears heavy shoes to help with his sensory integration issues. These things also help him with making transitions smoothly.

FAMILY HISTORY: There is a family history of thyroid problems in the mother, which required part of her thyroid to be removed; or ureteral reflux in the mother as a child, which resolved at 12 years; and of clubbed feet in the maternal grandmother. There is no family history of mental retardation, learning disabilities, attention problems, or seizures.

SOCIAL HISTORY: Justin lives with married parents. Justin’s mother is now 30 years old and has thyroid problems. She completed some college and is not employed outside the home. During the day, she baby-sits a child who is autistic. Justin’s father is in good health. He completed some college and works for the Lexington Herald-Leader while he finishes his college education. Both parents were in the military in the past. Justin has no siblings.

PHYSICAL EXAMINATION:
Measurements: Height: 40 inches (75th percentile)
Weight: 40 pounds (95th percentile)
Head Circumference: Not obtained.
Temperature: 96.4 degrees F
Blood Pressure: 94/61
Heart rate; 119 BPM

General: Justin is a well-developed, well-nourished boy. He was in a stroller and strapped in with a waist band, as this is his position of comfort. He did not make eye contact with the examiners as they entered the room or when they spoke to him. Justin was cooperative with the exam as appropriate for his age; however, he was difficult to engage in any conversation.

Head: Normocephalic, atraumatic.
Eyes: Normally formed and set. Sclera white. Pupils equally round and reactive to light and accommodation.
Ears: Normally formed and set. Tympanic membranes gray and mobile bilaterally.
Nose: No erythema or exudate.
Throat: Normal palate. Mucous membranes moist. No erythema or exudate.
Neck: Supple, with full range of motion.
Chest: Symmetric expansion with good air movement. Clear to auscultation bilaterally. No wheezes or rales.
Heart: Quiet precordium. Regular rate and rhythm. Normal S1 and S2. No murmurs. pulses equal in right radial and right inguinal areas.
Back: Non-tender and without obvious asymmetry.
Abdomen: Soft, non-tender, and non-distended. Normoactive bowel sounds. No hepatosplenomegaly or masses.
Extremities: Pink and warm, with brisk capillary refill. No cyanosis or clubbing.
Skin/Hair: No lesions.

NEUROLOGICAL EXAMINATION:
Cranial Nerves: Fundi not assessed. Pupils equally round and reactive to light and accommodation. Extraocular movements intact. Strong jaw clench. Intact corneal reflex. Symmetric facies with symmetric sensation. Intact gag. Strong, symmetric shrug. Tongue midline when protruded.
Cerebellar: No ataxia, nystagmus or tremor.
Deep Tendon Reflexes: 2+ bilaterally in the biceps, triceps, brachioradailis, knee and ankle. No clonus.
Pathologic Reflexes: None.
Motor: Normal in mass, strength and tone. No abnormal movements. Age-appropriate abilities.

DIAGNOSTIC IMPRESSIONS:
1. Autism Spectrum disorder.
2. Sensory Issues.
3. Previous diagnosis of verbal dyspraxia.

PLAN:
1. Justin would benefit from continuing in a structured preschool, such as the Jessamine Early Learning Village.
2. Justin would benefit from continuing occupational therapy.
3. Justin would benefit from continuing speech therapy. He would benefit from frequent, intensive speech therapy, since verbal apraxia involves intensive therapy for treatment. If he attends therapy outside of the preschool setting, his outside therapist and his in-school therapist should be in close contact to insure that therapy is consistent and coordinated. (*will be rewritten to be stronger wording about having additional out of school setting intensive speech therapy for verbal dyspraxia, and it being STRONGLY recommended!)
4. Justin should return to the clinic in one year.

Karen J. Mason, M.D.
Assistant Professor
Developmental-Behavioral Pediatrics

Laura Whitney, M.D.
Intern
Pediatrics<<<


PLEASE NOTE
Regarding this portion, " His parents lock him in his room at night, because otherwise he goes through the house and gets into things."
I already feel pretty crappy about having to do it, but I assure you it is for safety reasons. I sleep downstairs on the couch so I can hear every movement from him upstairs....if he's awake and jumping on the bed, crying, knocking on the door, fallen out of bed, etc. My ds is very explorative and no baby gate or unlocked door will stop him anymore. He's very strong and can move furniture. In other words, he knows how to stack stuff to get over a baby gate, and he's strong enough to knock them over....which could result in a serious injury. His bedroom is upstairs and there is no other way to keep him safe. Co-sleeping with Justin, who routinely wakes several times a night, doesn't work...he sees me and thinks its play time, no matter how hard I try to cuddle him back to sleep. And not only that, but I don't sleep. So nothing else we've tried works. I just don't want anyone to think I'm a cruel kid cuz I have to lock him in his bedroom at night.

Hopefully you’ll get an idea of what the doctors look for as far as behaviors go.

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

SECTION 5 Websites to check out for more information

AUTISM:

-Autism Society of America
http://www.autism-society.org/site/P...rx75shzt.app6b

-Do a search on www.google.com and type in Autism Society of (insert your state here).

-Autism and SS:
http://autism.about.com/library/week...htm?once=true&

Center for the Study of Autism
http://www.autism.org/contents.html

Cure Autism Now Foundation
http://www.canfoundation.org/

Autism/PDD Resources Network
http://www.autism-pdd.net/



VERBAL APRAXIA:

-Developmental Verbal Dyspraxia: Info for parents
http://www-unix.oit.umass.edu/~velleman/cas.html

-Straight talk about verbal dyspraxia
http://www.fortunecity.com/millenniu...raxiamain.html

-Apraxia Kids http://www.apraxia-kids.org/
-Here's the index of topics....great listing!!
http://www.apraxia-kids.org/indexes/indexhelp.html


SENSORY INTEGRATION DYSFUNCTION:

Sensory Integration International/The Ayers Clinic
http://home.earthlink.net/%7esensoryint/

PEC PICTURES FOR AUGMENTATIVE COMMUNICATION:
Pec pics link........
these are little pics you can print off of stuff like potty, wash your hands, go bye-bye, etc...that your child can point to or give you (cards, etc) to help your child communicate more effectively. My ds is autistic and has verbal apraxia so his expressive communication is lacking. This makes him frustrated at his inability to make us understand what he wants or needs and then he has a tantrum. Since using this picture system in school he's done SO Much better!

Here's the link (scroll down to the PEC pictures!)
http://trainland.tripod.com/pecs.htm

PLEASE share this with other mamas. I can't begin how important it is for your child, esp if they have developmental delays or other similar issues, to be able to communicate with you and others effectively. If not PEC pics, then try some basic ASL. (we use pics and words (him talking) and ASL in combination. Justin reverts to signs when he's getting frustrated at us not understanding him.)

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Stacy Wheeler
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