Even Ethan knows the drill at this point. I feel a little bad about that. At one point during the session, he literally picked up the picture he was supposed to be studying, and asked Jen, the speech pathologist, "So? What do YOU think this is?"
He kept turning around, too, giving me little smiles and looking for encouragement. "I'm doing a really good job," he announced several times, fishing for compliments.
This time Jen, the same speech pathologist who helped diagnose him and who saw Ethan for speech two years ago, administered the ADOS test to gauge his "social/pragmatic skills."
She is a wonderful practitioner, and I had just one qualm with one of the tests. She took out this picture book (no words to the story) and began grilling him on what was happening on each of the pages:
I remember seeing this book in the library when I used to work there. It's award-winning, but I thought it was weird. I don't even think I ever flipped through the whole thing, but it's about frogs flying, or something. To quote a review I found online, the book is “Sort of science fiction, sort of National Enquirer, sort of 1940s-style detective story, sort of 1960s-style comic book. Totally fun." Here's just one of the fun-filled pages Ethan was asked to describe:
Why in the world would someone use this whimsical book, so completely disengaged from reality and concrete concepts, to gauge a child with autism's skills at telling a story? I had trouble figuring out the story looking at it as a 20-year-old. It's just bizarre.
That aside, our 1 1/2 hour appointment told us things that I already knew. It's a little frustrating but much more gratifying to hear a professional say them.
Ethan is very smart.
He's come a long way, particularly with language.
He has some big gaps, most of which relate to critical thinking, sequencing (there's that word again) and something called "central coherence" (big picture thinking). It's hard for him to re-tell a story, in the right sequence; to understand why certain things happened, and to recognize the important parts of the story and how it all fits together.
These are issues I'm sure the staff at school is aware of, but they don't work as much on them as I think Ethan needs. I think I understand why. As Jen plainly stated: "The school sees that he knows most of the things a four-year-old needs to know. What we have to understand is that down the road, more and more as school goes on and he gets older, he's going to need to employ his critical thinking skills. It's important to work on that now so we can head off some of those challenges he may have down the road."
AMEN to that one.
And so: he is probably going to start a social skills group in the summer to work on sustaining conversation, play, interaction, all of that. And she recommended speech if he wasn't having other services in the summer, to work on things like understanding how the parts make up a whole, on how the little pieces fit together, on what motivates people and characters in books, about taking another person's perspective. This is big. These are core issues in autism world. I am simultaneously a little tired to always have something to be working on, but happy to have a plan. There is nothing worse than feeling something is missing but not being able to have anyone confirm your suspicions. I'm thankful that many, many of Ethan's teachers and therapists over the past few years have been receptive and proactive. It means so much to be heard -- and in the long run, will mean so much to Ethan, even if now it meant sitting through yet another test.
After school I ran into Ethan's physical therapist, Mrs. B. My heart sank at first. Last week he had acted like a little hellion with her, but today she was all smiles and reported that the Ethan she knew and loved was "back." I asked her something I'd been meaning to ask for awhile: if she thought next year when Ethan was 5 if he'd be able to do T-ball and soccer in town. I know there are challenger leagues for kids with special needs, but I wondered if she thought he could handle the environment with typical kids.
"He's nearly ready now," she said. She loved the idea. She thinks he can do it.
Tonight was the parent-teacher conference. Ethan was "calendar helper" at school today. His progress report looks great; it's the social goals on his IEP that continue to creep slowly but surely towards improvement. The speech therapist called him "Asperger-ish."
All in all, it was an informative, exhausting, rewarding day. I will go to bed remembering the best part, which was the song Ethan made up out of the blue this morning while getting dressed, something along the lines of:
Mom, I love you
I really love you
Nothing can be better than that.