Our pediatrician referred us to Dr. Cohen, a Developmental Behavioral Specialist who referred us to the ASD clinic. Here’s his report about Tristan:
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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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