Wednesday, October 28, 2009
He's stopped for the moment now mimicking some scenes from an Arthur learning CD where there must've been a spelling bee: "pee i c t u r e." He's also doing the oral stimming again, bringing water into his mouth from the bath and letting it run out of his mouth. I noticed specifically that he didn't do any of that last night, so maybe the B12 makes him stimmier the night of the injection? Who knows. This oral stimming with water drives us batty at bathtime and in the pool...but part of dealing with this junk is picking your battles and trying to not let every little anomaly and non-productive thing they do drive you apesh*t.
The Adam's Dad mystery of last night has an explanation. Dad says he went out to dinner with someone for their birthday, and he said something else quick that implied a "she" was involved. And when asked directly, he claims to still be sober. He stayed home from work today which lent additional suspicion, but he claims he didn't feel like going, has more vacation than he knows what to do with, and is resting up for inventory here soon, where they keep him around for 12 hours or so. I asked him directly if he was bullshittin me and he said he wasn't, so, I'll take that as a better than half chance that it's all as he stated. I'm not aware that he's lied to me before, and has been if nothing else, pretty honest with me about his problems and where he's at. I didn't press for why he didn't respond to my phone message, because that too could have two explanations. He's never been a reliable responder to phone messages. End of day: who knows. He did appear sober and fine when he dropped Adam off, and for that, I'm thankful.
When Adam got home here tonight, he went into the toy room and was playing with the 3 year old's train setup appropriately. That was good to see... he and our son are really about at that same level functionally in a lot of ways. Any time Adam's playing with toys appropriately and it's not something that makes noises, has lights, or is attached to a CPU, I'll take it.
The wife had a pretty good "crazy busdriver" story from this morning. The busdriver, who's WAY more erratic than the god-send woman of last year, and who we know is coming because she's speeding through the neighborhood up to the turnaround yelled at the wife this morning. Adam got on the bus, and the bus driver motioned for my wife to come out. The woman says "You have to keep him home--he's sneezing!"
"He doesn't have a fever, he doesn't act sick--what do you want me to do?"
Crazy erratic woman, we come to learn just got over pneumonia, so we probably had more to fear from her than she had of a special needs kid who's allergic to everything. This also explains why we had a cavalcade of bizarre sub bus drivers the past few days. Nothing like a sub bus driver assigned to the special needs short bus.
Bat-sh*t crazy bus drivers aside, this got us thinking "why IS Adam stuffy in the morning--it's not a high allergen time of year?" Then it dawns on us that that nice puffy new coat his uncle bought him... yup, sure enough, goose down. Doh. This burned us once before when I unwittingly made his bed once and mistakenly put the down comforter (to which he's allergic) on his bed, and puzzled for two nights over his sudden onset stuffiness at bed time. Duh.
Okay, he's ready to come out of the bath. "Adam, open the drain." He struggles a few times. "Up and left" I remind him. He gets it. "Put away the toys." After about 5 seconds (that's how long it seems to take for him to register a response), he starts doing it, and it slowly putting them all away. This is pretty good, actually--better than average. He puts all of them away, and steps out. Starts to nearly shiver.
I throw the towel over his head and he says "I'm cold." I tell him to rub his head to dry it. He doesn't do this well, so I put his hands on top of the towel, and help his hands make this motion. Then I tell him to dry his chest which he does, then his arms, then his hum (his 2nd language's word for his crotch), his butt, and his legs which he now can do okay with me pantomiming to him to give him a visual.
Now, we stand on the 3 year old's stool and he asks me for the hair dryer. I fire it up on high fan, medium heat and hand it to him. We've been working up to that. He has it for about a minute and then tries to give it back. "Turn it off, Adam." He does it.
"Go to your bedroom, get some underwear." He makes a detour en route to the 3 year old's room, I redirect him pushing him toward his room/closet. "Underwear" I say pointing to his closet. "On the floor, in the basket." He's unfocussed, I finally point his head toward the goal and he takes a pair. He thumbs through the shirts to pick one but I give him the one he wore last night. I come out to the hall to type some more. He sits up on the bed, puts his underwear on (hey, he got em on the right way tonight...hrmm... this he seems to be doing better with this finally!), and puts on his shirt (which he's done very reliably now for several months) and his sweat pants. He asks for his light to be turned on, I keep typing... and... hey how bout that, he's figured out how to turn it on with that rolling thumb wheel switch that's in line with the cord. Score for fine motor skills.
"Adam, go brush your teeth."
Right now, he's in front of the mirror in the bathroom. I'm trying to take a hands off approach here and just tell him what to do. He lathered up his hands with soap, and he's looking at himself in the mirror, making exaggerated faces and making Capital One noises and being silly. Now after prodding, he's turned on the water to rinse his hands. For about a minute now. "What's in YOUR wallet?" he asks me.
"Turn off the water, goofy." He does.
"900 dollars a month! No hassle payments. 900 dollars a month!" he says, looking at himself talk in the mirror, thoroughly pleased with his own performance. I'm having an idea that maybe he access to someone's YouTube connected laptop at Grandma's tonight? Toothbrush now moving around his mouth, and he's biting it pretty hard--must feel good.
"Adam, is there toothpaste on that toothbrush in your mouth?" He rolls the soap dispenser around looking at it down on counter level, toothbrush now hanging out of his mouth.
"Did you put toothpaste on the toothbrush?"
"Are you sure?"
"Yes I am sure," says Adam.
Wow, score one for Adam. Usually you get a contradictory "No I am sure" or "Yes, I am not sure." I had to take over the toothbrushing--he hadn't put any toothpaste on that brush. Rinse, and done. Wipes his mouth on the handtowel, and runs it up to his nose too (ick, but ... ). And off to bed.
He wanders out of his room into the 3 year old's room again looking through his toybox. I get up from the hall, turn the lights off in the 3 year old's room to make him lose interest, and redirect him to his room. He crawls into bed. He's smiling and verbalizing more random commercial stuff to himself. He crawls under the sheet and I kiss his right cheek good night (Uncle remembers just a year or so ago before we took over when that then-poorly-kept mouth of teeth smelled like morning breath on steroids because no one was willing to fight him to get them thoroughly brushed every day--old habits die hard), tell him to have a good night, and he had that big goofy grin like he often has when he's in a good moon. "Good night Adam." "Good night Uncle Tah."
He's quiet... and breathing sounds clear. Ahhhhh.
We are still letting him sleep with a low wattage light on in the room, and haven't tried turning that off.
Back when the diflucan was introduced to him, our normally rock solid sleeper got disturbed. We started having sleep problems, and then there was a trip we all went on that he slowly recovered from and wouldn't sleep by himself again for a time, but he's back to normal now, sleeping through the night, refreshed in the morning, and not bugging anyone to have to sleep with him. Before he got back into this good place with sleep, we'd fight a little to get him to bed, I'd have to sleep next to him (he sleeps with Dad or Grandma at the other house), and he'd frequently wake during the night and demand that I go back to sleep next to him. All that's gone now, thankfully, and it just occurred to me that it maybe deserved a note.
Tuesday, October 27, 2009
Today, Adam was well behaved, and had an okay Speech Therapy session. Some progress, some stayin the same. Bedtime routine went well here and he poured the water over his own head for bathtime, and was willing to do some of the lathering of shampoo into his hair. He's getting modestly better at drying himself with a ton of verbal and visual prompting, but there's work to do here. Dunno if dad/grandma make him dry himself over at their house on the weekends, but I've mentioned it before.
Adam's sleeping in the next room here, and has been coughing a bit which makes me hope he's not catching something. He'll cough something that sounds productive, and then we cringe to see him kinda chew with his mouth, and not spit anything out... Ick. Swallowing all that mucous. Meh. But, I haven't heard a cough since I started typing, so maybe he'll get through the night just fine.
Tonight, we got some carryout food and went to Grandma's/Dad's after afternoon therapy tonight to celebrate Adam's Dad's 1 month-iversary of sobriety. It's something I wanted to do so that Adam's Dad would get some positive attention from his family and me, instead of the usual highlighting of when he screws up. He has been (comparatively) great this past month since his discharge from his 5 day hospital stay for pancreatitis (3rd time now, yay alcoholism!).
Unfortunately, he wasn't there.
Now there are two possible explanations: 1) his company actually is working hard toward a deadline and he's working overtime, which would mesh with things he's said recently as there is a production deadline they're working this week. Or... ironically, or 2) maybe he's taken to--as he has before--going to a buddy's to drink after work so it's out of sight at home. If it was #2, the congratulations card signed by his brother, sister, me, and his mom will generate a great degree of guilt when he gets home, but guilt has never helped anyone get sober, though. I have a nagging feeling he's not as sober as he claims to be because when I've asked if he's stayed sober, his answers have not had the conviction they did in weeks 1/2 about him not having the urge. I dearly wish he'd get help with his sobriety via 12-step, but getting Asian immigrants to do 12 step is like pulling teeth though. As the wife explains, it's just not in the culture to show up in public at a meeting that says "hey look, I have a really serious embarrassing for the family problem and I need y'all's help." No wonder AA skews heavily white, and heavily Christian.
As loved ones of an addict, we have to abide by the mantra too--we're powerless over his disease just as much as he is--and if he's gonna get well, it's not going to be because we want if for him, HE's gotta really want it. And even then, he may not realize it, but statistically, he's gonna need help each day to keep sober.
He's in a bit of an enablement cocoon over there with Mom and 2 brothers in the same household, where no matter what he does, he'll have a place to sleep, and Mom being under the same roof won't throw him out on the street, and with a special needs child who needs his continued employment/medical care, the bottom he'll ever be allowed to hit is a pretty high one.
So for now, I'm keeping the good sober weekend we all had in mind,remembering that 3 weeks ago I somehow got him out of the house to join us all in a trip to the arboretum with his son (essentially unprecedented)....and being cautiously optimistic that maybe he really was working overtime tonight.
From the pharma world, things that really seem to help him are Flovent, a long-acting inhaler for his asthma, and Singulair. We've tried to take him off Flovent a few times, and every time we do, we seem to quickly end up regretting it. I'll mention that these two alone weren't enough to keep him clear at night, and it was only with the addition of diet and to a lesser extent supplementation that we really started seeing him be totally clear at night and in the day with respect to stuffiness and the asthma cough. He's also on a daily anti-fungal to help deal with gut yeast overgrowth. This really did improve the poop situation, and rather than having a mushy mess that wasn't formed, after a month or so of being on this, we started seeing normal looking poop.
Note that unless you're in the autism community, it's normal to think "ewwwww..." But in autismland, we talk about poop a lot, because it is a universal issue it seems. Autism poop has its own delightful god awful smell...now ya know.
Final note: we didn't just start him on this wad of crap. This was carefully and methodically phased in one at a time over a period of a week, with doses tweaked based on blood testing all under the supervision of our DAN doc. Adam's an 8 year old, 60lb kid.
To be given in the morning (between 7am-8am)
Probiotic (capsule – in blue bottle) 1 caps. Give 30 minutes before breakfast. Keep in fridge! This is a 12-strain active probiotic. As the theory goes, autistic kids gut issues have to do with the imbalance of yeast and good bacteria. Oral antibiotics rape and pillage good gut flora (bacteria) and probiotics help restore that. If you've ever seen a Danon yogurt commercial, Acidophilus is just one probiotic strain. In Europe, apparently, they prescribe probiotics any time they have to Rx an oral antibiotic to help keep all this in balance.
Caprylic Acid 1 caps.
Cod liver oil (liquid – in blue bottle) 1 tsp. Brain function, goof omega-3's and stuff, apparently.
Super Nu-Thera (liquid multi vitamin heavy on B vitamins which autistic kids don't get enough of and/or absorb poorly) 1 tsp.
Magnesium (powder – in big white container) ¼ tsp.
Vitamin C (Buffered Ascorbic Acid-powder) ¼ tsp.
Diflucan (Fluconazole-anti-fungal Rx) tablet (give w/food) ½ tablet Diflucan is an anti-fungal that actively attacks fungus overgrowth in the bowel.
Grapefruit Seed Extract (with lots of white grape juice) 10 drops GSE is a natural enemy of fungus.
ActiFolate 1 tablet
P5P (yellowish tablet) 1 tablet
Super Vit. B Complex 1 caps.
To be given between 12pm-3pm
Zinc (capsule – in small white bottle),1 capsule every 3 days
Cod liver oil (liquid – in blue bottle) 1 tsp.
Grapefruit Seed Extract (with lots of juice) 10 drops
Magnesium (powder – in big white container) ¼ tsp.
Vitamin C (Buffered Ascorbic Acid-powder) ¼ tsp. Helps with the immune system, and all that jazz.
Vitamin D3 (1 drop add to cod liver #3) 1 drop
CoQ10 1 caps.
To be given in the evening – late PM (7:30pm-8pm)
methyl B12 shot (1250mcg/0.05mL) 1/2ML once every 3 days
Singulair (pink tablet, Rx for asthma and lung repair) 1 tablet He's been on this forever it seems.
Diflucan (Fluconazole) tablet (give w/dinner) ½ tablet
Flovent Inhaler (long acting asthma Rx) 44mcg 1 puff He's been on this for a long long time too.
Caprylic Acid 1 caps.
Probiotic (capsule – in blue bottle) 1 caps.
On a time available basis I'll fill in what each is supposed to be doin for him.
The wife stumbled on this this article from Mercola's website.
Now, Mercola is a pretty heavy hitting name in natural health stuff... and I won't bore you of our HORRIBLE experience at his Hoffman Estates clinic with Adam when we tried to go there for want of a close DAN! doctor (summary: staff marginal at best, whole thing seems to be geared toward separating you from your money, and there are some things they espouse that broke our HokeyMeter--emotional freedom technique? EMF killing us in immeasurable ways?), but it is interesting to read this new info on the interaction of vitamins A and D.
Vitamin D has been shown to be a huge + in so many things and its deficiency seems to be a big deal in a lot of maladies. This was even mentioned by my ER doc friend when I was recently talking with him, so it's not stuff that's confined to the natural health nutjob sphere of medicine. When there's overlap between western and natural medicine, my ears always perk up. In other Vitamin D news, apparently 50,000 IU a day if you get the flu can be a very very good thing. There's a compounding pharmacy locally that's selling a "flu kit" by prescription that includes Vit D dosing and other goodies for battling off the flu.
At any rate, we'll be asking our DAN doc whether this new research suggests any change in his cod liver oil dose/brand/whatever.
Monday, October 26, 2009
Adam got his B12 shot last night, for whatever it's worth, and had a pretty good day. He is still pretty darned stimmy though. Today he rediscovered his "number cards" which are like Uno cards and he likes to arrange them on the floor and look at them. He used to be full on into this months back, and had abandoned em a while. He's back into them now, though for some reason. He wasn't too ridiculous with them, however, so it's not terribly concerning. He also dug out all his computer game CD's again, found a Nemo one, and as he loves to do, drills on down through the file system of the CD to the directory where the video clips are stored, and watches the video clips used in the game, watching them fast forward, then in reverse, watching Nemo swim backwards, and giggling like a drugged morphine addict. He didn't do it for too long though, and went to bed very easily tonight. He did ask for my cellphone once today, but didn't seem to be bothered when I told him "no." Hrmm.
Good news: Adam and his occupational therapist have been working hard on brushing his teeth, and by gum, that kid can nearly do it by himself now. With lots of redirection he'll put toothpaste on, and then slowly brush around his teeth. I prompt him to spit to keep him from being tempted to swallow the fluoride, and I had to prompt him to flip the brush up so he would brush his upper arch, but he's actually doing the motions and stuff...it's exciting. I clean up and make sure he gets all his teeth thoroughly covered though, as he's not gonna have that goofy dracula smile again that he had with baby teeth--at least not on my watch!
Another bit of "hrmm that's new" came today when the furnace repair guy was here and he was about to be taken to Grandma's by the wife. He goes into the garage and as usual says "take-a the van?" and instead of just going out there and blindly getting into the van as he always does (heading for the back seat--his favorite), he stopped and said "Ah Saen, ah Saen" in a fairly calm way. My wife got out there and realized furnace dude's van was behind our van. Adam had put together that taking the van was going to be a problem with where that other van was parked. He said then "Take-a the Outback?" and had the biggest grin on his face. Not sure why it was so amusing to him, but it was cool that he seemed to put together those concepts, and formulate a plan to get around the obstacle. With normal kids, we never think about this as a big deal, but with Adam, his progress is slowed to the point that you get to see every bit of development in slow motion. When it happens, it's definitely exciting.
Adam was also very sweet when I put him in bed tonight. He had a big smile on his face, happy that I agreed to put him into bed, after he requested that I specifically brush his teeth, and then when I gave him the usual good night hug, he looks me dead in the eye with a big smile and says "Thank you Uncle Tah." This isn't unprecedented, but you don't get it all the time, and it was just a really nice cap out to his day.
It seems that every day after a B12 shot is a really damned good day for him...I haven't seen a counter data point to that in recent memory.
Oh, in other news, speaking of shots, we're not vaccinating him against seasonal or H1N1 flus this year, following our gut, as well as the advice of his DAN! doctor. DAN practices are all pretty universally against these flu vaccines, since they all have thimerisol in the shot preparation, and the nasal preparations are live attenuated virus. Besides, I wouldn't be shocked that the long lingering awful chest congestion cough illness he and the wife had 3-4 weeks ago wasn't H1N1, or flu. With learning this year that Adam very very likely did have vaccine injury as part of his autistic progression, we are extremely cautious as his immune system is very clearly not as healthy as, say, our 3 year old who was breast fed for 2 years!
Also, my perfectly healthy friend who's an ER doc is also avoiding the H1N1 vaccine himself for now, indicating that for him, he really wants to see how many people stroll into his ER with Guillan Barre syndrome if any in reaction to the vaccine before he takes the plunge. I've heard several other anecdotes of vaccine researchers, and other physicians who are looking at this H1N1 thing with a lot of trepidation. There's no doubt it was a hurry up job, it's a relatively novel take on the seasonal flu vaccine, all the multidose preparations have the ethyl mercury and aluminum containing preservatives that we know autistic kids struggle with, and at the end of the day, h1n1 is often a pretty darned mild flu, although a lot more contagious than the regular flu. If any of us in the autism community trusted the CDC, it might be an easier decision. But, for us, we're all avoiding flu shots this year.
Sunday, October 25, 2009
After we got back, he gulped down some water, and about an hour later, had a near tantrum toward the middle of the afternoon. He either wanted a phone to stim on, or something not good for him and wans't happy with No for an answer. He also got a little destructive, tearing up some paper and throwing it around, and he got into my wallet and threw its contents kinda everywhere in the dining room, with a credit card on the ground and wadding up some receipts in the main section and throwing them on the ground. I caught him in the act of this, told him "no," and he laid on the ground calling "Dah-dee, dah-dee...." like he'd do when he was at our place earlier this week and I correct him for something (he'd call for my wife then).
He is due for B12 tonight, so this would seem to be a data point in our "maybe he needs more B12" thoughts, but Adam's dad reported that he wasn't appreciably different yesterday with respect to stimminess and making messes on purpose.
All this happened over at the in-laws (Adam's Dad/Grandma's house) around the corner by the way... I went there today to take in some football with Adam's dad. I'm thrilled that he's now just one day shy of being 1 month sober, and if I can be someone he can spend some time with without drinking, fine by me--I do enjoy his company when he's sober, and the idea of a boys day watching football is good times too.
This development with his Dad's sobriety is huge for Adam, and for his Dad I think. Getting Adam's dad more engaged will only help both of their recoveries. Big changes I see in his dad is that HE initiated us all going outside to play when it was clear Adam was getting a bit stir crazy inside, and was more than happy to amble all the way to the park and back.
Finally, there were some really cute moments between Adam and his Dad--they were playing a new game Adam seemed to pick up somewhere, where he talks (usually parotting a TV commercial like Capital One), and holds his dad's chin, making his chin move along with words Adam's saying. His dad was trying to do it back to him, but Adam didn't get that in this reverse role, he wasn't supopsed to talk! I got a video of it on my phone... it was awfully cute. So great to see the growth in Adam's dad here as he remains sober. I remain cautiously optimistic that it'll continue. His dad needs to learn how to fill up his time without thoughts drifting back to the drink, and hopefully in Adam he sees some opportunity in doing things with him as ways to keep his mind and body busy rather than just hanging around the house. For my part, I'll just keep engaging him in fun stuff to do with the boys and hope he continues to show interest in participating and keeps his car free of any places to pick up beer on the way home from work.
Saturday, October 24, 2009
First I'll say that we considered, but ultimately rejected any idea of putting him on any ADHD medicine like Ritalin and friends. Too many side effects, and it seemed like there was an awful lot of other things we could try first before doing the Western Medicine thing and shove a product of big pharma into him. His speech therapist said she wouldn't bark up that tree because she was able to find ways to work with him, and in comparison to her other special needs/autistic clients, he wasn't really that bad with respect to ADHD (although in comparison to a normal kid, yeah, he was bad). Even Adam's behavioral medicine specialist who Dx'd him as PDD-NOS also wasn't really suggesting it, but was willing to write the prescription when we inquired about its applicability and maybe trying it just to see. Ultimately, we didn't fill the prescription she wrote as there (thankfully, in retrospect) no stock at the first 2 pharamacies we went to. Later, our pediatrician (grrrr.... this guy and others in his practice almost seem to be the enemy in this autism battle sometimes), started actively pushing it, while simultaneously telling us we were wasting our time with the DAN! practitioner, diet, supplements, and being almost entirely dismissive of the results we were seeing. Of course, our DAN! doctor (former ER phsyician) would look at Adam now, look at the rest of his practice of ASD kids, along with Adam's specific results and say that Ritalin would be an insane first thing to to try.
Now, that all said, Adam doesn't take anything aimed specifically to help him focus, but there are several things he is doing/getting that have definitely helped a ton in this regard. He is a lot more focused these days at 8 than he was at 7 when his gut was all distended, he was constipated, and he was carb craving and eating every croissant, apple, and banana he could stuff in his mouth, and would only eat Costco chicken nuggets for every meal. They went through a box a week for about 2 years before we got on board and started getting into the diet, supplementation, and seeing a DAN! doc up north.
The first aspect of the focus improvement seemed to be the diet. We started this in earnest late in 2008. After we started the gluten-free, cassein-free (avoiding all milk proteins), and soy-free diet was the first time that we could ever get him to sit down long enough to read an entire children's book to him. His special ed teacher also affirmed the improvements saying "I think the diet is really helping. He is much more willing to work and participates more in groups" (1/30/2009). This matched with our observations at home, but is without the result-bias that we'd obviously have.
The science behind these dietary improvements has to do with the leaky gut theory of intestinal inflamation where the inflamed cells in the walls of the intestine inflame, and the sulfate bonds of the mucousa that normally exert tight control on what gets into the bloodstream get weaker than they otherwise would be in a healthy gut, and consequently are more permeable to letting crap into to the bloodstream that shouldn't be there. So, for instance, instead of digesting individual amino acids like yer supposed to, the ASD kids are taking in entire proteins instead. Gluten gets into the bloodstream without being fully broken down in the ASD kids, and the theory is that these substances that aren't fully broken contain peptides (sections of protein) that have a structure similar to opiates like morphine and heroin. The theory goes on that these structures may attach themselves to opiate receptors in the brain and acting as false neuotransmitters...and.... get this shit... it's possible the reason our ASD kids seem to crave carbs and gluten and crap is that if they don't, they may be experiencing withdrawal symptoms from these substances that are behaving like morphine or heroin in their system. For more info on this, check out "Changing the Course of Autism: A scientific approach for parents and physicians" by Bryan Jepson, MD.
Second step that seemed to contribute to better focus was supplementation, and following the program laid out for us by our DAN! doc. The cod liver oil portion of his supplement regimen (he was eased up to a dose of 1tsp morning and 1tsp afternoon each day, starting with 1/4tsp) is aimed at focus somewhat. This didn't give us a huge noticeable improvement, but it was part of a lot of other supplements that were setting the stage for him to get the methyl B12 injections, where the DAN! doc reports tend to be among the biggest improvements that they see. Sure enough, the methyl B12 injections we give him now twice a week (0.5mL once every 3 days) seem to have a dramatic impact. In fact the very day after we gave him his first methyl B12 injection, I innocently asked the teacher if she'd noticed any improvement in Adam, and noted that we had a really tough time giving him the first injection. The teacher's response: "I might have kept the [much improved] work sample for data. Today he made a transportation book. He told me most of the sentences and wrote everything by himself. (Ok I made one B for him.) He only sang 773 [202 beep beep beep beep LUNA] and I said no. He stopped immediately. He had to make his book in a group of 3. The other 2 students needed help as well. He worked the fastest and finished before them. Bring on the B12. I'll even give it to him." (5/18/2009)
With those pieces, he is a lot more focused these days than he was when his gut was all distended, he was constipated, and he was carb craving and allowed to eat every croissant, apple, and banana he could stuff in his mouth, and allowed to eat Costco chicken nuggets for every meal. They went through a box a week for about 2 years before we got on board and started the diet.
Right now, we're finding that in Occupational and Speech therapies that when his methyl B12 shot is on the wane (i.e. day 3, as he gets them every 3 days), he's a lot less effective at therapy, and becomes a lot more impulsive and unfocused. This seems to be very consistent, so we're awfully convinced that methyl B12 injections are doing something good for his focus and calmness.
Friday, October 23, 2009
I learned last night that that the autistic regression that's seen by so many is not universal. We never saw a dramatic regression with Adam--his story was not one of where he just lost a bunch of language or social interaction--he just never quite developed on par with his age. Apparently, Adam's story is the same as about 20% of autistic kids, while the other 80% do experience a dramatic regression over a short period of time. What's apparently been found in this regressive autism is that things are damaging the brain stem...which apparently is an area that is not protected from nasties by the blood/brain barrier. What I recall of the presentation is that some of the environmental toxins that seem to be most prone to damaging the brain stem are inorganic mercury, Cadmium, MSG (doh! it's friggin everywhere, especially in an Asian household!) and paraquat (some pestiticide that's cheap and in use in other countries). But, basically, research is showing that damage to this area of the brainstem seems to directly explain the loss of language, loss of social interaction, and mixes of those that are seen in regressive autistics. The talk at the conference concluded with the open ended question: Is autism a poisoning? I also walked away with the message that it's not any one toxin that will cause it, that it seems to be a combination. They also conceded that while it's great to figure out more of what's caused things, that doesn't do much for us dealing with the disorder already as we're now most interested in how to cure it!
At any rate, Adam must've known we were studying up for him last night because this morning, the wife reports he was extremely well behaved. No stims of any kind, no meltdowns, just waited for the bus so quietly that she started looking for where he was only to find him quietly standing with his hands in his pockets, looking around, calmly and just taking in all the fall colors and looking... very....um...normal! This of course was worth noting.
His current methyl B-12 dose is 0.5mL every 3 days. He seems to be better the day after and day 2 of the shot, but by day 3 seems to get a little out of sorts. We had some head ticking issues at 1.0mL twice a week, so we may see if maybe 0.75mL every 3 days might be better for him next time we order shots. Shot administration is going well and Adam's dad has now relieved me as the sole shot giver. Adam's dad has in fact given him the last 3 shots, and Adam's not going berzerk in anticipation of them like he used to. Man, he'd be a snotty meltdown mucousy mess in anticipation of the shot, even if he never actually felt it go in. Apparently we've gotten over that hump.
Oh, the al-carnatine...that's a supplement he was recently put on by our DAN doc, and it made him angry. Throwing things, tipping stuff over, and being a turd. We took him off of it twice and the DAN practice said that they seemed to be getting a lot of reports of that with that particular formulation. The benefit carnatine is supposed to give has to do with enhancing mitocondrial function (remember those little cell powerhouses from biology class), and apparently there is another form of carnatine that they're not seeing the wackiness from that we may try later. On a related note, it was funny to hear a speaker at this workshop mention in a brief aside "like how sometimes we put our kids on carnatine and them sometimes become raging anger machines..." So I guess it's not uncommon. Our DAN! doc said we did the right thing trusting our gut and pulling him off of it when the behvior started.
Who knows, the carnatine may have increased the B12 shot anxiety, as it seemed to happen around the same time. It's also possible I was prepping the area with a bit too much alcohol and it was burning when the shot went in. So much for those prepackaged alcohol wipes--back to the more controlled cotton ball and alcohol bottle approach!
Going back for a moment to the workshop/presentation... there were parts of the night that struck me as pure hokey bullshit--the electrodermal testing, and this wacky instrument that claims to diagnose allergies electrically, and treat for toxins. I wonder if this particular DAN! practitioner may come to regret bringing this hocus pocus into her practice. Now, I "get" that people who aren't getting results from biomedical intervention might want to try something else and put their faith in it, as the placebo effect can be very powerful, but do we really have to go down the avenue of Scientology electrical gizmos to do it? The engineer in me has a very hard time thinking these ZYTO machines possibly have reliable electrical signatures corresponding to various allergies and disorders, and that something known as an LED machine can have things whipped up for it to be therapeutic for the things the ZYTO claims ya have. I mean, hell, if we in information technology can't even come up with highly accurate anti-virus signatures in the computer field where behavior is very easy to electronically define, how in the sheep shit can they possibly have reliable signatures for every malady known to man based on the extremely indirect measurement of some electrodermal potentials? I guess it's something that's definitely "not for me."
Wednesday, October 21, 2009
The other thing new I see him doing is acting out with banging doors and stomping feet. He did that with me tonight--stomp stomp stomp in the hall, looking back at me for my attention, as though I was supposed to stop him. He then walked up to one of the interior bedroom doors and looked back at me before kinda slamming it open--similar to how he slammed doors yesterday while he was having his "i won't get my coat" meltdown. I wonder if one of the scenes in a computer game or something he's stimming off of at grandma's might have some door slamming or stomping in it. Usually any new behavior can be explained by something he's watched a video or animation of 8000 times while no one was paying attention. Grrrr. I get frustrated with his other residence sometimes as I know he's often on a floor separate from the adults. Raised ranch floor plans and autistic kids don't mix.
Left to his own devices for a bit tonight here while I was running an errand and the wife was cooking, the 8 year old Adam raided my son's baby toy bin again in the basement (doh, separate floor again), trying to find something that made noise to stim off of. The toys are all way below his development level, so it drives us positively apesh1t, but I suppose it's not the worst thing in the world he could be doing.
He seems a bit more stim-prone lately for reasons we can't really figure out. His meds/supplements have been pretty stable for a while now, but with us out of town, he's probably not had a whole lot of outside stimulation either. It's hard to say.
Tuesday, October 20, 2009
Doesn't seem like a big deal to most, but he's never come out and really said anything like this before, let alone in a full sentence. Baby steps...
Then again, right now, he's at his computer with one ear pressed to his right shoulder, the other ear covered by his left hand, and mousing away, talking about credit card miles, assumably to drown out the Veggi Tales DVD in the background. Should I offer him the earmuff noise killing headphones so he can keep his neck straight? LOL.
And then, before therapy today, he had a tantrum over having to get his own coat. On the floor, crying "A Saen, Ah Saen" ("aunt Saen" in Adam's 2nd language). When he was ignored enough, he finally got it himself, and slammed the door a few times to let us know he was mad. He also beat on the van window a couple times to express his anger. Expressing his anger this way is new--usually it'd just be the colossal meltdown. I'm keeping an eye on these outbursts because he's a pretty strong kid, and he knows if there's something that'll get his aunt and uncle's goat, it's pulling the hair or otherwise doing things to his 3 year old cousin. Happily it hasn't been any sort of issue other than a couple hair pulling episodes, but you always have to watch for something new.
Not sure what's up with this tantruming--he had his B12 shot yesterday, but maybe he's having some transition problems getting back into the groove after our long weekend away whilehe's been over at grandma/dad's.
His diagnosis is PDD-NOS, which those in the autism fold know as pervasive developmental delay-not otherwise specified. This is a diagnosis where you find the higher functioning autistic kids, where some but not all the symptoms of autism spectrum disorder are manifested.
He was diagnosed late--as many of the high functioning autistics are--in kindergarten, which was his first exposure to formal schooling. The issues of him being a bit unique quickly became very apparent as something more major when put in a room with 20 or so neurotypical kids. With such stark contrast, we couldn't attribute his poor language any more to his growing up in a bilingual household.
The kindergarten teacher recommended an evaluation, the team at the school considered him "from an educational perspective, traits consistent with autism spectrum disorder" and within a few months we'd chased down a behaviorist who confirmed this all with a formal medical diagnosis. With this, special education services began, and Adam was transitioned to a self contained special education classroom. That year, though I can't tell you how many freakin days he missed of school due to illness. He was sick all the time, complicated by his asthma and allergies. Emergency room visits due to grandma panicking over asthma symptoms, and vomiting were frequent as well.
Among the reasons he was diagnosed late included ignorance and the common denial aspects. Adam is a first/only child, and no one around him had had a typical kid around in many many years, so his missing milestones wasn't seen as a big red flag. He also wasn't going to the best of pediatricians, and to be fair, even those 5 or so years ago, pediatricians aren't as on the lookout with milestone questionnaires as they are these days. Diagnosis is getting better in pediatrics, and they're being caught earlier. In addition, there were many things that Adam did VERY well such that we thought he was ahead of the curb. He knew his letters and numbers very well before 3, was an ace computer user, and he craved attention and would give you eye contact that would teach adults how to give good attention to others. Like many folks I suppose, we all had that Dustin Hoffman in Rain Man picture of autism in our head, and Adam didn't fit that mold at all. He also did talk, but just not in sentences much, and he wasn't ever one to answer a question for ya. He did develop echolia which is where they'll repeat the question to you, knowing that you want some sort of response, but having no idea what to tell you.
Adam's 8 now, and remains verbal, echolia quite on the wane, still considered high functioning on the autistic spectrum, but compared to neurotypical (NT) children, there is a clear difference, mostly in language and style of play. If you watch him and he doesn't talk, folks wouldn't know this cute normal looking kid is really any different. But language and interactions are where it's extremely apparent that he's different. For instance, Adam at 8 is WAY behind our 3 year old's vocabulary, sentence structure, expressive language, and understanding of nuances like prepositions, what/where/why questions, and all the things that you tend to take for granted if you've never been around developmentally delayed kids. The three year old runs linguistic circles around where Adam still is.
On the plus side, he's made some great gains. In 2007, when he was 6, he started 1:1 speech therapy shortly after his diagnosis. In the first 6 months of speech his incredibly gifted speech therapist was able to help him achieve 2 years progress in language in just 6 months. Unfortunately his Kindergarten MLP teacher was not so gifted, was a mid-life career changer without a lot of talents to start with, and worst of all--a brand new special ed teacher. She could barely keep order in the classroom let alone lead any progress, unfortunately. We had a lot of school district wrangling with special education supervisors, learned a great deal about his rights to a free, appropriate public education (FAPE), and with the help of a special education consultant to get us into a better educational situation. The school district thankfully transferred us into a new school with teachers that are apparently the trainers for the district. His MLP (multi-level program, another name for the self contained special ed classroom) teacher is phenomenal, thank God. 2nd and now 3rd grade have been a night/day difference in peace of mind vs 1st grade because we know the school is doing their job so we can concentrate on the rest of the package.
This past year (2008-2009) since we've started him on a gluten/cassein-free (milk and friends/and soy free diet, supplements and biomedical fun last year, Adam had an INCREDIBLE 2nd grade year with some really remarkable progress. Since the diet started in 2nd grade, Adam is sick FAR FAR FAR less, allergies and skin eczema is far less of an issue, and he's able to attend school much more frequently than in the past. Furthermore, the fog of some sensory issues seems to have lifted, and he was able to actually feel when he needed to go to the bathroom. During 2nd grade, he was largely potty trained and would pee in the toilet, but poop remained a BIG STINKY LOOSE problem, and we were always on the hunt for pull-ups for a 60lb kid. Over the spring of 2009, though, several months into the diet/supplements and DAN! doctor care, we are finally diaper free. Gut issues went on the wane, the poop started looking more normal and formed, stopped stinking to high heaven of yeast and amonia, and he could feel when he needed to go... and he did. I can't tell you what a colossal freakin relief the whole poop/pee diaper free thing is. Took him until 8 years of age, but he made it (and grandma and all of us survived too).
My wife and I do a lot of care for Adam, as his family situation is complicated. Mom's not in the picture due to substance abuse and psychiatric issues. Dad's struggling with some demons of his own, but that's recently greatly improved and as I write this he's 3 weeks sober, and is slowly being drawn out of the house to participate in things with his son.
Grandma does most of his care, and Adam splits time between her house (where his Dad and 2 uncles also live), and our home where my wife, myself and our NT 3-year old boy live. Adam goes to school from our place where the bus picks him up and drops him off. He also sleeps here during the week so my wife can coordinate his schooling, supplements, therapy, and care. He's over at grandma/dad's an hour or so a day after school as well. After a year of having everyone bought into the program, transitions are going very well and Adam's able to spend more time with Dad/Grandma without falling off the wagon as it were.
Today, my observation of Adam is that he's healthy, not suffering any allergies, happy, alert, energetic, but he's not answering questions. He seems fixated on stimming off of cell phone videos, and was given a paper to take downstairs to my wife, but he just left it in the family room somewhere. When asked minutes later where he put it, he had no idea, and didn't answer. Smiles, and flitted on to play Pac Man, or with my 3 year old's trains, or something on computer. He has a therapy appointment today. And he "like to redeem my credit card miles." You see, he's rather fixated on the David Spade Capital One no hassle rewards credit card commercials. He has a sense of humor about it though. One question I can ask him: "Can I redeem my miles to go to Mexico?" He'll say with a huge smile: "No way Jose!" "How about Hawaii?" I could ask. "A-NO-ha!" he'd say.
There's something goin on in there... Hopefully one day we'll find out!