Thursday, May 7, 2009

Dr. Keck

Once we got past the morning, it was a big day for Nikko and me. We went to St. Alexius Medical Center in Hoffman Estates to see Dr. Nancy Keck, a doctor in Developmental and Behavioral Pediatrics. We saw her upon referral from Dr. Santiago, one of Nikko's pediatricians. When I told her how the Behavioral Therapist who came to our house told us that Nikko didn't have behavior problems, that it was a discipline problem instead, she recommended we see Dr. Keck for a second opinion. Personally, I think the BT, who lived in Oak Park, didn't want to come see Nikko in Mount Prospect each week. We got ushered into a play room with three therapists who sat and started interacting with Nikko while they asked me questions. It was similar to the diagnostic test we did for his original diagnosis. This time we weren't there for a second opinion, which in the end they agreed that yes, Nikko has autism. Instead, I told them we were there to see if Dr. Keck could fill in any holes, to see if Nikko had progressed or if he needed things other than what he was doing.

Nikko started out ok, but he didn't like being confined and didn't really warm up to the women that much. They played some interactive ball with him, but it was short-lived. He never really got happy, and there was a point when he started melting down while we tried to focus his play in a corner. He actually gave up his struggling and fell asleep in my lap right in front of everyone. The therapists were really kind and listened to me ask all sorts of questions that I've been dying to ask. A big question was whether or not I should pursue ABA therapy for him, and they all agreed that I should give Nikko's preschool a try for at least two months before trying to add on outside therapies. I understand their point. They said that District 57 is a good one, see what they offer before trying to battle out any advocating issues. I agree. Nikko will need an adjustment period to preschool, so it's probably best not to barrage him with new stuff all at once. I think I get impatient and want to see results now now now!

Nikko and I went into an exam room and waited for Dr. Keck. She came in with some other guy observing, and she was very nice. Asked questions following our application, and I was surprised that I really didn't have many questions for her that the therapists didn't already answer, but I did bring up the ABA stuff, whether or not Nikko needs an advocate for his future, and were we headed in the right direction. From everything that I gathered, we have been headed toward preschool and may see a big improvement in Nikko after we start this. The school has routines to follow and Nikko may benefit from this. Also from what I gathered, he should continue with his therapies while I try to do picture therapy with him and continue to socialize him and build a good relationship with him. They will send me copies of the tests and evaluation, so when they arrive I'll make sure to type all about it. I do remember generally that they were comparing his evaluation in October to today and he has made good improvement, especially in the motor skills department where he went from 18 months to 28 months. YEAAAAHHHH! As to be expected, he didn't make many gains in the verbal communication department. He went from 6 months to 9 months. BOOOOOOO.

I took Nikko to Costco afterward to squeeze in an errand. Mom was at the house helping us out, but I didn't want to take longer by going to Jewel. I'll go there tomorrow after Audrey's doctor appointment. After getting a few items and checking out, I stopped at the Costco food court because I hadn't eaten lunch and Nikko needed a snack. I got a slice of pizza, a cinnamon/sugar-coated churro and a Coke for us. I set the churro on the table in a sleeve and told Nikko it was for him. He looked at it curiously so I took a nibble first. After he tasted it, he bent down and started eating it as it rested on the table. Nikko made some kind of sing-song sound of content, almost saying, "Man, I'm happy!" It made me feel really good to see him happy, and I felt such a nice, calm bond with just Nikko and me sitting at the table. It's been a long time since he and I went alone anywhere. Back at Casa Umali, things were pretty calm with Mom and Denis around. Audrey was tired but awake, and Ronin was excited to see us. He and Nikko started running circles around each other in the living room. Even Nikko seemed happy to run after Ronin, and waited for Ronin when he paused and fell. Awww.

Tomorrow we have DT at noon, but Shelly is on vacation so there's no OT. Audrey has a doctor appointment so I'll leave the boys and take her tomorrow.

Wednesday, May 6, 2009

A Fishy Morning

Speech therapy went well for the first half, but Nikko got distracted and antsy for the latter. He started out with a fish-shaped peg board and he mimicked the fish swimming. Then he was doing some puzzles with magnets and a magnetic fishing pole. It was really a flash of productive play and he attended to it well. The fish moved on to vehicles, but then we were starting to lose his attention. We found out toward the end that Nikko had to do a #2, so maybe that's why he wasn't in the mood to sit still in the corner and work/play. Gloria noted that his intonation sounded good and he babbles to himself a lot. Stuff that seems on the verge of speaking, but we both know that he needs a few more things to click. Later in the day I got a call from Kathy from District 57 to set up 3 meetings that will evaluate Nikko and determine if he's eligible for special needs preschool. I'm glad I talked to Gloria a little bit after therapy about her thoughts on whether or not to proceed and see Dr. Keck (who was able to push our appointment to tomorrow to see her) and Dr. Keen and find out what kind of direction we should take with Nikko's autism and therapies. Gloria felt sympathy for me that I admitted I felt totally lost about when Early Intervention will end. Preschool will start for Nikko, but will he need home-based therapy, and who will determine that for us? Those are my worries.

I took Audrey with me to the chiro and I felt so bad that Chinny had to hold Nikko back on the floor. He was wailing really hard that I was leaving, but all the therapists are telling me that I need to encourage his independence and leave him more frequently. Chinny was great. The chiro is going to refer an orthopedist to give me a cortisone shot for my back. Thank heaven! Hopefully that will happen this week or next, latest. I went to Target on the way home to get a humidifier for Ronin and managed to pick up a few more things along the way. The best things I got were two little durable flashlights from the dollar bins. I put batteries in them and gave the boys one apiece. They enjoyed running around with them a lot, and will probably burn out their retinas from the light bulb. Nikko was able to turn his on and off and he watched the light on the ceiling very closely. I thought they were a success. I also got from the dollar bins a screwdriver for myself, and I must say that I love it. It's magnetized to hold the nib at the tip, and it's blue. Ooooooooooo.

I don't know why, but Nikko again displayed a ferocity in his attachment to me today. He also showed some empathy because this morning, while I was *ahem* yelling at Ronin, Nikko started to wail and looked a bit scared. Then he indicated that he wanted a vitamin and I got upset that he chose a very stressful moment to want that dreaded vitamin. Needless to say I gave in and gave him a vitamin, so I lost the fight today. We have had some big power struggles. Today we struggled over having more chocolate pudding. I gave him some earlier in the day, and he wanted more right before dinner. Of course I didn't give it to him until much later. But I have to show him the empty container of anything for him to see that there truly is no more of something. If he can comprehend that, it must be a really good thing, right?

St. Alexian called to tell me that our appointment in two weeks could be moved up to 1pm tomorrow. I had to call mom to secure her help in the afternoon with the babies. I have to mapquest directions. Overall, I'm excited for Nikko that we get to see someone, but I'm nervous as well.

Monday, May 4, 2009

Roller Coaster

Two little things happened today that I don't want to forget. One of them was while we were watching Hi-5, it was the Roller Coaster song where the guys mimic going up-up-up and down-down-down. I use my own spin on it and coast along the kitchen, singing the song nice and loud so the boys are entertained. I was changing Nikko's diaper on the floor when the song came on and he took his arms while flat on his back and put them up over his head, smiling, as if he were doing the roller coaster ride. He's never seen or been on one, but the imitation was awesome! Any kind of imitation he does is a good sign to me. The second good thing today was that Denis came home for a short while to mow the lawn, and I had the babies down for a nap so I ushered Nikko out the door and we ran around the driveway and backyard for 20 minutes. The weather was great, sunny and cool. Nikko was doing a funny wobbly run but I wasn't worried because I know he can run straight-legged as well. Nikko used the slide a little bit but also explored the backyard and used sticks to poke at tree debris. He's a fast runner; he took off down the driveway and rounded the corner as if he were racing toward the school, but he saw me chasing after him and he took a giggly left turn on Manolo's front lawn, going back up the driveway. If I was wearing Audrey I wouldn't have caught him. Alas, it was her cries that sent us back in. Despite this exercise, Nikko didn't take a nap this afternoon. He did, however, fall asleep quickly at night.


This morning I cancelled our playgroup visit because last night I had a sore throat and thought it would be worse this morning. It wasn't that bad, just a hacking cough, but I didn't want to deal with the drama of getting us out the door in the morning. I also didn't have daycare for Ronin so it was a moot point. I have to make it a point to call the daycare on Wednesdays to reserve for Monday morning. He was whining more than usual today for certain things. I think he assumes I know exactly what he wants when he sits in his chair and whines for it. But sometimes it is a serious guessing game and I have to tell him to show me what he wants. Lately it's been the Saltines crackers on top of the fridge, but before that it was the vitamin dealio. This morning he whined for a vitamin and I told him sternly that he gets one now, but if he eats the other one then there's NO MORE, that's it for the entire day. He only ate one, go figure. I'm surprised he forgot to ask for another. For some reason, Nikko also whined when I turned on Hi-5 today. I was taken aback because he loves watching it. Granted, we haven't seen it in a few days, but I was determined that we would watch it. When I fast-forwarded to a skit (passed the introduction song), he calmed down and was interested. I worried for a minute that my go-to DVD wasn't going to work anymore. *whew!* Nikko and Ronin battled over the deflating yellow balloon that came from Red Robin. They would both dive for the balloon and whoever got it first would run away with it, leaving the other one shrieking. Ronin was the one that lost out most of the time, of course. I guess the best thing that happened was that the balloon finally dissipated. Ronin brought me the empty carcass of the balloon and I told him the balloon went night-night. End of story.

Red Robin

Our big outing today was an early dinner/late lunch at Red Robin in Skokie. I've been to the one at Woodfield Mall and they have very good hamburgers, as well as an onion ring tower that's yummy. Any restaurant outing with the entire family, plus the entire Alog/Penepacker clan, is a challenge but I think we're getting better at doing it. Mainly because the boys are getting older and able to feed themselves, if not sit by themselves. I didn't pack entire meals because it was too early (4:30ish) for dinner. Snack time food would suffice. I also brought books and cars so the boys wouldn't be bored sitting there. We arrived and got the end of a long table, near mom and Pat. Ronin immediately sat next to mom, which was nice because she was able to entertain him. Nikko mostly sat with Denis, and Audrey stayed in her car seat pretty nicely. I propped a bottle for her to drink from, and I purposely didn't look behind me at a family with a baby and toddlers because I kinda felt that the mom was frowning at me for propping. I started thinking of a few comeback lines in case someone at her table approached me to say, "You're a bad mom. You're not supposed to prop the bottle for your baby. She could choke!" My rebuttal would be, "She's in plain view of me, my husband and my mom. And if you had 3 kids under 3 years old that you had to feed all at once, you'd find a way to do it, I'm sure." Instead, at the end of their meal, one lady asked me how old Audrey was.

"Six months," I said.
"Really? That's amazing, she's able to feed herself and holds her bottle so well!"
Another lady, the one I suspected might say something negative to me, said with a smile, "She's not feeding herself, the bottle is propped."
"When my daughter was 10 months old, she still wasn't able to feed herself," the first lady continued. The other lady walked on and the first lady said, "She's so cute!"
I thanked her and they left. Was that smile a real smile or a fake one? Whatever, I don't know how but I knew something was going to come from her mouth. Doesn't matter, she's GONE.

The boys were placated with crackers and juice and books and cars and balloons, until their "allergy alert" french fries arrived (plain, no seasoning). All seemed to be going well, but then I saw Ronin cramming a french fry into his mouth and starting to choke on the mush. Anna saw it, too, and remarked about it. I saw another heave and told an unassuming mom and Denis that they better watch out because something was going to happen. Sure enough, Ronin spit out the mush and started to throw up. I got up to get more napkins from the waitstaff and by the time I came back he was bathed in thrown-up fries and crackers and juice. It was such an icky mess. Atz was so kind to offer to watch Nikko while we cleaned Ronin up, changed his clothes, and promptly decided to pack up. No staying for dessert for us! Nikko was starting to melt down because he didn't want to sit anymore and Ronin wanted to walk around but I wouldn't let him because his shoes were covered in vomit and he was barefoot. I gave Nikko a vitamin because I knew that would calm him a bit and buy me a few minutes. Out came the double stroller to harness Nikko, put in Audrey, we said our good byes, and fled.

Our day as a whole had some ups. Nikko didn't do anything terrible, no nasty tantrums that were prompted by vitamins or wanting something he couldn't have. He follows me everywhere and I talk to him wherever I go. When we came back with a balloon in the living room, I asked Nikko where it was and he turned his head to look at it. He's been jargoning a lot lately, too. His new thing is that he takes something (a ball, a plastic corn on the cob, a flag) and throws it up in the air slightly behind his head. Then he turns to see where it landed. Be wary if it lands behind the couch or behind the TV! I've been beaned in the head by a plastic ball, and Audrey has escaped some narrow misses. He is also recognizing some of the Hi-5 songs I sing out of the blue and will smile at me while I sing it. Finally, he's getting used to the Twinkle Twinkle Little Star finger play song I do with him, so we've added this third song to our repertoire.

Sunday, May 3, 2009

Lions Park

It was a low-key day at home until we went to Lions Park as a family. We met up with Pat & Gail Creen and their two daughters, Riley and Samantha. Ah, it's the park we should have lived near, had we ended up getting a house in the district we wanted. (sigh) Ronin and Nikko loved running and climbing all over the equipment. There were many slides and ramps to choose from. For some reason, Ronin kept making a beeline toward the basketball court and we kept having to haul him back. I was surprised that Nikko didn't do the same thing, and right when I vocalized it he started trotting toward the court. Nikko did really well on the slides, but also started exploring a "netted" ladder a few times. He didn't really know how to climb it, but gave it his best try. Gail said that Nikko seemed to be doing better, lots of eye contact and he seemed very focused on running around and creating paths to his next destination. After the park, we passed by Culver's and got some double strawberry ice cream, the flavor of the Buy one pint get one free. Whee! The nighttime routine was pretty calm as well. Nikko was in a good mood. He still has some tendencies to hang onto something stick-like. This evening it was a little American flag he found somewhere and it ended up in bed with him. Other times it's a toy spatula or a toy fishing pole. Sometimes I remove the stim object, but other times I let him have it because he manages to lose interest in it at some point anyway. Besides, there's no way he'll be able to avoid these stick-like stim objects in everyday life, so he's going to have to learn to live with them. We were going to take away the flag during nighttime routine, but he was going to put up a fuss and a fight that I think weren't worth it. Tomorrow we'll meet up with the Penepackers for Tristan's bday dinner at Red Robin, so I'll be gearing up the troops for another public outing. Fun fun fun.

Saturday, May 2, 2009

What comes next after EI?

The only activity today with therapists was Cyndi the Social Worker coming over to chitchat. She helped me gather some goals to tackle after I unloaded some of the stuff that's been bothering me all week:

1.) Talk to the guy who founded that North Suburban Autism group to see if he knows about any updates to insurance compliance with therapy for autistic children -- I told Cyndi that this group doesn't seem to be as "with it" as the Naperville group, but I joined it nonetheless. It could be a nice group, but I posted something about our situation and had some views but no responses. Talk about a diss.

2.) Call Edie Brennan of ABCI Autism Behavioral Consultants to find out how she can help set up some home therapy (if I go this route) -- I am interested in what really happens to Nikko after he phases out of Early Intervention. Sure he'll go to preschool, but then what? They will give him therapy at school, but I think Nikko should probably have some home-based therapy as well. I think this is where the mega-research comes in, whether to try other interventions such as ABA or geez, I don't know all the acronyms. Gotta review my about.com info on all the different types of therapies. This is a scary area because there's no one around to hold my hand.

3.) Ask Dr. Keck how the program at St. Alexius provides behavioral help and support for parents -- Dr. Santiago referred us to Dr. Keck waaaaay back when, and now that we'll get to meet her I wonder what is supposed to happen. We're not going for another diagnosis, we already have that. I didn't know that St. Alexius has an autism program, so I'll have to research what that all entails.

4.) Work on "independence" skills with Nikko i.e. Sit Next To Mommy, not on her -- I told Cyndi how Nikko was clingier than usual to me. She said that I should practice more independence for him because he'll need that when he goes to preschool. Hard to do, when we're all together here in the house all day. I'm trying to get him to hang out with other people, it's not like I'm not trying. Even today, I really wondered where we could go, just us three, besides Costco. Right now I can't run after the boys while Audrey is in a car seat because I can't abandon the car seat somewhere. I have to mull over this. I wish there was just some kind of room that was protected (ok, padded!) and kid-safe that wasn't in our house and allowed us to be social! Getting Nikko to be independent also conflicts with Shelly's advice that with all the stuff we're pushing him to do, give him MORE hugs and MORE reassurance. He loves to hang onto me and I do enjoy his affection, but not the ball-and-chain kind.

5.) Limiting the opportunity with vitamins -- one alternative here would be to put two in a jar and tell him that when they are done, they are all gone. No more. So if he eats his two and there's no more left, that's really it. Until, of course, I can get a picture schedule going. Then I can put a picture of the vitamins on the board when they'll be eaten.

We didn't have many lows today because every time I started yelling at Ronin to get down from the high chair or the window or to stop doing something, I had to stop myself and say that it wasn't worth it right now. Sure, this all sounds easy, but it's not!

Friday, May 1, 2009

Swing!

Two therapies today and they both went well. Gotta point out that having Chinny around to take Ronin out of the room really helps keep distractions to a minimum.

We started the day with Denis helping get Nikko dressed. I woke up late, with Audrey next to me, because late at night I had to pick her up and take her into the bed. She was very congested and was waking up frequently, so I elevated her head and kept her close. She still stirred a few times, which is why I probably slept until 8:30, which is very late for me nowadays. Because we ran out of bananas, I toasted some Eggo waffles with chocolate chips and sliced them up for Nikko. I must say, he probably enjoyed the change from bananas. No complaints this morning! Before Bo came for DT I tried to start feeding the kids early because they both seemed hungry even though I felt our breakfast was late. Nikko started eating and was more than halfway finished when Bo walked through the door. He actually freaked out a little bit, more than Ronin reacted. Not sure why. But then he noticed her bag of toys and couldn't usher me fast enough into the living room so we could sit down and play with them. Once we settled, with Audrey next to me and Ronin & Chinny in the kitchen duking it out over lunch (he eventually fell asleep in the high chair), therapy seemed to go smoothly. Bo brought out plastic food and dishes but Nikko wasn't that interested. Elmo came out and he liked putting the arms in. Feeding Elmo was sort of successful but short-lived. Then came an animal puzzle with little knobs on the pieces and Nikko put it together well. He played with the peg board and a teddy bear book. Bo also broke out bubbles and Nikko seemed to enjoy them more today than in the past. He tried to pop them by flapping his hand at them instead of poking them with a finger, but he still tried. The air must have been funny today (it rained a lot) because the bubbles seemed to stay in the air much longer than the usual lifespan of bubbles. Weird. Nikko had pretty good transitions between activities. He was hanging on to a plastic watermelon slice but Bo switched it out and he didn't protest. Same with some of the utensils. Bo thought our session was a good one. She also gave me the # for a company called Community Alternatives, which I know nothing about, except that they help offer services for kids with autism. I'll have to check them out or call them to see what they offer.

It takes really long to get out of the house around here, no matter how much prep I do. I tried to usher us all out the door so we could go to OT with Shelly, but it seemed to take so long. Diaper changes, readying diaper bag, food bag, socks and shoes... We got there around 3pm and the Autism Resource Center was having an open house. I really wanted to go to it, but unfortunately it wasn't going to happen since Nikko's therapy was going on, plus I didn't have an opportunity to leave despite Chinny's presence. I had Audrey, too. The Center was a small room and the kids wouldn't sit still long enough for me to get something out of it. I have the coordinator's number, so perhaps I can call her to see how the laminating process works since that's the most important thing I'm looking for. Ronin and Chinny went into the other room to play with the vast amount of toys and objects in there, Audrey woke up and sat nearby, and Nikko ran around the obstacle course first to get his ya-yas out. He didn't paint well with the foam soap, but somehow Shelly was able to get him to rest tummy down on the swing. He didn't even had a stim toy in his hand. She was able to gently swing him back and forth, side to side, and a little round & round. Mind you, Nikko has totally avoided the swing for over a year and just recently took a slight interest in putting a foot on the base of the swing. But today he was on it like he loved it. The reason for this? I deduced that it was the mirror. He could see himself on the swing and was captivated by it. Sure, it was a little stimming for him to look at the floor and the mats back and forth, but he also watched himself swing and wasn't bothered by changes in movement at all. He even ventured to stand up in the swing and let Shelly push him. It was truly amazing. I wonder if he'll be able to swing on an outdoor swing without a mirror in front of him.

We went to Costco after OT. Nikko and Audrey fell asleep in the car so I left Chinny to watch them while I took Ronin inside since he was awake. Toward the end of my excursion I spotted Leticia Ferina, an old high school friend whom I connected with on Facebook, with her 4-5 year old daughter and her 20 month old twin boys. I acknowledged her in front of the diapers and wipes and she gave me a hug, glad to see me. She said to her kids, "This is a friend of mine who I used to play volleyball with!" The kids just looked at me. That's ok. Ronin whined a little, no biggie. We agreed to have a playdate in the future some time. She told me that her twins were starting speech therapy because they don't have a lot of words, and I remarked that the same thing will happen to Ronin.

We came home, snacked the kids and I lamented that their dinner would be late because of it. And it was, but Nikko ended up eating his nuggets heartily. Bathtime was late because the Bulls were playing game 6 vs. the Boston Celtics and the Bulls won in triple overtime. Denis and I got stuck watching it, but we recorded it on the DVR because we had to get the boys in the bathtub.

I received two phone calls recently regarding the two applications I sent out. The first was from Marianjoy for Dr. Keen, referred to us by Rupak Parikh after he saw on a Facebook post that Nikko was autistic. I think she's a doctor in Pediatric Rehabilitation. They set up an appointment for Nikko for October 2, but if someone cancels then they'll call us to move up. Yeah, that's a long time to wait, but I'll do it. The second was from St. Alexian for Dr. Keck, referred to us by Dr. Santiago. Dr. Keck is in the department of Developmental and Behavioral Pediatrics. The appointment here is in less than two weeks, on Wednesday, May 13th! I have to find out if Mom can babysit the little ones for this.