So, basically the details Kirin gave were sparse, in part, because the details are sparse at this point.

Basically, Early Start contracts out the therapy / treatment / whathaveyou to a company called Stepping Stones (presumably this one). They’re supposed to get in touch with us by the end of the month to set things up for the month of May. So far we like what we see from the website, assuming it’s the right one 🙂

Anyhow, for the month of May, they’re contracted for 15 hours a week of time with Tristan (here in our own home) – they’ll be bringing in various folks to our home to come work with Tristan and figure out what the most appropriate strategy is for now. 15 hours seems simultaneously like a lot, and like nothing – some of the therapies you read about can actually range from 20-40 hours a week, by themselves – but even 3 hours a (week) day seems like a significant portion of his day.

Additionally, they’re allowed to give us (as in the parents) 11 hours of education of some form (hopefully some general, but hopefully some related to getting us up to speed with whatever they’re going to be using to work with Tristan.) Not quite sure how that will play out, but we’ll find out soon enough.

At the end of May, they’ll make their proposals on what they think will work best for him, and we’ll meet with the coordinator from Early Start and the folks who will have been working with Tristan to finalize the tentative plan for the next six months as far as what therapies and how much of them there will be – it’s sort of hard to determine what that will entail, as a large part of it will be based on what happens in the month of therapy.

—

Tristan’s doing more neat (but fairly classic autistic-y) things, as well. Yesterday and today, we found that he’d fairly reliably echo “ha-ha-ha” said in descending tones (which, given that he rarely is interested in replicating sounds seems like somewhat a good thing). He’s also started grabbing my hand to indicate that he needs help with something (notably: playdoh) as well. He’ll also pretty reliably happy when I get home from work – I came in and laid on the ground near him, and he came over to give me a hug. Then again, when we let Samurai in, he did pretty much the same thing to him 🙂

This morning, James and I scrambled to get everything cleaned up before Julie with Early Start came to visit to discuss some of what’s going to happen next. I have pretty shitty listening comprehension, so I honestly have no clue other than soon we’re going to be experiencing 3 hours a day of therapy (well, education, as they put it) that’s to start in May or something to that extent. Some of it will be targeted toward Tristan and some toward us. Either James will write about it or I will clarify when I have a copy of the report on hand. Anyway, short form is that our lives are lives are indeed going to CHANGE. I have hopes that we can keep some semblance of normal life with a buddy rather than be stuck in school ALL of the damn time or something.

Anyway, no point in lending anxiety to that now. There will be plenty of time to mull over it.

We went to the Children’s Discovery Museum afterward – it’s another shitty day, all weeping from the sky but too cold to enjoy being out in. I had a lot of fun with Tristan. He’s getting really good at the stairs in the toddler room – he can officially walk up AND down them by himself while holding the rail. This is a major improvement over the last time we went – he very much felt on the verge but not yet ready. That being said, now that he’s mastered the stairs, he didn’t insist on going up and down them twelve thousand times. Even more astounding and possibly useful is that I got him to sit in my lap through a story time. I had to use a snack and the gentle back stroking trick, but he lasted through the entire book and Q&A session afterward. I dare say that I’m ready to try taking him to a reading event of some sort again.

Unfortunately, we’re not having a good track record with napping. He woke up screaming every time I’ve tried to type this entry, as per usual procedure. He’s still sleeping for approximately the same amount of time, but I am beginning to feel like I’m not permitted to type here. Seriously, EVERY TIME I TRY he wakes and starts screaming. So if my entries seem scattered or distracted lately, it is because I am forced to spit it out quickly.

This morning’s big event was the last portion of the autism evaluation – the physical exam. Same time – dick o’ clock in the morning (for most of you, that refers to “6am” and for us that refers to “8am”) we had to get up and going for our appointment on Friday.

I have to interrupt this to mention that yet again, Tristan’s screaming when he should be sleeping. I think he can hear the clicking of the keyboard.. even though I’m ACROSS the house.. be back in a few moments to write.

Anyway, he’s settled down now. Appointment today. Mostly questions about his medical history (not much, as it turns out – he’s been lucky and healthy – and also, he’s a baby..) and questions about his body in general as well as a physical examination. She examined his poop and manipulated his limbs.. well, not in the same moment. But the doctor was checking for related genetic conditions, of which she did not see any overt signs. He’ll have to have his blood drawn for some lab work, where they will test again for lead and also determine if he has any chromosomal clusterfucks. We’re now old champs at the Kaiser ASD clinic.

We got back from the opposite side of the city in time to attend playgroup today. We’ve still been going every Tuesday and Thursday when we can help it; it’s been something I forced myself to do first when Tristan was around 6 months old and again when we were invited to be sustained guests of the playgroup after we moved into here. Anyway, there was a large turnout due to the chilly, windy rain that felt like coming out. We saw some of the friends we don’t see often such as Mani & Arnav and Eileen & Elizabeth – friendly moms with kids within a month of Tristan’s age. I adore the playgroup, even when turnout is fairly low, because there is usually something that Tristan will focus on and leave me without having to attend to him every twelve seconds to make sure he’s still visible. I also will note that I started attending the playgroup to force Tristan to be around other children, and so far he still does just fine in that department. He’s a little bit more independent and explorety, but he does get right in there and play with what others are playing with, and he’s becoming more polite about it.

We had an impromptu playdate over at Eileen and Elizabeth’s place. We were all busy enough that it was 2pm before we knew it. The amazing and happy part of this is that Elizabeth is very “present” and was able to engage Tristan – the two of them spun around together and giggled, and Tristan made eye contact with her all familiar-person-like! I really hope that this will help him keep up with kids his age in terms of him perhaps starting to interact with children more. Elizabeth is a cutie and VERY opinionated, and I can actually manage her with Tristan fairly easily assuming Tristan’s not wandering off somewhere at ninja rocket speed.

This was a very good day, despite crazy indoors-only weather.

We have here the report from Early Start, who we met with on Tuesday, April 13.. these are the people who are going to provide services to help Tristan learn how to get along in our world. The password is the name of our orange kitty. If you are curious to read this but don’t know the password, just ask one of us.

[password]
In these areas, the following skills were observed or reported by parent:

Gross Motor (large movement)
* walks
* runs 10 feet without falling
* kicks a ball forward without falling
* walks up and down steps with support
* independently will typically crawl up steps; occasionally will hold rail for a few steps; cautious and will wait for help to come down
BDI-2 Raw Score: 54 — Age Equivalent: 19 months

Fine Motor (small movement)
* transfers an object from one hand to the other
* holds an object in each hand at the same time
* picks up a raisin with the ends of the thumb and index finger in an overhand approach (pincer graso)
* extends a toy to a person and releases it from grasp
* intentionally propels or throws an object
* holds crayon with a fisted grasp, making only a small mark on the paper
BDI-2 Raw Score: 27 — Age Equivalent: 16 months (15% below age – within normal limits)

Adaptive/Self-Help (sleeping, eating, dressing, toileting, etc.)
* feeds self bite-sized pieces of food
* drinks from a sippy cup
* asks for food or liquid by positioning himself near what he wants and reaching (i.e. reaches toward the cup rack for drink)
* assists parent with dressing by holding out arms or legs
* takes off shoes, socks, and pants
BDI-2 Raw Score: 27 — Age Equivalent: 15 months (21% below age – within normal limits)

Cognitive (responsiveness to environment, thinking skills, problem solving)
A. Attention and Memory
* attends to a game of peek-a-boo
* attends to an ongoing sound or activity for 15 seconds or more
* occupies self for 10 minutes without demanding attention; attends to the same activity for three minutes
BDI-2 Raw Score: 30 — Age Equivalent: 19 months
B. Perception and Concepts
* feels and explores objects
* physically explores the surroundings and/or objects in the surroundings
BDI-2 Raw Score: 12 — Age Equivalent: 13 months (37% below age)

Communication (language and speech)
Receptive (understanding): During the intake, Tristan presented as a self-directed boy who did not respond to his name or the name of family members (i.e. Where’s mama? Show daddy.). He did not respond to simple verbal commands with the exception of “No!” and “give me” accompanied with a gesture. In the area of Receptive Communication the following skills were observed or reported by the parents:
* turns head toward non-speech sounds like a horn or bell, but inconsistently responds to voices outside field of vision
* demonstrates brief attention to speaker and provides little eye contact when spoken to
* enjoys listening to music and singing and attempts to move body to the rhythm
* responds to a firm “No!” by hesitating at least temporarily
* not yet associates spoken words with familiar objects with the exception of “blocks”
* reportedly responds to own name approximately 50% of the time and appears more responsive to a firm or over-exaggerated tone
* inconsistently responds to the names of family members by looking toward them or going to them when named
* not yet identifying body parts or articles of clothing on request (i.e. where’s your nose? get your shoes.)
* requires gestures or contextual cues to respond to routine directions (i.e. doesn’t respond to the verbal command “Let’s go bye-bye” but runs to the door when he hears the gate open)
* typically responds to the simultaneous verbal and gestural command “give me” but inconsistently responds to other simultaneous verbal and gestural commands such as “come here,” “sit down,” “let’s go”
* prefers to look at books independently; pushes parent away when they attempt to talk about the pictures or read a short story

Expressive (making sounds, gestures, signing, talking): Parents expressed concern that Tristan tends to get desired objects on his own and doesn’t use eye gaze, gestures, sounds, or words to request or initiate interactions [parent note: he does use eye gaze; he gazes at what he wants or likes – he doesn’t get someone’s attention by gaining eye contact is what this seems to mean]. Mother reported Tristan just recently began to bring a parent his shoes to request “Let’s go outside.” Tristan imitates the word “the,” but does not imitate any other sounds or words and appears less interested in imitating gestures such as clapping or “high five.” During the intake, Tristan presented as a self-directed boy who vocalized and made throaty sounds while exploring the doom and playing with toys, but didn’t use eye gaze, gestures, sounds, or words to communicate intent. For example, when Tristan attempted to get a toy dinosaur that was out of his reach and dropped to the ground whining when he was unsuccessful. After a few moments, Tristan searched the room for another toy and did not request assistance from any adults including his parents. Tristan did not attend to the examiner’s face or demonstrate any interest in imitating gestures, oral movements, sounds, or words. According to parent report and observations made during the assessment, Tristan needs assistance becoming more intentional with his communication through the use of a consistent gesture system along with pictures and words to help convey his message.
* attempts to get desired item on his own or pulls parent by the arm and they guess what he is trying to communicate
* makes squealing sounds and laughs
* vocalizes and makes throaty sounds while exploring and playing, but not directed toward anyone
* not yet imitating parent’s sounds or words and reportedly appears less interested in imitating gestures such as hand clapping
* not yet waving “bye-bye” but reportedly makes the same sound for “hi” (haaaaahhhh)
* enjoys humming or singing along to music using his own words
* frequently initiates a game of peek-a-boo with parents by hiding behind furniture and saying an approximation of “peek-a-boo”
* sometimes uses words or word approximations (mama, dada, ma-ma-ma/more, up, bubble, bah/block)
REEL-3 Raw Score: 30 – Age Equivalent: 9 months (53% below age)
BDI-2 Raw Score: 12 – Age Equivalent: 8 months (58% below age)

Social/Emotional (relating to others)
Adult Interaction:
* shows awareness of other people in the room but demonstrates minimal interest in engaging with the people
* observed to maintain some sustained eye contact with parents but brief intermittent eye contact with others in the room
* appears to demonstrate more focus on objects than on faces of people in the room
* shows a desire to be picked up or held by parents and allowed father to pick him up and carry him to changing table for diaper change
* expresses displeasure for or dislike for certain activities by moving away from the object or requested task or taking the object and dropping it on the floor
* expresses pleasure for or like for certain activities by maintaining attention to the object or toy or carrying the object with him
* discriminates between familiar and unfamiliar people and tends to walk away from unfamiliar people
* engages in non-communicative vocalizations throughout the assessment period
* shows signs of separation anxiety when removed from mother, becoming fussy
* was not observed to respond to praise given to him by assessor but will get self praise by clapping and smiling
* will look at a book and turn the pages of a book but does not appear to be interested in a story being read to him
BDI-2 Raw Score: 22 – Age Equivalent: 10 months (47% below age)
Self-Concept and Social Role:
* sometimes smiles and vocalizes in response to attentiono from parents
* enjoys movement in space (frolic play)
* shows awareness of hands
* shows awareness of feet
* infrequently responds to his name being called
* demonstrates interest in certain toys and will attempt to get a toy from another child but will generally let a toy go if another child takes it
* does not appear to pay attention to many verbal direction and commands given to him that are related to his regular household routine
* probability of understanding a verbal direction increases if the direction is given accompanied with visual and/or auditory cues
* will bring shoes to parents to put on so he can go outside
* generally self-directed in his activities and infrequently makes requests for assistance
* appears to prefer solitary play even when in group situations such as play dates
* can play independently but not always use toys functionally or for their intended purpose
BDI-2 Raw Score: 13 – Age Equivalent: 10 months (47% below age)

Behavior during assessment:
Tristan presents as an ambulatory child who appeared his stated age. He did not demonstrate any overt gait difficulties. He was not observed to engage in toe walking during the assessment period. He was observed to walk around the room holding objects in his hand or walk around the room looking at the ceiling. Parent related that Tristan does not seem to like wet foods and was initially reluctant to touch textures such as playdough. Tristan presents as a self-directed child who demonstrated difficulty in attending to and following verbal directions that were given to him. It was difficult to obtain his participation in many of the structured tasks. Tristan was accompanied to the assessment by his parents. Parents were able to provide information regarding Tristan’s present level of skills. Tristan was able to follow his parents from the waiting room to the assessment room. He easily entered the assessment room and walked over to manipulate the latch on the toy cabinet. When finished, he walked over to the table where there was a formboard and a ring stacking toy. He was able to engage with the various toys that were in the room but did not always use them functionally or for their intended purpose. He would hold objects such as the stacking rings in his hands and wander around the room. At times, he would walk around the room looking up at the ceiling. At one point he went over to the door, pulled the lever handle down and opened the door. He was responsive to a firm “No” from his father and he did not run out of the room. He was interested in examining the door stop. Tristan was also able to maintain some sustained eye contact with his parents but his eye contact with the assessor was minimal. He did appear to have more interest in looking at objects that the assessor was presenting to him. Throughout the assessment period, Tristan was able to maintain a steady steam of vocalizations including repetitive sounds and screams. The vocalizations did not appear to be purposeful, directed, or used for communicative purposes. He was not observed to use the vocalizations to request assistance even when it was apparent that there was a toy that he wanted which was just out of his reach. When he was not able to obtain it, he easily moved on to another object. Although he would often by interested in the objects presented to him, he was not observed to engage in joint attention or reciprocal play with the assessor. He was not observed to make attempts to engage with any of the adults in the room. He was not observed to bring objects to show his parents or to engage them with the object. He was not observed to respond to praise given to him by the assessor and he did not elicit praise from others even when successful in a task. Mother relates that she has been trying to teach Tristan “high fives.”

In summary, Tristan presented as a self directed boy who appeared indifferent to those in the room. He appeared content playing with toys and objects independently and did not seek out any social interactions with anyone in the assessment room, including his parents. Tristan demonstrated little interest in adult directed activities and responded by walking away with a preferred object (i.e. rings) while exploring the room or sometimes looking up at the ceiling. He demonstrated brief attention to some visual tasks that included items he could manipulate (i.e. formboard, ring stack), but did not attend to any language tasks (i.e. following simple verbal directions, retrieving objects on request, identifying pictures or objects on request). Tristan did not respond when his name was called, appeared indifferent to praise, and did not display joint attention.
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Our pediatrician referred us to Dr. Cohen, a Developmental Behavioral Specialist who referred us to the ASD clinic. Here’s his report about Tristan:

Password: the name of our black kitty (don’t forget to capitalize the first letter)

Let us know if you need a reminder or are just really curious and wouldn’t know the answer otherwise – we don’t feel that the world at large needs this info, but if we know who you are, we’re likely happy to tell you about things.

[password]
Developmental Pediactrics Consultation Report 3/22/2010

Name: Long, Tristan

Tristan is an 18M boy who is being seen for a developmental pediatrics consultation at the rest of Dr. Krishnan becaus eof concerns about possible autism. He was accompanied by his parents, James and Kirin Long. The primary language spoken at home is English.

His parents say they think Tristan has sensory processing issues “as do one or more of us”. They have wondered whether he may have autism, and say that they are not sure if it’s autism or not. They were first concerned last month when he had a checkup by Dr. Krishnan, and they realized that Tristan did not have many of the skills addressed on the M-CHAT autism screen. Since then he has been learning more language, and he responds to name better, but this is till not consistent. He seems to respond more to objects than to people. An example of this occured when I entered the room today: he looked carefully at the door but paid no attention to me. He has had some loss fo skills, namely, he longer will feed himself with a spoon or allow himself to be fed from a spoon. He also “goes back and forth” with saying words, sometimes saying a word once or twice and not saying it again. He has a few consistent sounds he uses for words, like “uh” for “up” and other sounds for “block” and “peekaboo”. He also says hi in an “unusual way” and uses this to greet both people and familiar places. He tries to get his parents to play with him at times, but not to watch him. When he is in the crib and wants to be picked up he will raise his arms to grab onto his father’s shirt, but does not point or gesture towards any objects. He is fascinated by grates or covers in the ground such as water main covers, shower drains, etc., and likes to tap them with his foot. When he is with other children, he usually plays in parallel or goes over to where they are playing to grab a toy and then wanders off. He loves to open and close doors, and likes to put objects on a motorized gear toy he has, and watch them spin. He loves to swing on a swing, and will do this for an hour or more. He likes to walk around and around objects or people, and he gets reinforcement in that by being chased. He also loves physical play, and clearly expresses enjoyment when his father roughhouses with him. He has inconsistent responses to sound and other stimuli. He will sometimes clearly hear very soft sounds that he is interested in, but when his parent banged on a pot near his ears while he was playing, he did not respond at all. He does not have excessive tantrums or difficult behavior, and is generally an easygoing child. On the M-CHAT screen for autism his parents gave abnormal responses on all 6 critical items, which is a failing response.

At today’s visit, Tristan was active and appeared well, and was generally good natured. No abnormalities were noted on limited physical exam. His length was 90%, weight 75% and head circumference just above 95% (dad says he himself has never been able to find a hat that fit him). He made sporadic eye contact and had no recognizable speech or gesture. He was almost entirely on his own agenda during the visit, with no response to his name or to attempts to engage him in play. He did have some enjoyable interaction with his mother. For example, he smiled at her and said “Uh”””, which she identified as his word for “up”. When I lifted him up and down, he smiled and giggled, but as soon as I put him down he wandered off without looking at me. It was not possible to assess his developmental level due to his limited interest in cooperating with the testing procedures.

Assessment:

1. Tristan appears to be on the autism spectrum. I cannot determine if he meets criteria for Autistic Disorder at this time. A full evaluation in the Autism Spectrum Disorders Center at San Jose will be helpful in order to confirm the diagnosis, clarification of the diagnosis, specific recommendations for intervention, and information and support for the family.

2. I had an extensive discussion with the parents regarding my findings and recommendations. I explained the nature of the autism spectrum and stressed that if this is the diagnosis, the difficulties do not result from anything that the parents did or did nto do, but that they represent an abnormality in brain development and function which is almost certainly of prenatal origin.

3. Refer to Early Start. The parents signed a release form, and I will send a copy of this report to Early Start. I asked them to contact me if they are asked to provide a “denial letter” from the insurance plan.

4. He will most likely benefit from an early intervention program that is appropriate for children with autism, focusing on communication and socialization skills.

5. I gave his parents information about Parents Helping Parents, and also directed them to links on my homepage that may provide additional information and support, including Autism Speaks and the home page of the Autism Spectrum Disorders Center at San Jose. I also gave them a handout on Floortime, and discussed helpful books.

6. I would like to see him for a follow-up visit in approximately 6 months. I would be happy to see him sooner if additional questions or problems arise, or if he does not appear to be making expected progress.

Mark L. Cohen, M.D., F.A.A.P
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Yesterday, we got the rough draft of the report from Early Start (from the Tuesday meeting).   More details will follow, but it roughly followed what we expected – generally good in the motor skills, but not so good in the social and language side.  Worse than anticipated in the language side, actually.

Tristan’s medical assessment also got bumped to today (instead of May 12th) – we got a call asking if we wanted to take the place of a cancelled appointment yesterday afternoon – a little schedule juggling later, we were set for a 9 am today.  We’re not usually all up that early, but we figured saving a month was sort of worth it.

We headed down to Santa Teresa to Kaiser’s ASD assessment and diagnosis clinic to meet with two doctors who would be performing the assessment.    Very similar to the Tuesday setup, we sat at a table with one, answer questions,  while the other went through a battery of tests revolving around playing with various toys, and seeing what he could or could not do.   Given that this was about the 5th time (literally) we had answered roughly the same set of questions, so the question part went by pretty quickly, and the latter half involved us watching them play (or try to play) with Tristan.

They did a few batteries of tests, which were much the same as the ones they did at Early Start – stacking things, pretend play, peekaboo, imitating the play of another, etc.    Tristan seemed a little less cooperative (he’s had a cold for a couple of days, and coupled with the shortened sleep I don’t think he was feeling his best), but pretty much performed the same here as he did at early start.   Strong in motor skills, weak in language/social skills.  More details on that forthcoming.

Ultimately, at the end, they sent us off to get a snack while they conferred, and afterward, the  short answer was that we now have an official diagnosis of “Autistic Disorder” –  which is the technical term for what most people will think of as “Autism” (the other possibilities on the Autistic Spectrum being Asperger’s, which is sort of “Autism spectrum, but with language skills” or PDD-NOS, which is “Autism spectrum, but doesn’t really fit all the criteria for the other diagnoses)  We still have to go back Tuesday for a physical exam, as well, to check on more tangible things related.

More importantly, Wednesday morning we meet with our Case Manager from Early Start to go over the report they sent – after that, I believe we set up one more meeting to actually set up the IFSP (Individual Family Service Plan) – basically “What goals are we working on, and what services we’ll be getting to help work on them” – we already have documented goals (from the draft) but it’s still up in the air as to what services we’ll be getting (might be some form of pre-school, in home training/therapy, parent training, etc.)

The good part, though, is really that we have the diagnosis now, and not at 3 years, or 5, or 7.    Below 3 years, it’s handled by the County Office of Education, and from everything we’re hearing, the services are supposed to be good, and hopefully effective  After 3 years old, the responsibility shifts to the local school district, and everyone says to expect a dip in the quality of service.  Additionally, at that point, the focus shifts solely onto  Tristan – until then, it will be a  combined focus of teaching Tristan, and teaching us how to teach Tristan – generally a comprehensive plan to help him out the best we can.

—

On a cheerier note, Tristan really does have a lot of new tricks up his sleeves.  In the past month or so, some of the more interesting things he’s done:

• Learned to bring us his shoes so we’ll put them on him.  Generally as part of trying to get us to go out – although the latter part he doesn’t always follow through on – he’ll try to get us going, but then lose interest half way.
• Learned to put his lego blocks away in their container.
• Figured out how to climb onto our living room table, and as of today managed to climb up into one of our kitchen chairs and sit.  And stay sitting for a while!
• Brought a diaper from his diaper bag, and walked over to the door (when he very much needed a diaper change)
• While playing Peekaboo with the doctor (Melanie) today, repeated “Mellie” when the doc was saying “Where’s Mellie?”

So while it’s true that he may be behind in some areas, he’s certainly learning some new tricks along the way.

So, I spend a lot of my time lately trying to cope and not much time being fun and confident. I don’t really like this mode, for it wastes time I could spend just enjoying this life that is too short.

We went to playgroup today, as usual. The weather was nice enough that some people were even going to the pool with their babies! But for the most part, we convened outdoors instead of the large room that is fairly effective at containing Tristan. As a result, I spent a large period of time trying to keep him in an open area, which is code for running after him and bringing him back to where I left all of my shit and where people are hanging out. I felt myself getting very frustrated and I clipped on my sling, ready to enforce “stay with mommy” any way I could.

Someone intercepted me as I started preparing to flee and the next thing I knew, the other parents there were watching Tristan while I sort of huddled against a wall sobbing. I just felt so fucking tired, so defeated. I’ve got to face that this is my life. I will need to be a ninja to keep up with Tristan because I am utterly stumped at how to teach him not to run from me in general. I will have to train him to stay with me over time in each individual situation, at this rate.. just so I can let my guard down a little bit and have fun. Or have a chance to gather my belongings before Tristan is half a mile away.

A common observer would probably think that I spoil him. Technically, I do. I follow him when he walks off, because I don’t trust him to keep within a safe distance. He learns from this that he can run wherever the fuck he wants to and that mommy will be there. Getting mad at him has little effect other than to frighten him, so I try not to bother when I can control it. The situations where I do lose my shit are not situations we see behavioral improvement in. Time outs are only useful when they are used so he can regain control of his own emotions and stop screaming.

..as fate has it, I didn’t get as far as I’d like on this because of two phone calls and two instances of screamy baby during nap.

This afternoon was Tristan’s assessment with Early Start.  We headed over to Chandler Tripp school in San Jose.  Showed up just a bit early – they had a little waiting area with a bead-maze and xylophone – Tristan had only managed to try to escape two or three times before they brought us in.

The assessment itself took place in a 10×20 room, with a table (for us) at one end and an area with a bunch of toys and such on the other.    We met the four people who were doing the assessment – one doctor, one teacher, the case coordinator, and one other who we can’t remember what the heck she was.  They all seemed friendly and seemed to actuallt give a shit about what they were doing, which was nice.

The teacher of the group basically spent the entire time down on the ground “playing” with Tristan in various ways, seeing what he could and would do.   Blocks, crayons, stacking ring toys, wind up toys, bells, rattles – you name it, they more than likely brought it out.  He was actually in a more-social-than usual mood, as well, which helps when you’re stuck in a room with four strangers for a few hours - and the play not only allowed them to assess his skills, it also proved useful in that it mostly kept him entertained through the questions they were asking, which made things go fairly smoothly.

The rest mostly observed him, and asked us questions – going through his history (and ours) and asking questions about anything and everything.  Medical history, what he could and couldn’t do / say / etc.   During the conversation, Tristan would occasionally burst out laughing when everyone else did, which is pretty cute 🙂

So in general, after all that, what did they have to say?  Well, not much, yet.  We’ll get the draft of their report in about a week – Tuesday, folks will convene to determine what, if any, services should be provided.  From the sounds of it, it’s almost certain that they will be providing services – just have to figure out what.

We also need to get the official denial letter from Kaiser – something the Doctor we’d talked to previously had mentioned – basically, Early Start services require any services provided by the insurance to be exhausted.  “Thankfully”, Kaiser doesn’t provide squat here, so it’s easy to get the letter of denial necessary.  Still need to get him a TB test, and another hearing exam, and the full screening at Kaiser’s ASD center in Santa Teresa next month.

Many hoops left to jump through, but it feels like things are moving in the right direction there.

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In general, Tristan’s picked up a lot of neat new tricks lately – Kirin mentioned the shoes thing – he’s repeated this a few times as a means of asking to go out.    I took him out last night using a Kinder Kord (http://www.amazon.com/Kinderkord-Child-Safety-Restraint-System/dp/B001JKIG4W/ref=sr_1_1?ie=UTF8&s=baby-products&qid=1271203629&sr=8-1) – worked pretty well (Tristan caught on to the whole “have to stay close” part, up until the point where he lurched towards an openish grate – I had to give a yank, and the blasted thing tore apart.

He’s started to at least tear apart the playdoh, and even plays with the container, trying to get us to open it, now.   Although he seems to want to play with the lid about as much as the playdoh itself.

peering over the edge of my crib and testing out the location of footholds to learn to climb out

We introduced him to Play-doh last week sometime and he’s been sort of averse to actually touching the stuff for more than a second. Today he felt brave enough to poke it with his pokey little pointer finger. Of course, I had to praise the hell out of it and make it into a neat trick. I’m excited to try it again later!

[afternote: James claims that he saw and reinforced the poking first, so I thought to mention that there’s a good chance Tristan was practicing something he’d already learned. :D]