16 September, 2009

Notes About Jake

These are the notes I gave Wonderskool when Jake began school. I just got a copy of proposed goals from the teacher this afternoon, and we will be working on them together tomorrow morning. I got teary when I read her goals for Jake. It is so very clear that they see him, really *see* him.

The teacher wanted a cheat sheet on Jake so they could know a bit more about him before they met him in class, so here is what I sent:

Language

Jake is considered non-verbal, but speaks on occasion. When he does it is relevant, important, clear, and often funny. He has also spoken in Spanish.

He has sworn in frustration and noticed the rainy weather by saying “agua”. He has made commentary about a bad presentation “That’s stupid.” and expressed affection by saying “love”. He will say “uh-huh” and “no” at least once a day in response to something, and we have heard him say “Mom” more often in recent months. He signs “more” by using his left hand and tapping it against his side. He does not use any other typical signs.

He will often squint or twitch his eyes closed for a yes response, and when he is happy it is very clear by his utterances.

Physical

Jake comes with a diagnosis of CP, ataxia which basically means he sometimes looks like he walks like a drunk. When he is more tired his physical disability becomes more pronounced. When he was younger much attention was focused on his physical disability rather than any behavioral or academic issues because we all so desperately wanted him to walk, which he did just after his second birthday. He walked completely independently within that next year, and has slowly mastered many typical milestones: stairs, walking over objects, climbing on top of things (but not ladders) and just recently jumping rather than walking off of a low height.

Jake has low tone, and quite often his slouching and putting a foot up on his chair looks like a behavioral issue, when he is really trying to get more support for his trunk. He will cross mid-line, and uses his right hand almost exclusively, but has very poor bi-lateral coordination and so cannot pedal his tricycle. He has not mastered pincer grasp, but uses it on occasion, and he does not use both hands to carry objects, choosing to rely on his right hand against the item and his body instead.

In the last six months he has finally handed me an object when verbally prompted, and was able to use this skill again with another adult.

Academic

While it can be difficult to assess Jake, we believe he knows his colors, letters and numbers. When completing discrete trial learning so we could get a base line for each color and number he became increasingly bored and non-compliant, so we went back to asking him to choose from a field of four and he has at least 80% accuracy. Of course if you ask him for the red crayon he may take all of the crayons and leave behind the red one, rather than ever hand you the red one himself

He regularly uses icons, and a four-talker output device. He has just moved to an eight-window device.

He does not like hand-over-hand in general, but this often has to do with how much he likes his aide. Because his grip strength is variable, and his fine motor skills are so poor, he does not hold a writing instrument “properly”, or use scissors.

Two years ago he could not get his hand into a bucket a foot across, and he can now get his hand in and out of a pretzel bag without knocking it off the counter.

Self-care

Jake will help with dressing by putting his head through and placing his arms and legs into the proper parts of the clothing. He cannot pull off his own pants on a regular basis, but when a pair of pants was bothering him recently (tag issues) he was able to remove the pants by himself (but since we did not see him do it, we are just guessing that he used his feet to step on the legs and pull them off).

Jake is not toilet trained, but knows when he is wet/soiled and will often come to us to be changed. He will not eat wearing a wet/soiled diaper, and is showing an increased need for privacy by closing the door after we enter the bathroom. He is probably ready for a timed-void regimen.

Jake does not mind having his hands washed, but he does not ever liked to be held down so washing one hand at a time is the most successful model.

He has a high tolerance for pain, cold and heat, so we make these choices for him. When Jake is in physical pain due to injury he becomes silent and breathes haltingly. He was able to walk around our backyard with a three-inch nail all the way through his foot barely limping. He is constantly covered in bruises, and scratches.

Medical

In addition to typical Autism symptoms, CP ataxia and global developmental delay, Jake also suffers from two other issues.

“Episodes”

In the past: Pain from unknown source for 9-11 days every 5-6 weeks “episodes” resulting in near loss of sleep, severe agitation, self-injurious behavior and complete non-compliance. Jack also suffered from panic attacks, which could blow up into major tantrum/agitation.

Current: Pain has been partially attributed to migraines. Episodes continue to come every 5-6 weeks; duration has been decreased to 5-6 days. Severity seems to have diminished slightly. Reduction in symptoms can be attributed to better use of psychotropic drugs (Zoloft, Valium), better communication between home and school (to identify early symptoms) and use of Maxalt, an anti-migraine drug. Panic attacks have decreased dramatically.

Jake still has severe agitation during episodes.

ADHD

In the past: Inability to sit still in school, unable to calm down for dinner at home. Complete inability to eat in public, difficulty being calm enough to safely be a part of the community. Escaping, physical non-compliance led to (mild but constant) injury of both parents. Use of Adderall was ineffective after 6 months, adding late afternoon short-acting Ritalin had mild success.

Current: Jake now takes 18 milligrams of Concerta which lasts through most of the day without the side effect of aggression or tears as the medicine wears off. Evening (6-8pm) is still difficult because the medicine is out of his system, but his behavior is more manageable and not as dangerous to himself or others. Camping, hiking or other outdoor activities (including a grocery store parking lot!) which are not safely guarded continue to be a problem; Jack’s hand must be held AT ALL TIMES or he will run away.

Social/Family

Jake will greet people by grazing them with his hand, or by looking at them with a sideways glance. He has recently shown much more intimacy with his grandparents, nudging them to hold hands, and leaning in for hugs. If you ask him for a kiss or hug he will lean in if he wants to have it happen, or lean back if he does not. He recognizes familiar people and places, and develops strong attachments to his caretakers. He is a physical child, but won’t hold still for long. He loves to wrestle and be tickled.

He is gentle with his younger sister, and cautious in general around small children. He smirks when his sister cries to try to get what she wants, or for an unnecessary reason, but is quiet and attentive if someone is hurt.

He enjoys visits to Tahoe to visit his cousins, and likes to watch other kids his age engage in typical behavior. He is not violent towards others, except to flail in an attempt to disengage from the activity if he is in distress.

He will wait until another child abandons a toy before seeking it, but will circle around it while the other child is playing with the toy. He has hidden toys before to make sure no one else gets them (or at least it appears that way.)

When people treat Jake with respect, he normally proves himself to be a sweet boy who enjoys interaction with adults and children. When his caretaker, or those around him are unsure or disrespectful (speaking unkindly about him) he is uncomfortable and will not be persuaded to demonstrate very many abilities.

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