Birthday: Aug.4, 2002 Date of Evaluation: Nov. 5, 2009 Chronological Age: 7yrs/3months
Diagnosis: Autism Spectrum Disorder
Developmental Pediatrician: Millicent Mae Fronda-De Vera, MD, DPPS,FPSDBP
Test Administered: Griffiths Mental Developmental Scales
Present Developmental Profile: Locomotor: 6 yrs Personal/Social: 6.5 yrs Hearing and Speech: 4.5 to 5 yrs Eye and Hand Coordination: 6.5 yrs Performance: 7.5 yrs Practical Reasoning: 4.5 to 5 yrs
Behavioral Concerns: Miggy is generally behaved and compliant; impulsive at times; attention span has also improved as he can complete tasks when cued or prompted. He is very talkative but verbal reasons are still limited.
Here is Miggy's first developmental evaluation by Developmental Pediatrician: Joselyn Alonzo-Eusebio, M.D. Date of evaluation: May 13, 2005 Chronological Age: 2yrs / 9mos
Locomotor: par w/ age Personal and Social: 18 mos Hearing and speech: 15 mos Eye and Hand Coordination: 18 mos. Performance: > 2 yrs (non-verbal) Practical Reasoning > N /A
A quick drop-by at Video One is Miggy's routine every Tuesday and Thursday at 10:45am before going to his academic tutorials at the adjacent building.
At Video One, Miggy picks his favorite videos; shamelessly sings and dances; neatly returns the cds to the designated racks and waves bye to the friendly staff before he leaves.
Since I cannot break this routine because for sure it will put him in a bad mood, I always turn this into a learning experience. I ask him to name the characters and read the titles of the cds. That way, we both gain. He gets his way, I get mine.
November 1, 2009: All Saints' Day A day to remember and honor all the Saints of the ancient times and the less distant past. And that was what we just did. We chose to honor Saint Nicholas, popularly known as Santa Claus.
* Back in the days when we were still very young, my 4 sisters, my only brother and I would wake up on a December morning to find our simple Christmas tree in the living room all adorned already by my mother the previous night. Before, there were no fancy Christmas trees, instead a real tree glued with cotton was all you would ever see in any house. It was like a tree in the winter, all white. My mother wanted it to be a surprise but what she didn't know was that we could have had more fun decorating the Christmas tree ourselves. So this time, I'm breaking the rules. Let them have all the fun! Adorn it! Mess with it! Whatever! I don't care! What matters to me now is to see them happy and enjoying the Christmas spirit. Now, the tree looks the way they just wanted it to be... perfect.
MANILA, Philippines - The number of people with autism in the Philippines and other countries is on the rise, according to experts.
Dr. Alexis Reyes, Philippine Society for Developmental and Behavioral Pediatrics president, said there are no accurate statistics on autism in the Philippines but an upward trend has been observed across the globe. It is “imperative” to have a program to ensure a productive life for them despite their condition. Experts do not know why the number of people with autism is increasing. “There is no single cause so there is no single cure,” she said.
If the prevalence rate in the United States will be the basis, there are some 0.5 million Filipinos with the neuro-behavioral disorder. Of this figure, only two percent of them are given appropriate care. The ratio of autism in the US rose to 1:91 in 2009 from 1:150 a few years ago.
In 1960s-1980s the prevalence rate of autism in the US was 0.4 to 0.5 per 1,000 population but it increased to 0.71 to 1.1 per 1,000 children in 1990 and 4 to 6 per 1,1000. Autism is “likely the result of a variety of factors,” including genetic, infectious, neurologic, metabolism, immunological and environmental.
“Autism is not physical, it’s neuro-behavioral,” Doctor Reyes said. “That's what makes it very challenging for us… They look normal but they have social deficit, language problem, restricted interest and repetitive manners.” While autism is incurable, those who have it could still be productive if they would only be given adequate management and education.
Reyes said the initial cost of diagnosis for autism amounts to some P7,000. For follow ups in medical and educational, some P116,000 is required for the first year alone, she added. In the Philippines, there are only a few schools for children who have “special needs” and they are very expensive. And if there are public schools that offer special education, they mostly “fell short of expectation.”
Source: The Philippine Star (Updated November 04, 2009)
Nov. 1, 2009 : Miggy found this big empty box (which recently contained the plastic drawers I just bought). I always have my camera hanging around my neck so I wouldn't miss moments like this. Miggy excitedly asked: "Who is inside the box?" He answered himself: "Miggy is inside the box!!"
* I spent only a few pesos on the drawers but the fun he had was priceless..... far, far, far beyond what I paid for.
February 9, 2009: Miggy was waiting his turn for a haircut at SM Baguio's Barbero. He saw a man, eyes closed, lying comfortably in a chair, with shaving lotion all over his face. Pointing to the man, Miggy exclaimed: "Look, the man is dead!"
Oct. 21, 2009 : Miggy: "Mommy, drink medicine." mom: Why? Who is sick? Miggy: "Miggy is sick." mom: What hurts? Miggy. "My neck hurts. It's hot." I touched his neck and it was flaming hot. And later I found out that his front tooth had just erupted from his pink swollen gums, which caused his temperature to rise. Notice his red cheeks in the photo.
- Since birth, Miggy had sensory problems. When he was little, he would hit his head on walls, slap his face, hit his chest, scratch little bumps on his skin (vaccine marks, insect bites, old wounds) until he bled without so much as an "ouch" and not even a single tear. He did not register pain the way typical children do. Why did he not experience the appropriate reaction of pain after injury? Because the beta-endorphins released in the brain can produce an anesthetic effect, which would account for his indifference to pain. - Through sensory integration techniques (deep pressure, massage, pancake and vestibular ball rocking) integrated in his regular occupational therapies, his sensory problems had lessened. Now, he is able to feel pain and even verbalize his pain and discomfort, unlike before when we would always have to guess what was wrong with him.
October 16, 2009: Miggy at 7yrs/2months, ate his very first candy. Oops, wrong word, more so, tasted his first candy. It was his classmate's birthday and he received a loot bag containing sweets and some goodies. He knew candies are a no-no. It will trigger his hyperactivity. Perhaps curious, he opened his candy and licked it. Because he wasn't used to too much sugar, he handed it to me and said: "Mommy, eat it. Candy is not for Miggy."
Sept. 30, 2009: Bedtime It was 10pm and way past Miggy's bedtime. I checked. Miggy was breathing deeply and evenly and not moving. I tested, whispered: Is Miggy asleep? "Yes", he whispered too.
November 2008 (Calendar lessons with stamping as reinforcement): mom (Showing Miggy the angel rubber stamp as a come-on): Miggy, do you want a stamp? Miggy: "Yes." mom: Okay, get the calendar. (he complied) What month is this? Miggy: "January" (I rewarded him with a stamp on his arm) mom: Can you point to January? (he did) (another stamp) What month is this? Miggy: " August" (stamp) mom: When is your birthday? (he pointed) Miggy: "August 4. It's a Monday." (another stamp) mom: Can you look for December? (he turned the calendar pages to December). When is Christmas day? Miggy: "December 25" (he pointed) "Mommy, Miggy open the presents?" "Yes????" mom: No!
*Every year, before it turns November, we already have the Christmas tree with presents under it (to test if he can be trusted not to open them and wait until Christmas. Every morning, he just leafs through the presents, reading the names on each tag, "Look, mommy, this is for Miggy", "This for Clarisse". "Do not open" (he mimics me).
What Miggy is today is a testament to you and your family's struggles, sacrifices and most of all achievements. You've come a long way, and you should be proud. Miggy is continually progressing at a steady rate, thanks to you. He is one of the few so greatly blessed with a family who loves him dearly and gives their utmost effort to help him cope with the demands of daily life. With all our combined effort, we will reach our goals. =)
Developmental Pediatrician: Jocelyn Eusebio, M.D., Saint Luke’s MedicalCenter
Date of Diagnosis: May 13, 2005
Exactly 6 days after the diagnosis, Miggy started the intervention program.
May 2005 to December 2005
Occupational Therapy, one-on-one, 1hour, 2x a wk at Child’s Dream Foundation
- started May 19, 2005
Activities:
Sensory integration ( deep pressure, brushing, massage, pancake); Spooling – for concentration, attention span, color identification; Coin translation; Waiting skills; Pack away; Colored thumbnail; Ball rocking; Colored pop-locks; Coloring Activity using templates; Obstacle Course - jumping on trampoline & crawling w/ color identification; Puzzles – animals, numbers, alphabets; Alphabet flashcards; Number clock; Alphabet board; Drawing, tracing & shading of different geometric shapes using templates; Writing activities; Brushing of teeth simulation; Body parts identification; Letter sounds; Color sorting; Shape sorting; Speech & language stimulation; Number identification & Counting; Beads activity & spooling – for color ID, counting & concentration; ADL activities - Lacing; Alphabet identification; Feeding simulation; Shape identification; Animal sounds; Sounds of things; Pre-speech and Pre-writing activities.
(In some activities, HOHA – hand-over-hand-assistance was given.)
Mom Sessions:
Activities: 24/7 redirecting, modeling, prompting & copying what the occupational therapist did. Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) – ABCs, 123s, body parts, animals, colors, shapes. Flashcards of alphabets, numbers, body parts, animals, shapes & colors, food. Swinging in a hammock for 30mins -1hr per day for SI sensory integration (while Miggy listened to Mommy counting aloud or teaching alphabets: A is for apple, B is for ball, …. Z is for zebra (always stressing on the first beginning letter of the word). Deep pressure, massage for sensory integration, at least 30mins., 2x a day. Establishing eye-contact : peek-a-boo games; always talking to Miggy at eye level. Prompting Miggy to talk: not giving him what he wanted unless he said the word. Spelling of words (animals, colors, familiar words);
Reading common words. Puzzle completion (alphabets, numbers, 10 to 20-pc puzzles). Pointing – Point to ___. Pack away toys. Animal sounds; Vehicle sounds. Creative play – Lego building; building roads, railways, bridges. Pretend play – tea party, feeding stuff toy animals, actions like swimming, flying, driving, sleeping, eating, etc. Taking turns (but always unsuccessful).
Potty training (Unsuccessful: still diaper-clad at night and at poop-time; He probably did not like the feel of the cold seat on his bottom) (not diaper-clad during the day: he expresses his need to urinate by pulling down his shorts).
Family sessions: Regularly going to church (He remained seated inside the church for 5mins only, the rest of the time spent on just walking around the church or staying in the car);Bedtime prayers.
No diet - except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.
Occupational Therapy, one-on-one, 1hour, 2x a wk at Child’s Dream Foundation
Activities:
Sensory integration ( deep pressure, brushing, massage, ball rocking); Writing activities - straight, diagonal & horizontal dotted lines; Tracing / Drawing of geometric shapes with templates; Spelling activities; Picture dictionary; Learning opposites; Color combination; Spelling blocks & Spelling puzzle; Identification of common objects; Group activities; Alphabet sequencing; Problem solving skills training; Interpreting pictures; Fine motor activity - using clothespins & small pegs; Coloring within borders; Tracing / Writing letters; Puzzle completion; Obstacle Course - get a little___, go under table, put in correct slot; Pegboard & color sorting; Waiting skills; Following instructions; Answering questions; Color identification; Alphabet identification; Coloring / Tracing; Tracing letters of name; Number identification; Alphabet sounds; Speech & language stimulation - speaking in simple sentences & short phrases; Listening / Following instructions; Following more complex verbal instructions and responding to questions appropriately; Using complete simple sentences; Using longer phrases; Action songs; Coloring within small regular & irregular boundaries; Tracing numbers; Matching; Fill in the blanks; Connect-the-dots; Writing numbers; Functional counting; Writing name; Action words; Reading / Word recognition; Answering "how many?"; Missing letters of common words.
Regular preschool (July 17–Aug 17, 2006), 45mins, 3x a week, at StepTutorialCenter:
For social interaction with regular kids; Academics : alphabets, numbers, colors and shapes; coloring.
* (It lasted only for a month because Miggy and four other special children were
rejected by the center and some parents.)
Mom Sessions: 24/7 redirecting, modeling, prompting & copying what the occupational therapist did.
Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) –
Special Kids Video Collection: Alphabets, Numbers & Quantities, Colors & Shapes, Spelling, All about Jesus, Animals, Birds & fish, Body Parts & Grooming;
Bumble Bee Vocabulary Builders (Volumes 1-5) and Action Words (Vols. 1-3)
Swinging in a hammock for 30mins -1hr per day for SI sensory integration (Miggy listened while Mommy counted 1 – 50, pausing to see if he would say the next number, which he did.) (Teaching alphabets; Mommy prompted: A is for____. Miggy answered “airplane” , B is for ____. “balloon”,…... Z is for _____. “zipper”.) Flashcards - alphabets, numbers, body parts, shapes, colors, fruits & vegetables,
vehicles, action words.
Sensory integration – deep pressure, massage, 15 - 30mins, at least once a day. Maintaining eye contact - always talking to Miggy at eye level; always prompting him to look at me.
Following simple instructions – Miggy, get the___. Open the door. Wipe your mouth. Throw in the garbage can. Pack away your toys.
Vehicle sounds; Animal sounds.
Self-help skills – washing hands, eating cereals by himself using spoon, eating cake using fork, combing hair, taking a bath, getting dressed.
Requesting/ Naming the title of the cd he wants to watch.
Reading / Spelling of common words (colors, shapes, animals, body parts)
Creative play –Basic toy manipulation: Lego building; building roads, railways, bridges and houses.
Pretend/imaginative play – acting out action words (Mommy acts, Miggy imitates) and puppet play.
More complex puzzle completion (up to 120 puzzle pieces).
Taking turns (still unsuccessful; very impatient at waiting turns).
Potty training -(still unsuccessful): diaper-clad at bedtime. He wouldn’t go back to sleep if I wake him up to urinate; diaper-clad at poop-time. He probably did not like the feel of the cold seat on his bottom.
Family Sessions: Regularly going to church (now able to remain seated for 20-30mins,
still fidgety);
Praying at bedtime (Miggy listened only while Mommy prayed: Dear Jesus, bless Mommy, bless Daddy, bless Ate, bless Miggy.)
Still no diet, except for a little limitation on sugar intake, especially from 4pm onwards, as this will cause hyperactivity.
Socialization : play dates with typical peers (1-2hrs, 2x a week) at SM Kid Around
Occupational Therapy one-on-one, 1 hour, 2x a weekat Child’s Dream Foundation and
then at Systems Therapeutic Activity Center 1 hour, 2x a week
(Occupational therapies up to September 2007)
Activities:
Sensory integration ( deep pressure, massage, jumping on trampoline); Writing activities – letters, numbers; Pegboard & color sorting; Listening; Following simple verbal instructions; Answering simple what questions – what is this?, what color is the ____?; Using phrases; Describing pictures; Using simple sentences; Reading/Word recognition; Counting & answering how many?; Filling in blanks – what’s the missing letter?; Waiting skills;
ADL Board (buttons, snaps, strip with buckle, Velcro & zipper); Structured & Free hand name writing; Structured & Free hand beading and stacking; Shape progressions (progressive use of shapes that involves patterning from easy to difficult); Copying skills; Flashcards – words, colors, shapes, numbers, body parts, fruits and vegetables; Behavior modification techniques; Sentence strips for social graces; Iconographic representation of facial expressions; Socialization – introduction of other kids in the midst of activities; Free play; Sensory integration – trampoline and therapeutic/Swiss ball; Complex puzzles, like Philippine map).
Speech Therapy, one-on-one, 1 hour, 2x a week at Child’s Dream Foundation
-started January 19, 2007
Activities:
Answering simple what questions (about colors) - ex. What color is____?
Identification of objects by function - given choice of two pictures. Example: What do you use to call someone? (phone or chair), What do you use for brushing teeth?, to tell time?, when it’s raining?;
Increasing length of utterances (subject + verb + direct object. Ex: boy reading book);
Naming common objects; Identification of body parts; Behavior modification techniques;
Pretend play – Lego building (What are you doing?, what are you building?); Regulating – “give me + object + please”; “help me, teacher”, ”excuse me”, “bye + name”, “thank you”.;
Identification/naming of less familiar objects;
Attribution in 2 words – ex: blue boots, sitting doll, yellow t-shirt, green pail, red heart, orange skirt…
Yes and No – Is this a dog? (shown a picture of a horse) “No, it’s a horse.”, Is this a cow? (shown a picture of a cow), “Yes, it’s a cow.”
Answering “What’s that?” with familiar and less familiar objects;
Answering simple what questions: Animal sounds & vehicle sounds, ex. What does a dog say? Arf arf; What’s the sound of a train? choo choo;
Answering in complete sentences; Attribution in 2 words for familiar & less familiar objects;
Regulating – request for help, ex: Teacher Justine, give me ____./ Help me ____.
Describing actions in complete sentence using visual cues : subject + linking verb + verb + object, ex: The boy is pulling the rope.;
Increasing length of utterances – ex: Teacher asks: What color do you want? Miggy answers: Teacher Justine, I want yellow coin.;
Identification of objects by function – ex: What do you wear on your feet? Shoes.;
What questions – What can you eat? What can you drive? What can you drink?,
What do you use for coloring? What do you use to clean teeth? What do you wear when you’re cold?
Horseback riding therapy for 1 month 2x a week (June 2007) (speech lessons)
Big and small, long & short, tall & short;
“Over there” plus pointing to the object; Attribution in 2 words: color + object, number + object.
Attribution in 3 words: color + color + object, use of and, ex: black and white stripes;
Describing pictures; Part/Whole relationships;
Possessives - ex: Whose shirt is this? mine/teacher’s/yours
“I want ____.”, “Give me ____.”;
Yes and No: ex: Did Mommy drive the car?, Did you drink milk for breakfast?, Does an elephant say meow?, Can you eat a train?
Counting & counting slowly (one to one correspondence);
Pronouns (he/she); Negation – given 2-3 choices (Which is not a ____?);
Plurals – ex: flower/flowers; Using pronouns in sentences – ex: He is swimming in the water.
Regulating - given cues to request in complete sentences; Asking "What's this?";
Yes / No questions - ex. Is this a ___? "Yes, it's a ___." or "No, it's a ____."
Tutorials, one-on-one, 1 hour, 2x a week, February & March 2006 (2mos.) at University of Baguio,
given by U.B. student volunteers
Special Education, one-on-one, 2hrs, 3x a week,at Easter College Sped,
(started August 6, 2007):
Activities:
Colors, Pre-writing and writing skills, reading, letter name and
sounds, blending vowel and consonant sounds, matching words with their beginning/ending sounds, understanding comparisons (fat & thin, long & short, big & small, thick & thin), classification (same and different, What doesn’t belong?), fruits and vegetables parts of the body, nursery rhymes, art, praying.
Mom Sessions: 24/7 redirecting, modeling, prompting & copying what the occupational and speech therapists did;
Sensory Integration – occasional massage and deep pressure when fidgety and hyperactive.
Watching videos with Miggy (pausing the video every few minutes for step-by-step teaching) – alphabets, numbers, body parts, animals, colors, shapes, spelling, getting dressed, opposites, music, all about Jesus, places to go to ( school, church, restaurant, theater, barber shop, grocery store, library), grooming, getting ready, telling the time, counting, action words, food, simple math.
Flashcards – alphabets, numbers, animals, vehicles, body parts, shapes, colors, action words, fruits and vegetables, things found in the house.
Self-help skills – getting dressed, self-feeding, grooming, toileting (indicating need to urinate or defecate), buttoning/buckling/snapping/zipping/velcro.
Maintaining eye contact – always prompting Miggy to look at me.
Teaching Yes and No.
Hi, Hello, Thank you, I’m sorry. Goodbye.
Teaching facial expressions – happy, sad, angry, surprised, scared.
Connecting paper clips or clothespins – to increase concentration and attention span.
Always prompting Miggy to talk; Express wants – “Miggy wants___.”
Following simple instructions.
Creative play – drawing, painting, basic toy manipulation.
Pretend play – acting out scenes, like going to the grocery store, cooking, eating in a restaurant, going to the theater, riding a train.
Setting the table; Folding clothes; Clean up.
Taking turns (still unsuccessful; very impatient at waiting turns)
Potty training (still unsuccessful): diaper-clad at bedtime. He wouldn’t go back to sleep if I wake him up to urinate; diaper-clad at poop-time. He probably did not like the feel of the cold seat on his bottom. “Mommy, diaper on. Miggy u-u.”
Computer lessons (given by older sister) at least once a week (started April 2007)
Keyboard functions, using the mouse, Typing in Microsoft Word, Playing simple games (following instructions): ex: Click only the diamonds, Click on the green dots, Put yellow crayons in yellow pail, What’s missing?, Which way to the ____?
Family Sessions: Regularly going to church (Shortly before his 5th birthday, he was
successfully able to complete the whole 1hour mass; patiently waited for the mass to end to be able to kiss the priest’s hand);
