Officially Official Autism Diagnosis

I applied to the Agency for Persons with Disabilities a while back (originally shared with you in this post).

I found out last week that they have approved RoseBud for services.  She is on an incredibly long waiting list, but by the time she is an adult she should have some help through the agency.

The hold up for the APD was that they wanted a specific Autism test called an ADOS (Autism Diagnostic Observation Schedule) with a full psychological evaluation that showed without a shadow of a doubt that she was clearly Autistic and not just mentally retarded or ‘on the Autism spectrum’ (Aspergers, PDD-NOS, Rett Syndrome are not covered under the APD).

RoseBud went to visit with the psychologist a few weeks back to do the ADOS (module 2) testing.  She was 8 years and 4 months old when she had the test done.

The ADOS Module 2 had these components:

  • a construction task
  • response to name
  • make-believe play
  • joint interactive play
  • back and forth conversation
  • response to joint attention
  • demonstration of a task
  • description of a picture
  • telling a story from a book
  • free play
  • a pretend birthday party
  • anticipation of a routine with objects
  • playing with bubbles

Module 2 allowed me as mom to remain silently in the room.  This test was comprised of several areas which were scored to give a clearer picture of an accurate diagnosis (along with extensive records review and questionnaires).

Language and Communication – this included use of words and word combinations, reporting of events, use of gestures to communicate and use of to and from conversational skills.

Client primarily communicated using 2 or 3 word phrases with minimal grammatical markings.  She frequently repeated the phrase “play something else” when she wanted to transition to a different activity.  Her speech was flat and monotone.  Client did not express any echolalia and also did not make any noticeable attempts to attain the examiner’s attention.  She did not participate in any reciprocal conversation, and her spontaneous communicative speech was limited.  Client did utilize a distal point when wanting different toys or activities and to point to the bubbles, but she did not coordinate  her gaze or facial expression with her pointing.  Her use of gestures was solely conventional, as she nodded and shook her head if a question was asked of her.  However, she did not utilize any descriptive gestures.

I have to add that during the testing RoseBud was being shy.  She had actually met the examiner before (she played with her during her social skills classes when she was almost 7 for nearly a year!).  RoseBud can use phrases of more than 2 – 3 words, she was just reverting back to what I call her “classic communication”.  She knows that I and people close to her will greatly encourage her to use much more complex language, and we will keep working with her out of habit.  For instance, if she asks “play something else?” I would typically say “oh, you want to play with something else?  Say ‘May I play with something else’ ” and when she repeats and asks to play with “a ball” I typically model the correct sentence (again) and have her repeat it.  This takes time and energy, and can get a bit frustrating on RoseBud’s part.

RoseBud has learned, for the most part, to just use more complex language with those of us she is close to (family, teachers, etc).  In this situation of being tested without the requirement to request or respond in full sentences she reverted back to her classic communication because she could get away with it.

RoseBud sometimes comes up with “descriptive gestures” that are SO FUNNY!  Someone once taught her the cartoon version of the “WHY?” gesture.  She is SO funny when she pops out with it.  Not only is it totally out of the norm for what she normally does, but just the pure cuteness factor makes it that much more endearing.  She usually holds the arms really close to her body and her hands really close to her ears, with her shoulders scrunched up really high.

Back and Forth Social Interaction – included eye to eye gaze, facial expressions directed to others, insight into social roles, shared enjoyment in interaction with others, frequency and quality of social responses and overall rapport.

Client did not utilize eye contact throughout the evaluation.  She did direct some of her facial expressions toward her mother, particularly when she wanted to leave the evaluation toward the end of the administration.  She did demonstrate definite enjoyment when the examiner blew a balloon up and released it in the room, and appeared to request the activity through looking at the balloon, nodding that she was ready, smiling and wanting the activity to be repeated.  Client turned in the direction of the examiner on the second attempt of the examiner calling her name.  She did not show objects to either the examiner or her mother.  Client initiated joint attention during the activities that she enjoyed such as bubbles and balloon, but did not look back at the object to fully reference her intent.  She was also able to use the examiners facial cues and eyes to gaze alone to look toward a target object.  She did not make any social overtures or attempt to engage in any social interaction with the examiner.

Play – included functional and imaginative play.

Client did demonstrate some spontaneous functional play, including ‘feeding’ the dolls with the miniature food (though this was modeled by the examiner), and she repetitively placed items on the toy plate and moved them with a fork or spoon.  She walso placed the candles in the pretend birthday cake spontaneously.  Most of her play was repetitive, consisting of lining up blocks and plates.  Client failed to engage in creative or symbolic play during this assessment.

Stereotyped behaviors and restricted interest – included unusual sensory intersts in objectsk hand, finger and bomplex mannerisms, excessive interest in highly specific topics or objects and compulsions or rituals.

Client did not appear to have an unusual sensory interest in objects or play material, nor did she have any consistent unusual or repetitive hand gestures or movements.  She also did not engage in any self-injurious behavior.  She did have somewhat of a preoccupation with the activity of lining up blocks and using the plastic forks to move blocks from a plate into a line repetitively.

While she was testing, I saw RoseBud take out 4 plates and line them up.  Then she took 4 blocks and put them directly in the center of each plate, all facing the same direction.  Then she took 4 forks out and placed them very carefully under the blocks, each with their handles pointing the exact same direction.  Then she carefully picked up each fork with the block on it and laid the block in line with the plates.  Mind you, they were all facing the same direction and lined up precisely.  Then she got the cars out and started the process again.  It was amusing because this is typical for her.  Most little girls would pretend that the blocks were a piece of cake or something (this was during their pretend birthday party time).

Other behaviors

Client displayed some anxiety when she initially entered the testing room and was initially reluctant to join the table.  However, when her mother reassured her, she joined the table and was able to be redirected.  She did not display any overactivity or negative or disruptive behavior.

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