C ASE HISTORY QUESTIONNAIRE


Child's Name: Sammy Age:_3years, 2 Months______________ Sex:Male


Clinical History Completed By:____Parents John and Mary


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Please describe the presenting problem and at what age you became concerned:


We first became concerned about Sammy between 18 months and 2 1/2 years. His motor skills were always on time, however his speech was slow to develop. When we addressed our pediatrician with these concerns we were told not to worry and that we shouldn't compare him to his older sister who was an early talker. He suggested that we wait until his second birthday and then reassess the situation. We would hear words occasionally so we would feel reassured but then we would never hear them again. At 20 months the few words he used consistently disappeared and he started to withdraw. He didn't respond to his name when we called him yet he would come running when his favorite Barney video came on. We noticed a change in eye contact. He stopped looking at us or would turn his head away when we talked to him. He would stare blankly at other times or spend hours watching the wheels spin on his toy car. He also started to develop terrible temper tantrums. Sometimes we could tell what set him off yet most of the time we were clueless. Around the same time he became bothered by certain noises. He would cry whenever we used the blender, the garbage disposal, or the coffee grinder. He would also put his fingers in his ears and walk in circles while humming. We had him evaluated just before his third birthday. We had his hearing tested first and the results were normal. The neurologist tested him. They ruled out seizures or genetic disorders. At 35 months he was given a diagnosis of Autistic Spectrum disorder with developmental delays in all areas. We were referred to Child Find for evaluations. A family that we meet in the waiting room at the doctor's office who also had an autistic child suggested that we get an evaluation by a speech therapist and an occupational therapist.


PREGNANCY


The pregnancy was uneventful and without complications. I was able to enjoy a normal activity level until I gave birth.


LABOR AND DELIVERY


2 days before my due date my contractions began about 5 AM and I was admitted to the hospital at noon that day. I was given pitocin at 4 PM because I failed to dilate beyond 5 cm. At 6 PM they gave me an epidural and Sammy was born at 8: 39 PM weighing 7lbs 3oz. He cried immediately and his apgars were good.


D EVELOPMENTAL HISTORY


INFANCY :


He was colicky for 3 months but it was not very severe. He began sleeping through the night after this and was generally happy. He seemed to be a very alert baby and was interested in things and people in his environment. He smiled at 6 weeks and was fairly happy when people held and played with him. He mastered all his developmental milestones on time though he never really crawled going straight to walking at 11 months. We thought he had an excellent attention span because he could watch a full half hour children's video when he was only 10 months old. We thought he would be an early talker because he said "car" and "dog" by his first birthday though he lost these later.


He didn't babble much and didn't mouth toys a lot. He was interested in interactive games such as playing "peek a boo" yet he didn't initiate the game and didn't put his own hands up to his eyes. He never waved "bye bye" though he knew what it meant. He wasn't very interested in toys such as making the dials work on his busy box. His favorite toy was a rattle that had a spiral shape that would spin when you shook it. He also liked a spinner top with a design that rotated rapidly however he didn't know how to make this toy work by itself. In retrospect Sammy was able to amuse himself independently which was a relief because his sister was very jealous of him (She was 20 months when he was born) and she had been the exact opposite in that she was very demanding as an infant.


12-24 MONTHS:


Sammy's language was slow to develop yet there were always encouraging signs. He said "dog" but usually because he was afraid of the large dog we had, that we eventually had to get rid of because he was so upsetting to Sammy. Sammy would loose it whenever the dog barked. He also said "car" because he loved playing with his toy cars. Then he would really confuse us because he started to learn his numbers and letters. He would drag us to the TV screen during his favorite video to show us the letters and numbers. He would ask us to say them. He would also drag us to cars as we walked down the street so that we would read the licensee plate number and letters to him. Sometimes he would say the numbers and letters but this was usually when he was upset, like when he was at the doctors office, then he would say over and over "1 2 3 go". Most of the time he liked us to say them. We were also really certain that he could read because he would do strange things like when ever we passed an advertisement for our local public T. V. station, he would hum the "Barney " song. By 18 months his language failed to develop further and the temper tantrums started. He started to withdraw at this time we realize in retrospect, but it happened so slowly and we were pregnant with our third child who was born when Sammy was almost 2 years old.


24-36 MONTHS:


Things really deteriorated with the birth of our third child. Sammy started to become very frustrated. He would pick up toys but as soon as he realized that he didn't know how to play with them, he would throw them down or spin them. His favorite thing to do was spin the wheels of his toy cars or the lids of our saucepans. This was when he seemed happiest. His eye contact also deteriorated. He would just seem to glaze over. The baby crying set him off but also sounds such as the blender and coffee grinder would upset him. His language failed to progress and he started to lose the few words he had. His behavior was more aimless spending large amounts of time with his fingers in his ears, walking in circles and humming. Transitions became very difficult especially if he was watching a video which he wanted to spend more of his time doing. Even the letters that he used to enjoy held less meaning to him. Rather than want us to identify the letters, he started to line them up instead. His diet, which was never great, really became limited and consisted mainly of carbohydrates, milk and apple juice. We were very worried by this time. Our pediatrician suggested a hearing test to rule out a hearing loss. It was then recommended that we see the neurologist but we had to wait 4 months before we could get an appointment with him.