IEP Meeting Update

This morning we had Honeybunches' annual IEP meeting.  In attendance were the new Occupational Therapist, new Speech Pathologist, school Counselor, new IEP Chairperson, Old Special Education Director, Principal and his Special Education teacher.  His new outside counselor was not able to make it, but that's fine with me since there were so many other new people.  This meeting was bitter-sweet.  I got so much positive feedback about Honeybunches and how wonderful he's doing which was great!  It was, however, this Special Education Director's last IEP meeting.  He retires at the end of this week.  Having worked with him since before Honeybunches began Kindergarten, I'm going to really miss him.  He always did an excellent job advocating for what Honeybunches needs.  He's been a real blessing to so many children in this district.  On a good note, after the meeting I sent him an email thanking him.  He emailed me back with his email address and other contact information telling me if I ever need him to advocate for Honeybunches in the future he will (Which in the past he told me he'd do free of charge).  Again, I don't think there can be any better advocate than a retired Special Education Director.  IDK if I'll need him, but it is good to know the option is there.  Here are the highlights from the meeting:

IEP Eligibility changed to Autism Spectrum Disorder.  It was listed as "Intellectual Disability" which the new IEP Chairperson questioned because for that the IQ has to be 70 or below and his when last checked a couple years ago was 73.  It was also listed as "Emotional Disability", but where the recent eval done a few months ago said "Autism" as his primary disability and "Bipolar" as his secondary, we thought as a team that the Autism eligibility would be most beneficial.  In Massachusetts, for children who have Autism there are special regulations in place. He also questioned his PDD-NOS diagnosis because of the DSM-5, but I pointed out that the most recent eval stated "Autism Spectrum Disorder". I already know about the new Technical Advisory regarding "DSM-5 Changes and Impact on Students with Autism Spectrum Disorders" but thankfully didn't have to mention it.

Here were the reports:

Special Ed Teacher in the new ILC room:

• Making lots of progress socially, academically, behaviorally and with skills
• Honeybunches seems to be enjoying the class 
• The star chart and incentive system has been working well.  He's "Buying into it", counting up his stars. 
• He's wanting to engage with others
• Always asks good questions, inquisitive, curious
• Motivated
• Strong work ethic + once starts something likes to finish it.

School Counselor:

• When Honeybunches had a 1:1 he often chose not to participate, but has been making great gains without a 1:1 and is doing less isolating.  He's participating more now in class activities this year. 
• She's noticed his confidence increased (Very proud of himself, especially about riding the bus without an aide which is something he bragged to the counselor about).
• Amazed with his growth
• Wants to continue working with Honeybunches to build friendships and social skills with his peers
• New goals will be to work on verbalizing his feelings, to build on the social aspect and to work on calming techniques.  Her hope is that he can use more words to verbalize things before he gets upset. 

Speech (New pathologist):

• He met his objectives from last year with support. 
• Had a good 1st session
• Plans to work with counselor on his social skills and language
• She hopes to "Fade the cues to assess Honeybunches performance" (Such as with the previous speech pathologist, they were doing this pass the ball thing where they'd pass it and whomever had it would talk, every 1-5 minutes, but she hopes to increase the time and see if he could increase his language skills by having less cues). 
• Transition to include writing and thinking, delayed gratification.

 Occupational Therapist (New therapist):

• She seen him this year with 1 observation and 1 pull out. 
• Seems to have maintained skills (As they were noted last year)
• Met all objectives, but wants to continue services. 
• Mentioned that this is a "Potential transition year to identify specific needs". 
• Working towards paragraph level work
• She talked about sensory diets: how they should be pro-active instead of reactive (In the past in this district PT did sensory stuff, so it's great she is full of knowledge about that and other stuff. She actually impressed me and has a lot of new ideas she is bringing to the district.)

Physical Therapy:

• Skills not appropriate for his age level, but before speaking with Honeybunches she was considering changing to a "Consult" as she's been working with him since Kindergarten.  However, after speaking with Honeybunches and asking what he would want to work on he said "Getting stronger" and "Working with other students".  This year she wants to work with him as a group with 2-3 other students so we're changing his 1x30 individual to 1x30 group (1x30 = One time a week for 30 minutes). 
• No regression of motor skills over the Summer
• Agreed that Honeybunches presentation has been positive, displaying increased confidence and increased social skills. 

Special Education Director (Who did some housekeeping tasks on his IEP so things would be more clarified before he retires):

• Leave "1:1 will be reinstated for specific subjects as the team deems necessary" in his new IEP. 
• Changed the wording about his Ipad to make that more clear. He had it say "Will be provided with an Ipad for the duration of involvement of special education services" as he thought that was more beneficial than "For the duration of his IEP". 
• He cleared things up regarding who is to program Honeybunches Ipad and upload the applications to it.  They clarified that the teacher, IEP chairperson, old teacher and the "Tech guy" will consult. 
• Clarified that summer tutoring be added to his new IEP for next summer (2 hours per day, 4 days a week for 4 weeks). 
• Took "Scribe" out of his IEP for paragraph writing work so we can work more on his handwriting (Which OT said they will make a new goal about). 
• Made sure his Safety Plan and BIP are up-to-date.  His Safety Plan is, as I had them re-do it in June due to his wandering and being left outside along.  As for the BIP, they said the whole class he's in has it's own BIP (Level system, stars and other things that the special ed teacher and counselor said they'd get me information about). 

Services to be provided:
(All continued from last year)

1. Speech 2x30
2. OT 1x30
3. PT 1x30 (Group)
4. Counseling 1x30
5. Behavioral Management 5x270 (Which brought us to an interesting discussion regarding them figuring out just how long his behavioral management should be which turned out to be for the whole school day minus his pull outs, but his previous IEP had it as 5x190). 
6. Reading 5x60
7. Math 5x60 (Which made for another good discussion, because the teacher said they do Math and Reading each for 60-90 minutes per day, but the new IEP Chairperson said that's not technical enough... so they decided to put it at the minimum, but more is always okay). 

Vision Statement:
"The team envisions Honeybunches continuing to develop the academic, social and behavioral skills he will need to function productively across all settings.  The team would like to see Elijah develop self advocacy skills.

Here are his Educational Assessments his new ILC special education teacher did:

 Although this meeting was held six weeks early (Due to the special education director retiring), I agreed to have the dates on his IEP remain 10/28/13-10/28/14 so the district will have more adequate time next year to do his 3 year evaluations.  That will give them almost two months, instead of just over two weeks.

I went in there with a list of reasons why he still needed OT, in case they tried to cut it. Thankfully, I didn't need to go into that debate, but I'm glad I was over-prepared instead of under.

School's Reintroduction to Honeybunches Letter

School begins next week.  I have been working on a "Reintroduction to (Honeybunches)" for a couple weeks now.  I finally have it pretty much done.  Although he had this teacher in the past, it's been a few years.  Here is what I wrote:

"Dear Mr M----------, 

I wanted to give you the following updates regarding ----. 

Current Diagnoses:

The most recent evaluation we had done for him (And what his current psychiatric nurse practitioner is going by) state that his primary diagnosis is Autism Spectrum Disorder and Bipolar Disorder is secondary.

Current Medications and Medication Related Concerns:

--'s current medications include Lithium ER, Abilify, Clonidine, Tenex, Cogentin, Qvar and Metformin. The psychiatric nurse practitioner just increased his Abilify last week due to showing some signs of mania and anxiety. With his Lithium, he does best when his levels are at the higher end of the therapeutic range. Because of that, if he doesn't drink enough (But sweats a lot when it's hot), he is at high risk of Lithium toxicity. We try to encourage him to drink, but don't really push the issue too much because that backfires. Over the Summer, he drank plenty and it was not an issue. I send him in with a water bottle and flavor packets to add to the water. If he seems to not be drinking much, please let me know. In the past when that happens we've seen success with just changing the flavors of the packets we send him with. On days when it's very hot I send him with Powerade or Gatorade as the salt in them helps prevent Lithium toxicity and dehydration. His Abilify and Lithium both make him at higher risk of getting heat exhaustion and heat stroke. I apply sunscreen before school in the mornings when it's hot but would appreciate it if either you or the nurse could assist him with reapplying it before afternoon recess on hot days as well. (I have a bottle of sunscreen in his backpack to leave at school.) He has his Tenex around 11:30-12:00 each day. He has a PRN prescription for Clonidine for when he’s very agitated (In my opinion, the only time I would want to give it to him is if he seems like he's going to be physically aggressive towards people and uncontrollable as a last resort). It is on the medication order form “Call Mom first” before having the nurse give it to him because we only want to use it rarely, when other calming techniques have not worked and not too close to his dose of Tenex. I did leave some with the nurse and filled out the proper paperwork just in case he might need it at school.

Concerns and Challenges:

When -- is hungry he gets very irritable, especially if made to wait. He has a hard time waiting in general, but is even more impatient when it comes to food. At home over the Summer he often ate breakfast at 5 am or 6 am at the latest. He has a morning snack at different times when he's hungry usually around 8 or 9 am. By 10:15-10:30 he is usually ready for lunch. If I tried making him wait until 11-11:30 he often got angry. He's been sleeping well at home for the most part, but is a very early riser always waking between 4-5 am and sometimes earlier.

His brain often gets stuck on one thing and it's hard to change it. For example, when he orders things off Ebay which he does often, he wants to check the tracking information literally about 30+ times per day. He still does best when things remain consistent. He still likes to test people. He did wander a few times last year at school, which is my biggest concern during unstructured times. It would be in his best interest if he is supervised well until he can show he is trusted (Even on walks to the nurse's office). He's been threatening us a lot with what he will or won't do (For example “If you don't let me ____ then I'll _____”) His threats are usually about throwing or breaking things but sometimes aggression. -- using words is an improvement and beneficial because it helps us often divert these threats from becoming actions.

He still struggles with transitions. Besides the change of him coming into your class, he’s had other changes in his life. His best friend next door (Who was his 1^st out of school friend) moved at the end of July. He was mad at her for moving. He still has a hard time knowing how to express sadness, so often times it comes out in anger instead. He still struggles with identifying the correct words for how he is feeling, although we've seen some improvement at that area (Usually to tell us he's mad/angry). When he’s upset he needs his space and doesn’t like to talk (At least not immediately). The counselor B who he was seeing at YOU Inc for the past six months got a new job a couple weeks ago. He has his first appointment with the new counselor (Named Melissa) who is taking over his case this Thursday. The previous counselor L, who he seen there from ages 4-10 years old, finally retired at the end of last year. He still has sensory issues and cannot tolerate loud, crowded activities (Such as assemblies, crowded cafeterias etc). Demanding him to be in such a place after he's used his words stating he doesn't want to be there almost always causes aggression or other behaviors.

Home-School Communication:

I am hopeful that we can use a home-school communication book and/or email to communicate frequently. It's important for me to be updated on how his days (Behavior, attention span, etc) go for medication purposes.

I appreciate being updated on any changes you see with him. For example, some things such as odd movements especially facial ones including lip puckering/tongue slithering (Which are both symptoms of Tardive Dyskinesia from Abilify), abnormal limb movements (Such as jerking arms and legs which could be a Dystonic reaction that he's presented with in the past on a different med, but is possible on one of his current ones), internal restlessness (Akathisia which he also presented with in the past from Abilify), other movements + behaviors that are out of his norm could be medication side effects and need to be brought to his doctors attention right away. The lip puckering is the most recent side effect we've noticed, even last week so please keep an eye out for that. It's best to know about behaviors or side effects early on (Even when things you mention might not seem important), so I can share concerns with his psychiatric nurse practitioner. By doing so, we have been successful stabilizing him again with just making small changes with his medications.

Upcoming Appointments:

--- is being followed by several doctors (Endocrinologist and Gastroenterologist) down at (The big hospital). We have found that afternoon appointments, before his dinner time (Which is a very strict 4 pm in his brain with no leeway unless it's a few minutes early) help him be more cooperative for his counseling, psychiatry and other appointments. Unfortunately these times do interfere with school just a bit. His upcoming appointments in the next month are:

August 29^th (Counseling) Pick up at 2:10

September 4^th: (Psychiatry) Pick up at 1:30

September 12^th (Counseling) Pick up at 2:25

(Will pick up every other Thursday for counseling at this time until further notice.)

September 18^th: (Endocrinologist) Pick up at around 1:30

September 19^th: (Physical) will be late (Estimate around 10 am)

September 26^th (Counseling) Pick up at 2:25

I will write reminders about his upcoming appointments in his communication book.

Recent Interests and Positive Traits:

--- loves police, trains, ambulances, fire trucks, bugs, caterpillars, spiders, Beanie Babies, Webkinz and trains. He likes to wear his play police badges and carry around his handcuffs as he pretends to arrest people. He loved it when Officer S--- stopped in front of our house frequently to talk to him over the Summer. His favorite school activity last year was “Word-of-the-day” which he liked to take home and do with either his sister Monica or I. One thing he does that shows his caring heart is that he sometimes gives us rewards for when we do a good job and lets us pick from a prize box he makes us.

He often thinks about his sisters giving them money or buying candy for them at the store with his yard sale money. He notices any little changes in the environment, has a good sense of direction and an amazing memory. He loves getting $2 bills, dollar coins, fifty cent pieces and other uncommon denominations of money from the bank. He has very good negotiating skills (Which he's been putting to use a lot lately). His imagination has blossomed over this Summer (For example has an imaginary police boss named Andy who he has to call to check in with). His favorite thing to do on his Ipad is Dragon City.

How His Summer Went:

--- spent most of his Summer outside (Riding his bike, playing with the little girl next door who recently moved, looking for spiders, etc). He found a new hobby of setting up a table out front with some of his old Beanie Babies, books and other toys having himself a little “Yard sale”. He made a good amount of money doing so which kept his interest. He's still very reward driven.

At home we have a system we call “Marvelous Marbles”. This has been working okay because we can change up the rewards based on his interests. Currently the three goals have been using his coping skills (Deep breaths, taking space, etc), using nice hands + words and picking up after himself. He can get 3 marbles per hour. When he gets to 100 marbles he earns something from “The Marvelous Bag” which is filled with cheap toys, flashlights, bug catchers, games and other small stuff I find at Dollar Tree. Over the Summer, he did have some ups and downs with his moods, some aggression and irritability, but nothing major. They mostly happened around the full moon each month and also in the past few weeks when I think it was related to feelings regarding coming back to school.

I look forward to all the progress that --- is going to continue to make with you this year and working as a team with you to make his educational experience fit his needs the best it can.

Thanks,

-----------

Attachments: Summer Heat and Sun Risks, Information on Tardive Dyskinesia, Akathisia and Dystonia.(The last three are excerpts from NIH.gov.)"

**************************************************************

So there is the four page letter I wrote to Mr. M. I plan on writing the counselor just a quick update about his Summer.  Since she worked with him last year, she knows some things about him and got the extended version upon beginning to work with him. I also am sending in the Summer Heat and Sun Risks pamphlet, the info about TD, Akathisia, Dystonia, and Lithium toxicity to the nurse (Who is going to be a new person this year too as the previous one retired).  

Honeybunches Liver is Healing

We had a long trip to the lab this morning, but Honeybunches did awesome. We left at 6:45, got there at 7:15, registered and then waited in the lab. They didn't even draw his blood until after 8 am. Note to self: Next time go on another day besides Monday. IDK if that lab's just normally busier or if it's because it is a Monday morning. I always try to time it right so we get his blood work 12 hours after his last Lithium level. This time it was closer to 13 hours. IDK if it makes a difference or not. I wonder if it might show up low. Although it was a different lab with a much longer wait, different lab tech and the lady even used a big needle instead of a kiddie one he did amazing. He was actually more patient than some of the adults waiting. This lab has a prize box with toys that ours doesn't have. From there we went to this train park he loves for just a few minutes. (NOTE TO SELF: That's not a nice place early in the morning...) Then we stopped at the grocery store to buy him a donut for a treat and check the yesterday's baked goods reduced rack for other goodies. (Our grocery store doesn't have anything like that.) I should have brought his meds with me. We didn't get back home until after 9:15. At the hospital he wanted to go down to the cafeteria for breakfast, but I told him since we didn't have his medications with us he'd have to make a decision. I gave him two choices of either going to the cafeteria to eat breakfast or going to the park and then to get a donut. He thought about it for a minute and picked the 2nd choice.

Honeybunches GI doc just called. When docs call themselves, I am used to getting bad news. This time it could not have gotten any better!!! He said that his blood work done this morning showed that the inflammation in his liver is GONE! His fatty liver (NASH) is better. He was so happy with the liver function blood work results, that he doesn't need to see Honeybunches next Monday like we were scheduled and not again until February!!! Praise the Lord! He said for us to keep up with his diet. We haven't been giving him the Prilosec for a few days because that doc told me to stop it a week or so before his schedule appointment to see how he did without it, if the food went down the wrong throat again as Honeybunches said it or if his cough came back. So far he's symptom free!

Struggles at tutoring

Well tutoring didn't go so well today. :( When I got there to pick him up I was greeted by a female teacher who said she was just going to call me because Honeybunches was having a hard day.  She walked me to the ILC classroom where Mr. M was doing tutoring with him and another boy who I found out is going to be his classmate when school begins again.  Honeybunches was shaking, crying hysterically just standing in the corner of the room with his hands covering his face.  Mr. M was quiet to begin with trying to give Honeybunches a chance to tell me what happened, but he would not only saying "Ask him".  So Mr. M told me that Honeybunches was listening to a song on the Ipad and L (The little boy doing tutoring with him) didn't want to hear it so Mr. M said to finish that song and then not to play it anymore.  That made Honeybunches mad. He threw a whole container of paper clips all over the room, tried to knock a bookshelf full of heavy books over on himself and tried to bite Mr. M.  Mr. M said he had to restrain him.  (Honeybunches has a Safety Plan regarding doing this, it's referenced in his IEP and Mr. M is restraint trained.) Once I got there it took him a few minutes and some bribery to calm down.  I told him no marvelous bag for this hour, but if he helped me pick up he could still go on the computer and if he did a good job until after counseling we'd go to the train tracks afterwards.  I gave him space for a couple minutes. He said he'd pick up "When he leaves" talking about Mr. M. I tried telling Honeybunches that he'll have to get used to Mr. M because he's the Integrated Learning Center aka ILC teacher's helper. You can read more about the ILC and our decision to place him in that program here.

 So Mr. M went to check on the other little boy who was in the adjoining classroom while Honeybunches helped me pick up.  He handed me the books and I put them on the shelves.  Then he picked up the papers and we both picked up the paperclips.  On the way out Mr. M. said he thought it would be a good idea to have them do tutoring together since L will be his classmate in the Fall.  He said he's not sure if they just don't get along or what happened.  I told him how the little girl next door H is moving today and how he's going to miss Mrs. Understanding after being with her for so long.  I told him Honeybunches has a lot going on right now.  Since he does tutoring with L from 10:30-12 I told him I'll pick up Honeybunches closer to 10:30 tomorrow and Wednesday. 

We get home and Honeybunches tells Daddy "Had a hard time".  The 1st thing Daddy says is "No railroad tracks".  Honeybunches counselor had called this morning to tell me he talked to the pdoc who mentioned we had an appointment with her today, so he wanted to know if we'd rather see him today instead of Thursday to save a trip.  I said "Sure" since it does save gas.  They both work at the same counseling center which is about 25 miles away.  While Honeybunches is at the counseling center, DH has an appointment with his own doctor up the street. So that's going to leave Honeybunches and I at counseling alone, which sometimes doesn't turn out so well.  I explained to Daddy how I told Honeybunches if he did a good job at counseling he could still go, just no marbles for this hour.  If Honeybunches got it in his brain that he could not go to the railroad tracks, then I am 90% sure after how his morning went that counseling would have been a nightmare. 

Honeybunches only has two days left of tutoring.  Then there will be 27 days until school begins once that's done. 

Camping Trip June 2013

Friday we packed up to go camping.  We stayed four nights at a campground my parents brought me and my siblings to at least once a year while I was growing up.  It is full of great childhood memories, which is even more special to me now that my father is in heaven.

Friday afternoon while I was loading up the car for the second trip, "H"s father came over to talk to me for a few minutes.  At first he was telling us how it was going to rain and we had a flash flood warning.  Then he got in to how they are moving on August 1st because of issues with the apartment and the landlord.  I asked him if "H" was going to come to Honeybunches party.  He said "Yeah but he needs to learn to keep his hands to himself" as he explained how weeks ago he caught Honeybunches "Restraining" H out front.  I thought it was him playing cops.  He said "No it was more like him pinning her down to the ground holding a big rock to her head".  I explained how Honeybunches has Autism and is on meds to control his behavior.  I tried making it clear how when things like that happen we need to know right away so we can call his doctor.  Knowing weeks later is too late.  It's too late to discipline him.  It's too late to even talk to him about it.

Anyways, on to the camping trip...

Honeybunches was more irritable than on previous camping trips.  IDK what's up with that.  He had fun climbing trees, going down by the river to catch frogs, catching salimanders and more.

Friday was pretty rainy.  Actually so much that we could not even make a campfire. Sandwiches were dinner that night.  He still walked around and rode his scooter a bit between showers.  That night ended up going in the tent early to do crosswords.

 Saturday he was so cute.  The campground we were at has a very small shallow swimming area.  The water is only up to my stomach.  We decided to venture to a different beach which is deeper and bigger for an hour in the evening after dinner. There was a little boy there who was four-years-old.  Honeybunches was trying to teach him how to "Swim".  "You put your hands on the ground in the sand and you dig.  Then you kick your feet."  LOL.  He was also being a seal while in the water there too going "Art art" as he flapped his hands and kicked his feet.  I was calling him sealy.  That brought a whole other meaning to "Flappy when your happy". :) Saturday we also went on a nature trail.  He was well behaved on that for me as he was looking for more lizards the whole time.  He was very impatient that whole day and did plenty of fussing.  That night he was not happy with me.  He had sand in all sorts of places so needed a shower bad.  We didn't realize there was no hot water until in the showers already.  Regardless he still needed one.  He said "I'm never taking a shower here again"!  I can't blame him for being mad at me for that.  The water felt like ice water.  I took one too, which wasn't much fun.  They usually do have hot water, but the system broke.  He went to sleep early that night too.  Well not technically early.  He was on schedule, just too early for S'mores or to see the campfire.

Sunday morning we went down to the small lake at the campground for a bit where Princess was successful in catching another salamander.  She hunts with him too lol.  We let them visit with the creatures for an hour or two and then put them back so they don't die.  There is so much wildlife there which is what makes it so special.  That morning we also got to go on a free horse driven hayride.  This Momma loved it!  The children did too.  That's the quietest and most observant they were the whole camping trip lol.  The horses were a special treat.  The sign said it was a hayride, but I was expecting it to be driven by a tractor or something.  They were beautiful black horses that drove us around the back roads of the campground which are closed to traffic, but hold a lot of history.  We came home early that day so I could cook for his birthday party. He had a good party.  Two of his aunts plus their partners, one uncle and two cousins came along with the little girl next door he is friends with I call "H".  I am so happy she came, because again nobody from his school did. He was very cute organizing his dollars by serial number.  He was pleased with his presents of outdoor toys, money, flash light, police badges and gift cards that family got him along with the video camera DH and I did. 

Sunday afternoon back at the campground he had a great time using his video camera taking pictures and videos. That evening Honeybunches stomach was very sick.  He vomited 3x.  IDK why or what caused that.  Finally he went to sleep a bit later than usual because we kept him up to make sure he didn't puke in the tent.  Monday morning he woke up in a good mood.  He had a new activity he was enjoying... going for a jog around the campground.  He seen other people doing it.  I was happy he did because it's awesome exercise.  He tried getting Momma to join him, but my asthma would never have allowed me to do so.  We ended up coming home a day early.  BUNCH OF PARTY POOPERS!  LOL.  The only reason I agreed was because the showers had ice cold water because something broke on Saturday evening.  Plus when we woke up the day didn't look too promising weather wise.  It was pretty rainy.  Turns out after we came home and watched the news that there were tornado and flash flood watches for the town the campground is in, so it's a good thing we came home early.

When we got back I had an email from the pdoc saying his labs we had done on Thursday show his Lithium level is .9.  That's good.  She's waiting for the rest of the results. 

Medications--Side Effects--Summer Heat

There is a brochure I love regarding Summer Heat and Sun Risks.  I think I like that one best because it's easy to read and has a little box about Lithium.  In the Summertime people on that med are at a higher risk for toxicity.  Crazy Meds is a controversial website that goes into the good, the bad and the ugly about many different psych meds.

Here is a list of Honeybunches' current meds and any side effects he experiences:

Lithium: Can cause toxicity especially in the Summer when levels are known to spike up because of sweating (Which releases the salt in the body which Lithium works with).  A few Summers ago he had symptoms of diarrhea and a rash.  His level was 1.4 so we lowered his dose.  That's why in the Summer we keep a closer eye on his levels.  I request lab slips to check it as the seasons change, if he begins a new med or other times when I feel it to be necessary.

Abilify: In the past caused Tardive Dyskinesia (Which in Honeybunches showed up as lip puckering/smacking like he was blowing kisses in the air and tongue slithering where his tongue would go in and out like a snake) and Akathesia (Internal restlessness).  He takes Cogentin to help with both those side effects.  We also lowered his dosage down.  We tried replacing Abilify with Geodon and Seroquel, neither of which worked for him and caused even more side effects.

Cogentin aka Benztropine: None known.

Clonidine: This is the med he's been on the longest.  He can only take it at night time.  In 2008 during a rough patch we tried him on it during the day.  It caused him to be very tired and irritable.  With the night dose it helps him sleep, but doesn't cause any issues.  He does pee every single night, but it's hard to know if that's med induced because he was not potty trained at all until 4 1/2 and already on medications.  He's had issues with "Nocturnal Enuresis" as the docs call it his whole life. 

Tenex: Honeybunches doesn't currently have any side effects to this med.  In the very beginning he got headaches for a couple weeks and seemed dizzy when he first got up in the mornings, but that went away in a couple weeks.

His other meds are Qvar and Albuterol for his Asthma, Prilosec for his Reflux and Metformin to help with weight gain.  The Metformin seems to cause diarrhea and upset stomach when it's at 1000 mg 2x day.  We recently tried giving him that dose which is how we came to know about those side effects.  The Endocrinologist told us that's a common reaction and if it happened to lower it back down, which is what we did.

PAST MEDS AND THEIR SIDE EFFECTS:

Ritalin: This was Honeybunches 1st med ever, which he was on for one day at age three.  It caused him to have a 5 hour nonstop rage, which was his worst and longest one ever.  We only gave him one dose of this medication.

Risperdal: Honeybunches was on this med from ages 4-6.  He gained 65 lbs in those two years going from a skinny 35 lbs at age four to being 99 lbs at age six.  He had health problems because of it.  He looked very unhealthy and had no energy.  He could not even walk up a flight of stairs without being out of breath. Back in those days I trusted the doctors to know what was best.  If only I knew what I know now I would have never let things get that bad.  IMO this was the worst med for him and the one with the most side effects health wise. I have suspicions based on hospital reports when he was inpatient in a child psych ward where they took him off this med, that this is the one that began causing his liver issues because notes state he had elevated liver enzymes back then too.

Trileptal: He was tried on this med back in 2008.  It caused increased agitation and instability.

Vistaril: He was also on this back in 2008.  It caused excessive daytime sleepiness, irritability and possibly a mixed state. (He was on so many other meds at the time which also caused side effects so it was hard to know what was what).

Paxil: This was back in Fall 2008.  It caused him to be in a mixed state with increased aggression, hyperness, rages, irritability and deep depression.

Celexa: Also caused him to be in a mixed state, but also suicidal at age six in the beginning of 2009.

Fish Oil: Caused a rash from head to toe (But he can eat fish sticks w/o issues).

Geodon: 2013 caused disrupted sleep cycle where he was excessively sleepy during the day, but could not sleep at night as well as increased aggression.

Seroquel: 2013 caused a Dystonic reaction. 

So there we have it.  His list of medications past and present as well as their side effects.


As for Summer, my biggest concern is his Lithium because that one can easily become toxic if fluid intake is not adequate.  Since Lithium works off the salt in the body, I usually try to get him to drink Powerade or Gatorade on hot days.  Popsicles and jello are other ways to get increased fluid without drinking since they are water based. (Honeybunches just began liking pops and ice cream. In the past he'd say they were too cold and only liked foods room temperature.)  Honeybunches (Nor anyone in my family for that matter) doesn't like drinking plain water, but will drink Crystal Lite, Sugar Free Kool Aid, Propel and other flavored waters.  I try to change up the flavors every so often when I notice he's not drinking as much as usual.  Thankfully, most days he just drinks on his own and will ask for drinks.  In the past when he did not like to drink so much, the more we'd push it the less he'd want to drink.  Like many other things in life, it became a power battle.  He always loves to be in control.  We tried role modeling the adults drinking, for example his teacher would have her water bottle telling him how refreshing it was on a hot day or other things like that.  Sometimes they'd have contests to see who could drink the most in a day.  They put lines on his bottle in the past with times, which was a visual thing for him to drink a certain amount each hour.

Honeybunches doesn't sweat any more on meds than he did as an infant.  For some reason, his temperature regulation system never seemed quite right.  For example, in the winter he'd be happy wearing shorts and a t-shirt, while in the Summer he used to want to wear sweaters and boots.  Since he's gotten older he's gotten a little better with picking more season appropriate clothing.  He doesn't seem to sweat any more than I do though.  I never liked the heat. We rub his head and neck down with a cool wet washcloth when it's hot.  Now-a-days he seems happy staying outside for most of the day in the heat.  For example, today it was 90 degrees, but there was no keeping him in.  We reapplied sunscreen a few times and gave him a water bottle to take outside with him.  He's always gotten his hot and cold words mixed up.  For example he might say "I'm hot.  I need another blanket." when he means he is cold and might say "No blanket.  I'm too cold..." instead of saying he's hot.  So, no he doesn't complain about the heat much at all actually.

It's the end of 4th grade (Report card and progress reports)

Another school year has come to an end. Let the transitions begin!!!!

 Today was the last day that Honeybunches is a 4th grader.  In August he will go into 5th grade in Mr. M's room.  Yesterday Mrs. Understanding wrote in his book about how Honeybunches was crying because he didn't want to leave her.  He even wanted to go talk to the principal to see what she would say.  Transitions are always tough for him.  At least he'll get to stay at his current school (Which is technically the 3-4th grade school in town but he's been there since October of his Kindergarten year in two different substantially separate special ed classrooms) instead of having to make that transition which would be even tougher.  In the town we live in children have way too many transitions IMO.  K-2 is at one school, 3-4 at another, 5-6 at another, 7-8 at the middle school which kind of shares a building with the high school.  So if we can avoid him having to transition to the 5-6 grade school in two years when he's transitioning into 7th there won't be a choice, but it should be the only HUGE transition he'll have to make again for a long while (Unless of course we got Section 8 or have to move for another unknown reason).  My plan (Which may or may not be the school district's plan, but I believe they'll go along with me) is for him to stay with Mr. M for 5-6th grades. In August, it will be the 1st time EVER in his education that he'll  be without a 1:1 aide.  I have mixed feelings about that, but I'll worry about it in a couple months.  I am curious to see how he'll do without one.  He even had one at the exceptional home-based preschool he went to.  He began Kindergarten with one under his 504 plan that we had prior to getting his IEP a couple months into that year.  He's had one ever since.  Basically to begin next year it is only supposed to be Mr. M the class teacher, the aide who is also a male and one other student.  That should be okay, but I'm curious how the rest of that year will go.  The school sent home his Ipad for use over the Summer.  It's loaded with some educational games, tons of chapter books and some other applications. (He's loving "Who Wants to be a Millionaire".) We gave him rules to use it (At the table, with supervision, etc).  He also informed us of the school rules regarding it that we should follow too.  Those include keeping the volume down so it doesn't bother other people, no food or drinks and using it at the table. 

Today his progress reports and report card came home.  Here is his report card:

Here is an update on his progress reports: (In parentheses are how he's progressing...)

READING:
Current level of performance:
Honeybunches is able to read all 220 Dolch sight words.  His fall DIBELS benchmark score showed that he is currently reading 61 counted words per minute with 5 mistakes.  ___ is able to state the simple details of a story such as the setting and main characters.  He continues to have difficulty with retelling and recalling the important details in a story accurately.

Measurable Annual Goal:
After direction instruction, ___ will improve his independent reading skills by one grade level, this goal will be obtained by the benchmarks below.

Benchmarks/objectives:
1. Given selections at reading level, -- will recall important details in 3 out of 5 trials.(When reading information text -- is able to recall the important facts of the story 80% of the time however, when the text is fictional he has a more difficult time picking out the details of the story.  He is only able to do this 50% of the time.)
2. Given selections at reading level, -- will identify important details in 3 out of 5 trials. (HAS MET THIS GOAL!)
3. Given reading material containing unfamiliar words, -- will state their meanings by use of contextual clues in 3 out of 5 trials. (-- continues to work on words in context he is able to utilize new vocabulary 75% of the time.)
4. When given independent reading materials -- will read 80 wpm with no less than three mistakes. (According to --'s last DIBLES, he was able to read 67 wpm with 2 mistakes.  He is reading 62 words with no mistakes at his independent level.)

MATH:
Current level of performance:
--- continues to improve his math skills.  He has a good understanding of basic math concepts and he is able to rote count from 1 to 100.  He can skip count by 2s, 5s and 10s. He is able to tell time to the minute as well as identify all coins and dollar bills as well as identify their values.  --- is also able to add and subtract relating facts with sums up to 20.  He is able to add with one regrouping.  He is also able to solve simple story problems.

Measurable Annual Goal:
-- will continue to improve his math skills.  This goal will be obtained by the benchmarks below:

Benchmarks/Objectives:
1. Given any number, -- will state the place value of each numeral up to a million 80% of the time. (-- is able to confidently state the place value up to 100.  He is working on mnumber place value of a thousand and higher.)
2. Given addition problems with three or more addends, without regrouping, -- will find the sums with an 80% accuracy. (HE HAS MET THIS GOAL)
3. Given problems with subtrahends of three or more digits, without regrouping, -- will find the differences with 80% accuracy. (HE HAS MET THIS GOAL)
4. -- will learn multiplication facts 1-5 with 80% accuracy. (He knows his 1s, 2s and 5s times tables.  He continues to work on the 3s and 4s.)

WRITTEN LANGUAGE:

Current Level of Performance:
--- is now writing a complete simple sentence with teacher assistance.  He often verbalizes the sentence first and with the help of a scribe, then copies his thoughts onto paper.

Measurable Annual Goal:
--- will write a simple paragraph which contains a topic sentence, three details and a closing sentence.  The goal will be evidenced by the benchmarks below:

Benchmarks/Objectives:
1. --- will begin to use a graphic organizer to write his thoughts down and help him write a complete paragraph in 3 out of 5 trials.  (-- continues to require the assistance of a teacher to help him organize his thoughts and use a graphic organizer.)
2. Given choice of topic, -- will write a composition containing a topic, content and concluding paragraphs in 3 out of 5 trials. (-- is independently writing a paragraph which consist of simple sentences {a noun and a verb} the paragraph stays on topic.  He sometimes does not use a closing sentence.)
3. In his daily writing -- will use adjectives to expand his sentences in 3 out of 5 trials. (-- is able to do this 50% of the time independently).

COUNSELING:

Current Performance Level:
Currently -- has difficulty positively expressing his feelings of frustration, anxiety and stress.  He frequently uses verbal outbursts which become very disruptive to the class as well as limit his ability to complete work assignments.  When feeling frustrated and overwhelmed -- continues to escalate until he is often asked to remove himself from the class to take a time out.  -- is not able to verbalize his feelings, instead uses disruptive, negative behaviors to gain attention.  Despite these negative behaviors, -- has been able to transition into counseling very well.  He also participates in a social skills lesson given to his class every other week.  He has an incredible sense of humor and an be a very engaging young man.

Measurable Annual Goal:
--- will demonstrate the ability to verbalize his feelings associated with frustration, anxiety and stress in a positive manner in order to produce work representative of his ability.

Benchmarks/Goals:
1. -- will learn three coping skills (Relaxation techniques, breathing techniques and self talk) during counseling and utilize these strategies 50% of the time in order to help him appropriately express his feelings of frustration, anxiety and stress and reduce his disruptive behaviors during the class setting. (-- continues to work on identifying and appropriately 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 to --)
2. --- will participate appropriately during social skills group 50% of the time. (He 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.)

VISUAL MOTOR (OT):

Current Level of Performance:
-- continues to attend OT sessions both within and out of the classroom willingly.  He is a cooperative hard worker and can ask for a break when needed.  He demonstrates functional upper body strength and grasp patterns to perform expected academic tasks such as using school tools (stapler, ruler, scissors, pencil sharpener).  He uses a functional right hand tripod grasp on pencil.  When copying a scribed sentence or during penmanship lessons, his printing is legible to a non-familiar reader.  When composing, he is full of imaginative ideas and can use vocabulary words, but tends to print quickly to capture thoughts with little attention to spacing, letter formation and line placement.  He can print at a speed of 41 letters per minute (Which is near 4th grade level).  Use of a graphic organizer to promote topic maintenance and cohesive paragraphs is not yet automatic.  He needs adult scaffolding to organize his many creative thoughts to record on paper. His rough copy is legible to himself and a familiar reader.  Computer skills continue to improve to where he can now use a two handed hunt and peck approach to both type final copy and also to compose at a 8-10 wpm.  When typing, he tends to over or under focus upon mistakes, which can slow his pace.  He responds well to intermittent verbal cue to space, punctuate and check spelling.  He is not yet ready for computer operations such as spell check and word prediction as he needs practice and experience mastering writing conventions and using a graphic organizer.  -- has made great strides in all learning domains, but especially the development of frustration tolerance and work ethic.  -- is a self responsible learner who is proud of his many accomplishments.

Measurable Annual Goal:
-- will demonstrate improved paper/pencil and computer skills in order to complete daily writing tasks legibly at his expected academic level.

Benchmarks/Objectives:
1. Using a two handed hunt and peck approach to keyboarding, -- will type final copies of written comprehension up to 10 sentences with increasing attention to details of punctuation, capitalization and spelling 80% of trials {typing tests and work samples}...
2. -- will type 10-20 wpm using a hunt and peck two handed approach when composing rough drafts of assigned written comprehension, 80% of trials {Typing tests and work samples}...
(1 and 2: -- types 16-20 wpm often one handed even when composing.  Teacher has reported timing him at 23+ wpm.  This is excellent and indicates that technology and the use of IPad / Standard computer are the best methods for --.  both learn and demonstrate knowledge.  It is important to note, that printing skills have not regressed and he uses a combination of both typing and printing.) 
3. Given adapted worksheets as needed, -- will size and space numbers correctly on math assignments, legibly to himself and a familiar reader 80% of trials {Work samples}...
(-- prefers to use math worksheets rather than any adaptations and has made slow steady gains on this objective.  Work will continue.  He does best and output is more legible to himself and a familiar reader when cued to slow down.  His 1:1 aide follows through with all recommendations on a daily basis.)

General Note:
-- will most definitely master all expected classroom skills in the visual motor domain.  He is a delight to work with.  It is anticipated that he will most definitely meet all objectives by the end of this IEP.  It is recommended that OT complete at least an informal assessment before this IEP ends to determine the best method of service delivery.  It is a delight to witness such progress.  Best wishes for lovely Summer.

SENSORY MOTOR: (PT)
-- has made significant progress in the ability to participate in sensory motor activities in a small group physical therapy session.  He has also been observed weekly in his physical education class.  -- has been actively participating in all PE activities, requiring only minimal adult prompt with tasks that are difficult for him.  -- has been working on activities to improve his trunk/upper body strength and postural control with great success.  By improving his core strength, -- will improve his ability to complete tasks requiring balance.  -- is now able to assume all components of prone extension (On his stomach, lifting his head, upper trunk, arms and legs off the floor) for 10 seconds.  He easily completes 10 knee push ups in 30 seconds.  He continues to work on completing independent sit ups.  Skills requiring refined balance reactions of his feet have improved considerably.  He easily tandem walks backwards six feet.  He is able to hop in place x 5 on either foot.

Measurable Annual Goal:
--- will continue to improve his sensory motor skills for greater participation and independence in the educational environment.

Benchmarks/Objectives:
1. -- will assume and maintain all components only of prone extension (On his stomach - lifting his head, upper trunk arms and legs up off the floor) for 20 seconds with 80% accuracy. (-- demonstrates steady improvement in his overall trunk/upper body strength and postural control.  With greater ease, -- is able to maintain upper extremity components of prone extension for 20 seconds.)
2. -- will be complete 15 independent knee push ups and 15 independent sit ups in 30 seconds with 80% accuracy. (-- has partially achieved this objective.  He is able to complete 15 knee push ups in 30 seconds.  He continues to work on completing independent sit ups.)
3. During each physical therapy session and when given a choice, -- will select a physical therapy activity or exercise and will complete the task with 80% accuracy. (-- has partially achieved this objective.  When he is focused and attentive and feeling well, -- readily selects and completes a motor task/activity when given two choices.  He will also suggest activities that he would like to do and activities that he would prefer not to do.)
4. At the end of each therapy session and while using a visual assessment scale, -- will independently assess his motor performance and his participation with his peers with 80% accuracy. (-- is able to accurately assess his performance at the end of a session using a visual assessment scale.)

Note: "It has been a pleasure to work with --.  He would continue to benefit from direct physical therapy services during the 2013-2014 school year."

Note: -- has been participating in weekly individual PT sessions outside his resource room setting.  When focused and attentive, he clearly enjoys movement activities and puts forth his best effort.  He completes his best work when he knows there will be a prize at the end of the session.  His goal is his prize.  -- continues to demonstrate steady gains in all areas of his sensory motor development. 

Here is the behavioral reward chart that his school used this past year:

This was pretty cute!  I learned I am "Jovial" and what it means lol... 

 Here is a cute poem that Honeybunches' teacher wrote to him today (The last day of school)...