Another School Year Over... Progress Updates

Today was the last day of school for Honeybunches.  That means it's also report card and progress report time again.  It's confirmed in writing that his placement next year with be with Mr. M again. :)

Some highlights from his Progress Reports:

Honeybunches has:
(Counseling goal report) "Greatly improved his ability to verbalize his feeling associated with frustration, anxiety and stress.  He continues to struggle with using these strategies, however overall has made significant gains this year.... -- Continues to work on identifying and verbalizing his feelings.  He continues to struggle with the comprehension of his feelings, which in turn hindered successful peer interactions.  Continued work in this area would be beneficial... -- Continues to struggle in the larger group setting and often removes himself from the classroom's social skills lesson.  Continued work in this area for -- to remain in class and participate would be beneficial..."

(Behavioral) "During group lesson, -- may protest at times and want to do his independent work right away, but he will stay and participate in the classroom/group activity 100% of the time due in a large part to his desire to earn stars." (Sensory activities are a big part of his behavioral goals, but he refuses to do his sensory activities most of the time although he takes other breaks which are scheduled throughout his day...)

(Sensory Motor) "-- continues to participate in weekly therapy sessions in a small group setting. He is pleasant and cooperative. He will offer assistance when needed, suggest particular activities and state when he needs help.  It has been a pleasure working with -- again this school year and observing his significant progress in all areas of his sensory motor development."

(Occupational Therapy) "-- Has acheived his benchmarks and has improved his readability of hand written text through the use of a spacer. He is now working on correcting a few letter forms that further impact readability. When he works to monitor written output, speed of copying can vary. -- is always happy, polite and cooperative... The team should consider decreasing services if his progress continues next marking period..."

(Speech and Language) "I have enjoyed working with -- this year.  He continues to put forth good effort during language sessions on most days.  -- continues to benefit from multiple choice tasks when providing synonyms or antonyms for words and when identifying the main idea for short paragraph level material.  His ability to define multiple meaning words by using them in sentences has increased from 20%-100% for familiar words...."

(Reading) He is 60% accurate in the skill of "Given a written passage, written directions and a verbal prompt, -- will be able to identifying important details in writing". His goal was 80%. He can determine the meaning of words with 50% accuracy.  Goal for that skill was 60%. He had a goal to read 80 wpm with no more than 3 errors on 4 out of 5 trials.  He did not meet that goal, but did make progress (Which is what I look at the most) going from 55 wpm in November to 61 wpm in June on the DIBELS assessment.  The teacher did note that his "Ability to read fluently varies a lot from day to day and this assessment was done first thing in the morning when it is usually done in the afternoon..." The teacher also commented how he's "Put forth great effort on the Read Naturally Program.  At his request we were able to obtain some 5th grade materials... as he'd gone through most of the 4th grade..."

(Math) He is meeting most of his goals regarding place values, addition with three digits and regrouping, written subtraction with three digits (However the teacher wrote how he needs to be reminded to regroup before he gets going) as well as multiplication and division. He is not meeting his division goal as he's only 40% accurate on #s 100-200 although he's 90% accurate with the smaller numbers. The teacher says that multiplication is a strong skill for him.

(Written Language) "He is doing very well with writing paragraphs, but needs 1:1 help expanding his writing to 2-3 paragraphs.  -- will rewrite his sentences, but will need to get verbal prompts to be able to do this."

His report card does not go by A, B, C, D or F like most children's do.  His goes by
1: Developing grade level skills.  Not yet able to produce required grade level work.
2: Progressing toward grade level.  Producing required grade level work with direction and assistance.
3: Meeting grade level skill.  Producing quality work.
4: Exceeding grade level skills.  Producing highest quality work consistently.

In English Language Arts he got mostly 2's. He did get 3s this trimester in "Understands and utilizes new vocabulary" as well as "Reads with accuracy, fluency and expression". He got 1 in "Edits work" and "Writes an organized piece with purpose, clarity and details" but got a 4 for "Effort".

The narrative for this trimester says "--works very hard in reading.  He did a lot of Scholastic Reading Counts books and Read Naturally stories this trimester and has been improving significantly from his cold to hot reads."

Spelling he got 2 in "Learns spelling words for weekly tests" as well as "Applies correct spelling" but got another 4 for "Effort". :) That narrative says how "We don't do weekly spelling words as we try to focus more on reading and writing.  However, with the Word of the Day we do focus on proper spelling as well as with his written work."

In Math he got mostly 2s again, but got 4 in "Effort", 1 in "Communicates mathematics thinking using correct vocabulary, orally and in writing" and 3 in "Computes accurately". That narrative says " -- loves doing math and always wants to get to his worksheets.  We have been working with him to focus more on accuracy and less on speed."


Social Studies he got 2 in "Demonstrates understanding of concepts...", 2 in "Interprets and constructs data from maps, charts and tables", 1 in "Communicating understanding..."but again a 4 for "Effort".

Science his teacher says "Participates in Science lessons, although they are not his favorite.  He enjoyed our concluding field trip to the Aquarium..." ht moved up from 1 to 2 in "Communicates scientific thinking...", got a 4 for "Effort" and 2s in understanding, making skillful predictions, and draws appropriate conclusions.

In Work Habits he got a 4 for his overall grade; 2s in handwriting and communicates effectively in oral presentations and class discussions, presents neat and careful work; 4s in follows rules, uses time efficiently, accurately completes and returns homework on time, interacts and works cooperatively with peers and adults and follows oral and/or written directions; 3s in organizes work space and uses appropriate study skills. The teacher wrote "Has strong work habits and is one of the hardest workers I have ever had the pleasure to teach.  He has made some progress in making his work neater and more legible. He is very polite and interacts well with peers and adults alike.  He will have Mr. M next year as his teacher...."

Art and Music gave him a simple 3 while in Physical Education he got a 4.  They are not broken down like the other subjects are.

I am very pleased with the progress he's made this year.  He's been sitting hear timing himself doing "Read Naturally" that came home with him for over an hour.  He did it for quite a while this afternoon too. Three weeks until tutoring begins, which is our town's elementary school version of ESY.

Developmental Behavioral Pedi 2014 Part 1

Today Honeybunches had the appointment with the Developmental Behavioral Pediatrician down at the big hospital we've been on the waiting list for since October. This was the intake appointment.  Then they'll do two more appointments: One for the ADOS and another to go over results/reports.

Today's was very beneficial. She told me that many parents have been having a hard time with the school districts regarding the new DSM-5 and whether or not children still have Autism (Although they are technically just supposed to be given the new Autism Spectrum Disorder diagnosis).

She observed him, asked him some questions, me some questions, had him fill out a questionnaire and went over some paperwork previously sent in.  She said even from our appointment today, just going over certain questions and mostly through observing/talking with him she can tell he meets ALL the new criteria for Autism Spectrum Disorder. 

"Diagnostic Criteria for 299.00 Autism Spectrum Disorder

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. She said he met this one clearly.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. She said he met this one too.
   3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. She said although he's developing some new friendships, he still meets this category too.

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):She said he clearly meets all four, although to be diagnosed he only needed to meet two...
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior. She did not go over his severity in detail as of yet...

3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be beloiw that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder."

She said although she could have confidently diagnosed him today, some school districts have been giving parents issues if they don't have a ADOS report to go along with the new DSM-5 diagnosis.  She said there is a new ADOS to go along with the new DSM. She said that doing the ADOS (Although not necessary) will help prevent any school questions in the future. So we go back in exactly four weeks for the ADOS appointment, then we'll have a follow up appointment just to go over the results. She clearly seen him persevering about wanting to eat lunch lol.  I told her how he smells everything.  She said while many children with different diagnoses have sensory issues in different ways, it's the smelling everything is Autism related.  I found that interesting. She also found it interesting how his intense interest area is money.  I mentioned to her how he can go to the store and bank 5+ times per day to change his money.  For example he can have a $10, go change it for two $5s. Come back and go change it for 5 $2s.  Then ten $1s... Etc. He knows the serial numbers, secretary and treasurers.  I told her his other favorite area of intense interest is trains.  She began asking him a couple questions about his favorite train.  He said Netfork Southern lol. 

She mentioned that she can see an underlying anxiety disorder.  I mentioned how he was previously diagnosed by a Developmental Behavioral Pedi at Tufts with Generalized Anxiety Disorder, but a more recent eval by a child psychiatrist at the hospital she is affiliated with said it was part of his Autism and Bipolar.  She said that while what was previously diagnosed as ADHD was part of it (She did not see the hyperness that goes along with that diagnosis), the anxiety disorder she believes is separate.  She said she'd want to be careful about labeling him as ADHD because then doctor's would be likely to try stimulants, which are often a disaster for "Children like him".  I then mentioned how his first med was Ritalin at age three which was a disaster. She gave me a questionnaire regarding anxiety to fill out for our next appointment.  She suggests getting him a Cognitive Eval (Which they also do in her office) when he is between 15-16 to help get adult services into place.  She said that at that age I will be "Concerned about his cognition and memory". ;) That's the age when differences with IQ become more prominent.

Another thing the doc mentioned was that she does not understand why they gave him the diagnosis of PDD-NOS instead of Classic Autism to begin with.  From observing him, she said it's very appearant. He previously scored "Severely Autistic" on the CARS rating scale back in 2009. I mentioned to her that the doc who diagnosed him said that the only reason she did not give him that diagnosis was because he could speak (Although he has Receptive-Expressive Language delays) and he also made limited eye contact (Which he did not do with this doctor today). I can see her evaluation being very helpful with Honeybunches three year IEP eval coming up in September.