Wednesday, July 6, 2011

It's Time.

Time passes. You don't see it most of the time. More often than not, when we are feeling the stress, it feels like time actually stops. But it doesn't. It keeps going. And if we don't get on top of issues, they tend to grow. Or they will prevent growth.

We have been sitting on questions about Rachel for a very long time. What is going on with her? We know she has autism. It may have taken us a long time to come to terms with it, but we know it to be true. But is that all? We had been wondering if she also has OCD (Obsessive Compulsive Disorder) or ADHD (Attention Deficit and Hyperactivity Disorder).

Our concerns about OCD started probably before we knew about the autism. We know how ordered she can be. She can't stand it when things spill or when even a drop of juice from her cup spills on her. We used this to our advantage when potty-training her -- she couldn't stand being wet so she needed to go to the toilet. It worked. Everything can have a positive spin to it, right?

ADHD on the other hand, we had been pushing off feeling that it wasn't very important. When she was in the classroom, working with her teacher one-on-one, she was learning so well. They are constantly looking for new programs to teach her. They are now working on teaching her to write letters and numbers. We know she can read. She loves to play on the computer, and she can play the games and navigate through them (and the permitted websites she visits) appropriately.

We can wait on the ADHD.

Or can we?

When is it the right TIME?

Earlier this spring, I wrote a post about how she was having difficulty in school attending to the teacher in the typical pre-K classroom. Her inability to focus in that classroom was preventing her from learning in this setting and preventing her from interacting with her NT peers, the reason why she was in there. She spent 6 months attending this class and was unable to expand the time in the classroom from 15 minutes. The hope was that she would spend the morning in her special needs classroom and the afternoon in the NT setting. 6 months later, we're still not even taking steps to get there. And all because she can't attend. We need help. And a different kind of help than the local system can provide. We need a physician to determine if there is more going on than just autism. We need to seriously consider ADHD. And we need to do it NOW!!!!

After I went to visit her at school this spring, I called the doctor who originally informed us that the twins were on the spectrum and made an appointment to ask about these 2 co-morbid diagnoses. We had to wait until late June, but I got the appointment and we went.

The visit was, well, I'll call it interesting. We were called back and they measured Rachel's vitals. She was a bit rambunctious. She allowed them to weigh and measure her. She allowed the nurse to listen to her heart, take her blood pressure, everything that was expected of her. But she was playing with her. She kept trying to grab the stethoscope. She wanted it all for herself. But she did cooperate. Then we sat there for a little while and I think the doctor was watching her. She was trying to run in and out of the room. To me, this is normal and almost good. But it's another little tick on the doctor's clipboard. Then we head down the hall to begin the interview. The doctor asks Rachel to follow some simple instructions (come with me and sit down on the couch [2-step instruction]). Rachel is curious and looks everywhere else. But she does follow the doctor. But there were letters (stickers) all over the wall in this room. I had to take her by the hand and lead her to the couch. And she kept shrieking out the letter names she was seeing. The doctor wasn't sure if she was reading them or just reciting letters (I knew she was reading them).

Once we got Rachel to sit down, the doctor started asking her some basic questions (such as "How old are you?"). Rachel refused to look at her. Rachel continued to read the letters off the wall. So we changed tactics. "Rachel, can you find a letter 'D'?". She did that one without any problem. "What letter is that?" (pointing to a "Q" behind her) -- no reaction. After trying for a while, the doctor asked if I had something to distract her and we could have a conversation. So, I gave her my iPhone and allowed her to play.

After a while, the doctor started asking Rachel questions again. This time, she still had the phone. And this time, she had no problems answering ANYTHING the doctor presented to her. She needed that external object to focus on. And she wasn't just randomly playing a game. She went to my photo album and was looking at the pictures of her brother (Daniel at this moment). She was watching the video of Daniel at his swim meet that I had recorded while shouting my cheers. She was interested in looking at their FACES. It was strange to see the doctor's face.

Overall, by the end of the visit, the doctor told me that her impression is that we are looking at ADHD (but not OCD). And she does believe that we need to take action because it is preventing her from progressing. It is actually creating a stumbling block for her. It's possible that she will be able to be successful in a fully mainstreamed setting within a few years with little to no assistance, IF we can get the ADHD under control. So, now I'm starting to do my research. What IS ADHD and what can we do about it? What are the best medical treatments for a 4 year old girl with a co-diagnosis (and primary diagnosis) of autism? And how should this be managed?

That last one is very important. You see, this doctor is in the process of retiring. She will be leaving this practice at the end of the summer. She has given us some recommendations and will work with us to find someone to continue managing Rachel's treatment, and we are going to discuss this further when we go back in a couple of weeks. But we need to find a different doctor to manage her care.

This is my own fault. I knew we needed to look into this. I had suspected it for quite a while. And because I had put it off for so much TIME, I now have to deal with the added complication of needing to find a new doctor whom I can trust to help manage this long-term.

We have seen so much progress in both of them without medical intervention, I keep forgetting that body and brain chemistry is why we're here in the first place. We also have remember that there is a medical component to all of this and we need to look at all things if we are going to find an answer to make sure they can both succeed. And that's what I need to do.

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